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HomeMy Public PortalAboutC-20-040 - Rockin Blues Entertainment Funding Agreement, Cultural Arts GrantCITY OF CARSON HUMAN SERVICES DEPARTMENT CULTURAL ARTS FUNDING AGREEMENT CONTRACTOR Rockin Blues Entertainment FED TAX ID # ADDRESS CITY 714-784-7486 E-MAIL PERSON Donaldo Reed Carson ST CA ZIP 90745 PHONE 310-251-5948 FAX This Cultural Arts Funding Agreement (herein "Agreement") is made and entered into by the City of Carson (the "City") and Rockin Blues Entertainment (the "Contractor"). The Term of this Agreement commences on January 1, 2020. Unless terminated as provided in this Agreement, the Term shall expire on completion of Project Close -Out as described below, which shall not exceed December 31, 2020. THE PARTIES HERETO AGREE AS FOLLOWS: SECTION 1— DUTIES AND RESPONSIBILITIES OF THE CONTRACTOR: A. In exchange for funding from the City of Carson's Cultural Arts Program. Grant ("Grant Funds"), the Contractor shall: 1. Be a Carson -based artist or local community organization; 2. Provide Carson residents with arts, dance, drama, or music programs; 3. Provide programs in the City of Carson; and 4. Provide programs during the time period for which funding is provided. B. Contractor's service includes: Rockin Blues Entertainment will use this Grant to bring the Carson Community together through the art of music and dancing. Developing the community hidden talents by offering free Voice and Dancing lessons and participation in our events. We will teach the art of stage presence, expression when performing, microphone techniques bringing confidence in those that lack public speaking confidence. C. Contractor shall not discriminate against any person or group of persons on account of race, color, creed, religion, sex, gender, sexual orientation, marital status, national origin, ancestry, or other protected class in the performance of this Agreement. Contractor shall take affirmative action to ensure that applicants are employed and that employees are treated during employment without regard to their race, color, creed, religion, sex, gender, sexual orientation, marital status, national origin, ancestry, or other protected class. Contractor agrees that membership in its organization and participation in its activities shall not be restricted based upon race, color, 01007.00011533351.4 creed, religion, sex, marital status, national origin, ancestry, age, physical or mental handicap, medical condition, or sexual orientation except as otherwise permitted by law. Evidence of discrimination shall be cause for immediate termination of this Agreement and Contractor's full repayment of Grant Funds, regardless of whether Contractor has already expended said Funds. D. Contractor at all times agrees to make every effort to recruit Carson residents for membership. Participation roster listing the name, city of residence, and if applicable, the school of attendance of the participants for each production shall be filed with the Human Services Department. E. Contractor shall make every effort to utilize Carson vendors for goods and services, including, but not limited to, supplies, printing, equipment, and rentals. F. Contractor shall coordinate its own activities, including sole responsibility for bookings and tours, purchasing, conducting auditions and rehearsals, selecting casts, and arranging all scheduled performances. G. Contractor shall not have free use of City resources (buses, equipment, and/or facilities). All use of the Community Center and other City facilities will be on a paid permit basis. H. Contractor shall not use the City's address or any City facility addresses as the Contractor's business address. Contractor shall maintain its own business address. I. If the Contractor is a faith -based organization, the programs for which the Contractor uses the Grant Funds shall: 1. Be exclusively non -religious in nature and scope; 2. Not be used for religious services, proselytizing, or activities to convert, instruction, or any other religious influences in connection with the cultural services; and 3. Not discriminate or exclude program participants based on religion. J• Contractor shall be solely responsible for observing and complying with all local, State, and Federal laws and regulations. Contractor shall obtain licenses, permits, and approvals required for the performance of its obligations pursuant to this Agreement. Contractor agrees to maintain in good standing a business license issued by the City during the term of this Agreement, if required by the Carson Municipal Code. K. Contractor shall publicize the City at each function by: 1. Acknowledging that funding was made available to Contractor upon the recommendation of the "Cultural Arts Commission" and approval of the "Carson City Council." 