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Home My WebLink AboutALARCON, MADISSON ROMERO (2) INSURANCE NOT ON FILE WORK MAY NOT PROCEED N-2025484-01 CITY CLERI( DATE, MAR 10 2026 (&) FIRST AMENDMENT TO COUNCIL AIDE PROFESSIONAL SERVICES s to�hG1ni a{}prG`u(DL) AGREEMENT WITH MADISSON ROMERO ALARCON THIS FIRST AMENDMENT is made and entered into this 6th day of March, 2026 by and between Madisson Romero Alarcon ("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 ("City"). City and Consultant shall hereinafter collectively be referred to as "the Parties". RECITALS A. On July 1, 2025, the Parties entered into Agreement#N-2025-184 ("Agreement")to provide administrative, constituent, and legislative support for a member of the City Council. B. The term of the Agreement runs through June 30, 2026 and established a set hourly rate for the Consultant at$35 per hour with a total amount of compensation to be expended,under the terms of this Agreement, not to exceed$30,000. The Agreement is current and in-effect. C. The parties now wish to amend the Agreement to increase the hourly rate to the Consultant. No other changes are contemplated by this First Amendment to the Agreement. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions of said Agreement, except as herein modified, the parties agree as follows: 1. Section 2.a, Compensation, is amended to increase the hourly rate to $40.00 per hour. City shall recognize and compensate Consultant at this increased hourly rate for all services provided begiiuung February 1, 2026. 2. Except as modified by this First Amendment,all terms and conditions of the Agreement remain in full force and effect. [signatures appear on following page] Page 1 of 2 SIGNATURE PAGE: FIRST AMENDMENT TO COUNCIL AIDE PROFESSIONAL SERVICES AGREEMENT WITH MADISSON ROMERO ALARCON IN WITNESS WHEREOF, the parties hereto have executed this Amendment the date and year first above written. ATTEST: f_ <7�$ X CITY OF ANTA e A varo Nunez City Cler City Manager APPROVE O FORM: CONSULTANT Sonia R. Carvalho City Attorney g Madiss omerc Alarc6n(Mar 6,2026 13:34:09 PST) y• nathan T. Martinez Madisson Romero Alarcon Assistant City Atto y Page 2 of 2 Com_. amendment - CAO Signed Final Audit Report 2026-03-06 Created: 2026-03-06 By: Stephanie Garcia(SGarcia5@santa-ana.org) Status: Signed Transaction ID: CBJCHBCAABAAN2Gn4R51ziUu7X4Ag0w5YVDvkkUlBrE- "Com—. amendment - CAO Signed" History l Document created by Stephanie Garcia (SGarcia5@santa-ana.org) 2026-03-06-7:13:20 PM GMT Document emailed to Madisson (mcorbett@santa-ana.org) for signature 2026-03-06-7:13:24 PM GMT Email viewed by Madisson (mcorbett@santa-ana.org) 2026-03-06-9:33:25 PM GMT Signer Madisson (mcorbett@santa-ana.org) entered name at signing as Madisson Romero Alarcon 2026-03-06-9:34:07 PM GMT `o Document e-signed by Madisson Romero Alarcon (mcorbett@santa-ana.org) Signature Date:2026-03-06-9:34:09 PM GMT-Time Source:server Agreement completed. 2026-03-06-9:34:09 PM GMT Adobe Acrobat Sign CITY OF SANTA ANA 70' 114 Risk Management a division of Human Resources Managing Risk through Awareness and Action %��Jr�l AFFIDAVIT OF EXEMPTION FOR WORKERS' COMPENSATION INSURANCE I Madison Romero Alarcon ("Representative"), attest that I am all authorized {Name and Title of Vendor Representative) representative of Veritas AdVISUS ("Company"), and (Cunstdiant:Company Name) possess the authority to legally bind Company. In my capacity as Representative of Company, I represent and confirm the following, as relates to the