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2018-19 Rojas, Miguel Angel (Instructor) - Taekwondocza Q"tra — (,EM 4-,he DFNERT — MEMORANDUM TO: Chris Escobedo, Director Community Resources FROM: Caroline Doran, Community Resources Specialist DATE: October 22, 2018 RE: Miguel Angel Rojas, Sports, AGR#422601-18, Instructor Attached for your signature is an agreement with independent contracted instructor Miguel Angel Rojas for (Taekwondo) classes. Compensation is based on class attendance with a 70% portion of fees to instructor and 30% portion of fees to City of La Quinta. Please sign the attached agreement(s) and submit to the City Clerk for processing and distribution. Requesting department shnll check and attach the items below as appropriate: X Contract payments will be charged to account number: 101-0000-42214 X Amount of Agreement, Amendment, Change Order, etc.: 70% of fees are paid to instructor N/A A Conflict of Interest Form 700 Statement of Economic Interests from Consultant(s) is attached with no reportable interests in LQ or — reportable interests N/A A Conflict of Interest Form 700 Stotement of Economic Interests is not required because this Consultant does not meet the definition in FPPC regulation 18701(2). Authority to execute this a re went is based upon: Approved by the City Council on X Department Director's signature authority provided under Resolution No. 2015-045 for budgeted expenditures of $15.000 or less. N/A Initial to certify that 3 written informal bids or proposals were received and considered in selection The following required documents are attached -to the agreement: 2 I X Insurance certificates as required by the agreement (approved by Risk Manager on Lt " J +1 date) N/A Performance bonds as required by the agreement (originals) X City of La Quinta Business License number LIC-0107598 Expires 06/30/2019 N/A A requisition for a Purchase Order has been prepared (amounts over $5,000) N/A A copy of this Cover Memo has been emailed to Finance Revised May 2017 ta QW�Krav Cityf L o a Quanta - —GEMnfrb,DESERT— Community Services Department Contract # 422601-18 INSTRUCTOR AGREEMENT This INSTRUCTOR AGREEMENT is hereby formed on JULY 1, 2018 through JUNE 30, 2019 between the CITY OF LA QUINTA, COMMUNITY RESOURCES DEPARTMENT ("CITY") and MIGUEL ANGEL ROJAS, a person or business engaged in offering services ("CONTRACTOR") for Contractor's Provision of Services to the City. CITY AND CONTRACTOR MUTUALLY AGREE AS FOLLOWS: 1. SCOPE OF WORK. The scope of work is described as: Taekwondo/Sports classes held at a City of La Quinta facility. The scope of work includes all goods and actions necessary to complete the task CONTRACTOR has been hired to perform, whether specifically included in the scope of work or not. Specific dates and times for contracted work will be requested by letter to CONTRACTOR from CITY on a bi-annual basis. Work proposals, once approved by CITY will be attached as exhibits to this INSTRUCTOR AGREEMENT. _ (initials) 2. COMPENSATION. CONTRACTOR shall be paid for services performed under this INSTRUCTOR AGREEMENT as follows: CONTRACTOR shall recommend fees to be charged by CITY. Such fees shall be paid directly to CITY. CITY shall maintain written records of gross receipts and shall submit such records to CONTRACTOR upon request. CONTRACTOR shall be compensated based on the following: STANDARD SESSIONS. CITY shall pay 70% of gross receipts collected to CONTRACTOR as compensation based upon the records and shall retain the remaining 30% for the use of public facilities for such services. This compensation shall be the total compensation for services, including out-of-pocket costs. CITY shall pay no other compensation to CONTRACTOR. Payments will be made to CONTRACTOR after each session of work is completed as defined in Section 1, SCOPE OF WORK and will follow the approved annual payroll calendar. DROP -IN SESSIONS. CITY shall pay 70% of gross fees to CONTRACTOR as compensation based upon the records and shall retain the remaining 30% for the use of public facilities for such services. This compensation shall be the total compensation for services, including out- of-pocket costs. CITY shall pay no other compensation to CONTRACTOR. Payments will be made to CONTRACTOR after each session of work is completed as defined in the SCOPE OF SERVICES and will follow the approve3d annual payroll calendar. 