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HomeMy Public PortalAboutC-21-052 - AUDIOTECH PRODUCTIONCity of Carson Community Services Department Service Provider Application Dear Applicant, 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 eventat 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 promptassistance in submitting the requested documentation to the City staff member listed 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 member listed below. Truly, Bobby Grove Recreation Program Manager 532227.5 CFN Checklist Before submitting your application packet makesure each of the below Sv an Vv ve \ indicated items have been attached or completed. (FOR COMMUNITY SERVICES OFFICE USE ONLY) Service Provider Application Agreement Invoice for Future Event Date! Business License (if applicable)V/A Proof of Insurance/Certificate of Insurance LNotcopmirtedperriskmonksemietVirtualBue Waiver,Release,Hold Harmless,Agreement Not to Sue,Indemnification,and Photo Release Current Copy of W-9 Form (if not on file already) !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. §32227.5 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 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 subrogationendorsementsinfavoroftheCity,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 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 appointed officials,employees,volunteers and agents,are to be covered as additional insureds with respect to liability arising out of their work or operations performedat or on behalf of the City-sponsored eventincluding materials,parts,or equipment furnished in connection with the event. 532227.5 CFN City of Carson Community Services Department Service Provider Agreement Check one (staff use): ___Carson Event Center___Human Services___Recreation___Transportation Event:PID FLAG RAISING Cererottivent Location:YETEIAWS PARKent Date:08/22/2/ Name of Service Provider:AUDIOTECH pRODUCTIOH Business Entity Type:OT /PA SERVICE jurisdiction: Type of Service:PA SERVICE Contact Person:ARTAY J (MENEC Phone #:(310)95 3 ~7 OS9 Emer.Contact:BNN JIMEHEZ Phone #:(42G)339-9200 Billing Address:)21221 SHEM2OS?AVE Number StreetANRSONOA TOTESCityZIPStateTaxLD./SSN#:_626-66-1740 Proof of Insurance (check box)[LA¥es []No Ifno,would youlike to purchase one day insurance through the City (check box)?[__]ves [_]No Special Instructions /Notes: Total Service Fee ¢L0 0° NOTE:If provider is unable to perform or cannot 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. The undersigned,on behalf of the above-referenced Service Provider,agrees that Service Provider seeks andis willing to provide the above-referenced service(s)for the City of Carson on the date and time of the above-referenced event. 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 thatit 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 Providershall 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. Further Terms of Agreement between Service Provider and City of Carson: The undersigned signatory of Service Provider (being the above-referenced person or entity seeking to provide services at the above-referenced event,including all its officer,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,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 Agreementas the Service Provider, then all obligations,liabilities,covenants and conditions under this Agreement shall be joint andseveral. This Service Provider Agreementis 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. In the eventthat part of this Agreement is declared invalid or unenforceable by a valid judgment or decree ofa 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 carry out the intent of the parties hereunder. [signatures on the following page] Service Provider Agreement -AS OF 4-18-19 Service Provider and City have executed this Agreementon the dates written below. SERVICE PROVIDER:PA/FILMING POSS os/ia/2iSignatureofServiceProvidersAuthbrizedRepresentativeDate ARTA JTIMENESPrintedNameofSthviceProvider's Authorized Representative CITY OF “NEO. 5Sfho/>/ “Signature of Cicy Manager or Designee Dats Service Provider Agreement -AS OF4-18-19 Service Provider Rules &Regulations 1.SERVICE PROVIDER APPLICATION:Upon acceptance of a service provider application by the City of Carson (‘‘City”),these rules and provisions shall become binding anda part of the Service Provider Agreement between the applicant (being the entity providing a specified service to City),including its officers employees and agents (“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 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:Norefunds 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 andtermsandconditionsgoverninguseofCityfacilities.The Provider will forfeit all rents or otherfeespaidifejectedfrompremisesforviolationsofsame.Ejection shall not release Providerfromanyobligationsforthepaymentofrentsorotherfeesnotyetpaidundersuchpermitoradditionallyincurred.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 tochangewithoutnoticetoProviderunlessthechangeaffectsapermitalreadyissuedtoProvider. Provider shall be solely responsible for the orderly conduct ofall persons using the premises byitsinvitation,either expressed or implied,during all times covered by the Service ProviderAgreement.The City reserves the right to eject or cause to be ejected from the premises anypersonorpersonsduetounlawfulconduct. 6.RESPONSIBILITY:The Provider shall provide all material,equipment,and personnelnecessaryforprovisionoftheservicedescribedinthisagreement. 7.MOVE-IN/MOVE-OUT:Move-in to the event area will be set for each venue.Unlessotherwisestated,Provider will be required to keep its area fully set up and manned until theeventisofficiallyover.Please note that these times are subject to change. 8.SAFETY:Standing on chairs,tables or other rental equipmentis prohibited.This equipmentisnotengineeredtosupportyourweight.The City of Carson,its employees,agents,or officers willnotberesponsibleforinjuriesorfallscausedbytheimproperuseoffurniture.Please assist inoureffortstoprovideaSAFEWORKINGENVIRONMENT. Service Provider Agreement -AS OF 4-18-19 9.VOLUME/LIGHT CONTROL:TheCity reserves the right to regulate the volume orintensity 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 judgmentof 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 Departmentregulations. 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 oractivity . 