HomeMy WebLinkAboutMCCULLOUGH, SUE 2ACity of Santa Ana C 4200 ~
~ Clerk of the Council
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AGREEMENT TERMINATION FORM
COTC Office Use Only
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Please complete this form when the attached agreement and all
amendments (if any) are no longer in effect.
Return form to the Clerk of the Council Office (M-30).
Call 647-2520 if you have any questions.
The agreement with Sue McCuliou h
No. N-2008-103-01 was completed on 06/30/09 and final payment has been made.
(List all amendments. Use space below if needed.)
Department: Community Development Agency
Phone/Ext.: 5376
Signature: ~~'~'`~~'"
Date: 04/26/10
Revised 04-12-10
INS'iRA =CE ON i~IIE N-2008-103-01
~'dOF.K fv:aY FRCCEfD
UNTlL Ir~S'URANCE EXPIRES AMENDMENT TO AGREEMENT
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CLERK GF COL AMENDMENT, made and entered into this 1st day of June, 2009, by and between Sue Montelone
DATE:
(previously known as Sue McCullough) ("Consultant") and the City of Santa Ana, a charter city and municipal
~~9'~~ corporation duly organized and existing under the Constitution and laws of the State of California ("City").
RECITALS
A. The City and Consultant entered into that certain Consultant Agreement dated July 24, 2008, hereinafter
referred to as "said Agreement", to provide job preparedness instruction for clients at the Santa Ana
WORK Center.
B. The parties hereto now desire to amend the "Compensation" term found in Section 2.a of said
Agreement.
WHEREFORE, in consideration of the mutual and respective covenants and promises hereinafter contained and
made, and subject to all of the terms and conditions of said Agreement as hereby amended, the parties hereto do
hereby agree as follows:
1. The "Compensation" section of said Ageement will be amended to add additional funds of Three
Thousand Two Hundred Dollars ($3,200) to read:
"...amount not to exceed Eight Thousand Two Hundred and no/100 Dollars ($8,200.00)."
2. Except as hereinabove modified, the terms and conditions of said Agreement remain unchanged and in full
force and effect.
IN WITNESS WHEREOF, the parties hereto have executed this Amendment to said Agreement the date and
year first above written.
ATTEST:
Patricia E. Healy
Clerk of the Council
CITY OF SANTA ANA
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David N. Ream, City Manager
APPROVED AS TO FORM:
Joseph W. Fletcher, City Attorney
By:~~~~ ;
Lisa Storck, Assistant City Attorney
RECOMMENDED FOR APPROVAL:
Cyn is J. Nel on, Deputy City Manager
For Development Services
CONSULTANT
Sue Montelone
N-2008-103-01
EVANSTON INSURANCE COMPANY
CERTIFICATE NO.: 2009-19
CERTIFICATE OF INSURANCE
EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMWEE EVENTS.
SPECIAL EVENT LIABILITY PROGRAM
PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED)
City of Santa Ana
Alliant Insurance Services, Inc. in conjunction with 20 Civic Center PIaza
Apex Insurance Services Santa Ana, CA 92701
P. O. Box 6450
Newport Beach, CA 92658
(944) 660-8135
License No: OC 36861
NAMED JSURED (EVENT HOLDER): EVENT INFORMATION:
Sue Montelone TYPE: Instructional Course (Resume Writini;)_
19918 Paseo Lorenzo DATE(S): June 8, 2009 -December 31, 2009
Yorba Linda, CA 9288b LOCATION: Santa Ana WORK Center
*Liquor Liability Yes ^ No
**Li uor Liabili 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 maybe issued or may pertain, the insurance afforded by the policies described herein is subj ect 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 1000001-5
MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2009 EXPIRATION: JANUARY 1, 2010
COMMERCIAL GENERAL LIABILITY
Genera] Aggregate Limit $ 2,000,000 OCCURRENCE FORM DEDUCTIBLE: NONE
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) t,ooo,ooo
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 [o Eiability arising out of the
ownership, maintenance or use of the premises used by the named insured (event holder). This insurance does not apply to: Ar~y "occurrence" which tares place
after the event holder ceases to be a tenant in that premises.
OTHER ADDITIONAL INSUREDS
CANCELLATION: Should the above described policy to cancelled before the expiration date thereof, the issuing company will mail 30 days written notice co the
certificate holder and additional insureds listed.
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AUTHORIZED REPRESENTATIVE:
DATE ISSUED: June 8, 2009 ~~-~~/ L~CF,4z