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HomeMy WebLinkAboutUS NATIONAL BADMINTON FOUNDATION 1C-2011(D City of Santa Ana Clerk of the Council AGREEMENT TERMINATION Please complete this form when the attached agreement is no longer in effect. Flo jut 19 PM -V 13 Return form to the Clerk of the Council Office(M-30). O Call 647-5237 if you have any questions. CiTCLY AN/a 0 COUNCIL 54HTA TAAN The agreement with No. /�14— n:f was completed on (t" II W) L5 and final payment has been made. �1 -&QC3�_055 ---00 4 Department: ����� N - M CI0 `r- 038*- C+C ;;�,. Phone/Ext.: 115 -IS7-i Q --a &—C bS — CM G J )�-3 - aLCG,�S--G'vR--GO4 Signature: Date:[ Revised 07-23-07 INSURANCE ON FILE N-2008-038-003 WORK MAY PROCEED UNTIL INSURANCE EXPIRES 3 -/-/02 CLERK OF COUNCIL AMENDMENT TO AGREEMENT DATE: JUL 1 3 2011 THIS AMENDMENT TO AGREEMENT is made and entered into this 20"' day of June, 201 1 by and between U.S. National Badminton Foundation, anon-profit public benefit corporation, ti (hereinafter "Provider"), and the City of Santa Ana, (hereinafter "City"). -? y V RECITALS: V m ? ,? a- ?n 1. The parties entered into Agreement N-2008-038, as amended from time to time, ? (hereinafter the "Agreement") by which Provider has instructed badminton lessons. 2. In accordance with the terms and conditions of said Agreement, the parties wish to revise the Scope of Services and extend the term- WHEREFORE, in consideration of the covenants contained in said Agreement, and subject to all the terms and conditions of said Agreement and previous Amendments, except those amended in this Amendment to Agreement, the parties agree as follows: 1. Section 1, SCOPE OF SERVICES, shall be amended by substitution of a new Exhibit A, attached hereto and incorporated by reference. 2. Section 3, TERM, shall be amended to extend the termination date to June 30, 2012_ 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 Amendment to Provider Agreement on the day and year first set forth above. CITY OF SANTA ANA CANT^EST: Maria D. Huizar, Clerk a Council ?pnM n ? n r ,? DAVID N_ REAM APP?R/O?V'E?D AS T?O? FORM: City Manager 3"Lim--e-??1 J ep Straka, Inte 'm City Attorney U.S. NATIONAL BADMINTON FOUNDATION RECD MENDED FOR APPROVAL: erardo Mouet, Exe. Dir t PRCSA Terembang (Terry) S andhi jj (o??jJ/// Instructor EXHIBIT A SCOPE OF SERVICES 1) Provider will teach Badminton classes for children 5 and up. Participants will learn the fundamentals of badminton; rules of the game, court etiquette, swing production, foot work and more- 2) Provider will provide and be responsible for equipment, records, and personnel and clean up of the facilities and materials necessary to ensure the safety and effectiveness of said instruction. 3) If Provider allows others to teach his/her class, those teachers must be over 21, have obtained and maintain an instructor rating, and be covered by Providers' insurance. Provider shall provide City with documentation to verify instructor and insurance requirements. CLASS SIZE 1) Each class must have a minimum of 5 paid students and a maximum of 36. 2) In the event the minimum number of enrollees is not met by the first class meeting the class shall be canceled. Provider will be under no obligation to provide services and the City will have no obligations to pay Provider compensation CLASS FEES 1) Each participant shall pay a $5.00 registration fee per monthly class session. 2) No refunds will be made to participants after the second class meeting unless the class is cancelled by the City. 3) The City shall collect registration fees from each participant during the registration period. Provider shall not collect fees, but shall refer all interested participants to City for registration. 4) Provider shall receive seventy per cent (70%) ofthe total fees collected each month- City and Provider agree that City shall retain thirty per cent (30%) ofthe fees collected as an administration fee. 5) Provider agrees that City is entitled to audit Providers records and classes to insure compliance with this Agreement. 6) Provider may not waive class participation/registration fees. 7) City shall prepare class rosters and provide a copy to Provider. Only registered participants may participate in class. oP lo: Av '???'