HomeMy Public PortalAboutC-21-149 - THE TEA HOUSE MUSIC CO. - COUNTRY WESTERN FAIR SPA CITY OF CARSON —INTERNAL CONTRACT ROUTING SLIP
All fields are required to be completely fi led out.If not applicable,enter N/A.
FROM:JOSE PINA EXT.310-549-3962 DEPT:_CS/RECREATION ATTORNEY ASSIGNED:N/A
DOCUMENT TYPE:Service PRovIDER °~N/A APPROVALDATE:N/A ITEM NO:N/A
VENDOR NAME:THE TEA House Music COMPANY SERVICES/PRODUCT:PERFORMER
TERM OF CONTRACT:11/18/2021 tHroucH 11/21/2021 AMOUNT OF CONTRACT:N/A
SINGLE-SIDED DOCUMENT?[XIYES PAGECOUNT:_
a a oe ee _PRE-APPROVAL/PR'-CITY SIGNATURES CHECKLIST .
ASSISTING STAFF :oe ee ACTION REQUIRED.:|COMPLETION (INITIALS)
DIRECTOR Confirm approval toproceed.DD YP
CONTRACT OFFICER Confirm funds are budgeted and/or available.A
CONTRACT OFFICER Preparation of specifications.
This includes coordinating with Risk Management on the Insurance/Bond requiremen
PURCHASING Advertise bids,compliance with bid requirements;including posting on City’websi N/A
*RFP/RFQ must include form contract.
PURCHASING OR Evaluate bids/proposals and determine recommended bidder{(s).N/A
CONTRACT OFFICER .
CONTRACTOFFICER Complete contract negotiations/finalize contract (including atta i ith City N/A
&CITY ATTORNEY Attorney's Office.
CONTRACT OFFICER Present appropriate contract form to the recommended vendo,
*Verify correct agencytitles/corps. are listed.(ie:City.Counci iyor vs.CRA-Chairman)Wy)
CONTRACT OFFICER Verify compliance with businesslicense requirements,obtain3.original signatures of N/A
vendor,and request W-9 (once received,submit:we9 to urchasing).
*Signatures must be notarized for every original*.oe
CONTRACT OFFICER Verify corporate status,state of Incorporation andd Principles.N/A
&RISK MANAGEMENT
CONTRACT OFFICER Request insurance documents for approval withFRisk 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
insurance as well as all endorsement forms.
CONTRACT OFFICER Provide W-9 to Purchasing enda ‘Thursday if contract is on the upcoming agenda.
*Non-Council items:prov 2.urchasing on date submitted to City Clerk’s Office.
PURCHASING OR Present Department:endation to legislative body to award/approve contract,if N/A
CONTRACTOFFICER applicable.
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CONTRACT OFFICER
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CONTRACT OFFICER N/A
CONTRACT OFFIGER N/A
ote 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.Dp
&PURCHASING *Vendoris 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.&y
CONTRACT OFFICER Process contract completion forms.N/A *Notice of Completion to City Clerk’s Office
CHOOSE ONE FOR INTERNAL SIGNATURE PROCESSING:
CL)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
[]Route for City Attorney>City Manager WITH NOTARY>Clerk
Other:INPUTIN TYLER
SPECIAL COMMENTS/INSTRUCTIONS/REQUESTS:
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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 seck.
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:Jose Pifia
(Event Coordinator’s Name)
Dominguez Park -21330 Santa Fe Ave.Carson,CA.90810
(Enter Event Coordinator’s address (i.e.,city hall,corporate yard,or specific park address)
Email:jpina@carsonca.gov
(Enter event coordinator’s email address)
Should you have any questions,please feel free to contact the staff memberlisted below .
Truly,
Jose Pifia
(Name)
Recreation Center Supervig
(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)
Service Provider Application Agreement
x Invoice for Future Event Date’
ke Business License (if applicable)
Proof of Insurance/Certificate of Insurance
7 Waiver,Release,Hold Harmless,Agreement Not to
Sue,Indemnification,and Photo Release
a 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.
