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Home My WebLink AboutRIVERA, SALOMON 1eAGREEMENT TERMINATION Please complete this form when the attached agreement is no longer in effect Return form to the Deputy Clerk of the Council (M-30). Call 647-5238 if you have any questions f '; The agreement with No. was completed on and final payment has been made. Department: Q 4 Signature: a 0 (- Date: 101 �,5 4 City of Santa Ana Clerk of the Council Revised 05-22-08 4NORK MAY PROCEED A-2006-263-02 UNTIL INSURANCE EIPISES be€RA 0� OOUNCIL FIFTH AMENDMENT TO AGREEMENT DATE; 5 '1%-0 2 g(sec. (� THIS FIFTI4 MENDMENT TO AGREEMENT is made and entered into this 16`h day of May, -OA-T�,�. r.P€ 2008 by and between the City of Santa Ana, a charter city and municipal corporation of the State of California ("City") and Salomon Rivera ("Consultant"). RECITALS: City and Consultant entered into Agreement N-2004-033, dated April 22, 2004, hereinafter "said Agreement", by which Consultant has instructed salsa dance classes through the City's leisure class program. In accordance with the terms and conditions of said Agreement, the parties wish to renew the said Agreement for an additional one-year period. WHEREFORE, in consideration of the mutual and respective covenants contained in said Agreement, and subject to all the terms and conditions of said Agreement, City and Consultant agree as follows: Section 3, TERM, shall be amended to extend the term of said Agreement through June 30, 2009 2. Except as herein amended, all terns and conditions of said Agreement shall remain in full force and effect. IN WITNESS WHEREOF, City and Consultant have executed this Fifth Amendment to Consultant Agreement on the day and year first set forth above. ATTEST: _ 7v Patricia F. Healy Clerk of the Council APPROVED AS TO FORM: Joseph W. Fletcher, City Attorney Ey �l u�o1 4 Ladra Sheedy, Asst. Cit ey CITY OF SANTA ANA AGerMouet,l Executive Direct Parks Recreation ve Director Community Services EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2008-02 CERTIFICATE OF INSURANCE EXCLUDES COVERAGE FOR NOMINEE EV E`NTTSS. SSE SEPARATE TE APPLICATIONS FOR NOMINEE EVENTS. PROGRAM SPEC Alliant Insurance Services, Inc. Apex Insurance Services P. O. Box 6450 Newport Beach, CA 92659 (949)660-8135 Salomon Rivera 709 S. Parton Street Santa Ana, CA 92701 TYPE: Dance Class - Salsa DATE(S): Jan. 2008 —December 2008 LOCATION: Southwest Senior Center *Liquor Liability Yes ❑ No **T .' .. r ial,ility after 12 am ends before 2 ar ❑ This is to certify that the policies of insurance listed below have been issued to the insured named above for the policy period indicated. Notwithstanding any requirements, terms or conditions of any contract or other document with respect to which this certificate tray 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. Limits shown may have been reduced by paid claims. INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: 04SEP 1000001.4 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2008 EXPIRATION: IANUARY 1, 2009 OCCURRENCEFORM DEDUCTIBLE: NONE COMMERCIAL GENERAL LIABILITYS Z 000 000 General Aggregate Limit 1,000,000 Products & Coumleud Operations1000A00 Personal &Advertising Injury 1000p00 Each OccurrenceLimit 50,000 Fire Damage (Any One Fire) 5 ,000 Medical Paymerts(Any One Person) 1000000 Liquor Liability (If purchased) .-;--A t,., Ahia n EM as if a SCnaratepolicy of insurance 1!!Ib= issued ftm that event the hrtrirs otmsurance appy scpmcwr .+. �-.."_. _... "Who is insured" is amended to include, as an insured, the person a Organisation shown m this schedule, but only with respect to liability arising out of the ownership, maintenance or use of the premises used by the named insured (even tholder)- This vuuraoce dow not apply to: Any "Occurrence" which takes place CANCEL LATION� Should the above described policy to cancelled before the expiration date thereof, the issuing company will mail 30 days written notice to the certificate holder and additional insureds listed. lal AUTHORIZED REPRESENTATIVE: DATE ISSUED: EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2009-01 CERTIFICATE OF INSURANCE EXCLUDES COVERAGE FOR NOML'�� EVENTS. SEPARATEBILITY APPAM TIONS FOR NOMINEE EVENTS. AL F Apex Insurance Services P. O. Box 6450 Newport Beach, CA 92658 (949) 660-8135 r iernse No: OC 36861 } City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92701 NAMED INSURED (EVENT 11]1.ubx): TYPE: Dance - Salsa Salomon Rivera , a00(� _ o�(p3, DATE(S): Jan. 5- Dee.31 — 709 S. Parton Street LOCATION: Southwest Senior Center Santa Ana, CA 92701 *Liquor Liability Yes ❑ No ❑ err : ,, r T iahility after 12 am ends before 2 am ❑ d to the insured named above for the policy Period This is to certify that the poliane ref uirements, tinsurance teerms orted low have been conditions of any econtract other document with respect to which this indicated Notwithstanding y 4 policies described herein is subject to all the terms, certificate may be issued or may may pertain, the insurance afforded by P exclusions and conditions of such policies. Limits shown may have been reduced by paid claims. INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: 04SEP 100000I-5 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2009 EXPIRATION: jANUARY 1, 2010 OCCURRENCE FORM DEDUCTIBLE: NONE COMMERCIAL GENERAL LIABILITY g 2 000.000 General Aggregate Limit I,000,c00 Products &Completed Operations I (g0,000 personal & Advertising Injury 1 10,000 000,000 Each Occu cnee Limit Fire Damage (Any One Fire) Medical payments (Any One person) 5,000 1,000,OOo Liquor Liability (If purchased) The limits of insurance apply separately to e¢ch event insured by this Policy as if a separate policy of insurance has beer[ rssueo ror uur vvult organization shown in this schedule, but only with respect y occurre¢Ce" which tikes Place liability arising out of the "Who is insured" is amended to include, as an insured, the Person or oes not apply to: Any ownership, maintenance or use of the premisesen used by the named insured (event holder). This Insurance d" alter the event holder ceases to be a CANCELLATION: ATION: Should the above described policy to ="tied before the Wimdon date thereof, the issuingcompmyw'ill marl 30 days written notice to the ..,,---- ,._,,,._."A 4AA!6�..l insureds listed. AUTHORIZED REPRESENTATIVE: DATE ISSUED: