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AGREEMENT TERMINATION f
Please complete this form when the attached agreement is no longer in effect L
Return form to the Deputy Clerk of the Council (M -30). Call 647 -5238 if you haW J y quesliorts
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The agreement with
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and final payment has been made.
ts - 2001-o3S
Revised 05 -22 -08
was capleted on
Department:
Signature:;
Date:
City of Santa Ana
Clerk of the Council
INSURANCE ON FILE
WORK MAY PROCEED
UNTIL INSURANCE EXPIRES
CA~~-F~, n wry `
CLERK OF COUNCIL
DATE: ~-il,~$
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FIRST AMENDMENT TO AGREEMENT
N-2007-035-01
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r ~~ TH1S FIRST AMENDMENT TO AGREEMENT is made and entered into this 24`h day of April,
~u~ ~~~ ~„r`P~ 2008 by and between the City of Santa Ana, a charter city and municipal corporation of the State
of California ("City") and Alfred Ong ("Consultant").
RECITALS:
City and Consultant entered into Agreement N-2007-035, dated January 1, 2007,
hereinafter "said Agreement", by which Consultant has instructed Chess through the
City's leisure class program.
2. In accordance with the terms and conditions of said Agreement, the parties wish to
amend the Scope of Services and renew 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 I, SCOPE OF SERVICES, shall be amended to replace Exhibit A, attached to
said Agreement, with Exhibit A-1, attached hereto and incorporated by this reference.
2. Section 3, TERM, shall be amended to extend the term of said Agreement through
June 30, 2009.
3. Except as herein amended, all terms and conditions of said Agreement shall remain in
full force and effect.
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IN WITNESS WHEREOF, City and Consultant have executed this First Amendment to
Consultant Agreement on the day and year first set forth above.
ATTE~S.T~:
~--'~-cX-c.c-c....~.. ~, .
Patricia E. Healy, Clerk of the Cou i
CITY OF SANTA ANA
DAVID N. RE , City M lager
APPROVED AS TO FORM:
JOSEPH W.FLETCHER
City Attorney
sy: tee
L ra Sheedy
Assistant City Attorney
RECOMMENDED
FOR APPROVAL:
~ierado Mouet
Exec five Director
Park ,Recreation and
Cocrununity Services Agency
CONSULTANT
ALF D ONG
EXHIBIT A-1
SCOPE OF SERVICES
1. Consultant will prepare and instruct students in chess, including names of pieces,
basic movements, strategies, tournament rules and play procedures.
2. Classes will be held at Consultant's facility, on the days and hours set by Consultant.
Consultant shall provide City a class schedule, including holidays which will be
observed.
3. Consultant will provide and be responsible for equipment, records and personnel and
materials necessary to ensure the safety and effectiveness of said instruction.
4. If Consultant allows others to teach his classes, those teachers must be over 21, have
obtained and maintain an instructor rating and be covered by Consultant's insurance.
CLASS SIZE -REGISTRATION
1. The minimum number or participants is 1 per class, the maximum is 12.
2. No registration will be accepted after the second week of classes.
3. In the event the minimum number of enrollees is not realized by the second week of
classes, the class shall be cancelled, Consultant will be under no obligation to provide
services and the City will have no obligation to pay Consultant compensation.
FEES
1. Each participant shall pay a $35.00 class registration fee per monthly session.
2. No refunds will be made to participants after the commencement of a session unless
the class is cancelled by the City.
3. City shall collect registration fees from each participant. Consultant shall refer
interested students to City for registration.
4. Consultant shall receive seventy percent (70%) of the total fees collected each month.
City and Consultant agree that City shall retain thirty percent (30%) of the fees
collected as an administration fee.
5. Consultant agrees City is entitled to audit Consultant's records and classes to ensure
compliance with this Agreement.
6. Consultant may not waive class participation registration fees.
7. City shall prepare class rosters and provide a copy to Consultant. Only registered
participants may participate in class.
CERTIFICATE OF INSURANCE
This certifies that ^ STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois
® STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois
^ STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario
^ STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida
^ STATE FARM LLOYDS, Dallas, Texas
insures the following policyholder for the coverages indicated belovr.
