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HomeMy WebLinkAboutGEORGE, MARIE DBA ACT ONE ACADEMY OF DANCE (LITTLE STEPS DANCE SCHOOL) 2AAGREEMENT TERMINATION i! Hr t Please complete this form when the attached agreement is no longer in effect. Return form to the Sr. Deputy Clerk of the Council (M -30). Call 647 -51MI *t "— 1 questions. Frq 5. 3 i3 rib The agreement with �a2D . LlYielt�e- G, No— O�—O�® �1 was completed on �PJ ���✓ // and final payment has been made. N - 20Qto - 0loo Department: Signature: Date: Revised 3-2 -07 IRNJO a1119? City of Santa Ana Clerk of the Comicil , (p~::?~-o7 3-.).9-07 o ~ fRt-s (.l.) Cc..~) N-2006-060-01 AMENDMENT TO CONSULT ANT AGREEMENT THIS AMENDMENT TO CONSULTANT AGREEMENT is entered into this 201h day of November, 2006, by and between Marie George, an individual dba Little Steps Dance Studio (hereinafter "Consultant") and the City of Santa Ana, a charter city and municipal corporation of the State of Cali fomi a ("City"). RECITALS: A. The parties entered into Agreement N-2006-060, dated April 3, 2006, (hereinafter "said Agreement") by which Consultant has provided dance classes through the City's leisure class program. B. Consultant has changed the name of her business to Act One Academy of Dance and the parties desire that the Agreement reflect the new name of the studio. C. In accordance with the terms and conditions of said Agreement, the parties wish to renew said Agreement for an additional one-year. 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 Amendment to Consultant Agreement, the parties agree as follows: I. Consultant's business name shall be changed to Marie George, an individual doing business as Act One Academy of Dance. 2. Section 3, TERM shall be amended to extend the term through June 30, 2008. 3. Except as hereinabove amended, all terms and conditions of said Agreement shall remain in full force and effect. II II II II II . '. IN WllNESS WHEREOF, the parties hereto have executed this Amendment to Consultant Agreement on the date and year first written above. 1 A TrEST: / 0" 1 / oif /0., , i__# - ,{ ,., "..r -"2./ .' \. - o . PA~ICIAE. HEALY' J Clerk of the Council APPROVED AS TO FORM: ~ ~ ~AJ1A. n 1 d/ of! SEPH W. F TCHER 7 City Attorney RECOMMENDED FOR APPROVAL: ~~tt~ Executive Director Parks, Recreation and Community Services Agency CITY OF S~;A ANA/: v:~u#);2, DAVID ~. REAM City Manager CONSULTANT . \~\(tL~l ~{i ~ ~ARIE GEORGE DBA ACT ONE ACADEMY OF DANCE .~-", ,.. 10/17/202& 11:59 7145278898 STATE FARM PAGE 82 CERTIFICATE OF INSURANCE o STATE fARM FIRE AND CASUALTY COMPANY, Bloominglon, IlIinoi. 181 STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois o STATE FARM FIRE AND CASUALTY COMP~NY, Aurora, 001";0 o STATE FARM FLORIDA INSURANCE COMPANY. WInter H........ Fiori.. o STATE FARM LLOYDS. DelloI.. T.... ;"s_ tfte foJ1owing pnlicyholder fOf ,he co__ Indicated below. p~ Marie Georq~ DBA: AC~ Or.. Ac.demy of 03~C~ ~ This certifies that _"'policyholder L_"'aperetOno ~.of operation. lla6 Tustin Ave, OranqQ, C~ 92867 1166 Tustin Av~. Orang., CA g2867 O.,nce School - _ - below h8v8 been _ 10 tfte polioyhoIder b' tile policy poriode _. Tho ins""""", deoc:roOed in theoe ~ io oubjecI to oIlhe _ e><cluslo<1s ""d condttions of _ pofocie. The limits of_lily.hOwn mey haw been Ieduc:ed by any pa;d clolms. POLICY PERIOD ~S OF l.IA8/LlTY I'OIJCY NUM8I!R TYPE OF INSURANCE