HomeMy Public PortalAboutC-21-051 - FILIPINO AMERICAN CHAMBER OF COMMERCE SOUTHBAY LOS ANGELES AREACity of Carson
Community Services Department DEl ir
Service Provider Application Make
Ne
On behalf 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:
Dear Applicant,
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
[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:
Y Compliant Certificates of Liability Insurance (to be maintained for the duration of services
against claims which mayarise 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 SCOPEAND 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 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,and its 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
Checklist
Before submitting your application packet make sure each of the below
indicated items have been attached or completed.
(FOR COMMUNITY SERVICES OFFICE USE ONLY)
VY Service Provider Application Agreement
_/Invoice for Future Event Date!
r lv1BusinessLicense(if applicable)“-‘*bush
we Prog!of Insurrynee/Ce ificate of Insurance /LverdNotreyvnjetePercre&monssement.LAtné
4 Waiver,Release,Hold Harmless,Agreement Not to
Sue,Indemnification,and Photo Release
a 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 paymentwill be made until
the conclusion of the Event,at earliest.
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:
Name of Service Provider :Filipino American Chamber of Commerce Southbay Los Angeles Area
Business Form/Entity Type (if individual,sole proprietorship,corporation,or limited liability
company,specify here):
Corporation
Business Form/Entity Type (if general partnership,limited partnership,limited liability partnership,
or other,specify here):
Not Applicable
Business Entity State of Incorporation (ifapplicable):California
Type of Service:Catifornia.|edia PreAnction (Vide./phae)
Janice Jimenez Phone #:()31 0-941-2736
Contact Person:
Emer.Contact:Maximino (Mutch)Carino Phone #:()818-521-6009
20100 Western Ave., Suite 200
Billing Address:
Number Street
Torrance,California 90501
City State ZIP
Proof of Insurance (circle one)?Yes
If no,would you like to purchase special event insurance through the City (circle one)?Yes &
Special Inamations Wate This is a VIRTUAL and not a LIVE event.
532227.5 CFN
If Service Provider wishes to request any special accommodation neededto facilitate provision of the
services,please identify it here or contact the staff member referenced on page |of this application:
Total Service Fee $4,875.00
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.
[remainderofpageintentionally 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 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
Agreementas 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 Providernor anyof its agents
or employees shall at any time or in any mannerrepresent that Service Provideror any of its agents or
employees are agents or employees of City,or that it is a memberof a joint enterprise with City.Subject
to the requirements of this Service Provider Application Agreement,neither the City nor anyof its
employees shall have any control over the manner,mode or means by which Service Provider,its
agents or employees,performthe services set forth herein.
In the event that part of this Agreementis 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
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):
_Filipino American Chamber of Commerce Southbay Los Angeles Area
May 13,2021
GSpsine of Service Provider’s Authorized Representative Date
Janice Jimenez
Printed Nameof Service Provider’s Authorized Representative
(space below thisline for City use only)
APPLICATION APPROVAL:
CITY OF CARSON RL.../t /
Signature of City Manageror Designee ¢Datd :
532227.5 CFN
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:TheCity is not responsible for any damageto,loss or theft
of the Provider’s property,or that of Provider’s agents,employees or invitees.
5.CHARACTER OF ENTERTAINMENT:TheProvider shall 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.
Thepolicies,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.
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 eventarea 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 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:Eventspace is assigned to providers at the sole discretion of the City.
Concerns regarding competitive or specific types of providers should be communicatedto the City
at the time of application.
17.RULE CHANGES:TheCity 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
10
Waiver,Release,Hold Harmless,Agreement Not to Sue,Indemnification,and Photo Release
__danice Jimenez (“individual”)[on behalf of
Filipino American Chamber of Commerce SgaithkaydaeAngsdas AbBaa 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 Celebratigany)on June 11,2021 (“Date”).
Signatory understands that accidentsand 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 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 orin connection with the Event (“Likeness”),
for any purpose,including publicity and promotion of City andits 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 hereundershall not expire.
Signatory further agrees to indemnify,defend and hold harmless City from and against any andall 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 membersof 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.
Signed:
NAME-(Janice Jimenez
ORGANIZATION Filipino American Chamber of Commerce Southbay Los Angeles Area
Date.May 13,2021
532227.5 CFN
X HolefleMAXXule
MUTCH CARINO
CLIENT PHONECITYOFCARSON (310)919-7223
ADDRESS CELL18601S.Main Street
CITY STATE ZIP FAX
Carson,CA 90248
AUTHORIZED PERSON TITLE EMAIL
Robert Lennox
INVOICE
PHILIPPINE INDEPENDENCE DAY VIRTUAL CELEBRATION
June 11,2021 5:30pm to 7:30pm
LA18 with simulcast on YouTube and Facebook
Production Services for a 2-hour TV Special
Four Thousand Eight Hundred Seventty Five dollars ($4,875.00)$4,875.00
payable as follows:
Down Payment of two thousand four hundred thirty seven dollars
and fifty cents ($2,437.50)non-refundable security deposit
upon approval and/or signing of the agreement $2,437.50
Balance Due of two thousand four hundred thirty seven dollars
and fifty cents ($2,437.50)due on or before June 11,2021 $2,437.50
Please make check payable to
Filipino American Chamber of Commerce Southbay Los Angeles Area
20100 Western Avenue ¢Suite 200 °Torrance CA 90501 °(310)941-2736 ¢spotlight.tv.faccslaa@gmail.com