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HomeMy Public PortalAboutC-21-141 - ARDYANNA DUCUSIN - LARRY ITLIONG - SPA CITY OF CARSON —INTERNAL CONTRACT ROUTING SLIP All fields are required to be completely filled out.If not applicable,enter N/A. FROM:JOSE EMMANUEL TINGSON EXT.310-830-9991 DEPT:_CS/RECREATION ATTORNEY ASSIGNED:N/A DOCUMENT TYPE:Service PROVIDER N/A APPROVALDATE:N/A ITEMNO:N/A VENDOR NAME:ARDYANNA DUCUSIN SERVICES/PRODUCT:ENTERTAINMENT TERM OF CONTRACT:10/21/2021 tHroucH 10/24/2021 AMOUNT OF CONTRACT:N/A SINGLE-SIDED DOCUMENT?[XIYES PAGE COUNT: PRE-APPROVAL/PRE-CITY SIGNATURES CHECKLIST : ASSISTING STAFF Se cee ACTION REQUIRED ee ~COMPLETION(INITIALS) DIRECTOR Confirm approval to proceed.=e.De CONTRACT OFFICER Confirm funds are budgeted and/or available. CONTRACT OFFICER Preparation of specifications. This includes coordinating with Risk Management on the Insurance/Bond requireme PURCHASING Advertise bids,compliance with bid requirements;including posting on City’s website.N/A *RFP/RFQ mustinclude form contract. PURCHASING OR Evaluate bids/proposals and determine recommended bidder(s).N/A CONTRACT OFFICER ;‘ CONTRACT OFFICER Complete contract negotiations/finalize contract (including attachments)with City N/A &CITY ATTORNEY Attorney's Office. CONTRACT OFFICER Present appropriate contract form to the recommended vendor.©Vy *Verify correct agencytitles/corps.are listed.(ie:City Council-Mayor vs.CRA-Chairman) CONTRACT OFFICER Verify compliance with business license requirements,‘obtain3.original signatures of N/A vendor,and request W-9 (oncereceived,submit w-9 to purchasing). *Signatures must be notarized for every original*.s CONTRACT OFFICER Verify corporate status,state of Incorporation and Principles.N/A &RISK MANAGEMENT CONTRACT OFFICER Request insurance documents for approvalwith Risk Management for ail contracts. Verify approval of insurance requirements with Risk Management. *Communication through e-mail is preferred.Please provide the written agreement,certificate of E42 insurance as well as all endorsernent forms, CONTRACT OFFICER Provide W-9 to Purchasing oh.Agenda Thursday if contract is on the upcoming agenda. *Non-Council items:provi ti Purchasing on date submitted to City Clerk’s Office.i? PURCHASING OR Present Departmen ndation to legislative body to award/approve contract,if N/A CONTRACT OFFICER applicable. POST-APPROVAL/POST-VENDOR SIGNATURES CHECKLIST _ CONTRACT OFFICER Collect’and assembleinsurance (Initialed by Risk Management),*Certificate of Insurance with endorse ment must be attached to be processed;even on amendments*D CONTRACT OFFICER N/A CONTRACT OFFIGER 4 Ti N/A |ing. **Note any special services needed,including all prior Contracts,Amendments or Awards. CITY CLERK |Verify approval/routing slip completion;obtain signatures:City Attorney,City official,and N/A City Clerk. CITY CLERK Provides electronic copy and 1 original of executed contract to Contract Officer,City Clerk’s N/A Office retains 1 original and enters into Laserfiche PUBLIC WORKS Tyler Entry and Release for City Clerk approval N/A CITY CLERK Tyler approval;email staff upon completion N/A CONTRACT OFFICER Create a requisition in Tyler for Purchasing to issue a Purchase Order.Lf &PURCHASING *Vendor is not to proceed with work until the Purchase Order is approved. CONTRACT OFFICER Provide Notice to Proceed to vendor.N/A CONTRACT OFFICER Tickler contract expiration and insurance expiration N/A FINANCE Process contract purchase order and provide copies to department.N/A CONTRACT OFFICER Process progress payments.D CONTRACT OFFICER Process contract completion forms.N/A *Notice of Completion to City Clerk’s Office CHOOSE ONE FOR INTERNAL SIGNATURE PROCESSING: LJ Route for City Attorney>Mayor or Chair WITHOUT NOTARY?>Clerk L]Route for City Attorney>City Manager WITHOUT NOTARY>Clerk (]Route for City Attorney>Mayor or Chair WITH NOTARY>Clerk C]Route for City Attorney>City Manager WITH NOTARY>Clerk XJ Other:INPUTIN TYLER SPECIAL COMMENTS/INSTRUCTIONS/REQUESTS: SHIN)aHoiauasv1 [_] SIVILIND ‘ONJOWYINOD STVILINI dD ois-isodl_]—ois-3ud L_] AINO 4SfF}ADIdAO S$NYITD ALID YO4 AINO 3Sf)331ddO S$NYATD ALID YO4 AINO 3SQ)SADIAYSS TVWHLN3)HO4 Before submitting your application packet make sure each of the below indicated items have been attached or completed. (FOR COMMUNITYSERVICES OFFICE USE ONLY) K”Service Provider Application Agreement %Invoice for Future Event Date! N/K Business License (if applicable) Ve Proof of Insurance/Certificate of Insurance %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 fisted on the Invoice for Future Event Date (iFED}.If the Service Provider Application is approved,then the JFEO 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 (Date) (Company) (Company Address) (City,State ZIP) Insurance Requirements Dear Ardyanna Ducusin (Enter Provider’s Name) Please be advised pursuant to your desire to work with the City of Carson,you are required tosubmitthefollowing: v 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 fo submit such required forms shall be causeforCityofCarsontorejectorterminateanyserviceproviderapplicationagreement. 