Effec:_ Date : ~ Dolo (.t beginning or policy period) 92-GA-8133-8 G Compt'ehenslve 6/23/06 : 6/23/07 BODILY INJURY AND Business Liability ; PROPERTY DAMAGE "u. .. m. ........... ........... ..L......... h..... h h -----...._--... .iiiiS~iftCiUde.: 181 Products. Completed Operations 181 Contractual Uobility EocI1 Occurrence $1.000,000 o Personal Injury o Advertising Injury General Aggregate $ 2, OCO. COD 0 0 ProdUCU - Compl_ $ 2. oo~, 000 0 O.....otion. POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE EXCESS LIABILITY Elfecllve DMe : &pioation Dole (Combined Single Um;t) o Umb"'U" : Each Occurrence S DOt..... "'reoak- S POUCY PERIOD Part 1- Wortcers Compensation - Sl8tutory Effreetlve o.te : 1!!' . . lJiaa 0-. Workers' CCHnpensIItjon Part 11- EmpIo~ L_y and Employers liability Each Aocldent S Dj_.-E_~ $ Dioaae - Policy Umlt S POLICY Pl!RlOO LIMITS OF LlA8llITY POLICY lIl*9ell TYPE OF INSURANCE EfFectiw Dale : Dale (1l4 beginning or polity period) : : THE CERllFlC,tUl: OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFARMATlVELY NOR NEGATIVELY AMENDs, EXTaIDS OR AL TE"S THE COVERAGE APPROVED 8Y ~NY POLICY DESCRIBED HEREIN. Name and Addr... of Certifitale Holder CI7Y OF SANTA ANA THEIR O~FrCERS AND EHPLOY~ES 9S8 W SANTA ANA BlND STE 200 SaD.~. ADa, CA '2701 ~ any Of tna ~ poIic:ie$ are canceled before lIleIrexpiration dale. Slate Fa"" willtry to ITlIII a written notice to tile _ holder deys before canc8Uation. If however, we (iitil to m811 such nottce, no ObIigalion Of r_iIy IWI be imposed on State Fann or' agents or reprece ivee. lOIl7/0; Oat. S5~4a.e Pr.ntN;" U,S,A. ~C\I 05-0'-2001 . '-f;.~3;t~7}.e- .rLz_ h . . " '-.i..'.'.}l"o:;Y SIg"atllre Of AutnoriHd RepA!Hnt "-g-cnt Tit.. Ch~r1ene Hatak~y^m~ AgentNMte Tefephone NUfTl~r 714 527 8S91 I Agont'. Code stomp A;ent Code 75 AFOCOde aell Ck. , 12/19/2~26 12:25 7145278898 STATE FARM PAGE ~2 SK PorIOY No. 92-GA-B133-B FE_ SECllON II ADDITIONAL INSURED ENDORSEMENT ~ Policy No.: 92-GA-B133-B ......... InsuNd: GEORGE, MARIB Addiliana/ Insured (Inotude addrw8l: CITY OF SAln'll. _ '1'SIlIR OFFJ:CBRS & EMPLOYImS see W Sl\IlTA IllfA BLVD STE 200 SlIJITA JlRlI. CA 92701 WHO IS AN 1NSURl!D, under SECTION II DESIGNA noN OF INSURED, is 8Il18I'lded to in<:lude as an insured the AIIdilIonaI Insured shown above, but only to the extent thalliabftity is Impo8ed on that AddIIlonal Insured solely ~ of your WOI'Ic p..o1oolled for that Additlonellnlured shown sbove. Any insUra.- ........- '" the AddftIonaIlnaured shall only apply wtth respect '" a claim maae or a suit brought for damage6 for which you are provided ~. The PrlmaIY Insu/'B11Qe coverage below applies only when there Is lIl1 'X' in lf1e box. m PrinIlIry In_ce. The lnSU/'Bl1Qe provided 10 tile Additional Insured showr1 above shall be primalY instr.Ince. My Io$UI1II1C8 carried by the Additional rn~ shall be noocontrIbulory with respect 10 coverage provided 10 you. All olf1er paIioy provisions apply. ~ t<'?8 ~ I? Printed In u.