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HomeMy WebLinkAboutCARLOS MADRILES DBA (DOWNTOWN STADIUM GRILL FNA KARMINA RESTAURANT AND BANQUET HALL 1b-2014I .� AGREEMENT TERMINATION Please complete this form when the attached agreement is no longer in effect. 6Sw Return form to the Deputy Clerk of the Council (M-30). Call 647-cif you have any questions. The agreement with No. A—Wo-- hcq was completed on and final payment has been made. Department: pK6A Signature:A. aG7 Date: City of Santa Ana Clerk of the Council Revised 05-22-08 City of Santa Ana C;'Irk of the Council INSWANOF ON FiLp. A-2012-176-01 WORK MAY PROcEEi7 PONTIL INSURANCE EXPIRES _ SECOND AMENDMENT TO AGREEMENT CLERK KOF fTI 4ON1 11AI E' SECOND AMENDMENT TO AGREEMENT is entered into this First (1 s) day of September, 2014, by and between Carlos Madriles dba Downtown Stadium Grill formerly known as Karmina Restaurant and Banquet Hall, a California limited liability company ("Concessionaire") 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"). RECITALS: A. The parties entered into that certain Concession Agreement # A-2010-149, dated September 3, 2010, (hereinafter "Agreement') by which Concessionaire has provided concession services at the Santa Ana Stadium. In September, 2012, the Parties agreed to exercise the First Amendment to Agreement, thereby altering the financial terms of the Agreement and extending the term of the Agreement for an additional two (2) years. B. In accordance with the terns and conditions of said Agreement, the parties wish to extend the term for an additional two-year period. WHEREFORE, in consideration of the covenants contained in said Agreement and the First Amendment to Agreement, and subject to all the terms and conditions of said Agreement as amended, except as to those amended in this Second Amendment to Agreement, the parties agree as follows: Section 3, TERM, shall be amended to extend the Term of said Agreement for an additional two year period, through August 31, 2016. 2. Except as hereinabove amended, all terms and conditions of said Agreement, as Amended, shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Second Amendment to Agreement on the date and year first written above. ATTEST: M D. RUIZAR Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City A - ey By' Z_ I s h S ka sistant City Attorney CITY OF SANTA ANA L 1� David Cav es City Manager CONCESSIONAIRE Carlos Mardiles dba Doww,nttownnSStadium Grill CARLOS MADRILES Owner .—anti , 2?Rt CERTIFICATE OF LIABILITY INSURANCE 1 DATE (MMA)D 10/16/201Y4 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), AUTHOR1290 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 endorsement(s). PRODUCER Sariah Devereaux, Agent 1202 W 1st St Sfate&rm Santa Ana, CA 92703 a CA ACT NAME: Sariah Devereaux HC.ONE E$g• 714-541=7280 I c no 17" 4-3e4-Jess _ ess: sarlah.dovereaux,tSlb( atatelamr,com INSUAGR(S AFFORDING COVERAGE NAIC# INSURER A: State Farm Geneml Insurance Companyg1g INSURED Cados Madriles DBA Downtown Stadium Grill 602 N Flower St, Santa Ana, CA 02703 INSURER e: � wsuRERD: INSURER D: Ell INSURER E; INSURER P: NHMRpO• 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 MATH RESPECT TO MICH 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 OEEN REDUCED BY PAID CLAIMS. Ina TYPE OF INSURANCE INSR1WVQ POLICYNUMBER 0lrEY11 PS�aD�pA'WV LIMITS A GENERAL LIABILITY X XOMMERCIALOENERALLIABIUTY CLAIM&MADE❑OCCUR _ Y 92-C4-F307-T 0912912014 0912912016 EACH OCCURRENCE $ 1,00D,000 CAMAOT TORENTEO—"""'� PREMISES Ba eo urrBnce $ 300,000 MEOEXP(Anymnpmaron) PERSONAI. S ADV INJURY § 1,000,00(1 GENERAL AGGREGATE $ 2,000,000 GEML AGGREGATE LIMITAPPLIES PER: POLICY F7 Pas LOC PRODUCTS-COMPIOP AGO S 2,000,000 Business Property $ 26,000 AUTOMOBILE LIABILITY ANYAUTO AUTOS AUTOSCHS HIRED AUTOAUTOSD OaBWED O LIMIT $ BODILY INJURY (Per person) $ BODILYBODILY INJURY (Per accident) S PRe rI5ERr7)_. $ S UMBRELLA LIAB EXCESS LIAB OCCUR CLAIM&MADE EACH OCCURRENCE $ AGGREGATE $ DED RETEM'ION$ _ g WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOWARTNERIEXECUTNE OFFICEIMEMSER