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 FormCG00O01coveringCGLonan“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,areiobecoveredasadditionalinsuredswithrespecttoliabilityarisingoutoftheirworkoroperationsperformedatoronbehalfoftheCity-sponsored event including materials,parts,or equipment furnished in connection with the event. 532227.5 CFN 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:Larry Itliong Event Location:Veterans Park 5.0 ato.10/23/21 Ardyanna Ducusin Name of Service Provider: Business Form/Entity Type (if individual,sole proprietorship,corporation,or limited liabilitycompany,specify here): Individual Business Form/Entity Type (if general partnership,limited partnership,limited liability partnership,or other,specify here): N/A N/ABusinessEntityStateofIncorporation(if applicable): Entertainment Type ofService: Richelle Domingo 882-0844ContactPerson:Phone #:(310 )Richelle Domingo 882-0844Emer.Contact:Phone #:(310 J 1179 E 223RD St. Billing Address: Number StreetCarson,CA 90745 City State ZIP Proofof Insurance (check one)?[les [V]No Ifno,would you like to purchase special event insurance through the City (check one)?[lves [VINoThisisforindividualperformer Special Instructions /Notes: City of Carson wll provide insurance, 532227.5 CFN AS OF 1-22-2020 If Service Provider wishes to request any special accommodation needed to facilitate provision oftheservices,please identify it here or contact the staff member referenced on Page 1 of this application: Total Service Fee $150.00 NOTE:If service provideris unable to provide the services as proposed or requested orthe City of Carson cancels the service for any reason,the associatedfees will not be paid. [remainder ofpage intentionallyleft blank] 532227.5 CFN AS OF 1-22-2020 + Further Terms of Service Provider Application Agreement: The undersigned signatory of Service Provider (Service Provider being the above-referenced person orentity 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,”whichare 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 whicharise 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 hereundershall be joint and several, This Service Provider Application Agreement,unless and until accepted,approved,and executed by the City Managerordesignee,is only an application for provision of services to City,and does not constitute an approval orauthorization for Service Provider to perform or provide any service to City. Neither Service Providernorany of its agents or employees shall be deemed agents or employees of the City,nor a memberof a joint enterprise with the City.Neither Service Provider nor any of its agents or employees shall at any time or in any mannerrepresent that Service Provider or any of its agents or employees are agents or employees of City,orthat 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,performthe 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 the remaining portions of this Agreement which are hereby declared as severable and shall be interpreted to carryout 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 withall 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,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 onthe dates written below. APPLICATION SUBMISSION (wet signature required;no electronic signatures): Ardyanna Ducusin SERVICE PROVIDER: ;10/23/2021RucholleDomansroforArclyannaDucucin(Signature of Seryfee Provider's Authorizedepresentative)(Date) Richelle Dominan for Ardyanna Duasin (Printed Name of SeWice Provider's Authorized Representative) (Space belowthis line for City use only) APPLICATION APPROVAL: CITY OF CARSO (Signature of City Manager or Designee)(Date) 532227.5 CFN AS OF 1-22-2020 Service Provider Rules &Regulations 1,SERVICE PROVIDER APPLICATION:Uponacceptance,approval,and execution of aserviceproviderapplicationbytheCityofCarson(“City”),these rules and provisions shallbecomebindingandapartoftheServiceProviderApplicationAgreementbetweentheapplicant(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 theCity,on the other hand.Any additions and amendments thereto that may be established or putintoeffectbytheCity,and provided in writing to the Provider,shall also become binding and apartoftheServiceProviderApplicationAgreement. 2,PAYMENT/CANCELLATION:If the Provider is unable to perform or cannot provide theservicesasrequested,or the City cancels the service for any reason,the associated fees forservicewillnotbepaid. 3,CANCELLATION:No refunds will be given unless the subject event is cancelled by theCity’s Community Services Department.Applications may be denied or events cancelled infavorofCityprograms. 4.PROPERTY LOSS OR DAMAGES:The City is not responsible for any damageto,loss ortheftoftheProvider’s property,or that of Provider’s agents,employees orinvitees. 