$.A, .' .. SB Policy No. 92-GA-8133-8 FE-6609 '6 SECTION II ADDITIONAL INSURED ENDORSEMENT l...IIU,IlIC\ Policy No.: 92-GA-8133-8 Named Insured: GEORGE, MARIE DBA ACT ONE ACADEMY OF D1\NCE Additional Insured (include address): CITY OF SANTA ANA THEIR OFFICERS & EMPLOYEES 888 W SANTA ANA BLVD STH 200 SANTA ANA, CA 92701-4561 WHO IS AN INSURED, under SECTION" DESIGNATION OF INSURED, is amended to include as an insured the Additional Insured shown above, but only to the extent that liability is imposed on that Additional Insured solely because of your work performed for that Additional Insured shown above. Any insurance provided to the Additional Insured shall only apply with respect to a claim made or a suit brought for damages for which you are provided coverage. The Primary Insurance coverage below applies only when there is an "X" in the box. ~ Primary Insurance. The insurance provided to the Additional Insured shown above shall be primary insurance. Any insurance carried by the Additional Insured shall be noncontributory with respect to coverage provided to you. All other policy provisions apply. (t.:.: l ! ' Ii ',\ j ,._:...:o._i ,:." ,r;"1 ': 'J", ~ 1 ...... r--'t'1 i- \.! .' if' , ~ 'C_~._T .",,':;tZ.-1, ,:it\' !\ ~; ': : . FE-6609 Printed in U.S.A. '- '" .. Policy Numher 92-GA-8133-8 DECLARATIONS PAGE AMENDED JUN 23 2007 fA) ~ STATE FARM GENERAL INSURANCE COMPANY 900 OLD RIVER RD, BAKERSFIELD CA 93311-6000 A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS j\!- Z [J [J U? - (/{yD- 01 Named Insured and Mailing Address 23-8821-F790 S GEORGE, MARIE DBA ACT ONE ACADEMY OF DANCE 1186 N TUSTIN AVE ORANGE CA 92867-6006 Cov A -Inflation Coverage Index: N/A BUSINESS POLICY - SPECIAL FORM 3 Cov B - Consumer Pricelndex: 203.9 AUTOMATIC RENEWAL - If the POLICY PERIOD is shown as 12 MONlliS, this pol~wlU be renewed automaticallv subject 10 the premiums, rules and forms in effect for each succeedingpoJicy ~riod. If this policy is terminated, we win give you and the MortgageeJLienholder written notice in compliance W11H the policy provisionS or as required by law. Policy Period: 12 Months The policy period begins and ends at 12:01 am standard time althe Effective Date: JUN 23 2007 premises location. Expiration Date: JUN 23 2008 Named Insured: Individual location of Covered Premises: 1186 N TUSTIN AVE ORANGE CA 92867-6006 Your pOlicy is amended JUN 23 2007 ADDL INSURED NAME & ADDRESS ADDED ENDORSEMENT FE-6609 ADDED Coverages & Property Section I A Buildings B Business Personal Property C Loss of Income - 12 Months limits of Insurance Excluded $ 5 800 $ Actual [055 Section" L BUSiness Liability M Medical Payments Products-Completed Operations (PCO) Aggregate General Aggregate (other Than PCO) I 1,000,000 5,000 2,000,000 2,000,000 Deductibles - Section I $ 500 Basic $ In case of loss under this policy, the deductible will be applied to each occurrence and will be deducted from the amount of the loss. Other deductibles may apply - refer to policy. Endorsement Premium Increase $ 120 .00 Forms, Options, and Endorsements Special Form 3 'Section" Additional Insured Amendatory Endorsement Debris Removal Endorsement Policy Endorsement Business Policy Endorsement Glass Deductible - Section I . New Form Attached FP-6143 FE -6609 FE-6205 FE-6451 FE-6506.2 FE-6464 FE-6538.1 Discounts Applied: '. : '-'T.' r', . Renewal Year "" ."j /1-,"-.) iL~:; g.;:~ ~~~~~nes~_~~-:~!< {:Yc<-'i II~ ,<_.,~ l~' ',' ,,'..