HomeMy Public PortalAboutC-21-143 - RICHENZA PUNO - 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
DOCUMENT TYPE:SERVICE PROVIDER
EXT.310-830-9991
N/A APPROVALDATE:N/A ITEM NO:N/A
VENDOR NAME:CHENZA PUNO 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.SIGNATURESCHECKLIST
ASSISTING STAFF
"COMPLETION (INITIALS)_
DEPT:_CS/RECREATION ATTORNEY ASSIGNED:N/A
ACTION REQUIRED
DIRECTOR Confirm approval to5 proceed.
CONTRACT OFFICER Confirm funds are budgeted and/or available.
CONTRACT OFFICER Preparation of specifications..ns,
This includes coordinating with Risk Management on the Insurance/Bond requirements.:
PURCHASING Advertise bids,compliance with bid requirements;including posting on Citys website.N/A
*RFP/RFQ must include form contract.:
PURCHASING OR Evaluate bids/proposals and determine recommended bidder(s).N/A
CONTRACT OFFICER ““e
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 v dor.
*Verify correct agency titles/corps.are listed.(ie:Cit ncil-Mayor vs.CRA-Chairman)
CONTRACT OFFICER original signatures of N/A
vendor;and request W-9 {once received,subm
*Signatures must be notarized for every original*
CONTRACT OFFICER Verify corporate status,state of Incorporation and Priticiples N/A
&RISK MANAGEMENT
CONTRACT OFFICER Request insurance documents for ap Management for all contracts
Verify approval of insurance requi :Risk Management.
*Communication through e-mail is‘Please provide the written agreement,certificate of OD
insurance as well as all endorsement:
CONTRACT OFFICER Provide W-9 to Purchasingon.Thursdayif contract is on the upcoming agenda.
*Non-Council items:provide W-9 to Purchasing on date submitted to City Clerk’s Office.
PURCHASING OR Present Department’S.recommendation to legislative body to award/approvecontract,if N/A
CONTRACT OFFICER applicable.SO,
a rrr—sS “POST-APPROVAI/POST.VENDOR SIGNATURESCHECKLIST_a
CONTRACT OFFICER Collect‘and assembleinsurance (Initialed by Risk Management),*Certificate of Insurance with fo
endorsement must be attached to be processed;even on amendments*
CONTRACTOFFICER Collect and assemble bond requirements and forms.*Public Works contracts MUSTattach N/A
verification the bond has been executed by an admitted surety insurer*
CONTRACT OFFICER |Transmit 2 complete original sets with this routing slip to the City Clerk’s Office for further N/A
~~}-processing.
2")**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.
&PURCHASING *Vendoris not to proceed with work until the Purchase Order is approved.f?
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.fa
CONTRACT OFFICER Process contract completion forms.—N/A *Notice of Completion to City Clerk’s Office
CHOOSE ONE FOR INTERNAL SIGNATURE PROCESSING:
Li Route for City Attorney>Mayor or Chair WITHOUT NOTARY>Clerk
LC]Route for City Attorney>City Manager WITHOUT NOTARY>Clerk
C]Route for City Attorney>Mayor or Chair WITH NOTARY>Clerk
L]Route for City Attorney>City Manager WITH NOTARY>Clerk
Other:INPUTIN TYLER
SPECIAL COMMENTS/INSTRUCTIONS/REQUESTS:
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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!
Ni Business License (if applicable)
NA.Proof of Insurance/Certificate of Insurance
x Waiver,Release,Hold Harmless,Agreement Not to
Sue,Indemnification,and Photo Release
an 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 isapproved,then the IFED will be processed as an invoice for services rendered for the Event.No payment will be madeuntiltheconclusionoftheEvent,at earliest.
532227.5 CFN AS OF 1-22-2020
(Date)
(Company)
(Company Address)
(City,State ZIP)
Insurance Requirements
Dear Chenza Puno
(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 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 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 appointedofficials,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
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 Event Date:10/23/21
Chenza PunoNameofServiceProvider:
Business Form/Entity Type (if individual,sole proprietorship,corporation,or limited liability
company,specify here):
Individual
Business Form/Entity Type (if general partnership,limited partnership,limited liability partnership,
or other,specify here):
Performer
Business Entity State of Incorporation (if applicable):
Type of Service.Performer
Contact Person:Chenza Puno Phone #;(310)“66-0926
Emer,Contact:Phone #:(__)
Billing Address:9922 S.Silver Oak Way
Ontario CA 91761GySiateZiP
Proof of Insurance (check one)?[Ives INo
If no,would youlike to purchase special event insurance through the City (check one)?[ves [VINo
City to provide event insuranceSpecialInstructions/Notes:
532227.5 CFN ‘AS OF 1-22-2020
If Service Provider wishes to request any special accommodation needed to facilitate provision of the
services,please identify it here or contact the staff member referenced on Page |of this application:
$150.00
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
Further Terms of Service Provider Application Agreement:
The undersigned signatory of Service Provider (Service Provider being the above-referenced personorentityseekingtoprovideservicesattheabove-referenced event,including all its officers,agents,employees and volunteers)hereby represents and warrants that he or she is duly authorized byServiceProvidertoexecuteanddeliverthisapplicationonbehalfofServiceProvider,andthat by soexecutingthisapplication,and in consideration for the City’s review of this application,ServiceProviderisboundbytheseterms.
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 inaccordancewiththe“Waiver,Release,Hold Harmless,Agreement Not to Sue,Indemnification,andPhotoRelease”submitted concurrently herewith.