5.CHARACTER OF ENTERTAINMENT:The Provider shall observe,obey and comply withallapplicablelocal,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 Providershall at all times cooperate to this end. The policies,rules,regulations and conditions governing use of City facilities are subject tochangewithoutnoticetoProviderunlessthechangeaffectsapermitalreadyissuedtoProvider. Providershall be solely responsible for the orderly conduct of all persons using the premises byitsinvitation,either expressed or implied,during all times covered by the Service ProviderApplicationAgreement.The City reserves the right to eject or cause to be ejected from thepremisesanypersonorpersonsduetounlawfulconduct. 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 onchairs,tables or other rental equipment is prohibited.This equipment isnotengineeredtosupportyourweight.The City of Carson,its employees,agents,orofficers willnotberesponsibleforinjuriesorfallscausedbytheimproperuseoffurniture.Please assist inoureffortstoprovideaSAFEWORKINGENVIRONMENT, 532227.5 CFN AS OF 1-22-2020 9.VOLUME/LIGHT CONTROL:The City reserves the right to regulate the volume orintensityofanyandallnoiseorlightgeneratingmechanisms(including,but not limited to,loudspeakers,radios,television sets,musical instruments,entertainers,or blinking or flashing lights)in thereasonablejudgmentoftheCity. 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 thisagreement;subject to Fire Department regulations. 11,COPYRIGHT INFORMATION:Provider is responsible for licensing fees as required bylaw.Provider may be subject to legal action forthe use,display or sale of any item using anycopyrightedand/or trademarked name or logo which has not been specifically authorized underlicensefromthetrademarkholder. 12.PERMITS AND LICENSE:Provider shall procure at its own cost and expense all therequiredlicensesandpermitsapplicabletoProvider’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 bechargedadditionalfeesbasedonthecostofsuchmaintenance. 14,DISPUTES:All points not covered by the Service Provider Rules &Regulations are subjecttothedecisionoftheappropriateCityrepresentative. 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.Concerns regarding competitive or specific types of providers should be communicated totheCityatthetimeofapplication. 17.RULE CHANGES:The City reserves the right to make reasonable changes to 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. 932227.5 CFN AS OF 1-22-2020 Waiver,Release,Hold Harmless,Agreement Not to Sue,Indemnification,and Photo Release 1,Richelle Domingo ,(“individual”)[on behalf ofArdyannaDucusin(“Service Provider”),and as a bona fide agent of Service ProviderdulyauthorizedtoexecutethisWaiver,Release,Hold Harmless,Agreement Not to Sue and Indemnificationagreement(“Agreement”)on behalf of Service Provider](individual and Service Provider hereinaftercollectivelyreferredtoas“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 Larry Itong (“Event”)on October 23,2021 (“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,orpropertydamagewhichSignatorymayhave,or which hereafter accrue to Signatory,against the City ofCarson,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 participationinorpresenceattheEvent,even thoughthatliability may arise out of negligence or carelessness on the part ofCity.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 withtheEvent,and to use Signatory’s photographed or video-recorded likeness,and any image,silhouette,orreproductionofthevoiceorappearanceofSignatorytakenduringorinconnectionwiththeEvent(“Likeness”),for any purpose,including publicity and promotion of City and its events,and creation orproductionofmaterialsinanyformforsuchpurpose,with no claim of entitlement to any license fee or royaltyofanykindfromCity.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 and all claims,liabilities,losses,damages,expenses,and costs (including without limitation costs and fees of litigation)ofeverynature(including,but not limited to,property damage,bodily injury,or death),whether imposed by laworotherwise,sustained or alleged to be sustained by any personor entity (whether they be members of thepublicvisitingtheEvent,employees of 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’sactions,inactions,oruse 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 wascausedbythesolenegligenceorwillfulmisconductoftheCity. By signing below,I acknowledge and represent that |have read and understand the above,and that I voluntarily agree to its terms. Signed:Kechili Doninao Fer Ardy anna Duoasin NAME:Ardyanna Ducusin ORGANIZATION:N/A Date:10/23/2021 532227.5 CFN AS OF 1-22-2020 Request for Taxpayer Identification Number and Certification Departmentof tha TreasuryIntamalRevenueService »Go to www.irs.gov/FormW9for instructions and the latest information. 