HomeMy Public PortalAboutC-20-009 - Liebert, Cassidy, Whitmore Service Provider, Mandated Report Training4
City of Carson
Community Services Department
Service Provider Application Agreement
Check one (staff use):
Carson Event Center Human Services _ Recreation _ Transportation
Event: 1lLiw�lQ��c� ;ti" ` � iw+� Event Location:IJi F_C'�rrx:ti '-f-. Event Date: ,x
C4 C16-145
Name of Service Provider: 1-i4 e r t est cl r lam] n 4 ww�r Q
Business Form/Entity Type (if individual, sole proprietorship, corporation, or limited Iiability
company, specify here):
Business Form/Entity Type (if general partnership, limited partnership, limited Iiability partnership,
or other, specify here):
Business Entity State of Incorporation (if applicable):
Type of Service: ��`Cti t - tANt O RG f a jZTC-f2 Fo lL CrM EW LV `t EEs' :
Contact Person: khVVLS,nzu ti1� —�r Phone #: (3l V)
Emer. Contact:
Billing Address:
Phone #: (
Number stm-el
City
Proof of Insurance (circle one)? Yes) No
State
ZIP
If no, would you like to purchase special event insurance through the City (circle orae)? Yes No
Special Instructions / Notes: tj I A
532227.5 CFN
If Service Provider wishes to request any special accommodation needed to facilitate provision of the
services, please identify it here or contact the staff member referenced on page 1 of this application:
Total Service Fee � k , Q o D • t1 o
NOTE: If service provider is unable to 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.
[remainder of page intentionally left blank]
532227.5 CFN
1.1
Further Terms of Service Provider Application Agreement:
The undersigned signatory of Service Provider (Service Provider being the above -referenced person
or entity seeking to provide services at the above -referenced event, including all its officers, 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, Service
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 Service Provider Application
Agreement as the Service Provider, then all obligations, liabilities, covenants and conditions
hereunder shall be joint and several.
This Service Provider Application Agreement, unless and until accepted, approved, and executed by
the City Manager or designee, 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.
Neither Service Provider nor any of its agents or employees shall be deemed agents or employees of
the City, nor a member of a joint enterprise with the City. Neither Service Provider nor any of its
agents or employees shall at any time or in any manner represent that Service Provider or any of its
agents or employees are agents or employees of City, or that it is a member of a joint enterprise with
City. Subject to the requirements of this Service Provider Application Agreement, neither the City
nor any of its employees shall have any control over the manner, mode or means by which Service
Provider, its agents or employees, perform the services set forth herein.
532227.5 CFN
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 cant' out the intent of the parties hereunder.
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 4�arranta that it is and Nvill be in compliance with all applicable restrictions on the use
of intellectual property, including copyright laves, 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_
The undersigned, on behalf of Sen -ice Provider, agrees that Service Provider seeks and is ~villin- to
provide the above -referenced service(s) on the date and time of the above -referenced event.
This Service Provider Application Agreement has been executed on the dates written below.
S
I� m G
i
o Ia FSOV c.F o i= P S f1t tat [tom j
TTEsr:
Donesia Gause-Aldana, KMC
City Clerk, City of Carson
;
- t !C toe
6C4Vz_.L rrw DVM -T-
Service Provider Rules & Regulations
1. SERVICE PROVIDER APPLICATION: Upon acceptance, approval, and execution 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 Application Agreement between the applicant
(being the entity providing a service to City as specified in the service provider application),
including its officers, employees, agents and volunteers ("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 Application 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.
4. 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
Application Agreement. The City reserves the right to eject or cause to be ejected from the
premises any person or persons due to unlawful conduct.
5. 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.
532227.5 CFN
9
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
Iicense 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 Iots) 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.
532227.5 CFN
X10
Waher, Release, Hold Harmless, 4greement Not to Sue, Indemnification, and Photo Release
1
1r—F- , ("individual") [on behalf of
en ice Provider"), and as a bona fide aeam. of Service Providar
duly authorized to exc-cote this WaNer, Release, Hold Harmless, Agreement Not to Sue and Indemnificatioa
agreement ("Agree rient") on behalf of 5errice Provider] (individual and Service Provider hercinaiter
collectively referred to as "Signatory," and the term "Signatory" includes Service Provider's officers, officials,
employees, agents and Nolunteers), sock acceptance by the City of Carson of an application to provide ser, ices
inlat ("Event") on ("Date').
