HomeMy WebLinkAboutSense, Eric M. 1ac 2eo�
AGREEMENT TERMINATION
Please complete this form when the attached agreement is no longer in effect d T LEI
Return form to the Sr. Deputy Clerk of the Council (M -30). Call 647 738 if ynu haveyauy
questions.
----------------------------
The agreement with `'ter " i
was completed on ( j oL and final payment has been made.
Department: P-0 /}
Signature: b iir �A
Date: b 10 1 4
City of Santa Ana
Revised 8 -7 -03 Clerk of the Council
INSU~I\NCl UN flU
WORK MA Y PROCEED
UNTIL iNSURANCE EXPIRE:
-1...).. - ~ 1-0'1'
CLERK OF CDUNCIi
DAH:, I::>--~o-",,-\
N~",OO"'-O</~-ol
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C;\ (I1lt.t
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FIRST AMENDMENT TO
CONSULTANT AGREEMENT
THIS FIRST AMENDMENT TO CONSULTANT AGREEMENT is entered into
this .3 o~ day of 1::l.u.~V\oJo e.V' , 2004, by and between Eric Sense
("Consultant") and the City of Santa Ana, a charter city and municipal corporation of the
State of California ("City").
Recitals:
A. The parties entered into Agreement N-2004-042, dated May 25,2004, (hereinafter
"said Agreement") by which Consultant has provided massage workshops through the
City's leisure class program.
B. In accordance with the terms and conditions of said Agreement, the parties wish to
renew said Agreement for an additional one-year period.
Wherefore, in consideration of the covenants contained in said Agreement, and subject
to all the terms and conditions of said Agreement, except those amended in this First
Amendment to Consultant Agreement, the parties agree as follows:
1. Section 3, TERM shall be amended to extend the term through December 31, 2005.
2 Except as hereinabove amended, all terms and conditions of said Agreement shall
remain in full force and effect.
IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to
Consultant Agreement on the date and year first written above.
APPROVED AS TO FORM:
CITY OF SANTA ANA
/p YL-A/J
GERARDO MOUE1
Executive Director - Parks, Recreation and
Community Services Agency
~:(,tJ 001t
~O EPH W. ETCH
City Attorney
EY ANSTON INSURANCE COMPANY
CERTIfiCATE NO.:
CERTlFICA TE OF INSURANCE
EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS.
SPECIAL EVENT LIABILITY PROGRAM
PRODUCER:
PUBliC ENTITY (ADDITIONAL INSURED)
Driver A1IiaDt Insurance Services
P. O. Box 28323
Santa Ana, CA 92799-8323
(949) 660-8163
License No: OC 36861
NAMED INSURED (EVENT HOlDER):
EJUc. M. SelUe /V-J,/)(y!-o<}&l..
516 W. 17th S~eet, HC
Santa. AM, CA 92106
CUy o~ Sa.l1.t4 Ana.
20 Civ-ic, Cen.tVl Plo.za., M-28
Sa.n.ta. Ana., CA 92707
This is to certify that the policies of il1Slllance listed below ha ve been issued to the insured named above for the policy period
indicated. Notwithstanding any requirements, tenns or conditions of any contract or other document with respect to which this
certificate may be issued or may pertain, the insurance afforded by the policies descnbed herein is subject to al/ the terms,
exclusions and conditions of such policies. Limits shown may have been reduced by paid claims.
INSURANCE CARRIER: Evanston Insurance Company
MASTER POLICY NUMBER: 04SEPIOooool
MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2004 EXPIRATION: JANUARY I, 2005
EVENT INFORMATION:
TYPE: l-IonP1"h II f:it-MH _ T"A.thfl~;Uona~
DATE{S): r; /g /nd _ T9/~1In4
LOCAnON: L':"u'!4' '1~r{le{l(J3 <:~~tll'"
COMMERCIAL GENERAL LIABILITY
General Agvegate Limit
Products &; Completed Operations
l>>erso.nal & Advertisine Injwy
Eac'h Occurrence Limit
Fire Damage (Any One Fire)
ModicAJ Fa)'TllCnlS (Any One Person)
$ 2,000,000
1,000,000
1.000,000
1,000,000
50.000
5.000
OCCURRENCE FORM
DEDUCTIBLE, NONE
The limilS of insuroncc apply scpar.llely to each ""ent i_red by this policy as if. """,,Ie policy of insuroncc h.. been issued for that evCllt.
"Who is insured" is "nendod 10 include, as an illSUred, the person or OlpJIUation shown in this schedule. hot only wilh ""Peet to !iabHity ansing out ofthe
nWl>eBhip, maintenance or use of the premises u'Cd by the named insured (eve", holder). This insuranee does not apply to, Any "occurrence" which takes place
after the eVent bolder ceases to be a tenant in that premises.