$32227.5 CFN AS OF 1-22-2020
10/1/2021
(Date)
The Teahouse Music Company
(Company)
5030 Ventura BI #623
(Company Address)
Sherman Oaks,CA 91403
(City,State ZIP)
Insurance Requirements
Dear [he Teahouse Music Company
(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 may arise 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,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
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:Country Western Fair Dominguez Park 11/20/2021EventLocation:rs Event Date:
Name of Service Provider:The Teahouse Music Company
Business Form/Entity Type (if individual,sole proprietorship,corporation,or limited liability
company,specify here):
Limited Liability Company
Business Form/Entity Type (if general partnership,limited partnership,limited liability partnership,
or other,specify here):
Business Entity State of Incorporation (if applicable):CA
Live Music/Entertainment
Type of Service:
Contact Person:Daniel Saenz Phone #:(323)454-3039
Emer.Contact;CNTs Murphy Phone #:(213)926-1721
15030 Ventura BI #623
Billing Address:
Number Street
Sherman Oaks,CA 91403
City State ZIP
Proof of Insurance (check one)?[_lves [YIno
If no,would you like to purchase special event insurance through the City (check one)?VlyYes INo
Special Instructions /Notes:
532227.5 CFN AS OF1-22-2020
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:
Total Service Fee $1,500.00
NOTE:If service provider is unable to provide the services as proposed or requestedor the City
of Carson cancels the service for any reason,the associated fees will not be paid.
fremainderofpage intentionally left blank]
$32227.5 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
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 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
hereundershall 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 performor 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 mannerrepresent that Service Provideror 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 eventthat 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 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,or liabilities 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):
SERVICE PROVIDER:The Teahouse Company
Dun,bdverf 10/1/21
(Signature of Service Provider's Authofized Representative)(Date)
Daniel Saenz
(Printed Name of Service Provider’s Authorized Representative)
(Space below this line for City use only)
APPLICATION APPROVAL:
CITY OF CARS OZ
j a
(Signature of City Manageror Designee)
532227.5 CFN AS OF 1-22-2020
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),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 or invitees.
5.CHARACTER OF ENTERTAINMENT:The Providershall 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.
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 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 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 in
our efforts to provide a SAFE WORKING ENVIRONMENT.
532227.5 CEFN AS OF 1-22-2020
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 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 name or logo which has not been specifically authorized underlicensefromthetrademarkholder.
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 toenforcetheserulesandregulations.
16.SPACE ASSIGNMENT:Eventspace 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: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 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,Daniel Saenz ,(“individual”)[on behalf ofTheTeahouseMusicCompany
_
(“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 ofan application to provide servicesinatCOUNTRYWESTERNFAIR(“Event”)on NOVEMBER 20,2@ (“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 that liability may arise out of negligence or carelessness on the part of
City.It is further understood and agreed that this Agreement is 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 ofentitlement to any license fee orroyalty
of any kind from City.Signatory hereby waives anyright 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 notlimited 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 membersof the
public visiting the Event,employees of the City,other service providers at the Event,or otherwise),occurring
at,arising from,or connected with Signatory’s preparation or performanceofservices at the Event,Signatory’s
actions,inactions,or use offacilities at the Event,or any equipment,machinery oritems displayed or used by
the Signatory at or for the Event,except for such claim,liability,loss,damage,expense,or cost which was
caused bythe sole negligence or willful misconduct ofthe City.
By signing below,I acknowledge and represent that I have read and understand the above,and that I
voluntarily agree toits terms.
Signed:Dn,fdvenf
NAME:Daniel Saenz L
ORGANIZATION:The Teahouse Music Company
Date:10/1/21
532227.5 CFN AS OF 1-22-2020
Request for TaxpayerIdentificationNumberandCertification
>»Goto www.irs.gov/FormW9 for instructions and the latest information.
