HomeMy Public PortalAboutC-21-110 - Loose Ends Contract (White Linen)
|CITY OF CARSON —INTERNAL CONTRACT ROUTING SLIP FOR CITY CLERK’S OFFICE USE ONLY
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ATTORNEY ASSIGNED:
CC/CSA/CPFA/CHA/CRA APPROVAL DATE:ITEM NO:N/A
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VENDOR NAMES EncnnMeters /CSERVICES/PRODUCT_Fetate toy mecoT
[_|certificate of Insurance attached [VY ]!nsurance Not Applicable
(must list reason):
[Approved by Risk Management
*If applicable,performance bonds have been reviewed and approved by
administrator's department.[]Yes |N/A
CHOOSE ONE FOR INTERNAL SIGNATURE PROCESSING:
[|Route for City Attorney>Mayor or Chair WITHOUT NOTARY>Clerk
[|Route for City Attorney>City Manager WITHOUT NOTARY>Clerk
|Route for City Attorney>Mayor or Chair WITH NOTARY>Clerk
|Route for City Attorney>City Manager WITH NOTARY>Clerk
|Other:
SPECIAL COMMENTS/INSTRUCTIONS/REQUESTS:
DocuSign Envelope ID:C612A02F-BEA6-4B83-8147-AC6C63E59327
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)
Corp Yard 18601 South Main Street.Carson,Ca.90248
(Enter Event Coordinator’s address (i.e.,city hall,corporate yard,or specific park address)
Email:kharris@carsonca.gov
(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)
532227.5 CFN AS OF 1-22-2020
DocuSign Envelope ID:C612A02F-BEA6-4B83-8147-AC6C63E59327
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)
X__Service Provider Application Agreement
_Invoice for Future Event Date’
Business License (if applicable)
X__Proof of Insurance/Certificate of Insurance
Xx Waiver,Release,Hold Harmless,Agreement Not to
Sue,Indemnification,and Photo Release
X 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.
532227.5 CFN AS OF 1-22-2020
DocuSign Envelope ID:C612A02F-BEA6-4B83-8147-AC6C63E59327
(Date)
(Company)
(Company Address)
(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:
v 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 Carsonreserves the right to modify these requirements based on the nature of the
risk,prior events,insurance coverage,or other special requirements.
MINIMUM SCOPE ANDLIMIT 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,andits 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 performed at or on behalf of the City-sponsored event including materials,parts,or
equipmentfurnished in conection with the event.
532227.5 CFN AS OF 1-22-2020
DocuSign Envelope ID:C612A02F-BEA6-4B83-8147-AC6C63E59327
City of Carson
Community Services Department
Service Provider Application Agreement
Check one (staff use):
[|Carson Event Center|_|Human Services Recreation [|Transportation
Event:Cajun and Blues White Linen Affair Event Location:‘GarsonCommunityCenterEventDate:09/10/2021
Name of Service Provider:Vane Eugene Peters/A.K.A Loose Ends Ft.Jane Eugene
Business Form/Entity Type (if individual,sole proprietorship,corporation,or limited liability
company,specify here):
Business Form/Entity Type (if general partnership,limited partnership,limited liability partnership,
or other,specify here):
Business Entity State of Incorporation (if applicable):
Type of Service:Live Music and Vocal Performance
Contact Person,David Lombard Phone #:(213)448-6402
Emer.Contact;Yane Eugene Peters prone g:(310-)738-8431
Billing Address:203 S.Beverly Drive
Beverly Hills Ca.90212GySateZip
Proof of Insurance (check one)?[_lves INo
If no,would you like to purchase special event insurance through the City (check one)?[_les VINo
Loose Ends Ft.Jane Eugene will perform a 1 hour Live music and Vocal Set for the City of Carson
Special Instructions /Notes:
"Cajun Blues and White Linen Affair"on Friday,September 10th,2021.Load In and Sound Check Times will be communicated one week
before or sooner than the scheduled date of the event.Dressing Room/Hoiding Area will be provided for 15 members of Group,Full Paymentwill be on the day of Event.
