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HomeMy Public PortalAboutC-21-117 - Service Agreement - Virginia Carmelob x Cry ofCarson Community Services Departmen Service Provider Application Agreement Check ane (staff use): [|Carson Event Ceented)Human Services{_|Recreation [Transportation .Hispanic Mertage Month:Calebratian Fossa Park,Carson Oso BI?1kyentEventLocation:-_Event Dates Name of Service Provider:Xip e Totec Husiness Form/Entityfee inlividual,sole proprietorship,corporation,or limited Liabrlity company,specify her Sul€C Business Form/Entity Type(if general partnership,limtted parmership,limited ability parmership, or other,specify here: Business EnutyState ofIncorporation (if applicable} Type of Service:__Dweisret®Gof FAS dai \Cotte Mate Contact Person:Wes eyes ia Ca reMéle Phone 1 (29K Ie 70 Emer.Coniace _(!it lati Aru 7 Phone =CTH)Az 2 -A 2ee Billing Address:(1597 Gardenair&Lane Anahe iV (4 G20 Y . ee oT _ f ProofofInsurance (check anc)?lyes [AINO .“s .wal 'Hae,would you like to purchase special event insurance through the City (check one}?Yes 6 do Special Instructions /Notes:D200 for 20 minute ceremonial blessing. Estimated performance time is 12:20-12:40 p.m.(subject to change) EaPITT 8 OP AS OF 1222026 Sa a l If Service Provider wishes to request any special accommodation needed to fone provision ofthe services,please identify it her © Of Contact Ure stall member referenced on Page |of this application: $350TotalServiceFee| NOTE:lf 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. fremainder of page intentionatly leh blank} SA2227.5 CFA AS OF L.22 Bap 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 tprovide 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 Jaws,in connection with the services proposed to he provided.Service Provider shall indemnify,defend,and bold harmless the City against any penalties. claims,or Habiliiesarising fromor in connection with Service Provider's noncompliance with samme, The undersigned,on behalf of &vies-Provider,agrees that Service Provider secks and is willing to provide the above-referencedse }on thedate ane ume ofthe above-referenced event. Fhis Service Provider Application Agreement has been executed onthe dates written below -eclronic signatures): APPLICATION SUBMISSION (wet signature required:nc SERVICE PROVIDER:X pe Tatec.Dynzaiutes ABrCas¢;3 . 9 Ca vad ¢boa og acodheeheddtheLAAELO_7-¥-2eS/fue 8 i oewier’s Aanharvend Hegementewct Dens fooVifaqiata (arm elo. ateme of SincePr f Rayecucmiatees? CITY OF caneJe hyeratane at %ttarGeer ia Desegieed SELZLSS CPM AS GF 122 2a pe e r e e Waiver,Release,Hold Harmiex .Agreement Not te Sae,Indemmnifivativg,and Photo Release .:(Pralvidual®fon behalf of (fe Fetes Dengeaig 3 Service Provider"),and as a bonafide agent of Service Provider daly authonzedto execute this Waiver,Release,Hold Harmless Agreement Not to Sac and Indermmnific on behalf of Service Provider]¢Provider hereinafter “Signatory,”and the rerm “Signatory” :.agents and volunteers),seck acceptance by the City of Carsan of an application twoprovide serviocseniatheQosMeareCkyeaMjonF-[F-Quks |Date"), iiderstanc:that accwhents and mpgtigs cam arise out of the Event:knowing the risks,severtheless, Batt wividual and See collectively referred to as includes Servies Praweler’s officers,officials, etuple Sighstery t aed in consideration of the acceptance of an wpplication to provide a service at the Event ow de Doe, or damages for death.personal injury.o7 Signatory hereby waives,releases and discharges any and all clakns property damage which Signatory may have,or which hereafter aceruc to Slanatesry,agaist ine Cx Carson,tts elected and appointed officers,officnds,employees,agents and volunteers (collectively : and from and aguinst any and all Lebilicy arising out af o¢connected in sty way wit in or presence af the Event.even thoagh that lability may arise out of negli ¥ City,His further understood andagreed that this Agreement is to be binding on Signate Signatory Lily the nght i photograph or video-record Signstory daving ur in comection with the Event,ami to use si enaiory’s photesraphed or videu-recerded Ios and any image,silhoeeite,or reproduction of the voice or appearance of Signatory wken drine or in commection with dhe EventLikenessose,mchxding publicity and proemetion of City amd te events,amd creation or production of material:form for such purpose,with na claim ofentitlement to any Beense of any kind Grom Cro.tory batehy waives any nglt to the ovtellectual property of Signatory’s Likeness. The right.arar /Segnatory hereunder shall mot expire. fee or movalty wher agrees to idemmdy,defend and hold harmless Ciry front and agaist any a hes a,cxpenses,ad cosis Gnchalmg wihwet Lotation costs:and fees of every nature Gnckeding,but net limited to,property damage,bod sustained or alleged te be sustained by any person or onty (whether they be members of the public visting the Event.employers of the Cioy,other service providers at tee Eeors,or otherw We),COUT mg from,or conmected with Signatory’s preparation or performance of services at the Evert,Stenatory's achonsg,maclions,or use oftaeilities at the Event,or any catuipmient.machinery or items displayed of asad by the Signatory at or for the Event,¢excep for such clauw,labilins as causod by die sole negligence or willful misconduct of the Chey, /injury,or death),whethe a¢otherveis ato i which w By signing below,I ackaowledge and represent that |have read and understand the above,and that | voluntarily agree toits termes. % ak e “+Signed:_U/Asics[fintede uvNAME;Yi reinesa Carme le -—s Lane;ORGANIZATION.hide loler Dyan tants AgtecdsibasU-¥“9b G32237 4 CPN AS OF 122-2020