agreement between Company and City of Santa Ana, agreement number TBD (-Agree In Consultingent")to provide (`:Services"): (Services to be provided under agreementfeontract) During the course and scope of Company's agreement with the City of Santa Ana, Company will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if Company should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, Company shall forthwith comply with the provisions and provide proof of workers' compensation coverage immediately. If at any time it is found that Company is not adhering to any and/or all of the statements in this document and does not maintain the minimum workers' compensation insurance coverage as required in the Agreement, it will be considered a breach of Agreement rendering the Agreement null and void and Company will be fully liable for any and all damages. ' 06/27/25 Si nanicf a Date Madisson Romero Alarcon Print Name Coonsultant Title Contact Information.i e Telephone Number and/or Email Address WARUNING: FAILURE TO SECURE WORKERS* COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRItbINAL PENALTIES AND CIVIL FINES UP TO ONE HLTNDRED THOUSANT DOLLARS($100.000). LN ADDITION TO THE COST OF COMPENSATION.DAtiIAGES AS PROVIDED FOR IN SECTION 1706 OF THE LABOR CODE, INTEREST,AND ATTORNEY'S FEES. Affidavit of Exemption for Workers'Compensation Insurance 11,17.2024 as AMENDED DECLARATIONS PAGE — CALIFORNIA ire PERSONAL AUTO PROGRAM PQA1 1NSI,RANC.E Aspire General Insurance Services - CA DO[ LIC# 010876 Underwrillen by ASPIRE GENERAL INSURANCE COMPANY PG Got .'4'6 • Rancho Cucamonga, CA 91729.2425 • (916) 503 0313 A I QM I'rr'pa`e;t c+n r,;15'?CJ'S THIS DECLARATIONS PAGE Is PART OF YOUR POLICY,PLEASE READ CAREFULLY, AMENDED PERSONAL AVTO POLICY DECLARATIONS Policy Information: Polley Premium Policy Number Total Premiums. $73000 Inception 4/18/202S 1201 AM Expiration Total Fraud Fees S088 71291202E 12.01 AM SR Filing Fee. SO 00 Time Applied For, 4/16/2025 2 45 PM Policy Fee: S28.00 `lnrePhor time shall not be prior to the time applied for,or if this is a replacement declarations,not prior to the time of coverage change Named Insured(s): Additional Fees when applicable: MAGALI ALARCON Cancellation$50,Reinstatement S10,SR22. Fiiinr3 $15,SR22 Reinstatement WS, Nan-Suffiuent Funds$25,Endorsement$5,EFT Installment$10.Non-EFT Email Fee S35 Broker, 1T Su Segura Insurance 1210 E Mcfadaen Ave Suite A Santa Ana,=C:alrfomia 92705 (71.4) 836-4753 Credits/Surcharges: Calitomia Good Driver Forms and Endorsements: GPSV-OC1.GPSV-002,GPSV-003,GPSV-004,GBL-005,GBL-006,GPSV-016/GPSV-017,GPSV-0301-GBL-032,GPSV-200,GBL-250 Driver Information: Insured Driver Name DOB Marital/Gender Driver's Lic/State/Status Points Yrs Driving Exp Intl/Other Yrs IAAGALI ALARCON XX/XX/1978 Single/Female XXXXX2517/California/Valid 0 30 0 MADISSON ROMERO XX/XX/2006 Single/Femafe XXXXXS527/Califomia/Valid 0 0 ALARCON Excluded Drivers: Excluded Driver Name DOB Relation Driver's Lic/Status Vehicle Information All veh+ctes on this policy must be garaged in the same residential location Garaging Address Vehicle VIN usage Zip Vehicle Age 2015 BIAW 3201 Commute To;From 92805 10 Work/School Lfenholder/Additional Interest Vehicle ainsured.agicins.com C &tjaspjre Policy Detail Overview Aspire General Insurance Services Total Premium ED $541,01 Billing MAGALI ALARCON u Payment Center Drivers Date of Birth Policy Detail MAGALI ALARCON Rated Driver•Named Insured MADISSON ROMERO ALARCON Date of Birth Documents Rated Driver Vehicles Profile 2015 BMW 