HomeMy Public PortalAboutC-21-061 - DW3 SPA Juneteenth
City 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 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 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:Kenny Harris
(Event Coordinator’s Name)
2400 E.Dominguez St.Carson Ca.90810
(Enter Event Coordinator’s address (i.e.,city hall,corporate yard,or specific park address)
Email:kharris@carson.ca.us
(Enter event coordinator’s email address)
Should you have any questions,please feel free to contact the staff memberlisted below .
Truly,
Kenny Harris
(Name)
Recreation Center Supv.Il
(Title)
$32227.5 CFN AS OF 1-22-2020
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)
ee
n (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.
532227.5 CFN AS OF 1-22-2020
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SV ZA
(Date)
WDUse M oie Tee
(Company)
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(Company Address)
(2 2._M\orech 5 Ow Y2ST7 we
(City,State ZIP)
Insurance Aequirements
Dear DLo3 Mowe ime.
(Enter Davi S;Name)
Please be advised pursuant to your desire to work with the City of Carson,you are required tosubmitthefollowing:
~Compliant Certificates of Liability Insurance (to be maintained for the duration of servicesagainstclaimswhichmayarisefromorinconnectionwiththeservices),evidencing thecoverage(s)as indicated below.
Certificates of insurance,as well as additional insured and waiver of subrogationendorsementsinfavoroftheCity,must be submitted in their entirety before any servicesareprovidedortheeventtakesplace.Failure to submit such required forms shall be causeforCityofCarsontorejectorterminateanyserviceproviderapplicationagreement.
_The City of Carson reserves the right to modify these requirements based on the nature of the_"isk,prior events,insurance coverage,or other special requirements.
A SCOPE AND LIMIT OF INSURANCE
al Liability Insurance:Coverage shall be at least as broad as Insurance Services Form01coveringCGLonan“occurrence”basis,including property damage,bodily injuryonal&advertising injury with limits no less than $1,000,000 per occurrence and
1,
and
its elected and appointedofficials,employees,volunteers and agents,areadditionalinsuredswithrespecttoliabilityarisingoutoftheirworkororonbehalfoftheCity-sponsored event including materials,parts,or=ch on with theevent.
AS OF 1-22-2020
City of Carson
Community Services Department
Service Provider Application Agreement
Check one (staff use):
Carson Event Center|Human Services ||Recreation Transportation
Event:202!Junteenth Celebration 5.ot t ocation:Virtual Event Date:6/12/21
Name of Service Provider:DW3
Business Form/Entity Type (if general partnership,limited partnership,limited liability partnership,
or other,specify here):
Business Entity Stateof Incorporation (ifapplicabley;CA
type of service:Live Band Performance
Damon Reel Phone #:(562)“46-8740
B Phone #:(__)
Billing Address:1326 Clay St.
Redlands Ca 92374GiStateae
Proof of Insurance (check one)?Yes V'INo
If no,would you like to purchase special event insurance through the City (check one)?lves VINo
Special Instructions /Notes:DW3 will play one 30 min for the City of Carson's Juneteenth
Virtual Celebration.Group will arrive at designated venue(MixOne Sound)for taping on 6/12/2021.Time (TBD)
Band should arrive no later than one hour before start time for set up and level check.Please be advise
payment will be paid on day of event once band has completed its performance.Please Note:
532227.5 CFN AS OF 1-22-2020
Although Covid -19 restrictions continue to be lifted,we ask that all performers enlist the social distancing practices
by still wear a mask when not performing,proper spacing andlimiting those in attendance to essential Band Members.
$3000.00TotalServiceFee
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 ofpage intentionally left blank]
532227.5 CFN AS OF 1-22-2020
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,orliabilities arising from or in connection with Service Provider’s noncompliance with same.
The undersigned,on behalf of Service Provider,agrees that Service Provider seeks and is 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(wetsignature required;no electronic signatures):
SERVICE PROVIDER:DWws
—saz
oO}{SeetemareService Provider's AwtYerized Repfescatative)(Date)
yr Nok A Vets.
mied Name of Service Provider’s Authorized Representative)
(Space belowthis line for City use only)
_APPLICATION APPROVAL:
6/7/24ityManagerorDesignee)(Date)
_ASOF1-22-2020
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,includingall 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
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 appointedofficers,officials,employees and agents,forall
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
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 any of 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 employees of City,or that it is a member of 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 competent jurisdiction,such invalidity or unenforceability shall not affect any of
532227.5 CFN AS OF 1-22-2020
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
becomebinding 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: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 orinvitees.
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 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 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 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
event is officially over.Please note that these times are subject to change.
