HomeMy WebLinkAboutJames, Keith "White Wolf" 2005-06-06c�(030:� -A,;?--
PROFESSIONAL SERVICES CONTRACT AMENDMENT
This Agreement Amendment is made and entered into in Ukiah, California, on June 6, 2005,
by and between Keith"White Wolf' James (Consultant), a Native American Museum Educator, and
the City of Ukiah (Ukiah), a general law municipal corporation.
A. AGREEMENT AMENDMENT.
This amendment is to modify only Section 2. Time of Performance; Section 3. Term; and
Section 4. Compensation; of the Agreement entered into by Consultant and Ukiah on
January 3, 2003 and amended on April 1, 2004 to be as follows:
2. TIME OF PERFORMANCE.
Jan. 3, 2003 to June 30, 2006.
3. TERM.
The term of this Agreement shall begin on Jan. 3, 2003 and end on June 30,
2006, unless extended by mutual written agreement of the parties or terminated as provided in
paragraph 9.
4. COMPENSATION.
Ukiah shall pay Consultant as follows for services provided under this agreement:
Periodically, as invoiced by Consultant, at $18.00 per hour, to a maximum of
$52,484.00 (an additional $16,488 and an additional 916 hrs), unless renegotiated
with Project Director and Project Administration in compliance with all pertinent federal
grant guidelines.
All other sections of the Agreement remain intact.
2. DUPLICATE ORIGINALS
This Agreement Amendment may be executed in one or more duplicate originals bearing the
original signature of both parties and when so executed any such duplicate original shall be
admissible as proof of the existence and terms of the agreement between the parties.
WHEREFORE, the parties have entered this Agreement Amendment on the date first written
above.
CONSULTANT
Date: la . Z D — 0 5
UKIAH
By:
Title: City Manager
Date: L ---I& —_b
W I I t
WORKERS' COMPENSATION DECLARATION
I, Keith White Wolf James, certify that in the performance of the work as Native
American Educator for the City of Ukiah and the Grace Hudson Museum I have
contracted to do in FY 05-06, I will not employ any person or persons in any manner so
as to become subject to the workers' compensation laws of the State of California, and
agree that if I should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I will comply with those provisions.
Keith White Wolf J
Date: 4 / D
1 California State Automobile Association
Inter -Insurance Bureau
150 Van Ness Avenue
P.O. Box 429186
San Francisco, CA 94142-9186
1. NAME AND ADDRESS OF INSURED
GRUVER MIRIAM
1300 W CLAY ST
UKIAH CA 95482-4611
1111111111111111111111111111111111����111��111��111�
ALTERNATE ADDRESS
OCCUPATION
Automobile Policy Declarations
Please keep
with your policy.
See Important
Notice on reverse.
For questions or changes call: 1-800-922-8228
ITEM
DECLARATIONS TYPE
EACH PERSON EACH OCCURRENCE
PAGE
DEDUCT.i PREMIUM
Amended Declarations
1 of 1
z
Injury°y 100,000 300,000
...................................................................................................
,
a
O
POLICY TYPE
PROCESS DATE
P
Member
$6
12-21-2004
to
Uninsured 100,000 3O0,000`µ
Motorists
2
POLICY NUMBER
0
—
INSURED SINCE
¢
0
6C-00-05-8
$3
1993
? z
.................................................... '..................................
FROM
` 12:01 A.M. Standard Time at the
95482
SEE REVERSE
Undesignated s I FOR EXPLA-
IL
i address of the Named Insured,
>'
Your
1Z—ZO—ZOO4
i but not prior to the time applied
V
Collision
Actual Cash Value Less Deductible
500 '
for or, if this is a replacement
J
Policy
¢
declarations, not prior to the time
O
Period
No Coverage
coverage change was requested.
a
O
TO
12:01 A.M. Standard Time at the
12-20-2005
address of the Named Insured.