3. INDEPENDENT CONTRACTOR. This INSTRUCTOR AGREEMENT calls for the performance of the services of CONTRACTOR as an independent contractor and not as an employee of CITY. Neither CITY nor any of its employees shall have any control over the manner, mode, or means by which CONTRACTOR or its agents, perform the services required herein, except as otherwise set forth herein. CONTRACTOR shall perform all services required herein as an independent contractor of CITY and shall remain at all times as to CITY a wholly independent contractor with only such Rev May 2015 1 obligations as are consistent with that role. CONTRACTOR shall have no power to incur any debt, obligation, or liability on behalf of CITY. CONTRACTOR shall not at any time or in any manner represent that it or any of its agents or employees are agents or employees of CITY. CONTRACTOR and any of its agent, and subcontractors providing services under this INSTRUCTOR AGREEMENT shall not qualify for or become entitled to any compensation, benefit, or any incident of employment by CITY, including but not limited to eligibility to enroll in the California Public Employees Retirement System ("PERS") as an employee of CITY and entitlement to any contribution to be paid by CITY for employer contributions and/or employee contributions for PERS benefits. CONTRACTOR agrees to pay all required taxes on amounts paid to CONTRACTOR under this INSTRUCTOR AGREEMENT, and to indemnify and hold CITY harmless from any and all taxes, assessments, penalties, and interest asserted against CITY by reason of the independent contractor relationship created by this INSTRUCTOR AGREEMENT. CITY shall have the right to offset against the amount of any compensation due to CONTRACTOR under this INSTRUCTOR AGREEMENT any amount due to CITY from CONTRACTOR as a result of CONTRACTOR's failure to promptly pay to CITY any reimbursement or indemnification arising under this paragraph. 4. INDEMNIFICATION. To the fullest extent permitted bylaw, CONTRACTOR shall indemnify, protect, defend (with counsel selected by City) and hold harmless CITY and any and all of its officials, employees and agents ("Indemnified Parties") from and against any and all liability, claims, suits, actions arbitration proceedings, administrative proceedings, regulatory proceedings, losses, liabilities of every kind, nature, and description, damages, injury (including, without limitation, injury to or death of CONTRACTOR or of any subcontractor) costs and expenses of any kind, whether actual, alleged or threatened, including, without limitation, incidental and consequential damages, actual attorneys' fees incurred by CITY, court costs, interest, defense costs including fees of expert contractors or expert witnesses incurred in connection therewith and any other costs or expenses of any kind whatsoever incurred in relation to, as a consequence of, or arising out of or in any way attributable in whole or in part to the performance of this INSTRUCTOR AGREEMENT by CONTRACTOR or by any individual or entity for which CONTRACTOR is legally liable, including but not limited to agents or subcontractors of CONTRACTOR.. All obligations under this provision are to be paid by CONTRACTOR as CITY incurs them. Without affecting the rights of CITY under any provision of this INSTRUCTOR AGREEMENT, CONTRACTOR shall not be required to indemnify and hold harmless CITY for liability attributable to the active negligence of CITY, provided such active negligence is determined by contract between the parties or by the findings of a court of competent jurisdiction. In instances where CITY is shown to have been actively negligent and where CITY's active negligence accounts for only a percentage of the liability