OTHER ADDITIONAL INSUREDS
CANcm t A TtOl<: Should the ahove de..n"hed policy to cancelled before the expil1~on dale thereof. the j..uing cO~Y.,;1I mail 30 days writlen notice 10 Ihe
catificatc holder and additional insureds listed.
~,,7
AUT"""""'''''''''''A'''''' ~~
DATE ISSUED: 5/18/04
05/05/2005 15:12
7145714209
PARKS AND RECREATION
PAGE 02
FROM , GREGG CR~[J'/D STRTE FARM INS
poricy Number
92-QN75b9.2
FRX NO. , 7145301006
DECLARATIONS PAGE
Mar. 02 2005 EO: 2ePH P2
AM~~CiED
;:::E "i' ?[i'~:
r;=:
~
ST ATE FARM GiNEn....1NllURANCE COMPA.NY
900 OLD RIVER no, llAK.RSFIELO CA 93311.6000
A STOCK COMPANY WITK KOME OFFICES IN BLDOMIN5TON,ILLlNO'S
Agen. Copy
Namac1,nsured "nd "'oiling Allllress
9643.F4 i 9 S
SENSE. ERIC M DR
5H. W 17TH .T STE C
SANTA ANA ':;A 92706-3619
fI- ,d('{) 'f. (,;f,;(
.t'.. ;:J.oc4 D'f.J. ~()i
'. ~ ~ ur'1\~ VI
~ ...!(V \,J~~Jt' .
&-- r.:,v \: ~
\C:-~~'~
COy A -lnfUllion Cov<rraoe Index: 152.4
BUSINESS POLICY - SPECIAL FORM 3 COy B . Consumer Price lndex: 185.2 .
AUTOMATIC RENE.....AL - II the POLJCY PERIOD is shown as 12 MONTHS, tl'ti".f.OIR will be r8llewed autornaticll!1v
5~bjetl to lhepl'l!miunlS. rules and fOl1l1s in eflecl for 'laCh sUIlO..cllnll DOliGy Pllno . I! lIlis polic,,- is termiQaled, WtI wi!)
g'Y6 you a~cl me Mori/llIgeelLienholder written nOliCa in complie,nClI WIlli IIle pOlley provisions or as required by law.
,"Olley Pc!riocI: 12 '-lO"I~S The policy period Deglns and enas al 12:01 am 911nQarQ time Illhe
Effl!Ctive Date: MA. v 12 2004 premises Iooalian.
ExpintiClnDBte: MAl' 12 2005
Namec1lnwrQ(l: InooviClual
location 01 Co~ed PremIses:
516 W 17TI< STsn;: c
SANTA ANA CA 9~706.36t9
Your policy is amOnded liEB 11 2005
"DOL INSURED NAME & ADDRESS ,o,DDl;D
ENDORSEMENT liE-6320 ADDED
C"vllfagH . Property
Sechon I
^ Buildings
B Busines:s Personal!'rope"y
Closs ollncomo . 12 Monlh.
limhs of Insurance
eeup.ney;
Ice
i 263.000
22,500
Actual Loss
APPROVED AS TO FORM
Section 1I
L Busi""$:! lIaOility
M Meaical Paym.nlS
Products.Comp~ed Opmalioll$
(PCQ) Aggregate
General Ag\lregale (Olll..,
Than I>CO)
i
1.000,000
5,000
2,000,000
2,000,000
DedUeUb~-Sectionl
$ 500 Basic
rill
Laura Still Shet
Assistant City Au rney
s
Forma, Options, and E.ndorsementl:
Spe~ Form 3
. Addioonallnsured
Business POIi1;y Endorsamenl
Amenllalory Endorsemelll
Deb". Romov" E l1dorsemel'lt
POlicy EnoorSfment
GlaU Ceductible - Section I
. New Form ,,"achea
In Cll"'1 of lOss under !hili poli;y, the deduclibla wUl .""
applied to tach ~1I(fenCQ .and Will be de6uellld from ,hg
amount of the I,,", Olhsr deductibles may apply. refer 10
olic ,
El'ldor811menl Premium Hone
FP-6143
FE.8320
FE -6484
FE -6205
FE -645 I
F!;.6506.2
FE-6~38. ,
Discounls Appliea:
Oaim Record
Preparfid
F~g 152005
FP~80J02C
06/1993
y~, poIfc;:o,. C;:9Nr.rs ul lfIIa _lie, oiInJ'.dol'&llmeftllS
and Ih. pn''''v 'om.. P~[ASt KEEP nlESI! TOGETH~R.
Comlnu(l(l on l'IeV6l$~ Side oJ Page
- OTH!;R LIMITS AND UCLUSIQIIII M^Y APPLY, R
Countersign""
By
CIlECG CIiA~RD
f7U) n.~I1:1e1
I-FAa
....!'Jt'l,~
,...""'"....
(7""',
(.olt2:72b.