Please be advised that Masks must be worn by ALL that are in the Holding areas of the Group when off Stage,backstage,or side stage.
532227.5 CFN AS OF 1-22-2020
DocuSign Envelope ID:C612A02F-BEA6-4B883-8147-AC6C63E59327
There will be no exceptions.Due to the recent rise in Covid Cases,the City of Carson will continue to monitor and follow the direction of the CDC
and Los Angeles County and will communicate those directives to Loose Ends Ft.Jane Eugene as wegetcloser to the event date.
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:
$6500.00
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.
Total Service Fee
[remainder ofpage intentionally left blank]
532227.5 CFN AS OF 1-22-2020
DocuSign Envelope ID:C612A02F-BEA6-4B83-8147-AC6C63E59327
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
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 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 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 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 AS OF 1-22-2020
DocuSign Envelope ID:C612A02F-BEA6-4B83-8147-AC6C63E59327
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 warrantsthat 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 (wet signature required;no electronic signatures):
Loose Ends featuring Jane EugeneSERVICEPROVIDER:
DocuSigned by:
Doid Lombard 08/27/2021
CAIAACIT4Z9CBRES26
(Signature of Service Provider’s Authorized Representative)(Date)
David Lombard
(Printed Name of Service Provider’s Authorized Representative)
(Space belowthis line for City use only)
APPLICATION APPROVAL:
7 (Signature okey Manageror Designée}-<_(Date)
532227.5 CFN AS OF 1-22-2020
DocuSign Envelope ID:C612A02F-BEA6-4B83-8147-AC6C63E59327
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 betweenthe 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:The City 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: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 withoutnotice 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
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 AS OF 1-22-2020
DocuSign Envelope ID:C612A02F-BEA6-4B83-8 147-AC6C63E59327
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 judgmentof the City.
10.FLAMMABLE MATERIALS All decorations,props and electrical equipment must befireprooforoffireretardantmaterials,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 bylaw.Provider may be subject to legal action for the use,display or sale of any item using anycopyrightedand/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 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 to
enforce these rules and regulations.
16.SPACE ASSIGNMENT:Event space is assigned to providers at the sole discretion of theCity.Concerns regarding competitive or specific types of providers should be communicated to
the City at the time of application.
17.RULE CHANGES:The City 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 changeaffects a permit already issued to Provider.
532227.5 CFN AS OF 1-22-2020
DocuSign Envelope ID:C612A02F-BEA6-4B83-8147-AC6C63E59327
10
bsWaiver,nny Harmless,Agreement Not to Sue, Indemnification,and Photo Release
I,Jane Eugene Peters ;(“individual”)[on behalf of
Loose Ends Ft.Jane Eugene (“Service Provider”),and as a bonafide 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 Carson Community Center (“Event”)on 9/10/2021 (“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 andagainst 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
ofany 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 of the
public visiting the Event,employeesof the City,other service providers at the Event,or otherwise),occurring
at,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 misconductof the City.
By signing below,I acknowledge and represent that I have read and understand the above,and that I
voluntarilypegeee-tayits terms.
Dawid lombard
CATAAC TABOR ES 20Signed:
NAME:DPavi d Lombard
ORGANIZATION:[O°S®Ends featuring Jane Eugene
Date:08/27/2021
532227.5 CFN AS OF 1-22-2020
FROM:Loose Ends Productions Invoice Date
Jane Eugene Peters August 25,2021
Contact:David Lombard
213-448-6402
davidlombardmgt@aol.com
TO:City of Carson Recreation and Human Services Division
INVOICE
PAYMENT to be made out to JANE EUGENE PETERS for the Loose Ends featuring Jane Eugene
engagement at the Carson Community Center on September 10,2021.
Check to be made out to Jane Peters:$6,500
(CHECK due at Sound Check on September 10,2021)
Jane Peters or Loose Ends authorized representative will pick up payment from Kenneth Harris.
Loose Ends Productions:Los Angeles,CA