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HomeMy WebLinkAboutLE, CHOC 2GD VA e2 ' �t AGREEMENT TERMINATION Please complete this form when the attached agreement is no lo�;nefFsct= 25, -i Return form to the Sr. Deputy Clerk of the Council (M-30). Cali 6�P5i, 7; 238 �fyoR f any f i3-ti3� questions. ter-., The agreement with (/N(C� No. �%�0 e ✓� was completed on grj f✓ �' /�(�7 and final payment has been made. Department: Signature: Date-, 1 f City of Santa Ana Revised 8-7-03 Clerk of the Council INS 09! i CN HLL V&:"' "' v PROCEED oN .L MISURANCE EXPIRES "LEP,K OF COUNCIL DATE1—/ 9. U (v A-2006-145 SECOND AMENDMENT TO AGREEMENT p PkCs 07) �Cisca) THIS SECOND AMENDMENT TO CONSULTANT AGREEMENT is entered into on June 19, 2006, by and between Choc Le, a sole proprietor ("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 Consultant Agreement A-2004-122, dated June 21, 2004, (hereinafter "said Agreement") by which Consultant has provided martial arts instruction for participants registered through the City's Parks, Recreation and Community Services Agency. B. In accordance with the terms and conditions of said Agreement, the parties wish to extend the term for an additional one-year period and to increase the compensation to pay for services during the extended term. 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 Second Amendment to Agreement, the parties agree as follows: 1. Section 1, SCOPE OF SERVICES, shall be amended by replacing Exhibit A with Exhibit A-2, attached hereto and incorporated by this reference. 2. Section 2.a., COMPENSATION, shall be deleted in its entirety and replaced with the following language: "City agrees to pay, and Consultant agrees to accept as total payment for its services, the rates and charges identified in Exhibit A. The total sum to be expended under this Agreement shall not exceed $30,000.00, annually, during the term of this Agreement." Section 3., TERM, shall be amended to extend the termination date from June 30, 2006 to June 30, 2007. 4. Except as herein amended, all terms and conditions of said Agreement shall remain in full force and effect. // DATE (MWDOl9YYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 12@012005 PRODUCER Phone: (5001395-B075 vex toSB)B.&0822 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION FITNESS AND WELLNESS INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 380 STEVENSAVENUE, SUITE 206 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR $81 STEANA ENSBEACA 32075 •^^•�,eeene 1FFOROFD RV THE POLCCI INSURERS AFFORDING COVERAGE NAIC # INSURED CHOC V. LE INSURER B: 4 FA13RIANO INSURER C: IRVINE CA 92620.2576 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INaR R A TYPE OF ROURANCE GENERAL LABILITY X COMMERMALGENERALLIABLITY CLNMSMADE�OCCUR POLICYNUMBER EOL9012327-01 POLICY [PPEOTIYE T M 12117/06 POMCY PJVIMl10N 12117/06 LIMITS EACH OCCURRENCE S 1,00 ,GOO MWM TO RENTED PREMISES FAomuanoe 3 100,000 MED. EXP(MY RRD PRLER) 8 2SOO PERSONAL A ADV INJURY E 1,00vA,000 GENERAL AGGREGATE $ 3,60G,000 PRODUCTS-COMPIOP AGO. E 3,000,000 GENL AGGREGATE LIMIT APPLIES PER: X POLICY JECT LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOStpw SCHEDULED AUTOS HIREDAUTOS NON-OWNEDAUTOS COMBINED SINGLE LIMIT tee aoddent) E NURY Y ODILIN BJ BODILY E BODILY INJURY (Pv acciWnq E PROPERTYDAMAGE Per eccilMM S GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT E OTHER THAN EAACC AUTO ONLY: AGO E 8 EXG938 l UMBRELLA LABILITY OCCUR CLAMS MADE DEDUCTIBLE RETENTION S M lA. ) EACH OCCURRENCE E AGGREGATE E 8 W CAMPENCOMPENSATION AND lMPILOYEPLOYER9'VABILRY ANr MOPRMTOIwARTNlMXecuTM WPAZIIAIEMEER EXCUJWDT BpE.Buedw...• SPECIAL PROVMIONi Nb _,,. p l �..�� !-.� tux .�+ T Y1 is L.I I l't v .._.... _..'. ay (,. _ MSTATU- TORY LIMBS OTHER E.L. EACH ACCIDENT E EEI EL. 018EASE-EA EMPLOYEE E E.L. DISEASE -POLICY LIMIT E OTHER: DESCRIPTION OF OPERATIONSA.00ATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE HOLDER ADDED AS ADDITIONAL INSURED ONLY AS THEIR INTERESTS MAY APPEAR. CERTIFICATE HLX.UEH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO City OT Santa Am Recreation GO 80 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES. Santa Ana CA 92702 AUTHORIZED REPRESENTATIVE //i�.�J� U61 d 0 Hit e Attention; PEGGY CALVERT ACORD 26 (2001108) Certificate # 33091 I. d OZ80ZVCZ89 'QN/8£:£1 '1S/8E:St SOOZ OZ 03C(3nl) IY XVVRV VVR�v,v�••vr .+.... 