2. Distributing publications and literature about the Contractor and the City. Publications shall not be distributed unless they conform to the following guidelines: (a) The heading of the publication must always read, "The City of Carson Cultural Arts Commission Presents." All other pertinent City information must be included. (b) Contractor shall create and submit the draft of any publication/flyer to the Human Services Department prior to printing and distribution. If necessary, publications will be returned to the Contractor for revisions. Corrected publication shall be resubmitted to the Human Services Department for final approval. 01007.00011533361.4 2 (c) After reviewing the publications for completeness and accuracy, the Human Services Department will forward same to the Director of Community Services (or designee), who will then approve all publications in writing before going to print. L. Contractor is solely responsible for all costs associated with the publication and printing of literature (including flyers, programs, and invitations). M. Contractor shall participate in at least one City -sponsored event at no cost to the City. N. Contractor shall obtain written approval from the Director of Community Services prior to using Grant Funds to participate in events that are not City -sponsored or City -affiliated. O. Project Close -Out: Contractor's obligations to the City shall not end until all close-out requirements are completed. Activities during this close-out period shall include, but are not limited to: submission of final reports and supporting documents, returning unused Grant Funds, repaying Fund amounts that the Human Services Supervisor has deemed inappropriately expended, and submittal of participant information and publicity materials. Project Close -Out shall not extend beyond December 31, 2020. Failure to close out may disqualify the Contractor from subsequent grant awards. SECTION 2 — PAYMENT PROCEDURES AND REPORTING REQUIREMENTS A. Contractor is eligible for Grant Funds in the amount of ten thousand dollars ($ 10,000). B. Schedule of Disbursements and Reporting Requirements: The schedule below presents anticipated disbursement dates. Report dates are not, however, subject to change unless the parties amend this Agreement to modify the schedule. January 1, 2020 Anticipated Disbursement of $5,000 April 15, 2020 Deadline for Report on expenditure of Grant Funds from January 1 through March 31, 2020 May 15, 2020 Anticipated Disbursement of $21500 Deadline for Report on expenditure of Grant Funds through July August 15, 2020 31, 2020 September 1, 2020 Anticipated Disbursement of $2,500 November 1, 2020 Deadline for Report on expenditure of Grant Funds through October 15, 2020. December 31, Deadline for Project Close -Out, including returning unused funds 2020 or funds inappropriately expended C. Disbursement Conditions: 1. The Contractor shall attend a financial reporting training. 01007.0001/533361.4 3 2. Three (3) weeks prior to the first anticipated disbursement date, the Contractor shall submit, for the Human Services Supervisor's review and approval, a proposed budget for the use of Grant Funds. The Contractor shall not receive Grant Funds unless the Human Services Department has approved the Contractor's budget. The budget should be prepared as a line item budget. The budget must be in a format prescribed by the City. It shall be detailed and must provide specific sums for such items as salaries, fringe benefits, sets, rentals, musical scores, orchestration, publicity, props, costumes, printing, insurance, transportation, make-up, band and all other expenses. Income statements shall identify gross revenues, donations, interest income, and any other income sources. 3. The Contractor shall use a separate bank account for using Grant Funds, and shall provide the City with proof of a separate account by producing documents such as an account statement from the bank. D. Use of Funds 1. Funds may only be expended in accordance with a budget approved by the Human Services Supervisor. 2. All City -funded performances, concerts, or other programming shall be offered at no cost to the participants/attendees. E. Reporting Requirements 1. Reports shall include an Income and Expense Statement in the form provided by the City. 2. The report shall supporting documentation, such as receipts, invoices, and any other documents necessary to verify that the Contractor used the funds in a manner consistent with this Agreement and consistent with the Income and Expense Statement. 3. If the Contractor used Grant Funds to purchase goods, the Contractor shall also submit an Inventory Report, along with supporting documentation as described above. 4. Reports shall also include copies of all publicity materials that mention the City of Carson as a result of programs, services, and events supported by the Grant Funds. 5. Failure to submit reports and all required supporting documentation by the deadlines in the schedule above may result in delays in, or eligibility for, subsequent disbursements. 