HomeMy WebLinkAboutHERNANDEZ, FLORG) AGREEMENT TERMINATION
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Please complete this form when the attached agreement is no longer in effect tj E R In 0
Return form to the Deputy Clerk of the Council (M-30). Call 647-5238 if you have any questions.
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Department:
Signature:i
Date: ! G.
City of Santa Ana
Clerk of the Council
INSURANCE ON FILE
V'iORK MAY PROCEED
UNTIL INSURANCE EXPIRES
1-I-O`
CLERK OF COUNCIL
DATE:
CONSULTANT AGREEMENT
N-2008-139
THIS AGREEMENT made and entered into this 10°i day of October, 2008 by and
Ccwl� Ch mhk �s between Flor Hernandez, an individual (hereinafter "Consultant"), and the City of Santa
Ana, a charter city and municipal corporation organized and existing under the
Constitution and laws of the State of California (hereinafter "City").
RECITALS
A. The City desires to retain a consultant having special skill and knowledge in the
field of aerobics, to provide instruction in the City's leisure class program.
B. Consultant represents that Consultant is able and willing to provide such services
to the City.
C. In undertaking the performance of this Agreement, Consultant represents that it
is knowledgeable in its field and that any services performed by Consultant
under this Agreement will be performed in compliance with such standards as
may reasonably be expected from a professional consulting firm in the field.
NOW THEREFORE, in consideration of the mutual and respective promises, and
subject to the terms and conditions hereinafter set forth, the parties agree as follows:
1. SCOPE OF SERVICES
Consultant shall provide Aerobics classes as set forth in Exhibit A to this
Agreement.
2. COMPENSATION
a. 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 $10,000.00 during the term of this Agreement.
b. Payment by City shall be made within thirty (30) days following receipt of
proper invoice evidencing work performed, subject to City accounting procedures.
Payment need not be made for work which fails to meet the standards of performance set
forth in the Recitals which may reasonably be expected by City.
3. TERM
This Agreement shall commence on the date first written above and terminate on
December 31, 2009, unless terminated earlier in accordance with Section 12, below. The
term of this Agreement may be extended upon a writing executed by the Executive
Director of Parks, Recreation and Community Services and the City Attorney.
4. INDEPENDENT CONTRACTOR
Consultant shall, during the entire term of this Agreement, be construed to be an
independent contractor and not an employee of the City. This Agreement is not intended
nor shall it be construed to create an employer -employee relationship, a joint venture
relationship, or to allow the City to exercise discretion or control over the professional
manner in which Consultant performs the services which are the subject matter of this
Agreement; however, the services to be provided by Consultant shall be provided in a
manner consistent with all applicable standards and regulations governing such services.
Consultant shall pay all salaries and wages, employer's social security taxes, unemployment
insurance and similar taxes relating to employees and shall be responsible for all applicable
withholding taxes.
5. INSURANCE
Prior to undertaking performance of work under this Agreement, Consultant shall
maintain and shall require its subcontractors, if any, to obtain and maintain insurance as
described below:
a. Commercial General Liability Insurance. Consultant shall maintain
commercial general liability insurance naming the City, its officers, employees, agents,
volunteers and representatives as additional insured(s) and shall include, but not be
limited to protection against claims arising from bodily and personal injury, including
death resulting therefrom and damage to property, resulting from any act or occurrence
arising out of Consultant's operations in the performance of this Agreement, including,
without limitation, acts involving vehicles. The amounts of insurance shall be not less
than the following: single limit coverage applying to bodily and personal injury,
including death resulting therefrom, and property damage, in the total amount of
$1,000,000 per occurrence. Consultant shall supply City with a fully executed additional
insured endorsement in substantially the form attached hereto as Exhibit B upon
execution of this Agreement and shall be approved in form by the City Attorney.
b. Worker's Compensation Insurance. In accordance with the provisions of
Section 3300 of the Labor Code, Consultant, if Consultant has any employees, is required
to be insured against liability for worker's compensation or to undertake self-insurance.
Prior to commencing the performance of the work under this Agreement, Consultant
agrees to obtain and maintain any employer's liability insurance with limits not less than
$1,000,000 per accident.
c. The following requirements apply to the insurance to be provided by
Consultant pursuant to this section:
(i) Consultant shall maintain all insurance required above in fall force
and effect for the entire period covered by this Agreement.
(ii) Certificates of insurance shall be furnished to the City upon
execution of this Agreement and shall be approved in form by the
City Attorney.
