HomeMy Public PortalAboutC-20-020 - Montello Lisa Naa dba Nesian Management4
City of Carson
Community Services Department
Service Provider Application Agreement
Check one (staff use):
❑ Carson Event Center Human Services ❑ Recreation ❑ Transportation
Event:
Autism Awareness 5K RunNValk Event Location: CSUDH Event Date: 4/4/2020
Name of service Provider: Montello Lisa Naa (DBA-Nesian Management)
Business Form/Entity Type (if individual, sole proprietorship, corporation, or limited liability
company, specify here):
Individual
Business Form/Entity Type (if general partnership, limited partnership, limited liability partnership,
or other, specify here):
Business Entity State of Incorporation (if applicable). California
Type of Service: DJ LELA B:DJ Services, mixer, mic(s) at Autism Awareness 5K Run/Walk event
Contact Person: Montello Lisa Naa
Emer. Contact:
Billing Address:
3655
Phone #:3( n 766-2910
Phone #: ()
Torrance Blvd. Suite 300
Number Street
Torrance CA 90503
City State
Proof of Insurance (check one)? ❑Yes ✓❑No
ZIP
If no, would you like to purchase special event insurance through the City (check one)? ✓❑Yes []NO
Special Instructions / Notes:
532227.5 CFN AS OF 1-22-2020
5
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 I of this application:
Total Service Fee $ 5 5 0
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.
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532227.5 CFN AS OF 1-22-2020