6. The final report (November 1 report) shall, along with financial information required above, provide detailed descriptions of what services and programs the Contractor provided to Carson residents. F. Grant Funds disbursed to the Contractor but not expended by the Contractor by October 15, 2020, as indicated by required reports, or otherwise unaccounted for by the Contractor, shall be returned to the City. G. Contractor is subject to an audit by the City's Accounting Division to ensure compliance with this Agreement. H. Contractor shall comply with the Funding Implementation Manual. In the event of any conflict between this Agreement and the Funding Implementation Manual, this Agreement shall govern. 01007.0001/533361.4 4 SECTION 3 — INDEPENDENT CONTRACTORANDEMNITY A. Contractor is, and shall at all times remain to City, as a wholly independent contractor. Contractor shall have no power to incur any debt, obligation, or liability on behalf of City or otherwise act on behalf of City as an agent. Neither City nor any of its agents shall have control over the conduct of Contractor or any of Contractor's employees. Contractor shall not, at any time, or in any manner, represent that it or any of its agents or employees are in any manner employees of the City or that any programs conducted by the Contractor are official City programs. B. To the full extent permitted by law, Contractor agrees to indemnify, defend and hold harmless the City, its officers, employees and agents ("Indemnified Parties") against, and will hold and save them and each of them harmless from, any and all actions, either judicial, administrative, arbitration or regulatory claims, damages to persons or property, losses, costs, penalties, obligations, errors, omissions or liabilities whether actual or threatened (herein "claims or liabilities") that may be asserted or claimed by any person, firm or entity arising out of or in connection with the negligent performance of the work, operations or activities provided herein of Contractor, its officers, employees, agents, subcontractors, invitees, or any individual or entity for which Contractor is legally liable ("indemnitors"), or arising from Contractor's or indemnitors' reckless or willful misconduct, or arising from Contractor's or indemnitors' negligent performance of or failure to perform any term, provision, covenant or condition of this Agreement, except claims or liabilities occurring as a result of City's sole negligence or willful acts or omissions. The indemnity obligation shall be binding on successors and assigns of Contractor and shall survive termination of this Agreement. SECTION 4 — TERMINATION This Agreement may be terminated by either party, with or without cause, upon 30 days written notice. Upon termination as provided hereunder, Contractor shall return unused Grant Funds, and repay any Fund amounts that the Human Services Supervisor has deems inappropriately expended. SECTION S — INSURANCE REQUIREMENTS A. The Contractor shall procure and maintain, at its sole cost and expense, in a form and content satisfactory to City, during the entire term of this Agreement including any extension thereof, the following policies of insurance which shall cover all elected and appointed officers, employees and agents of City: 1. Comprehensive General Liability Insurance (Occurrence Form CG0001 or equivalent). A policy of comprehensive general liability insurance written on a per occurrence basis for bodily injury, personal injury and property damage. The policy of insurance shall be in an amount not less than $500,000.00 per occurrence or if a general aggregate limit is used, either the general aggregate limit shall apply separately to this contract/location, or the general aggregate limit shall be twice the occurrence limit. 2. Comprehensive Automobile Liability Insurance (Form CA 0001 (Ed 1/87) including "any auto" and endorsement CA 0025 or equivalent. A policy of comprehensive automobile liability insurance written on a per occurrence for bodily injury and property damage in an 01007.0001/533361.4 5 amount not less than either (i) bodily injury liability limits of $100,000 per person and $300,000 per occurrence and property damage liability limits of $50,000 per occurrence or (ii) combined single limit liability of $1,000,000. Said policy shall include coverage for owned, non -owned, leased, hired cars, and any other automobile. 3. Worker's Compensation Insurance. A policy of worker's compensation insurance in such amount as will fully comply with the laws of the State of California and which shall indemnify, insure and provide legal defense for the Contractor against any loss, claim or damage arising from any injuries or occupational diseases occurring to any worker employed by or any persons retained by the Contractor in the course of carrying out the work or services contemplated in this Agreement. B. Subcontractors. Contractor shall include all subcontractors as insureds under its policies or shall furnish separate certificates and certified endorsements for each subcontractor. All coverages for subcontractors shall be subject to all of the requirements stated herein. C. Such insurance shall name the City of Carson, its officers, employees, agents, elected officials, members of boards or commissions, and volunteers as additional insured parties. Coverage must include the provisions prescribed by the City. D. Contractor shall file and maintain the required endorsements and certificates of insurance with the Risk Management Division of the City at all times during the term of this Agreement. The endorsements and certificates are to be filed prior to the commencement of work and should state clearly: 1. The additional insured requested. 2. Insurance is to be primary to that of the additional insured. 3. Cross liability clause. 4. The insurance afforded to the additional insured shall apply as primary insurance and no other insurance maintained by the additional insured will be called upon to contribute with the insurance provided by the Contractor. E. Any notice of change or cancellation of insurance must be provided thirty days prior to the change or cancellation to: The City of Carson Risk Management Division P.O. Box 6234 Carson, CA 90749 F. General Insurance Requirements. All of the above policies of insurance shall be primary insurance and shall name the City, its elected and appointed officers, employees and agents as additional insureds and any insurance maintained by City or its officers, employees or agents may apply in excess of, and not contribute with Contractor's insurance. The insurer is deemed hereof to waive all rights of subrogation and contribution it may have against the City, its officers, employees and agents and their respective insurers. The insurance policy must specify 01007.0001/533361.4 6 that where the primary insured does not satisfy the self-insured retention, any additional insured may satisfy the self-insured retention. All of said policies of insurance shall provide that said insurance may not be amended or cancelled by the insurer or any party hereto without providing thirty (30) days prior written notice by certified mail return receipt requested to the City. In the event any of said policies of insurance are cancelled, the Contractor shall, prior to the cancellation date, submit new evidence of insurance in conformance with this Section 5.1 to the Contract Officer. No work or services under this Agreement shall commence until the Contractor has provided the City with Certificates of Insurance, additional insured endorsement forms or appropriate insurance binders evidencing the above insurance coverages and said Certificates of Insurance or binders are approved by the City. City reserves the right to inspect complete, certified copies of and endorsement to all required insurance policies at any time. Any failure to comply with the reporting or other provisions of the policies including breaches or warranties shall not affect coverage provided to City. The insurance required by this Agreement shall be satisfactory only if issued by companies qualified to do business in California, rated "A" or better in the most recent edition of Best Rating Guide, The Key Rating Guide or in the Federal Register, and only if they are of a financial category Class VII or better, unless such requirements are waived by the City's Risk Manager or other designee of the City due to unique circumstances. [Signatures on the following page.] 01007.0001/533361A 7 The City and Contractor execute this Agreement and warrant that the person executing this Agreement on behalf of each party is duly authorized to execute this Agreement and formally bind the Contractor this Agreement. APPROVED AS TO FORM: ALESHIRE & WYNDER, LLP CITY OF Mayor Sunny K. Soltani, City Attorney CONTRACTOR:** *** Byq/&�a Name: 7)DNAIr/76 AEF6 Title: Dwr1/EA� By: Name: Title: Address: ** CONTRACTOR'S SIGNATURES SHALL BE DULY NOTARIZED, AND APPROPRIATE ATTESTATIONS SHALL BE INCLUDED AS MAY BE REQUIRED BY THE BYLAWS, ARTICLES OF INCORPORATION, OR OTHER RULES OR REGULATIONS APPLICABLE TO CONTRACTOR'S BUSINESS ENTITY. ***Two corporate officer signatures required when Contractor is a corporation, with one signature required from each of the following groups: 1) Chairman of the Board, President or any Vice President; and 2) Secretary, any Assistant Secretary, Chief Financial Officer or any Assistant Treasurer. 01007.0001/533361.4 The City and Contractor execute this Agreement and warrant that the person executing this Agreement on behalf of each party is duly authorized to execute this Agreement and formally bind the Contractor this Agreement. ATTEST: Donesia Gause-Aldana, City Clerk APPROVED AS TO FORM: ALESHIRE & WYNDER, LLP '_5 ✓ Sunny K. Soltani, City Attorney CITY OF CARSON Albert Robles, Mayor CONTRACTOR:** *** M Name: V6AJAL,/,?D R6ro Title: U` uwA)6K_ Name: Title: ** CONTRACTOR'S SIGNATURES SHALL BE DULY NOTARIZED, AND APPROPRIATE ATTESTATIONS SHALL BE INCLUDED AS MAY BE REQUIRED BY THE BYLAWS, ARTICLES OF INCORPORATION, OR OTHER RULES OR REGULATIONS APPLICABLE TO CONTRACTOR'S BUSINESS ENTITY. ***Two corporate officer signatures required when Contractor is a corporation, with one signature required from each of the following groups: 1) Chairman of the Board, President or any Vice President; and 2) Secretary, any Assistant Secretary, Chief Financial Officer or any Assistant Treasurer. 01007.00Dtl533361.4 CALIFORNIA ACKNOWLEDGMENT CIVIL CODE § 1189 7r, public or other officer completing this certificate verifies only the identity of the individual who signed the document this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California 1 County of LOS On before me, f11m�2\' �QYQC �CtihYElt)S �d�QY� albll� Date I Here Insert Name and itle of the dfficer personally appeared Nomepo of who proved to me on the basis of satisfactory evidence to be the person,4 whose namepris/v6 subscribed to the within instrument and acknowledged to me that he/S>6/txy executed the same in his/her/tgetr authorized capacity and that by his/h/ttnerrsignature(sron the instrument the persono, or the entity upon behalf of which the perso#acted, executed the instrument. AMBER LARAE KERIAKOUS Notary Public - California Los Angeles County _ Commission N 2311155 MY Comm. Expires Nov 1, 2021 Place Notary Seal and/or Stamp Above I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature S ature o otory Public yr I Ivilwa. Completing this information can deter alteration of the document or fraudulent reattachment of this form to on unintended document. Description of Attached Title or Type of Docu�mennt-utivl sl t t II I I Document Date: `'�f-XX NumberofPages:Ck Signer(s) Other Than Named Above: ��f,ludtAk is Capacity(les) Claimed by Signers) Signer's Name:Mn ��ab C,Cf�' aUj ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: ©2018 National Notary Association Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator m rlThor Signer is Representing: Iire, ACC?RbP CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDDNVYY) 1 17C W20 19 East Main Street Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Will Maddux HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PO Box 1298 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Grass Valley, CA 95945 Phone: (530) 477-6521 Email: info@theeventhelper.com INSURERS AFFORDING COVERAGE NAIC # INsvRED Rockin Slues Entenairanent INSURER A: Evanston Insurance Company 35378 Donaldo Reed INSURER e'. Carson, CA INSURER C: INSURER 0: INSURER E: LICIES CF INSURANCE LISTED BELOW HAVE BEEN ISSl1ED TO THE INSURED NAM@D ABOVE POR THE POLICY PERIOD INDICEQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR ERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH k ES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICYNUMBER POLICYEFFECTVE DATE MWDD POLICYEXPIRATIONLIMITS DATE MMIODIYV GENERALLMBILrrY EACH OCCURRENCE Wauoss $ 1,000,000 BOeILY WIVPYtPPOPEPIYGAMFGE A Y GENERAL LIABILITY 3DS0`465-M'I0735524 SEE BELS:. _'`rE 3EL`CA` MED EXP (Any no person) 5,000 ]!COMMERCIAL CLAIMS MAGE ® OCCUR _$ PERSONAL 6 ADV INJURY S 1,000_000 GENERAL AGGREGATE $ 2,000,000 X Most Liquor Liability 31DS5466-M7073524 SEE BEL& „EE BELCIVb GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMPIOP AGG $ 1,009,000 X POLICY F-1JECCT LOC DEDUCTIBLE $ 1,000 I Retail Liquor Liability $ AUTOMOBILE LIABILITY ANY A(IrO COMBINED SINGLE LIMIT (Ea GocidcM) $ BODILY INJURY (Perpamm) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per.n.no $ HIRED AUTOS NON-0WNEIAUTOS PROPERTY DAMAGE $ (PerGaldsnQ GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $ OTHER 79AN EAACC $ ANYAUTO AUTO ONLY: AGG $ EXCE5S/UMBRELLA LIABILITY EACH OCCURRENCE It OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE It $ RETENTION $ WORKERS COMPENSATION AND WC O - TORY LIMITS ER LI EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ MY PROPRIETORNARTNER/EXEC11nVE E.L. DISEASE - EA EMPLOYE 5 OFFICER/MEMBER EXCLUDED? Ityes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Certificate holder listed below is named as additional insured per attached CG 20 26 07 04 EFF 12/30/2019 — 12/30/2020: Note: The Ciity of Carson,its officers,employees,agents,elected officials,members of boards, and volunteers as additional insured parties." City of Carson 801 E Carson St Carson, CA 90745 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. QEO REVXESENINIIVt Policy Number: 3DS5466-M1073524 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 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 Persons Or Organization(s) City of Carson 801 E Carson St Carson, CA 90745 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- ctude as an additional insured the persons) or organi- zation(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 omis- sions 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. CG 20 26 07 04 © ISO Properties, Inc., 2004 'r Page 1 of 1 ❑ t T �.