HomeMy Public PortalAboutC-20-005 - Mychal's Learning Place (Mykie's) Service Provider, Dolphin Park Playground OpeningN
Dear applicant,
City of Carson
Community Services Department
Service Provider
On behalf of the City of Carson, I would like to thank you for taking the time to explore business
opportunities with the City. As part of our application process you must complete, sign, and
return the following forms. Submission of forms does not guarantee you will be provided the
business opportunity you seek. Your prompt assistance in submitting the requested
documentation to Bobby Grove _ will be appreciated and will help
expedite the application process. Please send your completed application and attachments
directly to the following address:
City of Carson
Attn: Bobby Grove - Recreation Program Manager
701 E. Carson Street, Carson. CA 90745
Fax:
Should you have any questions, please feel free to contact Bobby Grove
at 310-847-3564
Truly,
Bobby Grove
Recreation Program Manager
Sen ice [Irm Eder •Icteement - .IS O[- 4- J8- 19
2
Checklist
Applicant: Before submitting your application packet make sure each of the
below indicated items have been attached or completed.
Service Provider Agreement
Invoice
Business License (if applicable)
Proof of Insurance/Certificate of Insurance
Waiver, Release, Hold Harmless, Agreement Not to
Sue, Indemnification, and Photo Release
Current Copy of W-9 Form (if not on file already)
Event Coordinator: Please check off each item above to verif3- Service
Provider Application is complete.
Scn i4c Prole ider '1 iverncFit - -%� 01. ;. 1 N•! 4
Insurance Requirements
Dear Mykies
Please be advised pursuant to your desire to work with the City of Carson, you are required to
submit the following:
✓ CompIiant Certificates of Liability Insurance (to be maintained for the duration of services
against claims which may arise from or in connection with the services), evidencing the
coverage(s) as indicated below.
Certificates of insurance, as well as additional insured and waiver of subrogation
endorsements in favor of the City, must be submitted in their entirety before any services
or provided or the event tapes place. Failure to submit such required forms shall be cause
for City of Carson to reject or terminate any service provider application/agreement.
The City of Carson reserves the right to modify these requirements based on the nature of the
risk, prior events, insurance coverage, or other special requirements.
MINIMUM SCOPE AND LIMIT OF INSURANCE
General Liability Insurance: Coverage shall be at least as broad as Insurance Services Form
CG 00 01 covering CGL on an "occurrence" basis, including properry damage, bodily i41113,
and personal & advertising injury Smith limits no less than 51,000,000 per occurrence and
S2, 000, 000 aggregate.
Additional Insured Status
The City of Carson, and its elected and appointed officials, employees, volumeers and agents, are
to be covered as additional insureds with respect to liability arising out of their wank or
operations peifortned at or on behalf of the City -sponsored event including materials, parts, or
equipment ftu•nished in connection with the event_
ticn iic l'rm ider - VS 01. 4.18-19
City of Carson
Community Services Department
Service Provider Agreement
Check one (staff use):
Carson Event Center Human Services X Recreation Transportation
Event: Dolphin Park Playground Opening Event Location: Dolphin Park
Name of Service Provider:
I V}
Business Entity Type: Jurisdiction:
Type of Service: Catering
4
Event Date:1 /16120
(6((P (R\11e_ieS
Contact Person: ��IM5 e &\A a VJ Phone #: ( W)
Einer, Contact: '4 V) Lyl Phone #: (,316 ) X1 i Ct _S3 3
Billing Address:
n
Number.', Street
- - A_Q\rj * oyne, C�2S
City State ZIP
Tax I.D. / SSN #:
Proof of Insurance (check box) EfYes FINo
If no, would you tike to purchase one day insurance through the City (check box)? 0Yes F�No
Special Instructions / Notes:
Total Service Fee 4 2 o
NOTE: If provider is unable to perform or cannot provide the services as proposed or requested
or the City of Carson cancels the service for any reason, the associated fees will not be paid.
The undersigned, on behalf of the above -referenced Service Provider, agrees that Service Provider seeks and is willing
to provide the above -referenced service(s) for the City of Carson on the date and time of the above -referenced event.
