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Home My WebLink AboutWELDY, SCOTT DR., DBA SERRANO ANIMAL & BIRD HOSPITAL -2014City of Santa Qna Clerk of the Cou:._il AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. Note: If your agreement is grant related, please ensure that all grant retention requirements have been satisfied prior to signing the termination form. Is the agreement(s) a permanent record? Yes _ No Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. i The agreement with COTC Office Use Only City of Santa Ana t;1e 02 2021 Clerk of the Council No. A—ao iLl—tO`Z—C.c; was completed on op/L721 12M� and final payment has been made. (List all amendments. Use space below if needed.) A—DD I L{--LD 9 A----ac I Y t0 �-'- 01 pt--a01W-- I &-0 :�L Revised: 10-18-16 Department: M--BA Phone/Ext.: Signature:fldw Date: ISO MAYOR Miguel A. Puitdo MAYOR PRO TEM Vincent F. Sarmiento COUNCILMEMBERS Angelica Amezcua P. David Benavides Michele Martinez Roman Rayne Sal Tmaiero CITY OF SANTA ANA PARKS, RECREATION, AND COMMUNITY SERVICES AGENCY 20 Civic Center Plaza M-23 . P.O. Box 1988 M-23 Santa Ana, California 92702 www.santa-ana ore May 16, 2016 Scott Weldy, DVM Serrano Animal & Bird Hospital 21771 Lake Forest Drive, Suite 1 I I Lake Forest, CA 92630 A-2014-108-02 CITY MANAGER David Cavazos CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar Re: Final One -Year Extension of Agreement for Veterinary Services Agreement No. 2014-108 Dear Dr. Weldy: Pursuant to Section 3 of Agreement No. A-2014-108, entered into by Dr. Scott Weldy, DVM dba Serrano Animal & Bird Hospital and the City of Santa Ana, dated July 1, 2014 and as previously extended, the term of such Agreement is hereby extended for one final one (1) year period, from July 1, 2016 through June 30, 2017. The insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement remain unchanged and in lull force and effect. Sincerely, lit ,i .. 1 /j• ;1 _Ay�� Gerardo Mouct Executive Director of Parks, Recreation and Community Services Agency APPROVED AS TO FORM: Sonia R. Carvalho City Attorney �-Y- M.Funk Assistant City Attorney CITY OF SANTA ANA David Cavazos � aer ATTEST; `1-/_� ;�:)- Marta D. Huizar Clerk of the Council SANTA ANA CITY COUNCIL. Miguel A. Pulido Vincent F. Samienta Michele Mim u ` Aagetim Anwwa P.Oa qd Bemidua i Roman Reyna Sal TUAM Mayor PAayhx Pro Tam, Ware i Ward 2 I Ward 3 " Ward 4 Wartl 5 t Wartl 6 MP�Ajttota�eanta-ana.ora I Vs mi t t¢ me m ! 6MDftn nia-ena.ore t �asnta an o I 3j�gtyraytlas�aema-ane wu I ftR mam? Ya- orq l 3iTt i2m�Tsanta- i i i i i t am wn AC-� SERANA OF ID: DT lft._..-- CERTIFICATE OF LIABILITY INSURANCE CATINAM'"Y"Yn THIS CER07107)2016 TIFICATE 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: it the celtifiaate holder Is an ADDITIONAL INSURED, the Poliay(les) must be andomed. It SUBROGATION IS WAIVED, subject to the terms and conditions of the PORGY, Certain Policies may require an ondomemenL A statement on this Certificate does not Conlar tights to the ceNiRcatu holder in lieu of suah entloreamen FRoaueaR Kethy R. Noe, DPCU ARM -VP Voterinary Ins. SoMaos Ca. - ..�__ -VP petal j�yµlwlb8 It ,;I0"` tty - p1 COVERAOFffi THIS 13 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUE p TO THE INSURF.btNASEEb INDICATED. NOTWITHSTANDING VISION NUMBER: ABOVE OR THE POLICY pEmQO AYBESUEDO ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR ANY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN ANY HAVE BEEN REDUCED BY PAID CLAIM HEREIN IS SUBJECT TO ALL THE TERMS. Ix TrPa A6Btl—_._..�,._..� OP WaaMNOa agePOLIO NUM !R 6FF LA:Y EAP Y 0 LIM TS A X GOMMHRaf11L OlNlRAL AaLlILIT' v. CLAIMS -MADE x IAZCS09,t904 EACH OCCURRENCE S 1,000.00 OCCUR 07f0,12018 07J01l20,8 i PeT6RERTEri--- : ,.goo,oa ----.