(iii) Certificates and policies shall state that the policies shall not be
canceled or reduced in coverage or changed in any other material
aspect without thirty (30) days prior written notice to the City.
d. If Consultant fails or refuses to produce or maintain the insurance required by
this section or fails or refuses to furnish the City with required proof that insurance has
been procured and is in force and paid for, the City shall have the right, at the City's
election, to forthwith terminate this Agreement. Such termination shall not effect
Consultant's right to be paid for its time and materials expended prior to notification of
termination. Consultant waives the right to receive compensation and agrees to
indemnify the City for any work performed prior to approval of insurance by the City.
6. INDEMNIFICATION
Consultant agrees to and shall indemnify and hold harmless the City, its officers,
agents, employees, consultants, special counsel, and representatives from liability for
personal injury, damages, just compensation, restitution, judicial or equitable relief
arising out of claims for personal injury, including health, and claims for property
damage, which may arise from the direct or indirect operations of the Consultant or its
contractors, subcontractors, agents, employees, or other persons acting on their behalf
which relates to the services described in section I of this Agreement. The Consultant
further agrees to indemnify, hold harmless, and pay all costs for the defense of the City,
including fees and costs for special counsel to be selected by the City, regarding any
action by a third party asserting that personal injury, damages, just compensation,
restitution, judicial or equitable relief due to personal or property rights arises by reason
of the terms of, or effects arising from this Agreement. City may make all reasonable
decisions with respect to its representation in any legal proceeding.
7. CONFIDENTIALITY
If Consultant receives from the City information which due to the nature of such
information is reasonably understood to be confidential and/or proprietary, Consultant
agrees that it shall not use or disclose such information except in the performance of this
Agreement, and further agrees to exercise the same degree of care it uses to protect its
own information of like importance, but in no event less than reasonable care.
"Confidential Information" shall include all nonpublic information. Confidential
information includes not only written information, but also information transferred orally,
visually, electronically, or by other means. Confidential information disclosed to either
parry by any subsidiary and/or agent of the other party is covered by this Agreement.
8. CONFLICT OF INTEREST CLAUSE
Consultant covenants that it presently has no interests and shall not have interests,
direct or indirect, which would conflict in any manner with performance of services
specified under this Agreement.
9. NOTICE
Any notice, tender, demand, delivery, or other communication pursuant to this
Agreement shall be in writing and shall be deemed to be properly given if delivered in
person or mailed by first class or certified mail, postage prepaid, or sent by telefacsimile
or other telegraphic communication in the manner provided in this Section, to the
following persons:
To City: Clerk of the City Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
telefacsimile (714) 647-6956
With courtesy copy to:
Executive Director of Parks, Recreation and Community Services
City of Santa Ana
20 Civic Center Plaza (M-23)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 571-4235
To Consultant: Flor Hernandez
1621 N. Linwood Avenue
Santa Ana, California 92701
A party may change its address by giving notice in writing to the other party.
Thereafter, any communication shall be addressed and transmitted to the new address. If
sent by mail, communication shall be effective or deemed to have been given three (3)
days after it has been deposited in the United States mail, duty registered or certified,
with postage prepaid, and addressed as set forth above. If sent by telefacsimile,
communication shall be effective or deemed to have been given twenty-four (24) hours
after the time set forth on the transmission report issued by the transmitting facsimile
machine, addressed as set forth above. For purposes of calculating these time frames,
weekends, federal, state, County or City holidays shall be excluded.
10. EXCLUSIVITY AND AMENDMENT
This Agreement represents the complete and exclusive statement between the City
and Consultant, and supersedes any and all other agreements, oral or written, between the
parties. In the event of a conflict between the terms of this Agreement and any
attachments hereto, the terms of this Agreement shall prevail. This Agreement may not
be modified except by written instrument signed by the City and by an authorized
representative of Consultant. The parties agree that any terms or conditions of any
purchase order or other instrument that are inconsistent with, or in addition to, the terms
and conditions hereof, shall not bind or obligate Consultant nor the City. Each party to
this Agreement acknowledges that no representations, inducements, promises or
agreements, orally or otherwise, have been made by any party, or anyone acting on behalf
of any party, which are not embodied herein.
11. ASSIGNMENT
Inasmuch as this Agreement is intended to secure the specialized services of
Consultant, Consultant may not assign, transfer, delegate, or subcontract any interest
herein without the prior written consent of the City and any such assignment, transfer,
delegation or subcontract without the City's prior written consent shall be considered null
and void. Nothing in this Agreement shall be construed to limit the City's ability to have
any of the services which are the subject to this Agreement performed by City personnel
or by other consultants retained by City.