EXCLUDED? (Mandatory In NH) yyee,dosndbeunder NIA ❑ WC BTq�U• OT bRY LD& . E.LEACH ACCIDENT $ E,L. DISEASE -EA EMPLOYEE $ E.L. DISEASE- POLICY LIMIT $ DG4CRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AHash ACORD 101, Additional Remarks Sosndutq R more space Is reaufmd) Certificate holder, ire officers, agents, and employees are named as Additional Iltsured in regards to General Liability. a30 days notice of cancellation for nonpayment. Additional insured: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES DE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana, its officers, employees, agents, and ACCORDANCE WITH THE POLICY PROVISIONS. representatives AUTHORIZED RBPRESENTATIVB Pt) Box 1868 Santa Ana, CA 92702 ID 1 S - 0 ACORD CORPORATION. All rights reserved. ACORD 28 (2010105) The ACORD name and logo are registered marks f ACORD 1001486 132849.8 01.23.2013 101V-Illy ADDITIONAL INSURED ENDORSEMENT Insurance Company `�Y�e.r+ lhSyYGz n CR This endorsement modifies such insurance as is afforded by the provisions of Policy # 61Z Gq 3g71 relating to the following; The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; it officers, employees, agents and representative 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. 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 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 City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (Completion of the following, including countersignature, Is required to make this endorsement effective.) Effective 16 1 L02- U this endorsement form as part of Policy # 04 C 4 FZq "l -] Issued to C(�r105 1 ` ajjX I" bV�,A D(Wa A&M <-I A { UVA 610 Name Insured Countersigned by2�Y/44�= Insumnee Agent Signature , hereby affirm undor penalty of perjury, the iollowing de4flaration, I md fy on behalf of flz04,� QVM% that during the term of my (cumultanucompoy Hamm) contract'for a ....... services with the City of Santa Am, I will not employ any person in tiny manner so as to become subject to the workers' componsation laws of California, and agroo that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith oomply with thou rovisions and provide prour covurago. D 1-9 BY: ... .. .....mom..._......,_.._ .Narne: Aga Title: WARNINCI: FAILURE,TO SECURE WORKERS" COMPENSAI'M COVERAGE IS UNLAWFUL, AND SFIALL SUBJECTAN EMPLOYER TO CRIMINALPFNA.131EI�s AND CIVIL PINES UPTO ONE HUNDRIU)TIMUSAND DOLl.,ARS ($1,00,000). IN ADDMON 1WfflF COST Cris COMPENSMION, T.)AMAGES AS PROVIDED FOR IN SEXTHON 3706 OFTHE, LABOR CODE, INTERI-NT, AND ATTURN.FY'S FEES. I hereby affirm under. penalty of pedury, the following declaration I certify on behalf of Pbt that during the torm of my contract for services with dw City of Santa Ana, I will not employ any person In any manner so as to become sulrioct to the workers' compensation laws of California, and agree that if I should become subject to the wk)rkm.' compensation provisions of Section 3700 of tile Ubor Coda, I shall forthwith Comply with thos provisions and provide coverage. DATB� 21 k- By: Nalne, Tifle: Telephono: I WARNING: FAIL(.METO SEXURE WORK-1,-,RSCOMPJ.',.'NSAI10N COVERAGE IS UNLAWFUL, KND SHALL SUBJEX,'TAN IWPLOYE R -1-0 CRIMINAL PENAUI'11"' 'IS AND CIVIL FINES UP TO ONE HUNDRI.,,l)THOUSAND DOLLARS ($1 ()0,000), IN ADDI'I'lON'R)THE COST 0FC0MPF'NW'I(.Y.N, DAMAGES AS PROVIDFI) FOR IN SECTION 3706 WITIE'LABOR CODE, INTEREST, AND Ar'J.'ORN.F,Y'S FEES. `° R" CERTIFICATE OF LIABILITYDATE (MM/201 YY) INSURANCE a9,29�2015 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 endorsement(s). PRODUCER CONTACT Sariah Deve reaux- Barrie ITtos, Agent NAME: Sariah Devereaux-Barriento5 'PHONE :FAX W `st St No, Ext: 714-541-7280 IC, No);. 714-384-3892 E-MAIL Staf,Far'm Santa Ana, CA 92703 ADDRESS: sartah.devereaux.t8lb@c taltefarm,com_ INSURERS) AFFORDING COVERAGE NAIC lR..... .... INSURER A : State Farm General Insurance Company 25151 INSURED Carlos. M.adriles INSURERS: _...... DBA Downtown Stadium Grill INSURERC: 602 N Flower St, Santa Ana, CA 92703 INSURER D _ IdWSURER E Ww �. w. - INSURER F : COVFRAC,FS r`-FRTIFIr..ATI= NI IMRKR• aetricrnMr wl rnxrsree. 