13.OBLIGATION FOR CLEANLINESS:Provider agrees that the facility and any othersurroundingCityproperty(including parking lots)used by the Provider must be left in a cleanandorderlycondition(equal to or better than the condition existing prior to the event).Ifadditionalmaintenanceisrequired,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 toenforcetheserulesandregulations. 16.SPACE ASSIGNMENT:Event space is assigned to providers at the sole discretion of theCity.Concems regarding competitive or specific types of providers should be communicatedtotheCityatthetimeofapplication. 17.RULE CHANGES:The City reserves the right to make reasonable changesto the foregoingrules,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. Service Provider Agreemunt ~AS OF 4-18-19 Waiver,Release,Hold Harmless,Agreement Not to Sue,Indemnification,and Photo Release 1 ARIAY TL MENEZ (“individual”)[on behalf of AUpLOT ECU v RODUCTICN (“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 avnlication to provide services ivat VETE RAH S PARK (“Event”)on O06/Zz/Zt (“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 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 thatliability 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 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 without limitation costs and fees of litigation)of every nature (including,butnot 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,employees of the City,other service providers at the Event,or otherwise),occurring at,arising from,or connected with Signatory’s preparation or performance ofservices 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 ofthe City. By signing below,I acknowledge and represent that I have read and understand the above,and that I voluntarily agree to its terms. x x Signed:hh NAMB:ARIPU T |MEHE C- ORGANIZATION:BUOIO TECH PRODUCT?on vae 05/18 /2) Service Provider Agreement ~AS OF 4-18-19 APR PDIGTECH INVOICE Arjay Jimenez DATE:05/17/21 21227 Shearer Ave INVOICE #:50921 Carson,Ca 90745 CUSTOMER ID: T:310.953.7059 E:djarjayL2@gmail.com BILL TO City of Carson 801 E.Carson St Carson,Ca 90745 T:310.952.1713 E:bgrove@carson.ca.us ele $1,000.00 DESCRIPTION Philipine Independence Day Flag Raising Cermony PA/Filming Services SUBTOTAL S 1,000.00 TAXABLE S - OTHER COMMENTS TAX RATE S - 1.Total payment due in 30 days TAX DUE S - 2.Please include the invoice number on your check OTHER S - TOTAL DUE $1,000.00 Make all checks payable to: AudioTech Production If you have any questions about this invoice,please contact Arjay Jimenez,P#:310.953.7059,E:djarjay12@gmail.com Thank You For Your Business! Form W-9 (Rev.October 2018) Departmentof the TreasuryInternalRevenueService ARJAY FERRER JIMENEZ 2 Business name/disregarded entity name,if different from above AUDIOTECH PRODUCTION Request for Taxpayer Identification Number and Certification »Go to www.irs.gov/FormW9for instructions and the latest information. 1 Name (as shown on your income tax retum).Name is required on this line;do not leave this line blank. Give Form to the requester.Do not send to the IRS. following seven boxes. Individual/sole proprietor or CI c corporation single-member LLC Pr i n t or ty p e . (C1 Other(seeinstructions)> Oo S$Corporation C1 Limited liability company.Enter the tax classification (C=C corporation,S=S corporation,P=Partnership) Note:Check the appropriate boxin 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 ownerof the LLC is another LLC that is not disregarded from the ownerfor U.S.federal tax purposes.Otherwise,a single~-member LLC that is disregarded from the owner should check the appropriate boxfor the tax classification of its owner. 3 Check appropriate box for federal tax classification of the person whose name is entered onfine 1.Check only one of the 4 Exemptions (codes apply only to certain entities,not individuals;see instructions on page 3): O Partnership Ol Trust/estate Exempt payee code (if any) code (if any) (Applies to accounts maintained autside the U.S.) §Address (number,street,and apt.or suite no.)See instructions. 21227 SHEARER AVES e e Sp e c i f i c In s t r u c t i o n s o n pa g e 3 . Requester’s name and address(optional) 6 City,state,and ZIP code CARSON CA 90745 7 List account number(s)here (optional) TaxpayerIdentification Number (TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given online 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 I,later.For other 6}2/6]-|;6/)6]-|7|7)4)0 entities,it is your employer identification number(EIN).If you do not have a number,see How to get a TIN,later. Note:If the account is in more than one name,see the instructions for line 1.Also see What Name and NumberTo Give the Requester for guidelines on whose number to enter. |Social security number | or [Employer identification number laa |Certification Under penalties of perjury,|certify that: 1.The number shown on this form is my correct taxpayer identification number (or |am waiting for a number to be issued to me);and 2.1am 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 |am 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.famaU-S.citizen or other U.S.person (defined below);and 4.The FATCA code(s)entered on this form (if any)indicating that |am exernpt from FATCA reporting is correct. Certification instructions.You must cross out item 2 aboveif you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report ail interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid, acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the instructions for Part ll,later. Sign Signature ofHereU.S.person > General Instructions Section referencesare to the Internal Revenue Code unless otherwise noted. Future developments.For the latest information about developments related to Form W-9 and its instructions,such aslegislation enacted after they were published,go to www.irs.gov/FormW9. Purpose of Form Anindividual or entity (Form W-9 requester)who is requiredto file an information return with the IRS must obtain your correct taxpayer identification number (TIN)which may be your social security number (SSN),individual taxpayer identification 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) oe S/in/at *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) «Form 1099-S (proceeds from real estate transactions) ¢Form 1099-K (merchant card and third party network transactions) *Form 1098 (home mortgage interest),1098-E (student loan interest), 4098-T(tuition) ¢Form 1099-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. If you do not return Form 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)