`r" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/°D/YYYY, 03/04/'1'1 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 POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER 800-526-'1379 B lll I CONTACT NAME: O n ger, nC. tOt JFK Parkway 973-92'1-2876 S,o G?NO,.Extl'_ - _-..___-__ -_. - _.(aC, ho) __._ _ ----- - _ - -------- - _-- Short Hills, NJ 07078-5000 E-MAIL AJ Morgan PRODUCER - - --- CUSTOMER ID#: USAI3A-2 INBU RER?LFFORDING COVERAGE NAIL # INSURED USA BadmintOn INSURERA Markel Insurance Com pany 38970 8a Its member CIDbS -2008-0S8-OO3 _ _ One Olympic Plaza INSURER B - - - - - Colorado Springs, CO 80909 INSURER c - _-_. _.- __.. _. _ ___. -.___.. INSURERD: ? - - - INSURER E _ -_- - -- - - INSURER F COVERAGES t'E RTIFIC ATF NIIMRFR? Ila clncllllJ NI Innoco. 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 REQUIREMENT, TERM OR CONDITION 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. INSR _-_--- A.DOTSUBR?- I POLICY EFF POLICY E%P ----- ------- ? ----- ----- ------ LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 9,000,00 A X? COMMERCIAL GENERAL LIABILITY X 8502AH024504 03/09/t 7 03/09/92 _ -DAFIAGE7a RENTED - '100 000 PREMISES E $ t I L X J ' I . _ __ ( a occurrence) I CLAIMS-MADE _ OCCUR . __i _ ? _ y person) $ S,OO MED EXP (An one _-_- -- X I Intl Participants I PERSONAL S ADV INJURY $ 9,000,UO X I Incl Drug Testing -_ _ _ -. _-.- __ ?li ; GENERAL AGGREGATE $ -. S,000,OO GE_ N'L AGGREGATE LIMIT APPLIES PER. I PRODUCTS -COMP/OP AGG $ ? ,000,00 PRO- i POLICY ? - I X ? Loc ? - - _ -_ - - - Abuse/Mol ?? $ 9mil/2mil AUT OMOBILE LIABILITY ' ? COMBINED SINGLE I_I MIT $ ' I ? (Ea acc tlenp ANV AUTO i ? '? BODILY INJURY (Per person) $ ? I ALL OWNED AUTOS ? BODILY INJURY (Per accitlenl) 5 SGH EDUCED AUTOS ' ? - -- - - - - -- I _ --- i j HIRED AUTOS : I PROPERTY DAMAGE ? ?, Per acc tl nl __- e ) ; ( 1 -- - -- ?---- _.1 I I NON-OW NED AUTOS i? $ __ --- __ __-. . -_-- $ UMBRELLA LIAB )( OCCUR i i EACH OCCURRENCE _ 5 {,??O,OO I E%CESS LIAB CLAIMS MADE?i I I AGGREGATE $ { 000 00 A -- ---- - - - ---- --? 4602AH024505 03/09/99 , , 03/0'1/12 ? - - ? 7 -- - - DEDUCTIBLE - ' 1 V $ RETENTION $ ?' ? 5 WORKERS COMPENSATION '. ? ? WC STATU OTH ? Y / N B ? TORY LIMITS ER i _ ?B „R EXCLUDED? ECUTIVE R E N / A i O ? ? E.L. EACH ACCIDENT 4 $ _. ? I ( Manda If yes, tlescribe antler li E L. DISEASE - EA EMPLOYEE $ - - f - DESCRIPT ON OF OPE RATIONS below E L. DISEASE -POLICY LIMIT '; $ ??RO ?n As ?? r?c??.?? CLES (AttacM1 ACORD '101, Atltlitional R¢marks Scb¢tlule, if more space Is r¢quir¢d) ?O - // afl I Th ifi h N named a - a e cert cate 0 der ls 5 dditional insured under the liability - _E%G?' policy. Coverage is provided under this policy for sponsored/supervised ? .- _. _ _ _^?, ? ?' _, activities of the named insured. This certificate is issued on behalf of (_,) fl ? ? .? ? ? _ Ll the USNBF Club. - y A9Jl1L3 C1L ?:il f-1 LLDP C ritr Fl i c rlvc?crt {..HNI.CLLAIIVN SALGCA9 SHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Salgado Community Center THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ; 706 NOrth NaWhope Street ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92703 AUTHORIZED REPRESENTATIVE __ ©9988-2009 ACORD CORPORATION- All rinMc recwrvPri ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: S502AH024504 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE City of Santa Ana, its officers, employees, agents, volunteers and representatives 20 Civic Center Plaza Santa Ana, CA 92701 Group Code: Irvine Badminton Club This insurance is primary and non-contributory- Section 11 -Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 ADDITIONAL INSURED ENDORSEMENT FOR COMMERCIAL GENERAL LIABILITY POLICY Insurance Company _ Markel Insurance Company- -NAIL" # 3$97U This endorsement modifies such insurance as is afforded by the provisions of Policy # -85U2AH(12?SU4 relating to the following: 1. The City of Santa Ana, and the City of Santa Ana, located at 20 Civic Center Plaza, Santa Ana, California 92701; and their respective officers, employees, agents, volunteers and representatives aze 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 Community Redevelopment Agency of the City of Santa Ana, 20 Civic Center Plaza (M-25), Santa Ana, California 92701. (Completion of the following, including countersignature, is required to make this endorsement effective.) Effective _ from U3!