— ..—..-_— MEO EAP me�rsa+ S_ 10.00 OENL AOGXEGAI"�E LINKAPPLIES PER IWURY_ POLICY L._.1 jE O LOC GENEWII AGOaEGATE b__-� 2,000.00 TO AGO E 1,000,0 NEa j �PRODUCTS.00NPiOP -.. S ------ AUVRoMLa LUaILITY SINGLE 1,000,0g A AXAUTO KHOM'ED0 40911904 07g,f2010 07f0i120,7All -lSsEOo`aa'l°LYr°NED w RYYCmPorILP,MarrI __X _ X�AA�UT®yW�e xIiNR'"IlUR;n• _ IaRERASIPO8 I S uMeaeunuAs OCCUR �....- exepaUu CLAW&MAflE FA6HOCCURRERCE a psaaEaAn; . E RON aeaNErACOMPaRq VW --- b A ANMGW%OYMU wAM AxY PROPa1ETORPARTXERFEECUNYE YIN IW2PetOS4300 07RIV2070 07SOti1017 X su EB_— ---- OPFICERMEMSSRE%OLUnEQ9 1aPAaAaryM1 NNI WAEL EACH AOOHIENT S t,000,00 ..-..— Et absEAEe-&L EAmLOTE EL n6iEASE POLICY LNR __ _ s �1,000.0 E '^.. 1,000,000 r aaEtMEerur INPttOX aaE�CMPtttlXOP aPaM,NMfaFteQA7lONa tv6ixOLfa IAWRa wr..tBanalNl Ramrpy ppWWp„peSA iXMpApttrw ypryy�quAr�} n(/ j,,, emPloyoes and roptosengtivaa are LM1� aW1t�,�/-)/, Included as awl UdiaureelaageR9M, 30 Days NOCl40 Days Roe for 7` 1A Pi�b yr/3 non-payment Eth A her Q CERTIFICATE unl ncn _. _ _ City of Santa Ana Fin a Mgt Svcs Agony PUrchasirpi Div, 20 Civic Center Pura M46 ACORD 25 tM4M) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES aE CANCELLED BEFORE 'me ERPutuvo 4 OATS THEREOF, NOTICE WALL Be DELNERED IN ACCORDANCE vatH THE POLICY PROIRSYONS W hew--aETta lwOROY'G,RPORATION. All riptd a The ACORD name and logo are Registered maEaa of ACORD NOTEPAD SERAN4 INNUPEU'a NAME Serrano Animal & Bird Hospital OP 10: OT by written insured contract, the insurance Provided under this primary & non contributory with any other insurance nal insured. available to 4i iAafAhYf a#�A of Inaurwda the Limits of Insurance, and any rights or duties in this Policy to the first Named Insured, this Hamad Insured were the only and to each insured against whom or suit is brought PAGE 2 ww 0710712016 Reviewed by: NAP I Ethan Fisher PRCSAJZoo Additional Insured — Owners, Lessees or Contractors — AB"67 12 93 Policy Amendment Section 11 do Ir d: Serrano Animal & Bird Hospital Pu is Numher AZC80911904 Produegr Veterinary Ins Services Cc Et 'vo 07/01/16 Schedule Name of Person(s) or organization($) City of Santa Ana, Its ajyicers, agents and employees ld Civic Center Plaza Santa Ana, CA 92701 City of Santa Ana, Its officers, agents, employees representatives are included as additional insureds, "Tire insurance provided under thh pancy is primary and non-contributory with any other insurance available to the additional insured. This insurance applies separately to each insured against whom claim is made or suit is brought except wish respect to the companies limit of liability, The inclusion of any person at organization as an insured shall not ];]feet any right which such person or organization would have as a claimant l not so included. " 30 Days Notice of Cancellation/10 Days Notice of Cancellation for Nonpayment of Premium (If no entry appears above, information required to complete this Endorsement will he shown in the Declarations as applicable to this Endorsement) The following is Added to Part 1- WHO IS AN IN» SURER in the Business Liability Section of this policy . 'The person or organization shown in the Schedule Is also an insured, but only with respects to liability arising out of your work for that insured by or Rlr YOU- S All other terms and conditions of the policy apply, Phis form must be nouchcd to change ]indorsement when issued alter the pala;y is written, One of Fireman's Fund Insuraaco Companies as named in the polley. Secretary A tharixel nt / A119067 1343 CoWWMoonYlinhledhWoA-1 aflmmorcc Seevieer fllitcue, Ino, lend Sltieiraa!'rE, ta42acco President trots Reviewed by: 4 Ethan Fisher PRCSAIZoo