12. TERMINATION
This Agreement may be terminated by the City upon thirty (30) days written notice of
termination. In such event, Consultant shall be entitled to receive and the City shall pay
Consultant compensation for all services performed by Consultant prior to receipt of such
notice of termination.
13. DISCRIMINATION
Consultant shall not discriminate because of race, color, creed, religion, sex,
marital status, sexual orientation, age, national origin, ancestry, or disability, as defined
and prohibited by applicable law, in the recruitment, selection, training, utilization,
promotion, termination or other employment related activities. Consultant affirms that it
is an equal opportunity employer and shall comply with all applicable federal, state and
local laws and regulations.
14. JURISDICTION - VENUE
This Agreement has been executed and delivered in the State of California and the
validity, interpretation, performance, and enforcement of any of the clauses of this
Agreement shall be determined and governed by the laws of the State of California. Both
parties further agree that Orange County, California, shall be the venue for any action or
proceeding that may be brought or arise out of, in connection with or by reason of this
Agreement.
15. PROFESSIONAL LICENSES
Consultant shall, throughout the term of this Agreement, maintain all necessary
licenses, permits, approvals, waivers, and exemptions necessary for the provision of the
services hereunder and required by the laws and regulations of the United States, the
State of California, the City of Santa Ana and all other governmental agencies.
16. MISCELLANEOUS PROVISIONS
a. All Exhibits referenced herein and attached hereto shall be incorporated as if fully
set forth in the body of this Agreement.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and
year first above written.
ATTEST:
PATRICIA E. HEALY'
Clerk of the Council
APPROVED AS TO FORM:
JOSEPH W.FLETCHER
City Attorney
By: C. c
Lau Sheedy J
Assistant City Attorney
RECOMMENDED FOR APPROVAL:
GERARDO MOUET
Executive Director of
Recreation and Conn
Services
CITY OF SANTA ANA
V //12
�---------
DAVID N. REAM
City Manager
CONSULTANT
�1?
LOR HERNANDEZ
Tax ID#
EXHIBIT A
SCOPE OF SERVICES
Consultant shall provide an Intro to Aerobics class as follows:
• The one -hour class will be taught at a beginner level. Consultant will use
accepted safe and healthy Aerobics techniques, warm up exercises and steps as
well as cool down.
• The class will be held at the Santa Ana Senior Center two times per week during
monthly sessions.
• Consultant shall inform City of the day and time of the classes to be conducted by
Consultant. Consultant and Parks, Recreation and Community Services staff may
change the days, time and/or location of the classes to be held during a given
monthly session, upon mutual agreement.
• Consultant shall provide equipment, records and personnel necessary to ensure
the safety and effectiveness of said instruction.
• Each class shall have a minimum of 10 and a maximum of 40, registered and paid
participants.
• If the minimum registration has not been reached by the second class, the class
may be cancelled by mutual agreement of Consultant and City, with no
compensation owed Consultant for any cancelled class session.
FEES
• Each participant shall pay a $15.00 class registration fee per monthly session.
• No refunds will be made to participants after the first week of class unless the
class is cancelled by the Parks, Recreation and Community Services Agency.
• City shall collect registration fees from each participant. Consultant shall refer
interested students to City for registration.
• Consultant shall receive seventy percent (70%) of total fees collected for the
classes within fifteen (15) working days after completion of each class session.
City shall retain thirty percent (30%) of the fees collected.
• Consultant agrees that City shall be entitled to audit Consultant's records and
classes to ensure compliance with this Agreement and that all participants are
registered.
• Consultant may not waive class participation/registration fees.
• City shall prepare class rosters and provide a copy to Consultant. Only registered
participants, listed on roster, may participate in class.
EXHIBIT B
ADDITIONAL INSURED ENDORSEMENT
FOR COMMERCIAL GENERAL LIABILITY POLICY
Insurance Company
This endorsement modifies such insurance as is afforded by the provisions of Policy
# relating to the following:
1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California
92701; its officers, employees, agents, volunteers and representatives are named as
additional insureds ("additional insureds") with regard to liability and defense of suits
arising from the operations and uses performed by or on behalf of the named insured.
2. With respect to claims arising out of the operations and uses performed by
or on behalf of the named insured, such insurance as is afforded by this policy is primary
and is not additional to or contributing with any other insurance carried by or for the
benefit of the additional insureds.
3. This insurance applies separately to each insured against whom claim is
made or suit is brought except with respect to the company's limits of liability. The
inclusion of any person or organization as an insured shall not affect any right which such
person or organization would have as a claimant if not so included.