involved, the obligation of CONTRACTOR will be for that entire portion or percentage of liability not attributable to the active negligence of CITY. PROMPT NOTICE. CONTRACTOR agrees to provide immediate notice to CITY of any claim or loss against CONTRACTOR arising out of the work performed under this INSTRUCTOR AGREEMENT. CITY assumes no obligation or liability by such notice, but has the right (but not the duty) to monitor the handling of any such claim or claims if they are likely to involve CITY. S. CANCELLATIONS/CHANGES. CITY RESPONSIBILITY. CITY will contact CONTRACTOR and all program participants if CITY cancels or changes a program from original Rev May 2015 2 approved schedule based on zero enrollments, minimum student requirement not met, or if use of facility becomes unavailable. CITY reserves the right to change original approved schedule of program if the facility becomes unavailable. CITY will attempt to re -locate said program to another suitable facility if one is available. If there are no available facilities, CITY will cancel said program and coordinate with CONTRACTOR to schedule a make-up date. /,�i _ (initials) CONTRACTOR RESPONSIBILITY. CONTRACTOR will contact CITY as defined in the NOTICE section in advance to notify of any cancellations or changes from original approved schedule if said program is cancelled or changed by CONTRACTOR. CONTRACTOR will be solely responsible to contact any and all participants of the program. Programs that are cancelled or changed by CONTRACTOR must be made up in a timely manner as approved by CITY. (initials) 6. INSURANCE. It is to be understood that CONTRACTOR is working under a contractual obligation as specified in this INSTRUCTOR AGREEMENT and is responsible as a self-employed person to remit any Federal or State Income Taxes, and to provide for his/her own Worker's Compensation, Disability Insurance, Unemployment Insurance coverage, Social Security, Liability Insurance and other such coverage, as applicable, in the amounts and under the conditions as set forth below. A. Commercial General Liability Insurance using Insurance Services Office "Commercial General Liability" policy form CG 00 01, with an edition date prior to 2004, or the exact equivalent. Coverage for an additional insured shall not be limited to its vicarious liability. The insurance policy shall contain a severability of interest clause providing that the coverage shall be primary for losses arising out of Contracting Party's performance hereunder and neither City nor its insurers shall be required to contribute to any such loss. Defense costs must be paid in addition to limits. Limits shall be no less than $1,000,000 per occurrence for all covered losses and no less than $2,000,000 general aggregate. Instructor shall obtain policy endorsement on Commercial General Liability Insurance that name Additional Insureds as follows: The City of La Quinta, its officers, officials, employees and agents. B. Excess or Umbrella Liability Insurance (Over Primary) if used to meet limit requirements, shall provide coverage at least as broad as specified for the underlying coverages. Such policy or policies shall include as insureds those covered by the underlying policies, including additional insureds. Coverage shall be "pay on behalf," with defense costs payable in addition to policy limits. There shall be no cross liability exclusion precluding coverage for claims or suits by one insured against another. Coverage shall be applicable to CITY for injury to employees of CONTRACTOR, subcontractors or others involved in the provision of services under this INSTRUCTOR AGREEMENT. The scope of coverage provided is subject to approval of CITY following receipt of proof of insurance as required herein. Rev May 2015 6.1 CONTRACTOR agrees to provide evidence of the insurance required herein, satisfactory to CITY, consisting of: (a) certificate(s) of insurance evidenclnng all of the coverages required and, (b) an additional insured endorsement to CONTRACTOR's Commercial general liability policy using ISO Form CG 20 10 with an edition date prior to 1988, which form shall include coverage for completed operations and, The additional insured endorsement shall expressly name CITY, its officers, and employees as additional insureds on the policy (ies) as to commercial general liability coverages, and completed operations coverages, with respect to liabilities arising out of CONTRACTOR's performance of the services under this INSTRUCTOR AGREEMENT. 