1 Name (as shawn on your income tax return),Name Is required on this tine;do not leavethis Ifne blank. ARDYANNA DUCUSIN 2 Business name/disregarded entily name,If different from above ARDYANNA DUCUSIN 3 Check appropriate box for federal tax classification of the person whose nama is entered on lina 1.Check only one of the 4 Exemptions (codes apply only tofollowingsevenboxes.certain entities,nat individuals;seainstructionsonpage3): Form W-9 (Rav.Oclober 2018) Give Form to the requester.Do not send to the IRS, individual/sale proprietor or CJ Carparation DO S Corporation Q Partnership CO Trust/estatesingla-mamber LLC Exempt payee code (i any) a Limited liability company.Enter the tax classification (C=C corporation,S=S corporation,P=Parinership)» Note:Gheckthe appropriate box In the line above for the tax classification of the singla-member owner.Do not check Exemption from FATCA reportingLUGIftheLLCisclassifiedasasingle-member LLC that is disregarded from the owner unless the owner of the LLC Is code (f any)another LLG that fs not disregarded from the ovmer for U.S.federal tax purposes.Othenvise,a single-member LLC that y)is disregarded fram the owner should check tha appropriate box for the tax classification of its awner. [1 other(see Instructions)> 5 Address (number,street,and apt.or suite no.)Sea instructions. 1179 E,223RD ST. 6 City,state,and ZIP coda CARSON,CA 90745 7 List account number(s}here (aptional) Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on line 7 to avoidbackupwilhhalding.For individuals,this is generally your social security number (SSN).However,for a (Apptes to accounts mavained outsidg tha U.S } Requester's name and address (optional) Pr i n t or t y p e Se e Sp e c i f i c In s t r u c t i o n s on pa g e 3. nia |Sectal securlty number resident alien,sole proprietor,or disregarded entity,see the instructions for Part |,later.Far other 8/5/14]-15131 -|1/7191 8entities,it is your employer identification number (EIN).If you do not have a number,sea How to getaTIN,later.or Note:If the account is in more than one name,see the instructions for line 1.Also see What Name and Employer [dentification numberNumberToGivetheRequesterforquidelinesonwhosenumbertoenter. Gay Certification Under penalties of perjury,|certify that: 1.The number shown on this form is my correct taxpayer identification number (or 1am waiting for a number to be issued to me);and2.Lam nat subject to backup withholding because:(a}!am exempt from backup withholding,or (b}|have not been notified by the internal RevenueService(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 |amnolongersubjecttobackupwithholding;and 3.fam a 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 FATCA reporting is correct. Certification instructions.You must cross out item 2 aboveif you have been nolified by the IRS that you are currently subject to backup withholding becauseyouhavefailedtoreportallinterastanddividendsonyourlaxreturn.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,paymentsotherthaninterestanddividends,you are not required to sign the certification,but you must provide your correct TIN.See the instructions for Part ll,later. Sign Signature of ,.’Here U.S.parson >Ruch,Larmenny For Arely anna Dywagirpate »10/23 [2ceA] General Instructions *Form 1099-DIV (dividends,including those from stocks or mutualfunds}Section references are to the Internal Revenue Code unless otherwise *Form 1099-MiSC (various types of income,prizes,awards,or grossnoted. Future developments.For the latest infarmation about developments related to Form W-9 and Its instructions,such as legislation enacted after they were published,go to www.irs.gov/FormW9, Purpose of Form An individual ar entity (Farm W-9 requester)who is required to file an information return with the [RS 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 employeridentification number (EIN),to report on an information return the amountpald to you,or ather amount reportable on an information return.Examples of information returns Include,but are not limited to,the following. *Form 1099-INT (interest earned or pald) proceeds) *Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) «Form 1099-5 (proceeds from real estate transactions) *Form 1099-K (merchant card and third party network transactions) *Form 1098 (hame mortgage interest),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-8onlyif 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 Whatis backup withholding,later. Cat.No.10231X Form W~G (Rev.10-2018) PUTSWeliTee]ne ray 1179 E.223RD ST.CARSON,Ch ba310-882-0844 |--CHELLIE,DEE22@GMAIL.COM Invoice #2021100 Date:10/23/2021 Bill To For Larry Itliong 2021 Event]City of Carson Performance /Show Act186014S.Main St.Carson,CA 90248 310-816-9381 sion Breraytne tn .Amount Event Performer for Larry Itliong 2021 Event |$150.00 | Subtotal $150.00 Tax Rate Other Costs Total Cost $150.00 Make all checks payable to Ardyanna Ducusin If you have any questions concerning this invoice,use the following contact information:Richelle Domingo |Chellie.dee22@gmail.com Thank you for your business!