Prl'*,:nLi.:5A
05/06/2005 15:12
7145714209
PARKS AND RECREATION
PAGE 03
FROM: [>REG(; CRAWFORD smTE FI'lRM INS FAX NO. 7145341006
Milr. 02 2005 03: 29Pt1 P3
CONTINUED FROM FRONT SlOE
m.-
~
Polley Number
92-0N-756!}-2
BUSINESS POLICY - S1~C1AL FORM 3
Forms,Oplions,8nd Endoruments
P~ysicians and SurgeonS
LOSS payaOl~ EnllQ'lleman\
Nl'lenaalory ConllllSII
Terrorism Ill9lJranCll Cov ~lob""
FE-6407
FE-6309
FE-6551
FE-6999
IMPORTANT NOTICE:
c..liturnia law tequircs us to pl'Ovldc you with inlormation for Rllng complaints with the Stlltc Insurance
Department regarding'he coverage and service provided under tliis palicV_
Oomp.l3ints should lie filed onlV after vou and Slale FllI'm or your ag,nt Of otller company ..presentative
have f31fell to reach.. satisfactory agrftme"t on D problem.
Ple6Se fonvard such campl.nls to: California Deplllrlmen. Of Insurance
Concumer SerVIces DIVision
~ Sa"'" Sp"'"l1 Street
Loa AngoeIta, C~ 90013
or call toll free: HlllfH27-HELP
.,UVilD AS '1'0 fORM
P"o)ptore"
FEB 15 2005
~<::l!:::'
Lauta 8rhr Sht:!:ed
,,(l!~/7e-\ y '-'~'-=-'
j y AUorn~y
. .
05/06/2005 15:12
7145714209
PARKS AND RECREATION
PAGE 04
FROM , = CRAL.l'TI<D STl'lTE Fl'lRM INS F"'X NO.
714534112106
M.r. \'l2 2005 1:13: 29PM P4
511 Policy No. 92 -QN"7569-l
,-:--;.,l..'.
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ADDITIONAL INSUREb ENDORSEMENT
DESIGN'" TED PR~MISe:S ONLY
fAl
~
POlicy No.: ., 'QN-7569-2
Named Insum,
SiNS!, ERIC M Ill!
,"",e 01 AdclilioIHlllneunld: TIlE CITY OF GlINT" l\N)l.
Adelf." Itf Additionlllntuted: ~o CIVIC <:1ll'lTER PLZ
SANTA ANA CA 92701-4058
lnlll'..l of AddlliOnalln'l.Ir.', USt;lQR
(SPECIAL EV~T ON PEB. 22, 200~, MARCH 29 2005,
APRIL 26 200. AND MAY 31 2005 ONLY) .
L......tion of Pnln.lsu: SANTIAQO LAWN BONLING C1.1JiIHOVSJ;l
S1.0 M!:MORY LN
SANTA AN~ CA ,9~706-1~25
Tho> wDI'd "InSUIlIO', wher...r uslKl in thiS policy, \lleo includes the designated person or "'ganlzallon namecl2l>oVli!
as Addilit;ln\lII~Sll'ed under !,he provilions Of the policy aeelion. .hown belloW liS appllCl!lble by an "X" to the ex:en:
jndicated.
o SECTION l.
o SECTION I,
This IIpplie. only to COVERAGE A . BUILDINGS.
This applies Qnly to COVERAGE B - BUSlNU8 PERSONAL PROPERTY.
DQJ:Cri~,ti"n of Property:
00 SECT10N II. TIllo appru.. only to COVERAOI L - BUlllNEU LIABIUTY and COVERAGE M -
MEDICAl JOAYMENTS IIIld then only wtth "'.PoetlO th" owne,ship, maintenance "'" "" of
_he premiSM des.lgnatM above end epsr9tionl;;. n8C8sssry Of incidGntsl Ulereto, ihQQQ
SeCTIOlI/1l ~v..rll9"'. do n(>t apply 10:
1. .lructu'al ..Iteration. or new construction performed by or on behalf of the designeted peroon or
organi.z:Jtion;
2. jMtllOnlil iilllity cau.ed by the ileaigna\ed per.on or orllanlz"flon;
3. tlabilily 11\41 d...igna\e<l p....on or orgQnlZll~On assumed Iinller a Don tract; or
4, prelluets-e"",p.elttd oper.~Ort, hazard "rilirlg 01.1' of good& 0' fnv<<1tory whi6t\ ar~ ,..ot solcl or
ClISlrillut..d by you o. arising out of \he mahufacluring o. packaging of ouch !loods Of invenlory.
All othlltr provision51 ot th8 policy aDPly.
l'Eo/ililll
~711l1)
APPROVED AS TO rv-".
~,;;<S ?:> / :? ".""',, "-,"-
Laura Still Sheedy
AssIstanl City AllQI'I'I~\'