6.2 CONTRACTOR shall provide written notice to CITY within ten (10) working days if: (1) any of the required insurance policies is terminated; (2) the limits of any of the required polices are reduced; or (3) the deductible or self -insured retention is increased. In the event any of said policies of insurance are cancelled, CONTRACTOR shall, prior to the cancellation date, submit new evidence of insurance in conformance with this Section 6 to CITY. The procuring of such insurance or the delivery of policies or certificates evidencing the same shall not be construed as a limitation of CONTRACTOR's obligation to indemnify CITY, its officers, employees, contractors, subcontractors, or agents. 7. BUSINESS LICENSE. CONTRACTOR will be required to obtain a City of La Quinta Business License within thirty (30) calendar days of this signed INSTRUCTOR AGREEMENT. A copy of the current La Quinta Business License must be provided to the Community Services Department within five (5) business days of receipt. S. COMPLIANCE WITH LAW. All services rendered hereunder shall be provided in accordance with all ordinances, resolutions, statutes, rules, regulations, and laws of CITY and any Federal, State, or local government agency of competent jurisdiction. 9. COVENANT AGAINST DISCRIMINATION. CONTRACTOR covenants that, by and for itself, its heirs, executors, assigns, and all persons claiming under or through them, that there shall be no discrimination against or segregation of, any person or group of persons on account of race, color, creed, religion, sex, marital status, national origin, disability, or ancestry in the performance of this INSTRUCTOR AGREEMENT. 10. NO ASSIGNMENT. CONTRACTOR shall not, under any circumstances, assign this INSTRUCTOR AGREEMENT or its rights or duties without prior written authorization from CITY. Should such authorization be granted, CONTRACTOR agrees to inform any subcontractor of all the stipulations of this INSTRUCTOR AGREEMENT. (initials) Please list any/all subcontractors you may hire for the term of this INSTRUCTOR AGREEMENT. Name I Address I Phone Number Subcontractors listed above have been approved by CITY to perform the scope of work, as provided in Section 1. Additional subcontractors will require prior written approval from CITY. Rev May 2015 11. TERMINATION. It is understood that CONTRACTOR will perform all services set forth herein in a good and workable manner. CITY reserves the right to terminate services for any reason, including, but not limited to, insufficient number of participants or unavailability of facilities. In such circumstances, CITY shall not be liable for compensation or damages to CONTRACTOR for remainder of this INSTRUCTOR AGREEMENT. 12. NOTICE. Notice shall be deemed given when CONTRACTOR contacts CITY COMMUNITY RESOURSES COORDINATOR or COMMUNITY SERVICES SPECIALIST in person, via telephone call, email, faxed with a fax return, or seventy-two (72) hours after deposit in the United States mail postage prepaid, return receipt requested, addressed as follows: CITY: CONTRACTOR: City of La Quinta Miguel Angel Rojas Community Resources Department 41098 Manchester 78495 Calle Tampico Indio, CA 92253 La Quinta, CA 92253 ffr-- (initials) U 13. DOCUMENTS. Any documents and marketing materials created by CONTRACTOR under this INSTRUCTOR AGREEMENT shall be submitted to CITY for approval prior to distribution. 