30NVdnsNi SS3NI73M CNV SS3NIIA N08J POLICY NUMBER: E0L9O12327-01 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ THIS CAREFULLY ADDITIONAL INSURED PRIMARY COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY. COVERAGE PART This insurance is primary for the person or organization shown in the schedule, but only with respect to liability arising out of your work or that insured by or for you. Other insurance afforded to that insured will apply as excess and not contribute as primary to the insurance afforded by this endorsement. All other endorsement provisions, conditions and exclusions of this insurance shall remain unchanged and apply to the additional insured and described below. SCHEDULE ADDITIONAL INSURED NAMED INSURED CHOC V. LE 4 FABRIANO IRVINE CA 92620-2576 CONTRACTIPROJECT t Certificate II 331191 Z d OZSOZVOZ89 'ON/BE:EL900Z OZ 03(J(3n1) 3oNVanSNI SS3Nl13M ONV SS3NiIJ WOtl3 /- - za1)�2-/ ACORD CERTIFICATE OF LIABILITY INSURANCE DAT;ii20/20 ' TM. 06 PRODUCER Prx,.: (800)395-8075 Fax: (858)519,0822 THIS CERTIFICATE IS ISSUED AS A MATTER OF FITNESS AND WELLNESS INSURANCE AGENCY INFORMATION 380 STEVENS AVENUE, SUITE 206 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SOLANA BEACH CA 92075 INSURERS AFFORDING COVERAGE NAIC # AgencyLiOli OD28716 INSURED INSURER A: Zurich North America CHOC V. LE INSURER e: 4 FABRIANO IRVINE CA 92620.2576 INSURER C: NSURER D. NSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR TR ADDL NSRp TYPE OF INSURANCE POLICYNUMBER POLICY EFFEmrvE ppTE MMN vpucr EzrwprlDM DATE(MMNp LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILIT CLAIMS MADJX OCCUR ST63733.00 12/17/06 12117107 EACH OCCURRENCE $ 1,000,000 OA.AGE TO RENTED PRE. SES(E......—) $ tOO,000 MED. EXP(My one person) $ 2,500 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PEE X POLICY PRO- LOC PRODUCTS-COMPIOP AGG. S 3,000,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per Person) $ BODILY accide t) (Per accident) $ PROPERTY DAMAGE Per accitlent $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EAACC AUTO ONLY: AGG $ $ EXCESS I UMBRELLA LABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION$ EACH OCCURRENCE $ AGGREGATE $ 5 $ It WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROYRIETORIPARTNENExECUTNrE OEFICER)MEMMEN CSCLUDED? ay... x..N .. EcuL PRPRwIWlaoxe slow ToevTurrnnD E.L. EACH ACCIDENT 5 E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ OTHER: DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS SEE SUPPLEMENTAL CERTIFICATE INFORMATION CERTIFICATE HOLDER :CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 CommunityRedevelopment A PRent Agency Y DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE of the City of Santa Ana INSURER, ITS AGENTS OR REPRESENTATIVES. 20 Civic Center Plaza (M-25) Santa Ana CA 92701 AUTHORIZED REPRESENTATIVE Attention: Jeffrey E. Frick, CEO ACORD 25 (2001108) Certificate # 51125 © ACORD CORPORATION 1988 RECE; ^ 6 2006 DATE SUPPLEMENT TO CERTIFICATE OF LIABILITY INS #51125 DEC 2006 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS The City of Santa Ana, and the City of Santa Ana, located at 20 Civic Center Plaza, Santa Ana, California 92701; and their respective off! employees, agents, volunteers and representatives are named as additional insureds ("additional insureds") with regard to liability and of suits arising from the operations and uses performed by or on behalf of the named insured. Additional Insured Endorsement is Effective: 12101106 /3 Certificate # 51125 CG 20 10 11 85 DATE: DEC 20 06 POLICY NUMBER: 5763733-00 INSURED NAME: CHOC V. LE 4 FABRIANO IRVINE CA 92620.2576 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization Job/Project: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section 11) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work' for that insured by or for you. Primary Insurance it is agreed that such insurance as is afforded by this policy for the benefit of the additional insured shown shall be primary insurance, and any other insurance maintained by the additional insured(s) shall be excess and noncontributory, but only as respects any claim, loss or liability arising out of the operations of the named insured(s) or its subcontractors, and only if such claim, loss or liability is determined to be solely the negligence or responsibility of the named insured. Notice of Cancellation or Non -renewal it is agreed that the company will provide the additional insured shown below with 30 days notice of cancellation of this policy in the event of cancellation due to company election only. WAIVER OF SUBROGATION It is agreed that we waive any right of recovery we may have against the person or organization shown in the schedule because of payment we make for injury or damage arising out of "your work' done under a contract with that person or organization. The waiver applies only to the person or organization