Signatory wderstan& 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 us: 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 xithout 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 scn.ice 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 Citv.
13y signing below, I acknowledge and reprrs t that I have read and understand the above, and that 1
voluntarily agree to its ter
Signed:
N.Aiv MU
—--�� -
ORGANIZATION:
Date:
tt^n rn. vn
'4i;p- CERTIFICATE OF LIABILITY INSURANCE
DATE 1211712019Y)
12/17/2019
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 lieu of such endorsement(s).
PRODUCER
Narver Associates Ins Agcy
P.O. Box 1509
CONTACT
NAME: June Samarin
PHONE
.626-943-2237 Arc N.1; 686-299.1010
n0�ss: jsamarin@narver.com
San Gabriel, CA 91778-1509
WESLEY HAMPTON HOUSE
LIEBE-1
INSUR S AFFORDING COVERAGE NAIL!
INSURED Liebert Cassidy Whitmore
INSURER A: Sentinel Insurance Company 11000
6033 W. Century Blvd. 5th Fir
Los Angeles, CA 90045
INSURERO:Federal Insurance Company 20281
INSURER c:As en S ecial Insurance 10717
INSURER 0 -
INSURER E
1211412019
INSURER F:
PREMISES Me occurrence S 1,040,00
COVERAGES CERTIFICATE NUMBER: REVIRICIN 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.
{LTR
TYPE OF INSURANCE
POLICY NUMBER
NM700! Y1�/Y
PMlpprp
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE s 2,000,00
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS•MADE FRI OCCUR
X
72SBAAK0318
1211412019
1211412020
PREMISES Me occurrence S 1,040,00
MED EXP (Any one parson) S 10,00
PERSONAL A AOV INJURY S 2,000,00
GENERAL AGGREGATE S 4,000,00
[GEf'LAGGREGATELIMITAPPLIESPER:
PR, F LOC
PRODUCTS-COMPIOPAGG S 4,000,00POLICY
S
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT S 2,000,00
(Ea acodenl)
ANY AUTO
BODILY INJURY (Per person) S
ALL OWNED AUTOS
BODILY INJURY (Per accident) S
A
X
SCHEDULED AUTOS
HIREDAUTOS
72SBAAK031B
12/1412019
12/14/2020
PROPERTY DAMAGE
(PERACCIDENT) S
A
X
NON -OWNED AUTOS
72SBAAK0318
12/1412019
12/1412020
s
s
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UMBRELLA UAB
](
OCCUR
EACH OCCURRENCE S 4,000,000
AGGREGATE S 4,000,000
A
EXCESS WAS
CLAIMS -MADE
725BAAK0318
1211412019
1211412020
DEDUCTIBLE
S
S
X
RETENTION S 1(),000
B
WORKERS COMPENSATION
AND EMPLOYERS' I'AatLRYER
ANY PROPRIETORIPARTNERIEXECUTNE Y I N
OFFICEMWMBEREXCLUDED? �
IMandatary In NH)
Byes, describe udder
DESCRIPTION OF OPERATIONS below
NIA
7175-05-95
04/01/2019
0410112020
X I WCSTATU- OTH-
E.L.EACH ACCIDENT S 1,000,{10
E.L. DISEASE -EA EMPLOYE S 1,000,00
E.L. DISEASE • POLICY LIMIT S 1,000,00
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Professional Liab.
ILRA9AF81
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121101201911211
D12020 JPer
Claim 5,000,000
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
Certificate Holder is named as an Additional Insured in regards to attached
General Liability Form SS 00 08, per written contract or agreement.
CITYCAR
City of Carson
City Manager
701 E Carson St.
Carson, CA 90745
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION HATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORDED REPRESENTATIVE
®1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009109) The ACORD name and ]ago are registered marks of ACORD