Service Provider acknowledges that the City of Carson's consideration of Service Provider's application to provide the
above -referenced services is on the express condition that Service Provider represents and warrants that it is and will be
in compliance with all applicable restrictions on the use of intellectual property, including copyright laws, in connection
with the services proposed to be provided. Service Provider shall indemnify, defend, and hold harmless the City against
any penalties, claims, or liabilities arising from or in connection with Service Provider's noncompliance with same.
5
Further Terms of Agreement between Service Provider and City of Carson:
The undersigned signatory of Service Provider (being the above -referenced person or entity seeking
to provide services at the above -referenced event, including all its officer, agents, employees and
volunteers) hereby represents and warrants that he or she is duly authorized by Service Provider to
execute and deliver this application on behalf of Service Provider, and that by so executing this
application, and in consideration for the City's review of this application, Provider is bound by these
terms.
Service Provider understands and agrees to comply with the City's "Service Provider Rules &
Regulations," which are set forth below and incorporated herein by this reference.
Service Provider agrees to indemnify and release City in connection with its proposed services in
accordance with the "Waiver, Release, Hold Harmless, Agreement Not to Sue, Indemnification, and
Photo Release submitted concurrently herewith."
Service Provider agrees to maintain all required insurance coverages and comply with all associated
insurance requirements as set forth on the above "Insurance Requirements" page, which is
incorporated herein by reference. Service Provider agrees that all required policies shall contain, or
be endorsed to contain, an agreement by Service Provider to waive all rights of subrogation and
contribution against the City, its elected or appointed officers, officials, employees and agents, for all
losses and liabilities paid under the terms of any policy which arise from the activities or operations
of, or the services performed by, Service Provider, regardless of any prior, concurrent, or subsequent
non-active negligence by the City.
In the event there is more than one person or entity named in this Agreement as the Service Provider,
then all obligations, liabilities, covenants and conditions under this Agreement shall be joint and
several.
This Service Provider Agreement is only an application for provision of services to City, and does not
constitute an approval or authorization for Service Provider to perform or provide any service to City.
In the event that part of this Agreement is declared invalid or unenforceable by a valid judgment or
decree of a court of competent jurisdiction, such invalidity or unenforceability shall not affect any of
the remaining portions of this Agreement which are hereby declared as severable and shall be
interpreted to carry out the intent of the parties hereunder.
[signatures on the following page]
SCr%ICC Pro% ider Agwernent -ASO F a- 1S• I')
Service Provider and City have executed this Agreement on the dates written below.
SERVICE PROVIDER:
Printed Name of Service Provider's Authorized Representative
CITY OF CARSON
Signature of City Manager or Designee
A
4
,DoneGaus-Aldana, M
sla
�City Clerk, City of Carson
SMIce Prmider Agrcement - A%; OF 4-I8-19
1ri()—p
Date
Iy-.
Date
6
7
Service Provider Rules & Regulations
I. SERVICE PROVIDER APPLICATION: Upon acceptance of a service provider application
by the City of Carson ("City"), these rules and provisions shall become binding and a part of the
Service Provider Agreement between the applicant (being the entity providing a specified service
to City), including its officers employees and agents ("Provider"), on the one hand, and the City,
on the other hand. Any additions and amendments thereto that may be established or put into
effect by the City, and provided in writing to the Provider, shall also become binding and a part
of the Service Provider Agreement.
2. PAYMENT/CANCELLATION: If the Provider is unable to perform or cannot provide the
services as requested, or the City cancels the service for any reason, the associated fees for
service will not be paid.
3. CANCELLATION: No refunds will be given unless the subject event is cancelled by the
City's Community Services Department. Applications may be denied or events cancelled in
favor of City programs.
q. PROPERTY LOSS OR DAMAGES: The City is not responsible for any damage to, loss or
theft of the Provider's property, or that of Provider's agents, employees or invitees.
5. CHARACTER OF ENTERTAINMENT: The Provider shall observe, obey and comply with
all applicable local, state and federal laws, and all applicable policies, rules, regulations and
terms and conditions governing use of City facilities. The Provider will forfeit all rents or other
fees paid if ejected from premises for violations of same. Ejection shall not release Provider
from any obligations for the payment of rents or other fees not yet paid under such permit or
additionally incurred. The policy of the City is to serve the public in the best possible manner.
The Provider shall at all times cooperate to this end.