shown in the schedule. SCHEDULE NAME OF PERSON OR ORGANIZATION The City of Santa Ana, its Respective Officers, Employees, Agents, Volunteers and Representatives 20 Civic Center Plaza (M-25) Santa Ana CA 92701 Y — % 610& — DATE (MWDDNYYY) ACORD TMCERTIFICATE OF LIABILITY INSURANCE 1212012006 . PRODUCER Phone. (800)395-8075 Fax (8M)519-0822 THIS CERTIFICATE IS ISSUED AS A MATTER OF FITNESS AND WELLNESS INSURANCE AGENCY INFORMATION 380 STEVENS AVENUE, SUITE 206 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SOLANA BEACH CA 92075 INSURERS AFFORDING COVERAGE NAIC # %49 INSURER B: 2620.2576 4-Aovu-145 INSURERC: INSURERD:NCOA r-%j091-/21—613 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI00 INDICATED, NOTWITHSTANDING OL ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TOWHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFELLNE VOLICY E%FIMTWN LIMITS L TYPE OF INSURANCE POOCV NUMBER DALE NMN oerE Nwop o E GENERAL LIABILITY 5763733.00 12117106 12117107 onM cEEACH o NERRNTECENCE $ X COMMERCIAL GENERAL LIABILIT nREP. lE. eccmrol CLAIMSMAD� OCCUR MED.EXP(Any onepeccon) $ PERSONAL 8 ADV INJURY $ rA 1,000,000 100,000 2,500 1,000,000 GENERAL AGGREGATE $ 3,000,000 GENT AGGREGATE LIMIT APPLIES PE PRODUCTS-COMPIOP AGG. S 3,000,000 X POLICY PRO- LOC AUTOMOBILE UABILITY COMBINED SINGLE LIMB (Ea accident) $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED AUTOS SCHEDU LED AUTOS HIRED AUTOS BODILY INJURY (Per accident) $ NON -OWNED AUTOS PROPERTY DAMAGE $ Par ac Idenl GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ EACH OCCURRENCE $ E%CESS I UMBRELLA LIABILITY OCCUR ❑ CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ we sinm-OiNEP WORKERS COMPENSATION AND EMPLOYERS' LIABILITY E.L. EACH ACCIDENT E E.L. DISEASE -EA EMPLOYEE 1 $ AkY ROPRIETOMPARTNFR6%FELINE OFFICERMEUSAR E%CLUOELI T.., a..�ns...a.. BPECALP ROV.... -1— EL. DISEASE -POLICY LIMIT Is OTHER: DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS SEE SUPPLEMENTAL CERTIFICATE INFORMATION neural I ennN CERTIFICATE HOLDER' - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVORTO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT Community Redevelopment Agency FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE of the City of Santa Ana INSURER, ITS AGENTS OR REPRESENTATIVES, 20 Civic Center Plaza (M-25) CA 92701 AUTHORIZED REPRESENTATIVE J y Santa Ana Attention: Jeffrey E. Frick, CEO ©ACORD CORPORATION 1988 ACORD 25 (2001108) Certificate # 51125 R E C E :::.: 6 2006 f SUPPLEMENT TO CERTIFICATE OF LIABILITY INS #51125 DDATE EC 2006 I DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS The City of Santa Ana, and the City of Santa Ana, located at 20 Civic Center Plaza, Santa Ana, California 92701; and their respective offh employees, agents, volunteers and representatives are named as additional insureds ("additional Insureds") with regard to liability and of suits arising from the operations and uses performed by or on behalf of the named insured. Additional Insured Endorsement is Effective: 12/01/06 Certificate 9 51125 CG 20 10 11 85 DATE: DEC 20 06 POLICY NUMBER: 5763733-00 INSURED NAME: CHOC V. LE 4 FABRIANO IRVINE CA 92620-2576 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Job/Project: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section 11) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work' for that insured by or for you. Primary Insurance it is agreed that such insurance as is afforded by this policy for the benefit of the additional insured shown shall be primary insurance, and any other insurance maintained by the additional insured(s) shall be excess and noncontributory, but only as respects any claim, loss or liability arising out of the operations of the named insured(s) or its subcontractors, and only if such claim, loss or liability is determined to be solely the negligence or responsibility of the named insured. Notice of Cancellation or Non -renewal it is agreed that the company will provide the additional insured shown below with 30 days notice of cancellation of this policy in the event of cancellation due to company election only. WAIVER OF SUBROGATION It is agreed that we waive any right of recovery we may have against the person or organization shown in the schedule because of payment we make for injury or damage arising out of "yourwork" done under a contract with that person or organization. The waiver applies only to the person or organization shown in the schedule. SCHEDULE NAME OF PERSON OR ORGANIZATION The City of Santa Ana, its Respective Officers, Employees, Agents, Volunteers and Representatives 20 Civic Center Plaza (M-25) Santa Ana CA 92701