^ iti'fbtJ�c{ �� ®� CERTIFICATE OF LIABILITY INSURANCE 3-t3-01DATE 12130/2019 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 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). PRoauceR AUTO CLUB SERVICES, LLC '- 3333 Fairview Rd A451 Costa Mesa, CA 92626- CONTACT NAME: AOOONNo est; FAX NP: AOR S: MSU 1 APPORDMG COVERAGE NAICI INSURER A: InSNIy Select Irromonco Company 20280 ulsuRED DONALD REED CARSON, CA 90745 INBURERB: f116URERa INSURER D: INsuRER e: INSURER P: COVERAGES CERTIFICATE NUMBER- REVISIUN 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. MSR LTR TYPE OFINSURANCE ADDL I SUER 4WD POUCYNUWMI"t POLICY EFF SAm POLICY EPP IND LIM98 ❑ COMIF C LGENENAL AS CLAIMS -MADE LJ OCCUR ❑ ❑ Commercial Agency Sales EACH OCCURRENCE DAMAGE TO RENTEO PREMISES mminar,aa MED EXP (Any one arson s _ PERSONAL A ADV INJURY OENL AGGREGATE LIMIT APPLIES PER: �I- POLICY ❑JECT El LOG 'OTHER: GENERAL AGOREGATE s PRODUCTS -COMPlOP Alto B s AUTOMOBILE UARVATYAUTOMOBIUI IAW AUTO �OWJEGFV78CHCOULED AUTOS ONLY AUTOS AUTOS ONLY AUTOS NOel,OONLY . ❑ SOI.81013306e-001 1213012018 12IiD2020 COMBINED )SINGLE BODILY INJURY or roan S 150 0. BODILYINJURY mead .t'M'M. R RIYDAM G ereaoWsnt s �r�• S UMBRELLA LIAR EXCESS LUIS HOCCUR CLAtMS-MADE EACH OCCURRENCE S AGGREGATE S iDED RETENTIONS S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YM ANY PROPRIEfORIPARTNERIEfELU1NE ❑ OFFItMWEMBEREXCLUDED? IMandatmyln NX1 (II yyaa, de=`ba under j DESGRPTION OF OPERATIONS below NUI E.L. EACH ACCIDENT EL DISEASE -EA EMPLOYEE S E.L. OISEAEE-POUCY LEGIT I I DESCRIPTION OF OPERATIONS/ LOCATIONS) VEHICLES(ACOROINN. Additional Remarks Schedule. bn ettaPRp�.fF.lOArB-aWaa kcaaubndl Note: The Ciity of Carson,its officers,employees,agents,elected officials,members of boards, and volunteers as additional Insured parties." r:aN(:FI I aT1ON r.crc nre..n c - ---- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Carson AUTHORREOREPREBENTATNS 701 Carson St Mindy Koo Carson, Ca 90745 Commercial Agency Sales ®1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD KEMPER Auto 111102: Customer Service: 800-722-3391 infinity Commercial Auto 11700 Great Oaks Way, Suite 450 Alpharetta, GA 30022 Underwritten by: WAIVER OF SUBROGATION CALIFORNIA insurance Company Claims Service: 800-334-1661 Copy To Policy ID Number Expiration Date ROCKIN BLUES ENT. 504-61013-3066-001 1213012020 12:01 AM 1145 E Renton St Named Insured Carson, CA 90745 Reed, Donaldo This endorsement is attached to and forms a part of the listed policy. No changes will be effective prior to the time changes are requested. In return for your premium payment shown below, we agree that our rights of subrogation or rights of recovery under the policy will not apply against the following person or organization: City of Carson 701 Carson St Carson, Ca 90745 Additional premium in the amount of $26.00 will be retained by us regardless of any early termination of this endorsement or the policy. All other policy provisions remain unchanged. 50461SWF01 Amenc uate: uonar/u/u r Customer Service: (800) 722-3391 Infinity Commercial Auto 11700 Great Oaks Way, Suite 450 Alpharetta, GA 30022 Underwritten by: Infinity Select Insurance Company Claims Service: (800) 3341661 ADDITIONAL NAMED INSURED ENDORSEMENT copy To Policy ID Number Expiration Date 504-61013-3066-001 12/30/2020 12:01 a.m. Donaldo Reed dba ROCKIN BLUES ENT Named Insured Carson, CA 90745- 530 Reed, Donaldo This endorsement is attached to and forms a part of the listed policy. No changes will be effective prior to the time changes are requested. Additional Insured City of Carson 701 Carson St, Carson Ca 90745 The City of Carson, its officers, employees, agents, elected officials, member's of boards and volunteers as additional insured parties. Part A — Liability Coverage, is changed as follows: The definition of insured is changed to include the additional insured named above. Adding an insured will not increase the limit of our liability. The insurance provided by this endorsement will be excess over any other valid and collectible insurance. All other parts of this Policy remain unchanged. INSURED COPY AMEND DATE: 03113/2020 50461AIS01 ENDORSEMENT: 1-5 ACC->�� n fi DATE 121=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, EY.TEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BET16JEEM 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 have ADDITIONAL INSURED provisions or be andorsad. if SUBROGATION IS WAIVED; suNect to the terms and conditions of the r ellcy, DerFain Policies may+ rel"he an endorsement. A statement on this carf�ficats does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER AUTO CLUB SERVICES, LLC 3333 Fairview Rd A451 Costa Mesa, CAMRR$g CONTACT NAME: PHONE r-. m: PAI No rrtttt--- ❑OCCUR INSURSRISt AFPOROINO COVERAGe NAICF, 92626- i INSURERA! IrrnitY$ded inwmRw 00ftVMY 25ZfiE INIeURED DONALDO REED INSURER In DAA OE TO RENTED INSURER IX INSURER D.