ALTERNATE NUMBER ITELEPHONE NUMBER
y ITEM I MAKE MODEL YR. BODY TYPE VEHICLE IDENTIFICATION NUMBER Drivers
M 01 CHRYS 1997 4D SED 2C31-ID56FOVH554341 do not
JO: necessarily
Q 02 FORD 1976 1/2 TN FlOYRA76260 m correspond
W 04 TB IRD € 1994 2D CPE 1FALP62W8RH135082 to principally
operated
vehicles.
468-1305
NAME
MIRIAM
LEW I S (,<E 1-159 ✓f�M�S�
w
COVERAGE ':.................... _..._•_••• `••••"
....................................................................................................................................:......................................................................................
..1— ui
ITFSII 02
ITEM 04
ITEM0.........................................................,........................................
ITEM
EACH PERSON EACH OCCURRENCE
DEDUCT, i PREMIUM
DEDUCT.i PREMIUM
DEDUCT PREMIUM
DEDUCT PREMIUM
Injury°y 100,000 300,000
...................................................................................................
,
a
$7
Medical 5,000
Payments 000
.................................................. i.................................................. 1 t
$6
{
to
Uninsured 100,000 3O0,000`µ
Motorists
$4
t
0
—
.............................................. ....................
Property
25,000
Damage 000
;
$3
95482
Principal F S I
.................................................... '..................................
02
PT 5,000 M I
95482
SEE REVERSE
Undesignated s I FOR EXPLA-
IL
Comprehensive
Actual Cash Value Less Deductible
............-....................................................................................................................................................................
50 i
i
No Coverage
50 $12—
W
a..........
Collision
Actual Cash Value Less Deductible
500 '
No Coverage
No Coverage
....................... ............................... ............ ............................ ..:........................................ ..................................
Enhanced Transportation Expense Coverage: Items)
¢
.... ..................... -................ ........................... .............. .................................... ..... ............ ...... .........................
All Risks
Actual Cash Value Less Deductible
No Coverage
No Coverage
No Coverage
O
Good Driver: Item(s) 01, 02, 04.
t0.►
TOTAL PREMIUM PER VEHICLE ►
Multi Policy H03 Homeowners: Item(s)
01, 02,
$12—
o
Automobile EXPLANATION A=$15,000 first named insured. B=$15,000 each first named insured and spouse.
LIMIT CODE
PREMIUM
Death Benefits I OF LIMIT CODES C=515,000 each additional named insured shown on endorsement F329.
A
,..., ,.. ,.. �ii")< "MOWN -'.1[: .. _
Premium Summary CA Surcharge: $0.00
THIS IS NOT A BILL. Total Return
Premium: $12.00
w
Change ItemV
0
z
a
V
y
ITEM i RATED DRIVER DRIV SAFETY RECORD i YRS DRIV EXP EST ANN MI DRIVEN i VEH GARAGE ZIP VEHICLE USAGE I GENDER MARITALUJI
01 1 MIRIAM
0 PT 51 10,000 M I i
95482
Principal F S I
a
02
PT 5,000 M I
95482
SEE REVERSE
Undesignated s I FOR EXPLA-
m
04 1 LEWIS
0 PT 31 10,000 MI
95482
Principal M S NATION OF
.................
PT MI
:.............................................................. _
I CODES.
i
11
....................... ............................... ............ ............................ ..:........................................ ..................................
Enhanced Transportation Expense Coverage: Items)
.................. .......................
01.
..................................................... .... ........_.................................................................................................
Z
DISCOUNTS:
Mature Driver: None.
O
Good Driver: Item(s) 01, 02, 04.
H
Multi Policy H03 Homeowners: Item(s)
01, 02,
04.
o
Multi Car: Item(s) 01, 02, 04.
ITEM
ITEM
,..., ,.. ,.. �ii")< "MOWN -'.1[: .. _
S
W
Lu
4
IL
N ITEM ITEM
V!
O
716 (Rev. 11112000)
1010CPD3 n—i—tinnc r..nntin—ri nr. Rn.—.