Policyholder ONG, ALFREDO DBA CHESS PALACE
__
Address ofpolicyhnlder 12872 VALLEY VIF'W ST STE 5
LofxtionofOpOrafiOflS GARDEN GAOVE CA 92895-2518
Description of operations CHESS
The policies listed below have been issued to the policyholder for the polity periods shown. The insurance described in these polities is
subject to all the terms extrusions, and conditions of those polities. The limits of liability shown may have been reduced by env paid claims
POLICY PERIOD LIMITS OF LU161LITY
POLICY NUMBER TYPE OF INSURANCE EtTacUve Date
Expiation Date
(at beginning of policy psdod)
92-D9-OSO8-1 c Comprehensive 6-i-06 coxTINUOUS BODILY INJURY AND
-------- Business Liability---___--• ------------- PROPERLY DAMAGE
This insurance includes: ^ Products -Completed Operetions
^ Contractual Liability
^ Underground Hazard Coverage Each Occurrence $ i, 000, 000
^ Personal Injury
^ Advertising Injury General Aggregate $ 2, OoO, 000
^ Explosion Hazard Coverage
^ Collapse Hazard Covenrge Products -Completed $ z, 000, 000
^ Operations Aggregate
^
POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE
EXCESS LIABILITY Effecflw Deco ~ Expiration Data (Cotnbirted Single Limit)
~ U
m~ la Each Occurrence E
O Aggregate $
Part t STATUTORY
Part 2 BODILY INJURY
NONE Workers' Compensation
and Empbyers Liability Each Accident $
Disease -Each Employee $
Disease -Policy Limit $
POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD
Effective Date ; 'cotton Gate LIMITS OF LUIBILIIY
(at beginning of policy period)
THE CERTIFICATE OF INS URANCE JS NOT A CONTR ACT OF INSURANCE eNe NEtTN FR er:r:tQUernct v unr? uer_ernici v
AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED
If any of tht
its expi '
no' o
Name and Address of Certificate Holder cel
t
ADDITIONAL INSURED: rILSE
CITY OF SANTA ANA; ITS OFFICERS, EMPLOYEES,AGENTS,VOLUNTEERS
AND REPRESENTATIVES
20 CIVIC CENTER PLAZA SANTA ANA, CA. 92701 Signature otA
' ~ ::.JOHN FULKL
STATE FARM INSURANCE CG'S - ~ Tale
JOHN FULWILER INSURANCE AGENCY, INC. ~rn,s
(714) 895-7882 `..,' 1
G/ ~~/ .
AFO Code
558-984 a.4 11-12-2002 Printed el U.SA
policies are can led before
to Farm o mail a written
trtifi der 30 days before
er, we tai! to mail such notice,
liability will be imposed on State
or representatives.
. .. _..~ Z2:'Ll /149952089 STATE FARM IM1ISUP.ANCE °AGE 82/02
~L-~ONAY. I1VT3UIlkLA E1~R4~'.T
FOR C____ ~ _~~' ~C~' G'~wn'v_ Ai. Y.tA3Ii.TTY Pd~I.I~'^Y
Irtsurallce CompAU,y s'~s ? ~ ~'e'`'r
~~ such iaatuance as is affarded by the provisions of Policy
0$-al- rr3atirfgto the following:
1. 'Che City of Santa Aua, and the City of Santa Ana, located at 20 Civic
CeatGr Plaza, Santa tea, Cslifbmis 92701; and their respective oi$cars, gazployees,
agents, ~rolunteers and representatives are Warned as additional insureds ("additional
-~~r:.de `) with sngard to liability and do£etfae of pttita arising fronx the operations tmd
tees nen•:ormad by ax on behalf of flee named insured.
;c., vJirb reapcct w claitng sxisirlg out o£the operations and uses performed by
or on behalf of the named i~ such insuuaneo as is afforded by this policy is primer; ~
artd ~ not addi 3otutl to or eoohibuting with any other insuxattce ~cd by ox fox the
banGfit of t11G addt4onal msm~eds.
't'his insurance applies soparaLaly to each inatlrcd Against whom cLsim. is
made tx suit is brongbt racocpt with respect to the cp~any's limits of liability. The
inclusion of any pe=sos or organlzatlon as an insttred shall not affxt sny right which stn sll
pmaem or arganization would have as a elaftnaut if slat s0 included.
,1. ~tlr respect to the additional insureds, this insurance shall not be
catuellcd, or nmtet4ally reduced in coverage ox lirndts except after thtrty (30) days writtc n
notice has hems given to the Community liedevelopment Agency of the City of Sattta
Ana 20 Civic t,'.antea" Plaza (lvf-25), Santa Ana, Califotatia 92701.
~,.arnplation of the follawin~ including cormtetsigtrahlre, is required to make this
-~±dcasem.ent effective.}
Effe.^ti~:e~A' to "] ,this ttadoxsanent farm ae a part of
Policy #!
?sstu:d to
~' P917d
' Jonrm z'utwuer7t~aurerrcc~gcnrsxnu.___.
State Farm Insaranu Co's
12752 Valley 4'icw St. Ste. T
Carden Grove,C~• 92&t5
(714) 895-7892 (800) SG3•tt22
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