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Home My WebLink AboutSEHUAME, RUDY R. 1cAGREEMENT TERMINATION 2011' JUIN 18 Pas 1� VII Please complete this form when the attached agreement is no longer in effect.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=1138 if you haveany questions. ----------------------------------------------------------------- The agreement with �Ljj,(� 1 r No. was completed on and final payment has been made. -a 06(e m CS I' -o r N _a-oou-MA- a - fv-a-O0(t-a2.9-03 (--'C� "( Department: T �-� 4 Signature: Q—k Revised3-2-07 Date: U 1 1 31 i-ci City of Santa Ana Clerk of the Council ::a .i,1NdE NOT ON FILE 4uh MAY NOT PROCEED CLERK OF COUNCIL N-2006-029-03 DATE: '1- -)� THIRD AMENDMENT TO AGREEMENT i 6tv%5 Ra.0 C. ;�r1u TIw" P' iTAIS THIRD AMENDMENT TO AGREEMENT is made and entered into this 22"d day of May, 2008 by and between the City of Santa Ana, a charter city and municipal corporation of the State of California ("City") and RUDY R. SEHUAME ("Consultant"). RECITALS: City and Consultant entered into Agreement N-2006-029, dated February 7, 2006, hereinafter "said Agreement", by which Consultant provides Karate instruction in the City's Leisure Class Program. 2. In accordance with the terms and conditions of said Agreement, the parties wish to renew the said Agreement for an additional one-year period and to amend the Scope of Services to increase the participant fees for the classes. 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 1, SCOPE OF SERVICES, shall be amended by increasing the participant fee from $20 to $25 per monthly session. 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. IN WITNESS WHEREOF, City and Consultant have executed this Third Amendment to Consultant Agreement on the day and year first set forth above. ATTEST: Patricia E. Healy Clerk of the Council APPROVED AS TO FORM: JOSEPH W.FLETCHER City Attorney By: Lau Needy Assistant City Attorney RECOMMENDED FOR APPROVAL: Gerardo Mouet Executive Director Parks, Recreation and Community Services Agency CITY OF SANTA ANA �4d)a� DAVID N. REAM City Manager CONSULTANT EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 200740 CERTIFICATE OF INSURANCE EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. SPECIAL EVENT LIABILITY PROGRAM PRODUCER PUBLIC ENTITY (ADDMONAL INSURED) City of Santa Ana Alliant Insurance Services, Inc. in conjunction with 20 Civic Center Plaza, M-28 Apex insurance Services Santa Ana, CA 92701 P_ O. Box 6450 Newport Beach, CA 92658 (949) 660-8163 Linens No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Rodolfo R. Sehuatae TYPE: Karate Class DATE(S): 01119/07-1251107 2424 w. First street #133 LOCATION: Santa Anita Park Santa Ana, CA 92703 **Liquor Liabi]i after tam ❑ 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 eesti5cah may be issued or may pertain, the insurance afforded by the policies d=ribed herein is subject to all the terms, 'exchlsions and conditions of such policies. Limits shown may have been reduced by paid claims. INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: 04SEPI000001 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2007 EXPIRATION: JANUARY 1, 2008 COMMFRCiALGENERAL LIABILITY OCCJRRENCEFORM DEDUCTIBLE: NONE General d81;c6W boat $ 2,000.000 Premrets & Completed Operations I.t�� Personal & Advabstag Injury 1.000,000 Each Occurrence Limit Foe Damage (Any One Fire) 50,000 Medical Paymmte(Any One Person) 5,000 7bs limits olmauamce apply separately to each event insured by this policy u if a =Wwc POlicy of irwrmtea has been issued for Out event. "who is irutued" is avtended to include, as an insured, the person or otganimtion shown in this schedule, but only with respect to liability arising out of the ownetbip, ttt®hnan,, m use of the premises used by the named insured (event holder} 'Kris haurunee does not apply to: Any `occurrence- which takes place after ft went holder eesses to be a taunt in that premises. . OTSER ADDITFONAL INSUREDS C6UCEt t & 1TONL Should the above described policy to cancelled before the expiration date tlweof, the issuing company will nail 30 days writmn notice to the certificate holds an4 additional insureds listed AUTHORIZED REPRESENTATIVE: — DATE ISSUED: JamiaT 29.2007 ` ' Generated by Rick Management Division by: Z2�4� } yd`s (110 N-aoo�,-oaq --03 EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2008-05 CERTIFICATE OF INSURANCE EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. SPECIAL EVENT LIABILITY PROGRAM AUTHORIZED REPRESENTATIVE: DATE ISSUED: PUBLIC ENTII1' (ADDITIONAL INSURED) PRODUCER: City of Santa Ana Alliam Insurance Services, Inc. in conjunction with 20 Civic Center Plaza, M-28 Apex Insurance Services Santa Ana, CA 92701 P. O. Box 6450 Newport Beach, CA 92658 (949)660-8135 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Rudy Sehuame TYPE: Karate Class 2424 W. First Street, Space 133 DATE(S): _January 2008 —December 2008 Santa Ana, CA 92703 LOCATION: Santa nits Park Center *Liquor Yes ❑ No N Liabihty **Liquor Liability after 12 am ends before 2 am 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 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. Limits shown may have been reduced by paid claims. INSURANCE CARRIER Evanston Insurance Company MASTER POLICY NUMBER: 04SEP100000I-4 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2008 EXPIRATION: JANUARY 1, 2009 COMMERCIAL GENERAL LIABILITY OCCIIRRENCEFORM DEDUCTIBLE; NONE Geneml Aggregate Limit $2,000,000 Produces & Completed Operations 100.000 Personal & Advertising Injury 1.000,00 Each Occurrence Limit 1.000,000 Fire Damage (Any One Fitt) 50,000 Medical Payments (Any One Person) 5,000 Liquor Liability (If purchased) 1,000.000 The limits of insurance apply separately to each event insured by this policy 0 if a separate policy of ionmoce has been issued for thel event. "Who is insured" is amended to include, as an insured, the person or organization shown in this schedule, butonly with respect to liability arising out of the ownership, maintenance or use of the Premises used by the named it and (evmt holder). This imus n a does not apply m: Any "occurrence" which talm Place after the event holder ceases to be a tenant in that promises. OT1D;R ADDITIONAL INSUREDS CANCEL LAT(ON: Should the above described policy to cancelled before the expiration date thereof, the issuing company anll mail 30 days written notice to the certificate bottler and additional insureds listed. AUTHORIZED REPRESENTATIVE: DATE ISSUED: EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2011-13 CERTIFICATE OF INSURANCE COVERAGE EXCLUDED FOR NOMINEE EVENTS SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. SPECIAL EVENT LIABILITY PROGRAM PRODUCER PUBLIC ENTITY (ADDITIONAL INSURED) Alliant Insurance Services, Inc. in conjunction with City of Santa Ana Apex Insurance Services C> _ 20 Civic Center Plaza /� %) _ 0,"� P. O. Box 6450 Santa Ana, CA 92701 / l� �- Newport Beach, CA 92658 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Rudy Sehuame TYPE: Martial Arts 2424 West 1", #133 DATE(S): 02/02/11 -12/31/11 Santa Ana, CA 92703 LOCATION: Santa Anita Recreation *Liquor Liability Yes 0 No **Liquor Liability after 12 am ends before 2 am E-] This is to certify that the insurance policy listed below has been issued to the above insured named (event holder) for the policy period indicated. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not affirmatively or negatively amend, extend or alter the coverage afforded by the policy listed and it does not constitute a contract between the insurance carrier, authorized representative, producer and certificate holder. The insurance described herein is subject to all the terms, exclusions and conditions of such policy(ies). INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: 11SEP1000001 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2011 EXPIRATION: JANUARY 1, 2012 COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE General Aggregate Limit $ 2,000,000 Products & Completed Operations 1,000,000 Personal & Advertising Injury 1,000,000 Each Occurrence Limit 1,000,000 Fire Damage (Any One Fire) 50,000 Medical Payments (Any One Person) 5,000 Liquor Liability (If purchased) 1.000 000 The limits of insurance apply separately to each event insured by this policy as if a separate policy of insurance has been issued for that event. "Who is insured" is amended to include, as an insured, the person or organization shown in this schedule, but only with respect to liability arising out of the ownership, maintenance or use of the premises used by the named insured (event holder). This insurance does not apply to. Any "occurrence" which takes place after the event holder ceases to be a tenant in that premises. OTHER ADDITIONAL INSUREDS CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy revisions. EveLy effort will be made to deliver 30 days written notice to the certificate holder and additional insured(s) listed. AUTHORIZED REPRESENTATIVE: DATE ISSUED: February 02, 2011 by Briza Morales