4. With respect to the additional insureds, this insurance shall not be
cancelled, or materially reduced in coverage or limits except after thirty (30) days written
notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana,
California 92701.
(Completion of the following, including countersignature, is required to make this
endorsement effective.)
Effective
Policy # _
Issued to
this endorsement form as a part of
Named Insured
Countersigned by
Authorized Representative
EVANSTON MURANCE COMPANY
CERTIFICATE NO.: 2008-39
CERTIFICATE OF INSURANCE
EXCLUDES COVERAGE FOR NOMINEEDE I AI EVENT EF SEPARATE
APP 1CATIONS FOR NOMINEE EVENTS•
PUBLIC ENTITY (ADDITIONAL INSURED)
PRODUCER:
City of Santa Ana
Alliant Insurance Services, Inc. in conjunction with
20 is CenterPlaza M-28
Apex Insurance Services
Santa CA 92701
P. O. Box 6450
Newport Beach, CA 92658
(949)660-8135
License No: OC 36861
NAMED INSURED (EVENT HOLDER):
EVENT INFORMATION:
Flor Hernandez
TYPE: Aerobics
DATE(S): November 1— December 31 2008
1621 N. Linwood Ave.
LOCATION: Senior Center — 3 Street
Santa Ana, CA 92701
*Liquor Liability Yes ❑ No N
**Liquor Liabiii 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
or other document with respect to which this
indicated. Notwithstanding any requirements, terms or conditions of any contract
be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms,
certificate may
exclusions and conditions of such policies. Limits shown may have been reduced by paid claims.
INSURANCE CARRIER: Evanston Insurance Company
MASTER POLICY NUMBER: 04SEP10000014
MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2009 EXPIRATION: JANUARY 1, 2009
COMMERCIAL GENERAL LIABILITY
OCCURRENCEFORM
DEDUCTIBLE: NONE
General Aggegete Limit S 2,1100,000
1.000,000
Products & Completed Operations
1,000.000
Personal & Advertising Injury
Each Occurrence Limit 11000,000
Fire Damage (Any One Fire) 50,000
5,000
Medical Payments (Any one Person)
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 miturmsec has been issued for that event
"Who is insured" is amended to include, es an insured, the person a organization shown in this schedule, but only with respect to liability arising out of the
ownership, maintenance or use ofthe premises used by the named insured (event bolder). This insurance does not apply to: Any "cecurrence" which takes place
after the event holder ceases to be a tenant in thstpromises.
OTHER ADDITIONAL INSUREDS
Michael Saucedo Nutritional Supplement
Juan Sanchez
Inner City Child Development Youth Foundation
dames S. Stapleton
CANCELLATION: Should the above described policy to cancelled before the expiration date thereof, the issuing company will mail 30 days written notice to the
certillcate holder and additional insureds listed.
/,v �Z, A , Vn VORM
AT ITI-IORLZED REPRESENTATIVE:
DATE ISSUED:
EVANSTON INSURANCE COMPANY
CERTIFICATE NO.: 2009-10
CERTIFICATE OF INSURANCE
EXCLUDES COVERAGE FOR NOMINECE ,NTS- SEE
IAL E NT LIABILIITY4PROGTE PRAMATION5FQR NOMINEE EVENTS.
SPE
Alliant lnsumnce Services, Inc. in
Apex Insurance Services
p, O. Box 6450
Newport Beach, CA 92658
(949) 660-8135
T.icense No: OC 36861
Flor Hernandez
1621 N. Linwood Ave.
Santa Ana, CA 92701
City of Santa Ana
To —civic Center Plaza
Santa Ana, CA 92701
TYPE: Aerobics
DATE(S): San. 12 - Dec. 31
LOCATION: Southwest Senior Center
*Liquor Liability Yes ❑ No ❑
r.r r ;nl,ility after 12 am an 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 p
er od
indicated Notwithstanding any re4ui ements, terms or conditions of any contract or other document with respect m 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 policciie'Ss ance Limits shown
wnymay have been reduced by paid claims.