--- CARSON, CA 90745 INauReR E: INSURrR P: NUMBER' THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 114DCATED. NOTWITHSTANDING ANY REQUiREME10, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH 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. EJSR L TYFE 0FIPJSURAh10E ADOL IMSD SUER WVD POUGYNUMBEit , POLICYSPF =iQOjYVYY POLICY OF MWO I LIMITS AUTHORIZED REPRESENTATNE rrtttt--- ❑OCCUR El BD1 E Carson St i Gerson, CA 90745 Commercial Agency Sales EACH OCCURRENCE DAA OE TO RENTED LoMCLAPA5WAOE H ! PREMISES ffa rnxumanwL r MEOEY.P az PERSONAL&ADV&AOV INJURI` 5 GENERAL AGGREGATE GENL AGGREGATE LNMT APPLIES PER: 1 PRODUCTS-COMPIOPAGG 9 (—I PRO, r I I POLICY LJ JECT i LOC ^GTI;ER� I i 4 r1 iA AUFOFWe1LE iSASM.nYfaUTU'F.OEVS ANY AUTO OWNED nAOHEOULED I)C FOW ONLY !uu,'AUN-O AUTOS ONLY iim AUTOS ONLDY 0 ❑ I 504.610133066A0t 1213012019 I 12136f2020 COPIRINED SING—LETIM-IT accido S _ SO=INJURY OPW mann $ 150,009• eOOiLY INJURY (Pere ocidem} _^ g t,OS0,000. —� P ERTY DAMAGE I.iPWeAcfden ' I6 501000. $ .UMMLA LOAM IOCCUR EACH OCCURI`.ENCE AGGREGATE II _ sxcEgsLIAS 1j,CLAW94AADE I 'DED I )RETEKTIONS S I WORRERSGOUPENSATION I STFTUTE AND EMPLOY ES' LIAVU—if YIN ! i I —_ ANYPROPRIETO..WARTNER09CU(NE I—I EL. EACH ACCIDENT S 010ERh5EB®CIFEXCLUOM? I_I FllA I -- E.L. At4yAnMatasyiMNF}1 I I E.L. DISEASE -FA EMPLOYEE 5 _ IDESCRIPTIOG OP OPERATIONS Imbm � � � E.L. DI5EA9E •POLICY L&MT 8 _ I OSSCRIPTYOIJ OP OFERATIOIJBlLOCATItliJ$lYEIfiCLES 1ACORD 451, Add,Sorml Remarlts 5ebntluln,maybe ®[gecired ir,rtatemaCe is Yer6de6lil Note: The Cilty of CErson,its officiais,members of boards, and volunteers as additional insured parties." j nr_m PAMf.FI I QFirlat ®1988-2018 ACORD CORPORATION. AD rights reserved. ACORD 2z paha/63} The ACORD nine and Pogo are regisiered rnarlis Dr Ak;O Z SHOULD ANY OF THE ABOVE DESCRIBED POLICIES Be CANCELLED BEFORE THE RRPFRATFON 041 a THEREOF, 0. fnrli WILL BE DEFISVERED IN A:CCORDARCE UJiTH THE POLICY PROVISION& AUTHORIZED REPRESENTATNE City of Cama, Mindy Kon BD1 E Carson St i Gerson, CA 90745 Commercial Agency Sales ®1988-2018 ACORD CORPORATION. AD rights reserved. ACORD 2z paha/63} The ACORD nine and Pogo are regisiered rnarlis Dr Ak;O Z � -1 - 11700 Creat Oaks Way, Suite 450 Alpharetta, CA 30022 underwritten By, infinity Select 1"Bura"Ce Company TeI,srpava[y GE;-muvomcs WwVfilumda t Golfe, mAic Etc. 20,260 California 504-61013-3060-001 Agency: AUTO CLUB SERVICES, LLC Insumd (La6Ez::: DONALDO REED Address: 3333 FaWaty Rd A451 DE -A: ROCKIN SLICES Costa Mesa, CA 92626 CARSON, CA 90746 Agency Humbev: 8884162402 (( qq,, ([pp, ;i(56E°afial� Data: 1213€12020 12:01 This earl is applicable with respect to the fallowing Motor Vahicle(s): uEli Fc.r...d 1n�IODELVEhftGLi; iF3EtfYiFlcdt€$ii�1 Nl1EUIB F'2017 Sia VOU MAVE AN ACGREN7 M0 EE IFY POLOCE. _ Utfrite dotmn Starnes, addresses, te(uphone numbers, and license numbers ar parsons involved and of witnesses. 2. i'�atify Wintry (nsurance Companies promptly. 3, Do iZol admit fault. Do not discuss the accident vuith anyone e}crept infinity or the Po€ice. REPORT ALL ACCIDENTS, REGARDLESS OF FAULT, TO: 1-SGD-334-1661 SHOW THIS CARD TO THE REQUESTING PEACE OFFICER WHEN ASKED TO PROVIDE EVIDENCE OF FINANCIAL RESPONSIBILITY. KERP THIS CGPV WITH YOU 5€745 1DCO i I WAiVER AND RELEASE OF LIA-BUTY IN CONSIDERATION OF the risk of injury that exists while participating InCULTURAL ARTS EVENTS (hereinafter the "Activity"); and IN CONSIDERATION OF my desire to participate in said Activity and being given the right to partUcipate in same; HEREBY, fT myself, my heirs, executors, administrators, assigns, or personal representatives (hereinafter collectively, "Releasor," "I" or "me", which terms shall also include Releasor's parents or guardian if Releasor is under 18 years of age), knowingly and voluntarily enter into this WAIVER AND RELEASE OF LIABILITY ITV andhereby waive any and all rights, rlaimg nr raiises of action of any kind arising out of my participation in the Activity; and I HEREBY release and forever discharge CITY OF CARSON, located at 701 E Carson St, Carson, California 90745, their affiliates, managers, members, agents, attorneys, staff, volunteers; heirs, representatives, predecessors, successors and assigns (collectively "Releasees"), from any physical or psychological injury that I may suffer as a direct result of my participation in the aforementioned Activity. I AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I AM PARTICIPATING IN THE ACTIVITY ENTIRELY AT MY OWN RISK. I AM AWARE OF THE RISKS ASSOCIATED WITH PARTICIPATING IN THIS ACTIVITY, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO: PHYSICAL OR PSYCHOLOGICAL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL LOSS, AND DEAT H. I UNDERSTAND T HAT THESE INJURIES OR OUTCOMES MAY ARISE FROM MY OWN OR OTHERS' NEGLIGENCE, CONDITIONS RELATED TO TRAVEL TO AND FROM THE ACTIVITY, OR FROM CONDITIONS AT THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED RISKS, BOTH KNOWN AND UNKNOWN TO ME, OF MY PARTICIPATION IN THIS ACTIVITY. I FURTHER AGREE to indemnify, defend and hold harmless the Releasees against any and all eiaims, suits or actions of any kind whatsoever for liability, damages, cornpensd`Cwun or otherVvise brought by me or anyone on my behalf, including attorney's fees and any related costs. I FURTHER ACKNOWLEDGE that ReloagceW aura not rasnnnsible for errors, omissions, arts or .. failures to act of any parry or entity conducting a specific event or activity on behalf