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Home My WebLink AboutSEHUAME, RUDY R. 1dc a oob AGREEMENT TERMINATION 2011' . UIN 18 Pas 1� VII Please complete this form when the attached agreement is no longer in effect.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 � 1 r No. was completed on and final payment has been made. N _a- oou -MA- a - fv - a- O0 (t - a2.9 -03 v co Department: T �-� 4 Signature: Q—k Revised 3-2-07 Date: U 1 1 31 i -ci City of Santa Ana Clerk of the Council INSURANCE ON FILE IVORK MAY PROCEED UN M INSURANCE EXPIRES N- 2006 - 029 -04 CLERK OF COUNCIL DATE: JUN I� " 9 ZQ09 FOURTH AMENDMENT TO AGREEMENT Aiheoc, f✓ � �Y� z THIS FOURTH AMENDMENT TO AGREEMENT is made and entered into this 3`d day of June, 2009 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, Amendment N- 2006 - 029 -01; Amendment N- 2006 - 029 -02 dated April 24, 2007 and Amendment N- 2006 - 029 -03 dated May 22, 2008 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. 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 Fourth Amendment to Agreement, the parties agree as follows: Section 3, TERM, shall be amended to extend the term of said Agreement through June 30, 2010. 2. 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 Fourth 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: ,`� Kylee Ottq Assistant City Attorney CITY OF SANTA ANA L� GERARDO MOUE Executive Director of Parks, Recreation and Community Services I VANSTON INSURANCE COMPANY t: ERTIFICATE NO.: 2009 -09 CERTIFICATE OF INSURANCE EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. SPECIAL EVENT LIABILITY PROGRAM PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) City of Santa Ana Thant Insurance Services, Inc. in conjunction with 20 Civic Center Plaza ^• pex Insurance Services Santa Ana, CA 92701 1`_ 0. Box 6450 1, ewpon Beach, UA 92658 •1491 660-8135 to --nse No: OC 36861 \`ANIED INSURED (EVENT HOLDER): EVENT INFORMATION: R.udv Seltuame TYPE: Karate Class .1424 1V. First Street, Space 133 DATE(S): Jan. 12 - Dec. 31 Santa Ana, CA 92703 LOCATION: Santa Anita Park *Liquor Liability Yes ❑ No W "Liquor Liability after 12 am ends before 2 am ❑ I'his is to certify that the policies of insurance listed below have been issued to the insured named above for the policy period nd cated. Notwithstanding any requirements, terms or conditions of any contract or other document with respect to which this c.rtificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, �: xclusions and conditions of such policies. Limits shown may have been reduced by paid claims. IN'SURANCF. CARRIER: Evanston Insurance Company NIASTER POLICY NUMBER: 04SEP1000001 -5 >1ASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2009 EXPIRATION: JANUARY 1, 2010 OMIvtERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE i eneral Aggregate Limit $ 2,000,000 ?roclucts & Completed Operations 1,000,000 °ersonal & Advertising Injury 1,000,000 Ciach Occurrence Limit 1,000,000 Fire Damage (Any One Fire) 50,000 Vecical Payments (Any One Person) 5,000 Liquor Liability (If purchased) 1,000,000 ] he 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. I 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 w iership, maintenance or use of the premises used by the named insured (event holder). This insurance does not apply to: Any "occurrence" which takes place a fter the event holder ceases to be a tenant in that premises. OTHER ADDITIONAL INSUREDS u AW 1,-1.f.ATION: Should the above described policy to cancelled before the expiration date thereof, the issuing company will mail 30 days written notice to the c _rt:flcate holder and additional insureds listed. ,( TfiOKILND REPRESENTATIVE: 1).',Tt. 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 /� � %� _ C,� g —�,� � � 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 � No * *Li uor Liabilit after 12 am ends before 2 am � 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 8c Completed Operations 1,000,000 Personal 8c 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) l,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, [he 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 (even[ 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 rovi sions. Eve of %rt will be made to deliver 30 days written notice to the certi£cate holder and additional insureds) listed. AUTHORIZED REPRESENTATIVE: DATE ISSUED: February 02. 2011 by Briza Morales