INSURANCE CARRIER� Evanston
MASTER POLICY NUMBER: 04SEP1000001-5
MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2009 EXPIRRATION: JANUARY 1, 2010 _
thi
OCCURRENCE FORM DEDUCTIBLE: NONE
COMMERCIAL GENERAL LIABILITY
$ Z 000,000
General Aggregate Limit
1.000,000
Products & Completed Operations
1,000,000
Personal & Advertising injury
1,000,000
Each Occureence Limit
50,000
Fire Damage (Arty One Fire)
5,000
Medical Payments (Any One Person)
1,000,000
Liquor Liability (If purchased)
lic as if a sepatate policy of insurance has been issued for that
The limits Of insurance apply separately to each event insured by s po y
"Who is insured" is amended to include, as an insure, the pization shown m this schedulq but only with respect to liability
insured, or organarising out of the
maintenance duse of the remises used by the named insured (event holder). This insurance does not apply to: Any °occurrence" which tykes place
ownership, p
after the event
the expiration date thereof, the issuing.eon"ny will mail 30 days written notice to the
rexrgLLAT10N: Should the above described policy to cancelled before
c=tMcate holder and additional insureds listed-
Wt/'
AUTHORIZED REPRESENTATIVE:
DATE ISSUED:
EVANSTON INSURANCE COMPANY
CERTIFICATE NO.: 2011-10
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
Citv of Santa Ana
Apex Insurance Services
20 Civic Center Plaza
P. O. Box 6450
Santa Ana, CA 92701
Newport Beach, CA 92658
License No: OC 36861
NAMED INSURED (EVENT HOLDER):
EVENT INFORMATION:
Flor Hernandez
TYPE: Aerobics
13100 Chapman Ave., Apt. 3-108
DATE(S): 01/19/11 — 12/31/11
Carden Grove, CA 92840
LOCATION: Jerome, Loean, Santa Ana Centers
_
*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(ics).
INSURANCE CARRIER: Evanston Insurance Company
MASTER POLICY NUMBER: 11SEP1000001
MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2011 EXPIRATION: JANUARY 1, 2012
('OMNIFRC'IAL Cil?NFRAL LIABILITY
OC'C'URRENC'E FORM
DF.DI1("I'II31 F: NONF
General Aggregate Limit S 2,000,000
Products & Completed Operations 1,000,000
Personal & Advenismg Injury 1,000,000
I ach Occurrence Limit 1,000,00)
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,fa separate policy of insurance has been issued for that event.
"who is insured" is amended to include, as an insured, the person or orgam—ion shown in this schedule, but only with respect to liability arising out ofthe
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
alter 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
provisions. Every effort will be made to deliver 30 clays written notice to the certificate holder and additional msured(s) listed.
�f
AUTHORIZED REPRESENTATIVE:
DATE ISSUED:
EVANSTON INSURANCE COMPANY
CERTIFICATE NO.: 2012-03
CERTIFICATE OF INSURANCE
SPECIAL EVENT LIABILITY PROGRARf
PRODUCER
PUBLIC ENTITY (ADDITIONAL INSURED)
Alliant Insurance Services, Inc. in conjunction with
City Of Santa Ana
Apex Insurance Services
20 Civic Center Plaza
P. O. Box 6450
Newport Beach, CA 92658
Santa Ana CA 92701
License No: OC 36861
NAMED INSURED (EVENT HOLDER):
EVENT INFORMATION:
Flor Hernandez
TYPE: Aerobics
13100 Chapman Ave., Apt. 3-108
DATE(S): 01/03/12 — 12/31/12
Garden Grove, CA 92940
LOCATION: Jerome Center, Loean Center
*Liquor Liability Yes Q No
**Li uor Liability after 12 am ends before 2 am 0
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 NUtNIBER: 12SEP1000001
MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2012 EXPIRATION: JANUARY 1, 2013
COMMERCIAL GENERAL LL4BILUUY
OCCURRF_NCE FORM
DEDUCTIBLE: NONL.
General Aggregate Limit $ 2.000,000
Products 8 Completed Operations 1,000,0oo
Personal Advertising Injury 1,000.000
Each Occurrence Limit 1,000,000
Fire l>—ge (Any One Fir.) 100,000
Medical Payments (Any One Person) 5.000
Liquor Liability (If purchased) 1,000,000
Optional Limits Purchased
0 51,000,000/S3,000,000
0 $2,000,000/$2,000,000
The limits of insurance apply se stately w each event insured by this olicv xts if a sc aratc. policy of insurance has been tssuod for that event.
"Who is insured" is amended to include, as an insured, the person or organization shown in [his schedule, but only with respect to liability arising out ofthe
ownership, maintenance or use ofthe premises used by the named insured (event holder). This insurance does not apply to. Any "occurrence" which takes place
alter the event holder ceases to be a tenant in that premises.
OTHER ADDITIONAL INSUREDS
CANCELi_A T] )NV Should the above d -scribed policy be cancelled before the expiration date thereof. notice will be delivered in accordance with the policy
rovisions.
AUTHORIZED REPRESENTATIVE:
DATE ISSUED: 12/20/11 by Briza Morales