8.SAFETY:Standing on chairs,tables or other rental equipmentis prohibited.This equipmentis
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 AS OF 1-22-2020
9.VOLUME/LIGHT CONTROL:TheCity reserves the right to regulate the volumeorintensity
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 nameor 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:Event space is assigned to providers at 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 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 AS OF 1-22-2020
10
Waiver,Release,Hold Harmless,Agreement Not to Sue,Indemnification,and Photo Release
1,Damon Reel ;(“individual”)[on behalf of
DWS Ine.(“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 services
in/at City of Carson Juneteenth Virtual Celebration (“Event”)on Saturday,June 12th,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 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 agreedthat 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,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 ofthe
public visiting the Event,employees of the City,other service providers at the Event,or otherwise),occurring
____@,arising from,or connected with Signatory’s preparation or performanceof services at the Event,Signatory’s
__actions,inactions,or use offacilities at the Event,or any equipment,machinery or items displayed or used by
theSignatory at or for the Event,except for such claim,liability,loss,damage,expense,or cost which was
used by ie10 negligence or willful misconductof the City.
bom,I memoiedge and represent that I have read and understand the above,and thatI
rom W=-9
(Rev.October 2018)
Department of the TreasuryInternalRevenueService
Request for Taxpayer
identification Number and Certification
»Go to www.irs.gov/FormW9 for instructions and the latest information.
Give Form to the
requester.Do not
send to the IRS.
DW3 Music Inc
1 Name (as shown on your income tax return).Name is required on this line;do not feave this line blank.
2 Business name/disregarded entity name,if different from above
following seven boxes.
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):
4 Trust/estate
Exempt payee code (if any}
code (if any) (Apples to accounts maintained outside the US.)
Requester’s name and address (optional)
i)aGaS|(1 individuaisole proprietor or 44 Corporation []S Corporation [)Partnership
‘g single-member LLC
&Po Cc]Limited liability company.Enter the tax classification (C=C corporation,S=S corporation,P=Partnership)»
a2 Note:Check the appropriate box in the line above for the tax classification of the single-rmember owner.Do not check Exemption from FATCA reporting
= a LLCif the LLC is classified as a single-member LLC thatis disregarded from the owner unless the ownerof the LLC is
=&another LLC thatis not disregarded from the ownerfor U.S.federal tax purposes.Otherwise,a single-member LLC that
2 is disregarded from the owner should check the appropriate box for the tax classification of its owner.
3 [_]Other(see instructions)»
@ &Address (number,street,and apt.or suite no.)See instructions.
3 1326 Clay St
6 City,state,and ZIP code
Redlands Ca 92374 7 List account number(s)here (optional)
i 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 (GSN).However,for a
resident alien,sole proprietor,or disregarded entity,see the instructions for Part I,later.For other - ~
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 far line 1.Also see What Name and
NumberTo Give the Requester for guidelines on whose numberto enter.
|Social security number
clea 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.|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 |am subject to backup withholding as a result of a failure to report all interest or dividends,or (c)the [RS 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 FATCAreporting 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 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 dividends,you are not required to sign the certification,but you must provide your correct TIN.See the instructions for Part Il,later.
Sign Signature of tHereU.S.person > Datem 05/17/2021
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments.For the latest information about developments
related to Form W-9 andits instructions,such as legislation enacted
after they were published,go to www.irs.gov/FormW49.
Purpose of Form
An individual or entity (Form W-9 requester)who is 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 taxpayer identification number(ITIN),adoption
taxpayer identification 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 not limited 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)
«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 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)
_p..i SAC
(562)746-8740
dw3music@gqmail.com
INVOICE TO
City of Carson,Ca
QUANTITY DESCRIPTION UNIT PRICE LINE TOTAL
—(1)30min Performance Juneteenth Celebration (Virtual Show)$3,000.00 $3,000.00
Subtotal _$3,000.00
Sales Tax N/A
Total $3,000.00
From:Galoosian
To:Tim Grierson;Bobby Grove;Scott Griffee
Ce:KevinIbarra;Johnson
Subject:Special Event Insurance for Remote Online Events
Date:Tuesday,April 27,2021 8:09:47 PM
Hello CS team,
Over the last few days |met with our insurance broker and special event insurance underwriter and
received a quote for the online Cinco de Mayo event @ approx.$675 and can do the same for the
online Memorial Day event.
However,after |explained that these events are pre-recorded and edited for content,the
consensus was that the risks are already covered by the normal Cyber and General Liability policies.
|don’t recommend getting the event insurance for these.If you plan a live online event,we
probably should revisit the issue.
Thanks,
Roobik Galoosian
Risk Management
City of Carson
701 E.CarsonStreet
Carson,CA 90745