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HomeMy Public PortalAboutC-21-050 - MAXX PROMOSCity of Carson Community Services Department Service Provider Application Dear Applicant, Onbehalf of the City of Carson,I would like to thank you for taking the time to explore business opportunities with the City by applying to provide services for an event at a City facility.As part of our application process,you must complete,sign,and return the following forms.Submission of these forms does not guarantee that you will be provided the business opportunity you seek. Your prompt assistance in submitting the requested documentation to the City staff memberlisted below 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 18601 S.Main Street,Carson,CA 90248 Email:bgrove@carsonca.gov Should you have any questions,please feel free to contact the staff memberlisted below. Truly, Bobby Grove Recreation Program Manager 532227.5 CFN Checklist Before submitting your application packet makesure each of the below indicated items have been attached or completed. (FOR COMMUNITY SERVICES OFFICE USE ONLY) 4 Service Provider Application Agreement h Invoice for Future Event Date! __~_Business License (if applicable)Msn-pyphicable Proof of Insuy ance/Certificate of Insurance cn .Mot repre pee “et Mandgeon endsVie fuel|kuwd ~._Waiver,Release,Hold Harmless,Agreement Not to Sue,Indemnification,and Photo Release “Current Copy of W-9 Form (if not on file already) 1 The date of the Event shall be listed on the Invoice for Future Event Date (IFED).If the Service Provider Application is approved,then the IFED will be processed as an invoice for services rendered for the Event.No payment will be made until the conclusion of the Event,at earliest. 532227.5 CFN {Enter Date] [Enter Company Name] [Enter Company Address] {Enter City,State ZIP] Insurance Requirements Dear [Enter Provider’s Name]: Please be advised pursuant to your desire to work with the City of Carson,you are required to submit the following: ¥Compliant 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 are provided or the event takes 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 shail be at least as broad as Insurance Services Form CG 00 O01 covering CGL on an “occurrence”basis,including property damage,bodily injury and personal &advertising injury with limits no less than $1,000,000 per occurrence and $2,000,000 aggregate. Additional Insured Status The City of Carson,andits elected and appointedofficials,employees,volunteers and agents,are to be covered as additional insureds with respect to liability arising out of their work or operations performed at or on behalf of the City-sponsored event including materials,parts,or equipment furnished in connection with the event. 532227.5 CFN City of Carson Community Services Department Service Provider Application Agreement Check one (staff use): ____Carson Event Center_Human Services __Recreation__Transportation Philippine Independence Day Celebration Virtual &TV June 11,2021 Event:Event Location:Event Date: Nameof Service Provider :Maxx Promos Business Form/Entity Type (if individual,sole proprietorship,corporation,or limited liability company,specify here): Sole Proprietor Business Form/Entity Type (if general partnership,limited partnership,limited liability partnership, or other,specify here): Not Applicable Business Entity State of Incorporation (if applicable): Talent Procurement Type of Service: Contact Person;Maximino (Mutch)Carino Phone#:()81 8-621-8992 Emer.Contact.‘lice Gonzalez Phone#:()818-521-6009 22102 Normandie Avenue Billing Address: Number Street Torrance,California 90502 City State ZIP Proof of Insurance (circle one)?Yes & If no,would youlike to purchase special event insurance throughthe City (circle one)?Yes &® Special Instructions /Notes:This is a VIRTUAL and not a LIVE event. 532227.5 CEN 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 |of this application: Total Service Fee $1,950.00 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 ofpageintentionally left blank] 532227,.5 CFN 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 Provideris 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 andliabilities 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 anyof 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 employeesof City,or thatit is a memberof 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. In the event that part of this Agreement is declared invalid or unenforceable by a valid judgment or decree of a court of competentjurisdiction,such invalidity or unenforceability shall not affect any of 532227.5 CFN 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. 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. The undersigned,on behalf of Service Provider,agrees that Service Provider seeks andis willing 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. APPLICATION SUBMISSION(wet signature required;no electronic signatures): SERVICE PROVIDER:Maxx Promos Woe May 13,2021 Signature of Service Provider's Authorized Representative Date Maximino (Mutch)Carino Printed Nameof Service Provider’s Authorized Representative (space below this line for City use only) APPLICATION APPROVAL: CITY OF CARSON,slifo Signature of City Manager or Designee 532227.5 CFN Service Provider Rules &Regulations 1.SERVICE PROVIDER APPLICATION:Uponacceptance,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),includingits 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:TheCity is not responsible for any damageto,loss ortheft of the Provider’s property, or that of Provider’s agents,employeesor invitees. 5.CHARACTER OF ENTERTAINMENT:TheProvidershall observe,obey and comply withall 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 conductofall 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. 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 eventis officially over.Please note that these times are subject to change. 8.SAFETY:Standing on chairs,tables or other rental equipmentis 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.VOLUME/LIGHT CONTROL:The City reserves the right to regulate the volumeor intensity of any andall 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 ofthe 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 whois authorized to enforce these rules and regulations. 