Service Provider agrees to maintain all required insurance coverages and comply with all associatedinsurancerequirementsassetforthontheabove“Insurance Requirements”page,which isincorporatedhereinbyreference.Service Provider agrees thatall required policies shall contain,orbeendorsedtocontain,an agreement by Service Provider to waive all rights of subrogation andcontributionagainsttheCity,its elected or appointed officers,officials,employees and agents,for alllossesandliabilitiespaidunderthetermsofanypolicywhicharisefromtheactivitiesoroperationsof,or the services performed by,Service Provider,regardless of any prior,concurrent,or subsequentnon-active negligence by the City.
In the event there is more than one person or entity named in this Service Provider ApplicationAgreementastheServiceProvider,then all obligations,liabilities,covenants and conditionshereundershallbejointandseveral.
This Service Provider Application Agreement,unless and until accepted,approved,and executed bytheCityManagerordesignee,is only an application for provision of services to City,and does notconstituteanapprovalorauthorizationforServiceProvidertoperformorprovideanyservicetoCity.
Neither Service Provider norany of its agents or employees shall be deemed agents or employees oftheCity,nor a member of a joint enterprise with the City.Neither Service Provider nor any of itsagentsoremployeesshallatanytimeorinanymannerrepresentthatServiceProvideroranyofitsagentsoremployeesareagentsoremployeesofCity,or that it is a member of a joint enterprise withCity.Subject to the requirements of this Service Provider Application Agreement,neither the Citynoranyofitsemployeesshallhaveanycontroloverthemanner,mode or means by which ServiceProvider,its agents or employees,perform the services set forth herein.
In the event that part of this Agreementis declared invalid or unenforceable by a valid judgment ordecreeofacourtofcompetentjurisdiction,such invalidity or unenforceability shall not affect any of
532227.5 CFN AS OF 1-22-2020
s Service Provider Application Agreement has been ex
APPLICATION SUBMISSION (wet signature required;no electronic signatures)
(Signature ofSéorice Provider's Authorized,Representative)
CHENZA FUN?
:(Printed Namie of.Service Provider's Authorized Representative)
(Space below thisline for Cityuse only).
Service Provider Rules &Regulations
1.SERVICE PROVIDER APPLICATION:Upon acceptance,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),includingits officers,employees,agents and volunteers (“Provider”),on the one hand,and theCity,on the other hand.Any additions and amendments thereto that maybe 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:Norefunds 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:TheCity is not responsible for any damageto,loss ortheftoftheProvider’s property,or that of Provider’s agents,employees or invitees.
5.CHARACTER OF ENTERTAINMENT:The Provider shall observe,obey and comply withallapplicablelocal,state and federal laws,andall 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 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 on chairs,tables or other rental equipmentis prohibited.This equipmentisnotengineeredtosupportyourweight.The City of Carson,its employees,agents,or officers 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 or intensityofanyandallnoiseorlightgeneratingmechanisms(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 for the use,display or sale of any item using anycopyrightedand/or trademarked nameor 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.
532227.5 CFN AS OF 1-22-2020
but of the Event;of the acceptance of an:application to.provide a se
!:appointed officers,officials,employees,agents and rolunteomandagainstanyandallliabilityarisingoutoforconnectedinanywaywh eninorpresenceattheEvent,even though that liability mayarise out of negligenCity.Itiis further understood and agreed that this Anremnent
Signatory hereby grants City the right to photograph or video-record.Signatory d-the Event,and to use Signatory’s.photographed.or video-recorded likeness,
of any kind from City.Signatory Ihereby w.
TheTights granted by Signatory hereunder #ty
or otherwise,sustained or ‘alleged to be sustained by any person’or entity (whet
nevisiting ‘the Event,employees ofthe City,other service providers atthe Ev
at,arising from,or conr ected with Signatory’s preparation or performance,ofsi
number,street,and apt.or suite no.)See Instructions.2 9 SILVER DAK WAY
ity;State,and ZIP.codeONTARIO,CA,F7647Ustaccountnumber(s)here (optional)
___Taxpayeridentification Number(TIN}
Enter your:TIN Inthe appropriate box.The TIN provided must match the name givenon line 1 to avoid~backup withholding.Forindividuals,this is generally your social security number (SSN).However,for a-fasident alien,sole proprietor,or disregarded entity,see the instructions far Part |,later.For otherentities,it is your employer identification number (EIN).If you da not have a number,see How to get aTIN,later.
Note:If the account is in more than one name,scethe instructions forline 1.Also see What Name andNumberToGivetheRequesterforguidelinesonwhosenumbertoenter,
EE Certification
Under penalties of perjury,|certify that:
1.The:number shown on this farm is my correct taxpayer identification number (or 1am waiting for a number.to beissued_.2../am_not subject to backup withholding because:(a)|am exempt from backup withholding,or (b).|have not been notifiedService(IRS)that |am subject to backup withholding as a result of a failure to report all interest or dividends,{c}.:no longer subject to backup withholding;and Ces
Bel am a.U.S.citizen or other U.S.person (defined below);and —
@ FATCA code(s)entered on this form (if any)indicating that |am exempt from FATGA reporting is correct.’
on |structions.‘You must cross out item 2 aboveif you have been notifled by the IAS thatyou are currelfailedtoreportallinterestanddividendsonyourtaxreturn.For real estate transactions:item 2.,
f idonment of secured property,cancellation of debt,contributions to an individual retwementterestanddividends,you are not required to sign the certification,but you must provide your
Richenza Puno :els
3922 S.Silver Oak Way Pareate i -cra 2
Ontario,CA 91761 ee Peete rrr
P:310-786-0928 "9 puepate:=<toaarzozt
BILL TO:City of Carson
Atin:Accounts Payable
801 E.Carson St,,Carson,CA 90745
310-830-7600
Dieter:
1 Entertainment;singing for Larry Itliong Event,10/23/21 $150.00 $150.00
Make all checks payable to Richenza Puno SHIPPING $0.00
Thank you for your business!TOTAL $150.00