of Releasees. in t1l 4 e event tI6.IQt ! JiIUUjd rC.Li1C InCU1'.Q1 la1C UI tl Caan11Cj a, 1 authorize City of Carson to prVVl G all emergency medical care deemed necessary, including but not limited to, first aid, CPR, the use of AEDs, emergency medical transport, and sharing of medical information with medical nersonnel. I further agree to assume all costs involved and agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my n health Insurance. t I FURTHER ACKNOWLEDGE that this Activity may involve a test of a person's physical and mental limits and may carry with it the potential for death, serious injury, and property loss. I agree not to participate in the Activity unless I am medically able and properly trained, and I agree to abide by the decision of the City of Carson official or agent, regarding my approval to participate in the Activity. . I HEREBY ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS "WAIVER AND RELEASE" AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE City of CarsonAND ALL OF ITS AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST City of Carson FOR PERSONAL INJURY OR PROPERTY DAMAGE. To the extent that statute or case law does not prohibit releases for ordinary negligence, this release is also for such negligence on the part of City of Carson, its agents, and employees. I agree that this Release shall be governed for all purposes byCalifornia law, without regard to any conflict of law principles. This Release supersedes any and all previous oral or written promises or other agreements. In the event that any damage to equipment or facilities occurs as a result of my or my family's or my agent's willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any such actions of neglect or recklessness. THIS WAIVER AND RELEASE OF LIABILITY SHALL REMAIN IN EFFECT FOR THE DURATION OF MY PARTICIPATION IN THE ACTIVITY, DURING THIS INITIAL AND ALL SUBSEQUENT EVENTS OF PARTICIPATION. THIS AGREEMENT was entered into at arm's-length, without duress or coercion, and is to be interpreted as an agreement between two parties of equal bargaining strength. Both Donaldo C. Reed and City of Carson agree that this agreement is clear and unambiguous as to its terms, and that no other evidence shall be used or admitted to alter or explain the terms of this agreement, but that it will be interpreted based on the language in accordance with the purposes for which it is entered into. In the event that any provision contained within this Release of Liability shall be deemed to be severable or invalid, or if any term, condition, phrase or portion of this agreement shall be determined to be unlawful or otherwise unenforceable, the remainder of this agreement shall remain in full force and effect. If a court should find that any provision of this agreement to be invalid or unenforceable, but that by limiting said provision it would become valid and enforceable, then said provision shall be deemed to be written, construed and enforced as so limited. In the event of an emergency please contact the following person(s) in the order presented: Emergency Contact Norma Robles Contact Relationship Wife Contact Telephone 310-251-5948 I, THE UNDERSIGNED PARTICIPANT, AFFIRM THAT I AM OF THE AGE OF 18 YEARS OR OLDER, AND THAT I AM FREELY SIGNING THIS AGREEMENT. I CERTIFY THAT I HAVE READ THIS AGREEMENT, THAT I FULLY UNDERSTAND ITS CONTENT AND THAT THIS RELEASE CANNOT BE MODIFIED ORALLY. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND THAT I AM SIGNING IT OF MY OWN FREE WILL. I have read this entire Release. I fully understand the entire Release and acknowledge that 1 have had the opportunity to review this Release with an attorney of my choosing if I so desire, and I agree to be legally bound by the Release. THIS IS A RELEASE OF YOUR RIGHTS. READ CAREFULLY AND UNDERSTAND BEFORE SIGNING. (Signature) Donaldo C. Reed 1145 E Renton St, Carson California 90745 (D e) 01 T AdNFINITY pnflnKly 9, LAG 11700 Great Oaks Way, Suite 451) Alpharetta, GA 30022 une'emeriften By: Infinity Select Insurance Company California Raiicy Nuinber: 504-61013-3066-001 Agency: AUTO GLUE SERVICES, LLC Insured Mame: DONALD REED Address: 3333 Fairvieku Rd A451 DBA: ROCIUN BLUES Costa Mesa, CA 92526 Address: CARSON, CA 9074.5 Agency Dumber: 8884162402 Effecilve Date: 121Mi2019 Exparatilon late: Q13012020 12:01 This card is applicable Mth respect to the fellovving Motor Vehicles): SEE, YE IL^,�tCE MODEL VEHICLE 1DFoiTiricATiow NEIC4iam-, I I 2UJ7 I CHEVROLET I EXPRC$S 03.5106 LT �MIIIIII1123056 3 �i= YOU C AVE Ail A,MDEDIT M OT'EFY PQLCE. 1, Write down names, addresses, telephorte numbers, and license numbers of persons invo€bed and of wfinesses. 2. Notify Infinity Insurance Companies promptly. 3. Do not admit fault. Do not discuss the accident with anyone except Infinity or the Police. REPORT ALL ACCIDENITS, REGARDLESS OF FAULT, TO: 1-800-334-1661 SHOW THIS CARD TO THE REQUESTING PEACE OFFICER WHEN ASKED TO PROVIDE EVIDENCE OF FINANCIAL RESPONSIBILITY. KEEP This COCA' VATH YOU 50461iDCD1 t