16.SPACE ASSIGNMENT:Eventspace is assigned to providersat 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:TheCity reserves the right to make reasonable changesto 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 10 Waiver,Release,Hold Harmless,Agreement Not to Sue, Indemnification,and Photo Release I Maximino (Mutch)Carino:;(“individual”)[on behalf of Maxx Promos (“Service Provider”),and as a bona fide agent of Service Provider duly 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 servicesin/at Philippine Independence Day Celebratignn)on June 11,2021 (“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 andall 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 andall 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 Agreementis 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 promotionof 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 rightto the intellectual property of Signatory’s Likeness.The rights granted by Signatory hereundershall 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 feesof 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,employeesof the City,other service providers at the Event,or otherwise),occurringat,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 I have read and understand the above,and that I voluntarily agree to its terms. Signed:h ae NAME:Maximino (Mutch)Carino ORGANIZATION:Maxx Promos May 13,2021Date: 532227.5 CFN MUTCH CARINO CLIENT PHONECITYOFCARSON (310)919-7223 ADDRESS CELL18601S.Main Street CITY STATE ziP FAX Carson,CA 90248 AUTHORIZED PERSON TITLE EMAIL Robert Lennox PHILIPPINE INDEPENDENCE DAY VIRTUAL CELEBRATION June 11,2021 5:30pm to 7:30pm LA18 with simulcast on YouTube and Facebook Talent Procurements Services for a 2-hour TV Special One Thousand Nine Hundred Fifty dollars ($1,950.00)$1,950.00 payable as follows: Down Payment of Nine Hundred Seventy Five dollars ($975.00) non-refundable security deposit upon approval $975.00 Balance Due of Nine Hundred Seventy Five dollars ($975.00) on or before June 11,2021 $975.00 Please make check payable to MAXX PROMOS 22102 Normandie Avenue «Torrance CA 90502 «(818)521-6009 »mutch1020@.com Form W-9 (Rev.October 2018) Department of the TreasuryinternalRevenueService Maxx Promos 2 Business name/disregarded entity name,if different from above Maxx Promos Request for Taxpayer identification Number and Certification »Go to www.irs.gov/FarmW¢for instructions and the latest information. 1 Name (as shown on your incometax return).Name is required on this line;do not leave this line blank. Give Form to the requester.Do not send to the IRS. following seven boxes. individual/sole proprietor or C]C Corporation single-member LLC Cl Other (see instructions)» Ol S Corporation im Limited liability company.Enter the tax classification (C=C corporation,S=S corporation,P=Partnership)> Note:Check the appropriate box in the line abovefor the tax classification of the single-member owner.Do not check Exemption from FATCA reporting LLCif the LLC is classified as a single-member LLC thatis disregarded from the owner unless the owner of the LLC is another LLCthat is not disregarded from the ownerfor U.S.federal tax purposes.Otherwise,a single-member LLCthat is disregarded from the owner should check the appropriate box for the tax classification ofits owner. 3 Check appropriate box for federal tax classification of the person whose nameis entered on line 1.Check only one of the 4 Exemptions (codes apply only to certain entities,not individuals;see instructions on page 3): i”Partnership C]Trust/estate Exempt payee code (if any) code(if any) fAppiies to accounts maintained outside the U.S.} 5 Address (number,street,and apt.or suite no.)See instructions. 22102 Normandie Avenue Pr i n t or t y p e S e e Sp e c i f i c In s t r u c t i o n s o n p a g e 3. Requester's name and address (optional) 6 City,state,and ZIP code Torrance CA $0502 7 List account number(s)here (optional) Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid backup withholding.For individuals,this Is generally your social security number (SSN).However,for a resident alien,sole proprietor,or disregarded entity,see the instructions for Part |,later.For other ~- entities,it is your ernployer identification number(EIN).If you do not have a number,see How to geta TIN,later. Note:If the account is in more than one name,see the instructions for line 1.Also see What Name and Number To Give the Requester for guidelines on whose number to enter. |Social security number cael Certification Under penalties of perjury,|certify that: 1.The number shown on this form is my correct taxpayeridentification number {or |am waiting for a number to be issued to me);and 2.1.am not subject to backup withholding because:(a)|am exempt from backup withholding,or (b)|have not been notified by the Internal Revenue Service (IRS)that lam subject to backup withholding as a result of a failure to report all interest or dividends,or (c)the IRS has notified me that |am no longer subject to backup withholding;and 3.lama U.S.citizen or other U.S.person (defined below);and 4.The FATCA code(s)entered on this form (if any)indicating that |am exempt from FATCAreportingis correct. Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you havefailed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgageinterest paid, acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement (IRA),and generally,payments other than interest and dividgnds,you are not required to sign the certification,but you must provide your correct TIN.See the instructions for Part Il,later. pate»May 13,2021 Hoe (8 oNHereUapersonA Ne General Instructions Section references are to the Internal Revenue Code uniess otherwise noted. Future developments.For the latest information about developments related to Form W-9 and its instructions,such as legislation enacted after they were published,go to www.irs.gov/FormW9. Purpose of Form An individual or entity (Form W-9 requester)whois required to file an information return with the IRS must obtain your correct taxpayer identification number(TIN)which may be your social security number (SSN),individual taxpayeridentification number (ITIN),adoption taxpayeridentification number (ATIN),or employer identification number (EIN),to report on an information return the amount paid to you,or other amount reportable on an information return.Examples of information returns include,but are notlimited to,the following. *Form 1099-INT (interest earned or paid) ¢Form 1099-DIV (dividends,including those from stocks or mutual funds) «Form 1099-MISC (various types of income,prizes,awards,or gross proceeds) ¢Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) e Form 1099-S (proceeds from real estate transactions) ¢Form 1099-K (merchant card and third party network transactions) *Form 1098 (home mortgageinterest),1098-E (student loan interest), 1098-T (tuition) ®Form 1098-C (canceled debt) *Form 1099-A (acquisition or abandonment of secured property} Use Form W-9 only if you are a U.S.person (including a resident alien),to provide your correct TIN. !f you do not return Farm W-9 to the requester with a TIN,you might be subject to backup withholding.See What is backup withholding, later. Cat.No.10231X Form W-9 (Rev.10-2018)