The policies, rules, regulations and conditions governing use of City facilities are subject to
change without notice to Provider unless the change affects a permit already issued to Provider.
Provider shall be solely responsible for the orderly conduct of all persons using the premises by
its invitation, either expressed or implied, during all times covered by the Service Provider
Agreement. The City reserves the right to eject or cause to be ejected from the premises any
person or persons due to unlawful conduct.
6. RESPONSIBILITY: The Provider shall provide all material, equipment, and personnel
necessary for provision of the service described in this agreement.
7. MOVE-IN/MOVE-OUT: Move -in to the event area will be set for each venue. Unless
otherwise stated, Provider will be required to keep its area fully set up and manned until the
event is officially over. Please note that these times are subject to change.
8. SAFETY: Standing on chairs, tables or other rental equipment is prohibited. This equipment is
not engineered to support your weight. The City of Carson, its employees, agents, or officers will
not be responsible for injuries or falls caused by the improper use of furniture. Please assist in
our efforts to provide a SAFE WORKING ENVIRONMENT.
Sen ice No%leder A urecmen! - AS OF -i-Is-14
9. VOLUME/LIGHT CONTROL: The City reserves the right to regulate the volume or intensity
of any and all noise or light generating mechanisms (including, but not limited to, loudspeakers,
radios, television sets, musical instruments, entertainers, or blinking or Flashing lights) in the
reasonable judgment of the City.
10. FLAMMABLE MATERIALS — All decorations, props and electrical equipment must be
fireproof or of fire retardant materials, must meet City requirements and are subject to removal.
Candles and other open Flame devices will not be permitted except as authorized on this
agreement; subject to Fire Department regulations.
11. COPYRIGHT INFORMATION: Provider is responsible for licensing fees as required by
law. Provider may be subject to legal action for the use, display or sale of any item using any
copyrighted and/or trademarked name or logo which has not been specifically authorized under
license from the trademark holder.
12. PERMITS AND LICENSE: Provider shall procure at its own cost and expense all the
required licenses and permits applicable to Provider's use or activity .
13. OBLIGATION FOR CLEANLINESS: Provider agrees that the facility and any other
surrounding City property (including parking lots) used by the Provider must be left in a clean
and orderly condition (equal to or better than the condition existing prior to the event). If
additional maintenance is required, other than the normal cleaning process, the Provider will be
charged additional fees based on the cost of such maintenance.
14. DISPUTES: All points not covered by the Service Provider Rules & Regulations are subject
to the decision of the appropriate City representative.
15. FLOOR MANAGEMENT: The City will appoint a Floor Manager who is authorized to
enforce these rules and regulations.
16. SPACE ASSIGNMENT: Event space is assigned to providers at the sole discretion of the
City. Concerns regarding competitive or specific types of providers should be communicated to
the City at the time of application.
17. RULE CHANGES: The City reserves the right to make reasonable changes to the foregoing
rules, event hours and move-in/move-out arrangements at any time without notice to Provider,
unless the change affects a permit already issued to Provider.
Sen ice Pro%Wer Agreement - 1S 01• 4-18-19
9
Waiver, Release, Hold Harmless, Agreement Not to Sue, Indemnification, and Photo Release
S �Q ("individual") [on behalf of
S Y4r2 ("Service Provider"). and as a bona fide agent of Service Provider
dul authorized to execute this Waiver, Release, Hold Harmless, Agreement Not to Sue and Indemnification
agreement ("Agreement') on behalf of Service Provider] (individual and Service Provider hereinafter
collectively referred to as "Signatory," and the term "Signatory" includes Service Provider's officers, officials,
employees, agents and volunteers), seek acceptance by the City of Carson of an application to provide services
in/at Dolphin Park Playground Opening ("Event") on Thursday 1116120 ("Date").
Signatory understands that accidents and injuries can arise out of the Event; knowing the risks, nevertheless,
and in consideration of the acceptance of an application to provide a service at the Event on the Date,
Signatory hereby waives, releases and discharges any and all claims for damages for death, personal injury, or
property damage which Signatory may have, or which hereafter accrue to Signatory, against the City of
Carson, its elected and appointed officers, officials, employees, agents and volunteers (collectively "City"),
and from and against any and all liability arising out of or connected in any way with Signatory's participation
in or presence at the Event, even though that liability may arise out of negligence or carelessness on the part of
City. It is further understood and agreed that this Agreement is to be binding on Signatory's heirs and assigns.