13201 My Policies Garage ZIP:92805 Miles Driven/Year:7,000 ID Cards Coverage Limit Premium Bodily Injury $30,000 per person 1$60,000 per accident $376.00 Property Damage $15,000 per accident $354.00 Total Premium for this vehicle: $730.00 APPROVED By Tu Tran Nguyen at 3:40 pm,Apr 23,2025 Tu Tran DIg@auy,ignedhy T,Tran Nguyen Nguyen 15gp49?OT003 w N -e C C'r1 L a G Y, C e6 a p �p oho ^o q•, ! P01 fyy b > 4 an y r "n " ] to � � ►Jn � ;� Gry o Ut C P' C7 e a g � In �'W � q ti c c a 41 {C N Zy 7 b'ES yy rl W t7 a a L ri w � > G O b N C 4 o 01-V cat 5ANt.a A.,Y,a { DISK MANAGEMENT a dlvtwil nt HUMAN 1411C )QCE5 QC.., WORKERS' COMPENSATION DECLARATION If hereby affirm under penalty of perjury, the following declaration: I certify can behalf of "v, Vic that daring the terra (Consufront/Carrmport Name) of my contract far services with the City of Santa Ana, (iypr of serviev provide) I will not employ any person in any manner so as to become subject to the workers" compensation laws of California, and agree that if I should become subject to the workers` compensation provisions of Section 3700 of -the Labor Code, I shall forthwith comply with the provisions and provide proof of workers' compensation coverage immediately. Date: Print Name: 1� Print Title; Signature: Telephone: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 UNLAWFUL, AND SHALL SURJt~CT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 15100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES A5 PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I IH,sh htgmtlJftturrrnee Rrq„r�rte•nIs1WC!')rrluucroet 118J5d�19 ----------- --- -- PC)LIC.Y DECLA RATI ONS NEW POLICY pulit: CALIFORNIA LOW COST POLICY — Polio Number:CAR Insurer: 21st Century Centennial Insurance Co 01 CA Automobile Insurance Plan Issuing Company Address C. A.I.P. Case No.: ATTN: BW Assigned Risk o PO Box 248983 The Policy Period Begins and Ends at 12:01 A.M. Oklahoma City, OK 73124-8983 Standard Time From 07/25/25 To 07/25/26 0 a Effective Date of Change: 07/25/25 Producer : Co HUSSEIN ABUBAKER o Named Insured: 520 N BROOKHURST ST MAGALI A ALARCON CANCINO STE 113 1-714-882-5060 ST. 04 CO: 0054 ACCT. 00013000 DESCRIPTION OF YOUR COVERED AUTO(S): Pointe/ AUTO TERR SYMBOL AGE YR MAKE-MODEL SERIAL NUMBER CLASS Surcharge 1 47 37 33 11 15 BMW X3 9LZ 000 COVERAGE IS ONLY PROVIDED WHERE A SPECIFIC PREMIUM CHARGE IS SHOWN COVERAGE LIMITS OF LIABILITY AUTO 1 Bodily Injury. . . . . . . . . . . . . .$10,000/$20,000 Per Person/Accident $ 648.00 Property Damage. . . . . . . . . . . .$3,000 Per Accident INCL Total Premium Per Auto $648.00 TOTAL FULL TERM PREMIUM $648 .00 When a Low Cost Auto Policy is cancelled, the premium refund will be determined based on the pro rata unearned premium for the period of coverage, subject to a minimum premium of$50 per policy. APPROVED By Tu Tran Nguyen at 9:53 am,Sep 29,2025 Tu Tran Digitally signed by Tu Tran Nguyen Date:20 Nguyen 095341-0700'9 •�nl_ Authorized Company Representative(where required) 01 08/13/25 Page 1 of 2 Form AR D-105(1/06) Po im-Y DECLARATIC)NS NEW POLICY Account: CALIFORNIA LOW COST POLICY CA Aut-omobilc Insurancc Plan A.I.P. Casc No.: Insurer: 21st Century Centennial Insurance Co The Policy Period Begins and Ends at 1201 A.M. Standard Time From 07R5R5 To 07R5126 Effective Date of Change:07/25/25 DRIVER NAME LICENSE NUMBER BIRTH DATE 1) MAGALI ALARCON CANCINO 2) MADISON ROMERO ALARCON ENDORSEMENTS. AR-POLJAC(08/22) PPA 00 02.2 PPA 12 01.7 PPA 90 29.0 PPA 90 33.0 01 08/13/25 Page 2 of 2 Form AR D-105(1/06)