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 _ "ADDL SUBR......... ......... _. POLICY FEE ........POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMfDD/YYYY) fMMIDDIYYYYI _.. _...... __. LIMITS L LIABILITY L', A GENERAY 92-EDZ9660 09/2912015 05P2912016 EACH OCCURRENCE $ 1,000,000 ,.. COMMERCIALDAMAGE GENERAL LIABILITY TO RENTEDI PREMISES (Ea occurrence) _,'. $ 300,000.... ....._. _ CLAIMS -MADE .... ., OCCUR MED EXP (Any one person) $ 5,000 ......... ......... _._ __. _. PERSONAL 3 ADV INJURY S 1,000,.000 GENERAL AGGREGATE $ 2,000 000 GEN"L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG S 2'.,000,000 _... POLICY PE C LOC Business Property S 25,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ......._ �:...... (Ea accident) S ......... ............. ANY AUTO BODILY INJURY (Per person) $ ALLOWNEDDULEO AUTOS AUTO .. NON-GOWNEDN BODILY INJURY (Per accident) PROPERTY DAMAGE $ HIREDAUTOS AUTOS a1, (Per awdem) $ i� ^C.d ... _. III a S UMBRELLA LIAR OCCUR El 11. /' _�' �� ;.�fy � ... EACH OCCURRENCE 'S EXCESS LIAR CLAVMS-MADE ,^` "'..1 AGGREGATE ..-.S S DED RETENTIONS WORKERS COMPENSATION' (*� AND EMPLOYERS' LIABILITY Y WC STATU- CTH- TORY LIMITS... ER Y 1 N f"" - ANY PROPRIE.TOR(PARTNERIEXECUTIVE -_- \„± OF'FICEIMEMBER EXCLUDED? NIA ,..... E L EACH ACCIDENT ._.. S (Mandatery in NH) E L. DISEASE - EA EMPLOYEE $ It yes, describe under .... __ 12ES R T ATIO b low E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder, it's officers, agents, and employees are named as Additional Insured in regards to General Liability. *30 days notice of cancellation for nonpayment. - I " 1 g1/L.W"FN Additional Insured': City of Santa Ana, its officers, employees, agents, and representatives PO Box 1988 Santa Ana, CA 92702 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 Sariah Devereaux-Barrientos lNJ 5 dem 6 M S M. '"W10 r'arm, au bblalrzaM1 tleueran�ax f8lG�std'mlarrn cam,c us �t5.pp.24I©:SB:24.Qp"r'h3' O 1988 2010 ACORD CORPORATION. All rights reserved. ACORD 25 (20'10/05) The ACORD name and logo are registered marks of ACORD 1001486 132849.8 01-23-2013 ADDITIONAL INSURED ENDORSEMENT Insurance Company State Farm Insurance This endorsement modifies such insurance as is afforded by the provisions of Policy # 92EDZ9660 relating to the following: The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; it officers, employees, agents and representative 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 it not so included. 4. With respect 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 City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (Completion of the following, including countersignature, is required to make this endorsement effective.) Effective 9/29/2015 Mmaa= Issued to Cados Madriles OBA QOwntown Stadium Grill this endorsement farm as part of Name Insured Countersigned by— InsurunceAg flrgnOture WORK.J." 'R,S1 COMPENSATION DECLARATION Carlos Madriles / Owner hereby of under pe nalty of perjury, the ­—­T,i-NT1m,,r i I lo following declaration: I certi fy on behalf of Stadium Grill-— that during the terra of my (CM,Suftant/Company Name� contract for _____Food & Beverage_.__ services with the City of Santa Ana, I will not employ any person in any inanner 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 those provisions and provide proof of workers' compensation coverage. DA'11 E: ---October I., 2015­_ By: Name. CaTlosMadriles 'Title: O-vNmer 'Telephone: WARNING: F AfLUIRETO SECURE WORKERS' COMPENSATION COVERAGE UNLA, �k'F 1JL, A ND S HALL S U BJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FTNES (,)P'1'0 ()NE HUNDRED THOUSAND DOLLARS ($100,000). IN AJANTIONTO THE COST OF COMPENSATION, DAMAGE'S AS PROVIDED FOR 3706 (A"T'HE LABOR CODE, INTEREST, AND ATTORNEYS FEES. PROOF OF INSURANCE PROOF OF INSURANCE VEHICLES ON POLICY I nterinsurance Exchange of the Automobile Club YEAR MAKE VEH I.D. # NAIL #: 15598 2001 FORD 1FMNLJ42FOlEA39349 Named Insured Policy Number: CAA095289036 MADMILES, KATIE AND CARLOS W o DRIVERS ON POLICY