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Home My WebLink AboutRIVERA, SALOMON 1gOf;y of Santa Ana Clerk of the Council AGREEMENT TERMINATION FORM Please complete this form when the attached agreement and all amendments (if any) are no longer in effect.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). The agreement with (19) No. A-2006-263-04 was completed on ( I ( and final payment has been made. (List all amendments. Use space below it needed.) N - 2004-033 CI) Cofg' Department: FU'SAA # -o( Clad• A - 0 �, (Ib) . Phone/Ext.: R -�oob -2b3 00* rt � - 01 Clay: Signature: - 0 2 Cie) -0 3 CIIP)- Date: ( f 1< Revised 04-12-10 INSURANCE ON FILE A-2006-263-04 WORK MAY PROCEED UNTIL INSURANCE EXPIRES GL /.?-13 /0 CLERK OF COUNCIL AMENDMENT TO AGREEMENT DATE: JUL 1 9 2010 O: PRCS (,Q,) Donna Schultze THIS AMENDMENT TO AGREEMENT is entered into this 1st day of July, 2010, between Salomon Rivera (hereinafter "Provider") 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 parties entered into Agreement N-2004-033, as amended from time to time dated, (the "Agreement') by which Provider provides recreation and leisure class services. B. The parties wish to amend said Agreement to renew the agreement for another one year term and to revise the Scope of Services (Exhibit A). 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 Second Amendment to Agreement, the parties agree as follows: Section 1, entitled "Scope of Services", shall be amended by substitution of a new Exhibit A, attached hereto. 2. Section 3, TERM, shall be deleted in its entirety and replaced with the following: "This Agreement shall commence on July 1. 2010 and terminate on June 30, 2011, unless terminated earlier in accordance with Section 12, below." 3. Except as herein amended, all terms and conditions of said Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Second Amendment to Agreement the date and year first above written. ATTEST: CITY OF SANTA A�NA l "�/�"� sJr ✓ MARIA D. IY'TJIZAR. DAVID N. REAM Clerk of the Council City Manager APPROVED AS TO FORM: 2 PROVIDER Salomon Rivera Tax ID No. Exhibit A SCOPE OF SERVICES Provider shall provide Salsa Dance for teens and adults as follows: • Consultant shall instruct one -hour classes for Salsa once a week for six -weeks. • The classes will be held at Southwest Senior Center on Wednesday for Salsa from 6:00 — 9:00 pm. at various levels. • Consultant may adjust the schedule, based on the availability of rooms in the facility. • Each class shall have a minimum of 10 and maximum of 50, registered and paid participants. • If the minimum registration has not been reached by the first class, the class may be cancelled by mutual agreement of Consultant and City, with no compensation owed Consultant for any cancelled class session. • Consultant shall provide all necessary materials and supplies CLASS FEES The registration fee for the Salsa class is $30 per session. • No refunds shall be made to participants after the first week of class unless the class is cancelled by the Parks, Recreation, and Community Services Agency. • The City shall collect the class fees from each participant during the registration period. • Provider shall retain seventy per cent (70%) of the total fees within fifteen (15) working days after completion of the class session. City shall receive thirty per cent (30%) of the fees collected as an administrative fee. • Consultant agrees that City representative shall be entitled to audit Consultant's records to insure 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. EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2010-001 CERTIFICATE OF INSURANCE EXCLUDES COVERAGE 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 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: Salomon Rivera TYPE: Dance 709 S. Parton Street DATE(S): 1/13110—12/18110 Santa Ana, CA 92701 LOCATION: Southwest Senior Center "Liquor Liability Yes ❑ No 5a "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: I OSEP 1000001 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2010 EXPIRATION: JANUARY 1 COMMERCIAL GENERAL LIABILITY OCCURRENCE IjQ,RMRiO D DUCTIBLL: NONE General Aggregate Limit S 2,0(A),000 Products & Completed Operations 1,000,000 Personal & Advertising Injury 1,000,000 LETCHER Each Occurrence Limit 1,000,000 Fire Damage (Any One Fire) 50,000 y qT , ORNEY 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 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 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, the issuing company will mail 30 days written notice to the certificate holder and additional insureds listed, AUTHORIZED REPRESENTATIVE: DATE ISSUED: January 7, 2010 by Briza Morales /gM+ EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2011-12 CERTIFICATE OF INSURANCE,,,, tt 1 3, �t1 q� COVERAGE EXCLUDED FOR NOMINEE EVENTS SEE SEPARATE APRJCAW>EO1 A F&k R61QI EVENTS. SPECIAL EVENT LIABILITY PROGRAM PRODUCER PUBLIC ENTITY (ADDITIONA41�I.0 ?I D) Alliant Insurance Services, Inc. in conjunction with City 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: Salomon Rivera TYPE: Dance 709 S. Parton Street DATE(S): 01/26/11-12/31/11 Santa Ana, CA 92701 LOCATION: Southwest Senior Center *Liquor Liability Yes ❑ No N I "Liquor Liability 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: 11SEP100000I 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 provisions. Every effort will be made to deliver 30 days written notice to the certificate holder and additional insured(s) listed. AUTHORIZED REPRESENTATIVE: J" DATE ISSUED: January 26 2011 by Briza Morales