(I111 1 to 0310.1./12 ,this endorsement form as a part of Policy # i3?(12AI-IU245(1-1 Issued to LISA Badminton ? ifs member clubs Named Insured Countersigned by Authorized Representative from Insurance Provider INSURANCE e0212R/12 USABA-2 OF ID: AY ,ql?.t?, CERTIFICATE OF LIABILITY INSURANCE DATE 1 02/28/12 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 POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements . PRODUCER 800-526-1379 Bollin er Inc CONTACT NAME: g , . 101 JFK Parkway 973-921-2876 pHC NNO E.b: NFAX C No: Short Hills, NJ 07078-5000 AJ Morgan ADDRESS: ADDRESS: INSURERS AFFORDING COVERAGE NAIC0 INSURERA: Markel Insurance Company 38970 INSURED USA Badminton INSURER B: & its member clubs One Olympic Plaza INSURERC: Colorado Springs, CO 80909 INSURER D t \ _ (`? yi ('? O2 INSURERE! ? J ! D (} /l.?? v INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NHMRFR- 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 REQUIREMENT, TERM OR CONDITION 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. INSR TYPE OF INSURANCE SUB POLICY NUMBER MMILDOY EFF POLICYEXVPY LIMBS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X 8502AH024504 03/01112 03101113 PREMISES Ea occurrence $ 100,00 CLAIMS-MADE OCCUR MED EXP(Any one pereon) S 5,00 X Incl Participants PERSONAL S AOV INJURY $ 1,000 000 X IROI Drug Testing .. , , ' I ! GENERAL AGGREGATE S 5,000,000 . . . V GENT AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGO $ 1,000,000 POLICY 71 PR0. X LOC -- ---'---'- .- - -- - - Abuse/Mol $ $lmil/$2mi AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT a accident E ANY AUTO BODILY INJURY (Per pereon) $ ALL OWNED AUTOS SCHEDULED AUTOS - - - BODILY INJURY Peraaldenl ( ) $ HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE Per accident) $ $ UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,00 A EXCESS LIAR CLAIMS-MADE 4602AH024505 03/01112 03101113 AGGREGATE $ 1,000,00 DEO RETENTIONS $ WO RKERS COMPENSATION WCSTATU- OTH AND EMPLOYERS' LIABILITY I TORY LIMITS I YIN ANY PROPRIETORIPARTNEPo XECUTIVE OFFICERNEMBER EXCLUDED] ? N I A E.L. EACH ACCIDENT E (Mandatory In NH) N E.L. DISEASE - EA EMPLOYEE $ yee deecdbe antler DESCRIPTION OF OPERATIONS below E.L. DISEASE. POLICY LIMIT $ A Accident Insurance 4102AH022026 03101112 03101113 Mod Max 25,00 Full Excess Ded 1,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Abmch ACORD 101, Additional Remadus Schedule, If more spec. Is required) The certificate holder is listed as an additional insured on the liability policy. Coverage is provided under this policy only for sponsored/supervised activities of the named Insured for which a premium has been paid. The certificate is Issued on behalf of USBNF - Irvine Badminton Club. Salgado Community Center 706 North Newhope Street Santa Ana, CA 92703 USBNCA2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD CORPORATION. All rlahts raterved ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 8502AH024504 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) City of Santa Ana, its officers, employees, agents, volunteers and representatives 20 Civic Center Plaza Santa Ana, CA 92701 Group Code: USBNF - Irvine Badminton Club This insurance is primary and non-contributory. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ADDITIONAL INSURED ENDORSEMENT FOR COMMERCIAL GENERAL LIABILITY POLICY Insurance Company Markel Insurance Company - NAIL # 38970 This endorsement modifies such insurance as is afforded by the provisions of Policy # _8502AH024504 relating to the following: 1. The City of Santa Ana, and the City of Santa Ana, located at 20 Civic Center Plaza, Santa Ana, California 92701; and their respective 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 Community Redevelopment Agency of the City of Santa Ana, 20 Civic Center Plaza (M-25), Santa Ana, California 92701. (Completion of the following, including countersignature, is required to make this endorsement effective.) Effective - from 03/01/12 to 03101113 , this endorsement form as a part of Policy # 8502AH024504 Issued to USA Badminton & its member clubs Named Insured c Countersigned by C Authorized Representative from Insurance Provider