14. MISCELLANEOUS. This INSTRUCTOR AGREEMENT is the only agreement between CONTRACTOR and CITY and may be amended in writing and agreed upon by both parties. No waiver of any term or condition of this INSTRUCTOR AGREEMENT shall be a continuing waiver thereof. Rev May 2015 IN WITNESS WHEREOF, the parties hereto have caused this INSTRUCTOR AGREEMENT to be executed the day and year as first stated above. CITY OF LA QUINTA, Miguel Angel Rojas COMMUNITY RESOURCES DEPARTMENT ("CONTRACTOR") ("CITY") APPROVED: APPROVED: By: By CYRISTINA CALDERON Community Resources Manager 41098 Manchester Indio, CA 92253 760.673.6760 Required for over $5,000: By: CHRIS ESCOBEDO Community Resources Director Rev May 2015 cam► rya' CERTIFICATE OF LIABILITY INSURANCE DATE[M 08/22/201YYY} /2018 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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 endorsoment(s). PRODUCER K&K Insurance Group, Inc. 1712 Magnavox Way Fort Wayne IN 46804 CONTACT NAME: Mass Merchandising PHOi1rNn E,tt, 1-800-648-6406 we NO, 1-260-459-5940 E-MAIL ADDRESS: info@martialartsinsurance-kk.com PRODUCER CUSTOMER ID: INSURER(S) AFFORDING COVERAGE NAIC # INSURED 2000085676 CP# 876 Rojas, Angel Jr. DBA: Rojas TKD 41098 Manchester Street Indio, CA 92203 A Member of the Sports, Leisure & Entertainment RPG INSURER A: Nationwide Mutual Insurance Company 23787 INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 2000379054 REVISION NUMBER: 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X 6BMAS0000006289700 07/17/18 07/17/19 EACH OCCURRENCE $1,000,000 CLAIMS -MADE z OCCUR 2:24PMEDT 12:01 AM DAMAGE TO RENTED PREMISES (Ea Occurrence) $1,000,000 MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $5,000,000 POLICY ❑ PROJECT ❑ LOC PRODUCTS — COMP/OP AGG $1,000,000 PROFESSIONAL LIABILITY $1,000,000 OTHER: LEGAL LIAB TO PARTICIPANTS $1,000,000 A AUTOMOBILE LIABILITY 6BMAS0000006289700 07/17/18 2:24 PM EDT 07/17/19 12:01 AM COMBINED SINGLE LIMIT (Ea accident $1,000,000 BODILY INJURY (Per person) ANY AUTO OWNED SCHEDULED AUTOS ONLYMAUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident) HIRED NON -OWNED X AUTOS ONLY AUTOS ONLY X Not provided while in Hawaii UMBRE LA OCCUR LIAg EACH OCCURRENCE AGGREGATE EXCESS LIAB CLAIMS -MADE DED 7 RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N/A PER STATUTE OTHER ANY PROPRIETOR/PARTNER/ Y / N E.L. EACH ACCIDENT EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE — EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE— POLICY LIMIT A MEDICAL PAYMENTS FOR PARTICIPANTS 6BMAS0000006289700 07/17/18 2:24 PM EDT 07/17/19 12:01 AM PRIMARY MEDICAL EXCESS MEDICAL $150,000 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached it more space is required) Location: 78450 Avenida La Fonda, La Quinta, CA 92253 Martial Arts Style: Taekwondo The certificate holder is added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured. The general liability policy is primary, subject to the policy terms and conditions, as per form CO 00 01. " This certificate voids and replaces certificate # 2000378435 " CERTIFICATE HOLDER CANCELLATION City of La Quinta 78495 Calle Tampico SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH La Quinta, CA 92253 THE POLICY PROVISIONS. Owner/Manager/Lessor of Premises AUTHORIZED REPRESENTATIVE 9)198B-2015 ACORD CORPORATION. All rights reserved. Coverage is only extended to U.S. events and activities. " NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 6BMAS0000006289700 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 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 La Quinta 78495 Calle Tampico La Quinta, CA 92253 Insured: Rojas, Angel Jr. DBA: Rojas TKD Cert # 876 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. 