Signatory hereby grants City the right to photograph or video -record Signatory during or in connection with
the Event, and to use Signatory's photographed or video -recorded likeness, and any image, silhouette, or
reproduction of the voice or appearance of Signatory taken during or in connection with the Event
("Likeness"), for any purpose, including publicity and promotion of City and its events, and creation or
production of materials in any form for such purpose, with no claim of entitlement to any license fee or royalty
of any kind from City. Signatory hereby waives any right to the intellectual property of Signatory's Likeness.
The rights granted by Signatory hereunder shall not expire.
Signatory further agrees to indemnify, defend and hold harmless City from and against any and all claims,
liabilities, losses, damages, expenses, and costs (including without limitation costs and fees of litigation) of
every nature (including, but not limited to, property damage, bodily injury, or death), whether imposed by law
or otherwise, sustained or alleged to be sustained by any person or entity (whether they be members of the
public visiting the Event, employees of the City, other service providers at the Event, or otherwise), occurring
at, arising from, or connected with Signatory's preparation or performance of services at the Event, Signatory's
actions, inactions, or use of facilities at the Event, or any equipment, machinery or items displayed or used by
the Signatory at or for the Event, except for such claim, liability, loss, damage, expense, or cost which was
caused by the sole negligence or willful misconduct of the City.
By signing below, I acknowledge and represent that 1 have read and understand the above, and that I
voluntarily agree to its terms.
Signed: 0 29 1A,— .
NAME• ���Sha�
ORGANIZATION: C ��S f(IM4Jj Had
Date:
tion ice Prnti uls Agrcernoll - A% l * 4.18- 1 N
MYCHLEA-{}1
CERTIFICATE OF LIABILITY INSURANCE `1) — OATE(MMIDDr M)
111012020
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 pollcy(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 endorsement(s).
PRODUCER C�IRUPCT
Arroyo Insurance ervices - LA PHONE FAX, Nq:{323} 256-0800
?900 W BroadwayINC, No, Eat): (323) 550-7900
Los Angeles, CA 90041
PtKNED
Mychal's Learning Place, Inc.
4901 W. Rosecrans Ave.
Hawthorne, CA 90250
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Mutual Insurance Com
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OVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTOTHE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENTWITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERErN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
R TYPE OF INSURANCE DDL UBR MMAD EFF�POLICYE)CP LIMITS
INSD AVD POLICY NUMBERL X COMMERCIAL GENERAL LIABILITY 1 OOOD
JEACH OCCURRENCE 3CLAIt. &WDE aOCCUR X x451-935 685/2019 !2512020F.DAMAGE�� RErITED I = 100,0
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rhe City of Carson and its elected and appointed Officials, employees, volunteers and agents, are included as additional insured as respects General Liability
:overage; as respects to the operations of the named insured under City -sponsored event only as per attached endorsements.
CERTIFICATE HOLDER _ _ _. _ CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
The City of Carson THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
701 E. Carson Street ACCORDANCE WITH THE POLICY PROVISIONS.
Carson, CA 90745
AUTNORIZED REPRESENTATIVE
ACORD 25 (2016/03) (1) 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and Togo are registered marks of ACORD
829.031
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rhe City of Carson and its elected and appointed Officials, employees, volunteers and agents, are included as additional insured as respects General Liability
:overage; as respects to the operations of the named insured under City -sponsored event only as per attached endorsements.
CERTIFICATE HOLDER _ _ _. _ CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
The City of Carson THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
701 E. Carson Street ACCORDANCE WITH THE POLICY PROVISIONS.
Carson, CA 90745
AUTNORIZED REPRESENTATIVE
ACORD 25 (2016/03) (1) 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and Togo are registered marks of ACORD
ADDITIONAL INSURED --
DESIGNATED PERSON OR ORGANIZATION
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following-
COMMERCIAL
ollowing-
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
The City of Carson, & its elected & appointed officials, employees
volunteers & angents
Section 11 — 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:
A. In the performance of your ongoing operations, or
B. In connection with your premises owned by or rented to you_
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