o CARLOS MADRILES Effective Date: 0 1-15-2015 Expiration Date: 01-15-2016 I KATIE MADRILES This policy provides at least the minimum amounts of liability insurance required by the CA VEH CODE SECTION 16056 for the specified vehicles and named insureds and may provide coverage for other persons and other vehicles as provided by the insurance policy. -------------------------------------------------------------------------------------------------------------------- u'—,; 'Jf I i, After an accident, follow these 5 easy steps: Stop 4: Call our AAA Accident Assist Hotline at 1-800-67-CLAIM (1 -800-672-5246) to report the accident and, if necessary, have Step 1: Get the names and addresses of all persons your vehicle towed to the repair shop or location of your involved in the accident, e.g., pedestrians, witnesses, other 1, preference passengers, etc. UJ J- Step 5: Safely wait for the tow truck. Our independent service Step 2: Get the driver's license number and insurance 0 providers' tow trucks always display the AAA emblem information of the driver(s) of the other vehicle(s) 0u- Do not admit responsibifity for or discuss the circumstances of the accident Step 3: Write down the vetncle(s) license plate, including with anyone other than the police or an authorized Auto Club clairris state of registration representative Do not disclose your policy limits to anyone Coverage subject to policy terms and limits. For questions or changes to your poi cy, call 1-877-422-2100. Monday through Friday from 7 a.m. to 9 p.m. or Saturday from 8 a.m. to 5 p.in -------------------------------------------------------------------------------------------------------------------- Place the Proof of Insurance in each vehicle insured under your policy. In addition, we suggest that each listed driver carry a card. Under California law, drivers and owners of a motor vehicle must be able to establish financial responsibility at all times. These cards become invalid on the expiration or termination date of the policy. ------------------------------------------------------------------------------------------------------------------- PROOF OF INSURANCE VEHICLES ON POLICY Interinsurance Exchange of the Automobile Club YEAR MAKE VEH I.D. # Calm NAIL #: 15598 2001 FORD 1FMNU42FOl EA39349 Named Insured Policy Number: CAA095289036 MADRILES. KATIE AND CARLOS f Effective Date: 01-15-2015 Expiration Date: ol-15-2016 I This policy provides at feast the minimum amounts of liability insurance required by the CA VEH CODE SECTION 16056 for the specified vehicles o and named insureds and may provide coverage for other persons and other vehicles as provided by the insurance policy. ------------------------------------------------------- After an accident, follow these 5 easy steps: Stop 1: Get the names and addresses of all persons involved in the accident, e.g., pedestrians, witnesses, other passengers, etc. Step 2: Get the driver's license number and insurance information of the driver(s) of the other vehicle(s) r 60 ---------- " , " : , if l I , � i � I � I HI i i Step 4: Galt our AAA Accident Assist Hotline at 1-800-67-CLAIM (1-800-672-5246) to report the accident and, if necessary, have your vehicle towed to the repair shop or location of your preference LU LU ca Step 5: Safely wait for the tow truck. Our independent service providers' tow trucks always display the AAA emblem 0 LL 1 Do not admit responsibility for or discuss the circumstances of the accident Stop 3: Write down the vehicle(s) license plate, including with anyone other than the police or an authorized Auto Club claims state of registration representative. Do not disclose your policy limits to anyone. Coverage subject to policy terms and limits. For questions or changes to your policy, call 1-877-422-2100, Monday through Friday from 7 a.m. to 9 p.m or Saturday from 8 a.m. to 5 p.m. -------------------------------------------------------------------------------------------------------------------- I LCAA0805A, 681 2011BI01101 ! 8165 (ell 0) UJ DRIVERS ON POLICY 0 CARLOS MADRILES KATIE MADRILES