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: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 6BMAS0000006289700 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY INSURANCE - ADDITIONAL INSURED This endorsement modifies insurance under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance, a. the following is added: Coverage afforded under this Policy is primary insurance and OTHER INSURANCE shall not apply as respects to the additional insured named below, however this insurance does not apply to the sole negligence of such additional insured. Further, we will have no duty to defend such additional insured against any suit to which this insurance does not apply. Additional Insured: City of La Quinta ' 78495 Calle Tampico La Quinta, CA 92253 Insured: Rojas, Angel Jr. DBA: Rojas TKD Effective Dates: 08/20/2018 — 07/17/2019 Cert # 876 SRPG8018 09/08 Hello Angel, Below is your class information for October 2018 — April 2019. Please review and verify by typing your name and dating the lines below: Taekwondo Master Instructor: Angel Rojas #430101 Cost Day/s Time/s Level Location M/W 5-6pm Beginning Class- White Belts (4-8yrs) #430102 Cost Day/s Time/s Level _ Location IVI/W 6-7pm Intermediate Class —Yellow/ Orange Belts (4-8yrs) #430103 Cost Day/s Time/s Level Location M/W 7-8pm All Belts (9-up) Sessions: 10/1- 10/31= $62.50 (10 classes) Sessions: 11/5—11/28; 2/4 — 2/27; 3/4 — 3/27 = (8 classes) Sessions: 12/3 - 12/31; 1/2 - 1/30; 4/1— 4/29 = $56.25 (9 classes) The following class dates will be makeup dates: December 24 & December 31, January 14 -Dr King, February 18 -Presidents Day, March 4 & March 6- Arts Festival Other Taekwondo locations are offered by the instructor for the make up dates/classes. List is located at the front desk on clipboard. November 21? Taekwondo: Master Instructor Angel Rojas Train in traditional Tae Kwon do that includes self -development, physical and mental conditioning, Sportsmanship, self-defense, integrity, discipline, and world class competition. Contact Chief Instructor: Angel Rojas at 760-673-6760 for more information. Materials to Bring: Uniforms purchased from instructor The La Quinta Arts Festival will be utilizing the Wellness Center from Monday, March 4 through Monday, March 11, 2019. Instructor Signature: Date f°'°/� �Z Signing this document o iy erifies that you have read and understand the material within this document. This d cu ent shall not act as a contractual agreement between you and the City of La Quinta. If paying monthly the per day fee is $6.25 Drop in fees are per day $8.00 491201 Taekwondo Beginning Drop in fee $8.00 491202 Taekwondo Intermediate Drop in fee $8.00 491203 Taekwondo 9-yrs up Drop in fee $8.00 NATIONWIDE MUTUAL INSURANCE COMPANY C/O K & K INSURANCE GROUP, INC. 1712 MAGNAVOX WAY FORT WAYNE IN 46804 RESCISSION NOTICE Named Insured & Mailing Address: ROJAS, ANGEL JR. ROJAS TKD 41098 MANCHESTER ST INDIO CA 92203 Policy No.: MAS000006289700 876 Type of Policy: COMMERCIAL GENERAL LIABILITY Producer: 4016193 DESERT CORNERSTONE INSURANCE SERVICE 81713 HIGHWAY 111 STE E INDIO CA 92201 The CANCELLATION notice issued to be effective 10/17/2018 is hereby rescinded. I Additional Insured 2000085676 22 CITY OF LA QUINTA 78450 AVENIDA LA FONDA LA QUINTA CA 92253 Date Mailed: 17th day of October, 2018 CACS15RSCN_C FORM# CS01CA22006 10172018SINY ODEN 3.0.18.10a Copy for Additional Insured Page 1 of 1 BUSINESS LICENSE RASE BUSINESS LOCATION 78450 AVENIDA LA FONDA BUSINESS NAME: ROJAS, ANGEL T MAILING ADDRESS: 41098 MANCHESTER I N D I O, CA 92203 DESIGN AND DEVELOPMENT DIRECTOR PY W GEM ofdx DESERT — — 78-„495 Calle Tampico La quinta, California 92253 li (760)_ 7277= h, Dear Business Owner: Please be aware that issuance of a business license by the City does not authorize you to conduct business in a building or tenant space that has not been approved For _ occupancy by. the Design and Development Department. if ygsU,h.ave any q7estii ns regarding this issue, or if you are not sure if a Certificate afflff uparcy.has been Issued — for your place nF business, please contact Design and DevefDpmer- at t76pj:7.2-7-700e The Licensee named herein having paid to the City of La Quinta all fees required, license is hereby granted said licensee to transact the business herein set forth, for the period stated, in conformity with the Provisions of Ordinance No. 2 of this City. This Licensee is issued without verfication that the licensee is subject to or exempt from licensing by the State. of_Calac BUSINESS M O-MIM CLASSIFICATION: OTHER BUSINESS EXPIRATION DATE: 6/30/2019