-:',t., '_; ,f Continued on Reverse Side of Page OTHER LIMITS AND EXCLUSIONS MAY APPLY. REFER TO YOUR POLICY Counte signed By CHARLENE HATAKEYAMA (714) 527-8897 A3TN enJCl1 Prepared JUL 06 2007 FP-8030.2C 0611993 Your policy consists of this page, any endorsements and the polley form. PLEASE KEEP THESE TOGETHER. Agent (ol12172b) 07/28/2009 16:31 71A5278898 STATE 1=AF2M PACaE 02 pECLARATIpN5 PAGE covERAGE suAAMARY , Policy Number JUL 2d 2009 82-t~A 8i33-8 STATE FAaM GENERAL INSURANCE COMPANY ""`" 900 OLD RIVER RD. BAKERSFtELD CA 93311.6044 ASTOCK COMPANY Wli'H HOME OFFICES IN BLOOMINGTON, ILLINOIS Named Insured and Meiting23d8d82f F790 S QEOFiQE, MARIE D8A ACT ONE ACADEMY Of DANCE 1186 N TUSTIN AVE ORANGE CA 92867-6006 ~2 00l - OGO, ~/t 0,2~ - C~ 3 Cov A -Inflation Coveragge Index: NIA . BU91NE95 POLICY - SPECIAL PORM S Cov B - Consumer Pricelndex: 220.0 AUT4MATtC RENEWAI. - If the POLICY P1=R O~~fl Is showwnn as i2 ~nba~N~o~I! S, th s o 1 will be renewed aufomatical~Y s b ect to the remtoms, ruled and fa rnwri~te ~notlcerln comS~i~@ce Iwmt the p~lia~ pro~is(onspo°rla r qu~rlej~~y~awe w tl g~v~ you and tie [wortgapee~IL~enhatde P Policy Period:, 12 Months em~sesYocat onbegtns and ends at 121 am standard time attlte Effective Date. JUN z3 2009 P Expiration Date: JUN 23 2010 Named Insured: (ndiv uet Requested i3y: Actd$fonel Insured Location of Covered Premis®a: 11$6 N TIJSTiN AVE ORANGE GA 92867.6008 Coverages & Properly Section l A Buildings H Business Personal Property C LOSS Of lnoorrr9 - 12 MOrtthS Seotion If L 8uslness Ltabllily M Medical Payments Products-Completed Operetians (PCO) Aggregate General Aqgg regate (Other 7nan PCi:?~) Limits of Insaranoe Ex~Olu300 Actual doss 1,D0~~~~~ 2,000, 2,000,OOQ Forms options, and Endorsementg Sp®cia~ Form 3 FP-6143 Amendatory Endorsemr~nt FE-8205 Debris Removal Endorsement FE-6451 Policy Endorsement FE-6508.2 Business Policy Endorsement FE-64fi4 glass Deductible - S9ctfon [ FE-6638.1 Terrorism Insurance Cov Notice i=E-6999.1 Deductibles - 9eotioe r 600 Basic In case of toss under this policy the deductible will be applied to each occurrenoe and will be deducted from the amount of the Ioes. Outer deduotlbies may apply -refer to policy Premium Discounts ApAlted: Renewal Year Years in Business Cfalrtl Reoord Continued en Reverse Side of Page i Prepared OTHER LIMITS AtdO 1:xCLi1810NS MAY APPLY- RHEA JUL 20ggpp2008 Count atgned 0~8~93.2C CU7Q BY Your afroy eonststs of this page,any ehdorsemanta CHARLENE HATAKEYAi ahd the papcy torm. Pi.tcASfi KEEP THE.4E TOGIETNICR. (714) 827-8897 ,09D.0 p0~ .~0 /~ ,~ ~_ Aaent (0112 t7Rb} 07/28/2009 15:31 7145278898 STATE FARM PAGE 03 CORD POI[Cy NO,: 92-GA $133-8 FE- eeo9 .,.,,.. SECTION tl ADDITIONAL INSURED ENDORSEMENT Policy No.: 92-OA 8133-8 Named Insured: DEOROE, MARfE 013A: ACT ONE ACADEMY OF DANCE Additional Insured include address}: CITY OF SANTA ANA THEIR 4FFICER8 & EMPLOYEES 886 W SANTA ANA BLVD STE 200 SANTA ANA CA 92701-4561 WW© IS AN INSURED, under SECTION it DESlONATION OF INSURED, is amended to include as an insured the Additional insured shown above, but only to the extent that Hasbiifty Is imposed on that Additlonasl Insured solely because of your work ~rformed for that Addltional Insured shown above. Any Insurance provided to the Additional Insured shall oniy apply with respect to a claim made or a suit brought for damages for vrhioh you are provided coverage. The Primary insurance coverage below applies oniy when there is an "X" In the box. Primary insurance. The insurance provided to the Additional Insured shown above shall be primary insurance. Any Insurance Carried by the Additional Insured shall be noncontributory with respect to Coverage provided to you. All other potlcy provisions apply. FE-0609 Pdnled In tl,5.A,