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Active Sports Clubs - 2015 Agreement - Amendment No. 1FIRST AMENDMENT TO THE AGREEMENT FOR SERVICES BETWEEN THE CITY OF GILROY AND ACTIVE SPORTS CLUBS This document constitutes the First Amendment to that certain agreement entitled Agreement for Services between the City of Gilroy and Active Acquisition Partners, LLC, doing business as Active Sports Clubs, effective on April 2, 2015, hereinafter referred to as "Agreement." RECITALS This First Amendment is entered into with reference to the following facts and circumstances: A. The City and Active Acquisition Partners, LLC, doing business as Active Sports Clubs, have determined it is in their mutual interest to amend certain terms of the Agreement. B. Active Acquisition Partners, LLC, doing business as Active Sports Clubs, was a consultant to the City of Gilroy pursuant to the Agreement. Active Acquisition Partners, LLC, doing business as Active Sports Clubs, has changed its name. C. This First Amendment amends the Agreement by replacing the name of the consultant from "Active Acquisition Partners, LLC" doing business as Active Sports Clubs, to "Active Wellness, LLC." D. This First Amendment shall be effective on January 25, 2016. E. Except as expressly modified herein, all of the provisions of the Agreement shall remain in full force and effect. In the case of any inconsistencies between the Agreement and this First Amendment, the terms of this First Amendment shall control. F. This First Amendment may be executed in counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument. IN WITNESS WHEREOF, the parties have caused this First Amendment to be executed as of the dates set forth besides their signatures below. CITY O"41 OY By: ur —`� [signature] Edward Tewes [employee name] Interim City Administrator [title/department] Date: 3 —/.Y -ilk APPROVED AS TO FORM ��City Attorney 4845 -0560 -72130 _ 1 004706083 Active Wellness, LLC Date: 2 1Z �eS 1 Client #: 26916 ACTIACQU ACORD. CERTIFICATE OF LIABILITY INSURANCE D0212620`16YY) 02P26l2016 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(les) 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 Ileu of such endorsement(s). PRODUCER NAME: COINTACT Rose King Barney & Barney, A Marsh & a "CNNo Ext :858- 587 -7521 Arc, No): 858- 909 -9840 McLennan Ins Agy LLC E -MAIL barne PO Box 85638; CA Lie #OH18131 ADDRESS: rose. kin gG Y andbarne y• eom INSURERS) AFFORDING COVERAGE NAIC # San Diego, CA 92186 INSURER A: Philadelphia Indemnity Insuranc 18058 INSURED Active Wellness, LLC; Active Acquisition INSURER B: Everest National Insurance Comp 10120 Partners, LLC dba Active Sports Clubs INSURER C: 1200 Clay Street, Ste 100 INSURER D: Oakland, CA 94612 INSURER E COVERAGES CERTIFICATE NUMBER- RFVI.%IOM NIIMRFR- T HIS 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 CONTRACTOR 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 LTR TYPE OF INSURANCE ADDLSUBR IKSR WVD POLICY NUMBER POLICY EFF (MM1DDfYYYY POLICY EXP M D) YYY LIMITS A GENERAL LIABILITY X PHPK1469522 0310312016 -MID 031031201 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREH115 5 Ee occuErrence $300,000 CLAIMS -MADE I I OCCUR VIED EXP (Any one person) $6,000 PERSONAL & ADV INJURY $1,000,000 X BI1PD Ded:25000 GENERAL AGGREGATE s2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMPICPAGG $2,000000 POLICY SCOT- X LOO $ A AUTOMOBILE LIABILITY PHPK1459522 3/0312016 03103/201 COMBINED LIMIT 1,000,000 - BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS ALUTOSWNEO (PReraccidT DAMAGE $ A X UMBRELLA LIAR X OCCUR PHUB531624 310312016 03/031201 EACH OCCURRENCE $10,000,000 AGGREGATE $10,000,000 EXCESS LUSB CLAIMS -MADE DED X RETENTION$10000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOPJPA.RTNERlEXECUTIVE YIN N OFF!CERIMEMBERFXCI_UDED9 � NIA CA10002071151 2/31/2015 12131/2016 X WCSTATU- OTH- E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory In NH) If yes, desenDe under DESCRIPTION OF OPERATIONS below I E.L. DISEASE - POLICY LIMIT $1,000,000 A Professional PHPK1459522 3/0312016 0310312017 $1,000,000 Each Claim Liability $1,000,000 Aggregate Claims Made DESCRIPTION OF OPERATIONS] LOCATIONS !VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space Is required) Service Agreement: Fire Department Personnel Testing City of Gilroy, its officers, officials and employees are named as an additional insured, per the attached endorsement c r— City of Gilroy, its officers, officials and employees 7070 Chestnut St Gilroy, CA 95020 ACORD 25 (2010105) 1 of 1 #S6732741M673207 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 Gras,¢. lv1 • fS'vrl�c ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD KINR INSURED: Active Wellness, LLC; Active Acqulsition POLICY #: PHPK1459522 POLICY PERIOD: 03103/2016 TO 03103/2017 COMMERCIAL GENERAL U ABILITY CG 20 26 07 04 'PHIS ENDORSEMENT CHANGES THE PGLJCY. PLEASE READ IT CAREF(ILILY. ADDITIONAL INSURED -- DESIGNATED PERSON OR ORGANIZATION This endgrVWWd raodif s0.fis9rfrtende iaoWded und* the f0 owing: COMIMERCI'AL RiAd.I.IIAEI[LI f'r CO'dERAGfr PA9'C9` SCHEDULE or City of Gilroy. its officers, officials and employees 7070 Chestnut St Gilroy, CA 95020 Service Agreement: Fire Department Personnel Testing City of Gilroy, its officers, officials and employeesare named as an additional Insured, per the attached endorsement Ssction Ip - Who 1s, An Insuir -ed Its emended to iri- o':ude as an aIdfNonal trreured the persons} or nrgemi- zatlon(s) shaven In the Srhsdule, but orlfy Wth respect to liability for 'badRY Irp , "prbPerty demagla` or 'pers cal ond,6.dvot'45rnp Ir4ur-/ - caused, In vwhoI& or In (part, b ' yaw Ods or ofrltisIons or tho acts or amis- Blon5 of thwic atiN Pfk yolwr'b0W: A Irl Sic. peatarmAr m of your orgaIng operiatonis; or B. In c"hiadon wlth your premises owned by or Ferried to ym CO W460 04 0 160 Proj ertloo. Ina., 2004 Page d art