Form W-9
(Rev.October 2018}
Department ofthe TreasuryintemalRevenueService
Give Form to the
requester.Do not
send to the IRS,
1 Name (as shown on your income tax return).Nameis required onthis line;do not leave this line blank,Teahouse Company LLC
2 Business name/disregarded entity name,if different from above
S 3 Check appropriate boxfor federaltax classification of the personwhose name is entered on fine 1.Check only one of the
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4 Exemptions (codes apply only to
&following seven boxes,
certain entities,nolindividuals;seea
instrucilons.on page 3):S|(3 tndividuasote proprietaror CJ]c Corporation LC]s Corporation O Partnership Oj Trust/estateg2single-member LLC
Exempt payee code {if any}
3S22 Umiled liability company.Enter the fax classification {C=C corporation,S<S Corporation,P=Partnership)Cc8zNote:Check the appropriate boxin the line abovefor the tax classification of the single-member owner.Oo not check Exemption from FATCA reporting
<2 LLC if the LLC is classified as a single-member LLCthat is disregarded from the owner unless the ownerof the LLC is cade (if any)=another LLC thatis not disregarded from the owner far US.federal tax purposes.Otherwise,a single-momber LLC thal ¥te
a 2 is disregarded from the owner should check the appropriate boxfor the lax classification of its owner,&
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_[]Other (see instructions}»Applies to necourts maintainedoutsids tha US}é 5 Address (number,street,and apt.or suite no.)See instructions.Requester’s name and address (optional@[15030 Ventura Bivd #623
&City,state,and ZIP code
Sherman Oaks,CA 91403
7 List account number(s)here (optional)
Ea TaxpayerIdentification Number(TIN)Enter your TIN in the appropriate box.The TIN provided must match the name given online 1 to avoidbackupwithholding.For individuals,this is generally your social security number (SSN).However,for a
Social security number
residentalien,sole proprietor,or disregarded entity,see the instructions for Part |,later.For other --entities,itis your employeridentification number {EIN}.if you do not have a number,see How to get aTIN,later,
or
Note:If the accountis in mare than one name,See the instructionsfor line 1.Also see What Name and Employeridentification numberNumberToGivetheRequesterforguidelinesonwhosenumberto
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Gag Certification
Under penalties of perjury,|certify that:1,The number shown on this form is my correct taxpayeridentification number (or |am waiting for a number to be issued to-me);and2.Lam not subject to backup withholding because:(a)|am exempt from backupwithholding,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 J am
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3.lam a U.S.citizen or other U.S.person (defined below);and4.The FATCA code(s)entered on this form (if any}indicating that |am exempt from FATCA Feporting is correct.Certification instructions.You must Cross outitem 2 aboveif you have been notified by the IRS that you are currently subject to backup withholding becauseyouhavefailedtereportallinterestanddividendsonyourtaxreturn.Forreal estate transactions,item 2 dees not apply.For mongageinterest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement (IRA),and genarally,paymentsotherthaninterestanddividends,you are not required to sign the certification,but you mustprovide yourcorrect TIN.See the instructions for Part |,tater,Le ;-~-qLOAPLe>)Date >CO.edGeneralInstructions*Form 1099-DIV (dividends,including those from stocks or mutualfunds)Section references are to the Internal Revenue Code unless otherwise
Sign Signature ofHere4S.persan >
ted *Form 1099-MISC (various types of income,prizes,awards,or grossnoted,
Future developments.Forthe latest information about developmentsrelatedtoFormW-9 andits instructions,such as legislation enactedaftertheywerapublished,go to www.irs.gov/FormW9,
Purpose of Form
An individual or entity (Form W-9 requester)who {s required tofile aninformationreturnwiththeIRSmustobtainyourcorrecttaxpayeridentificationnumber(TIN)which may be your social Security number(SSN),individual taxpayeridentification number (ITIN),adoption ,taxpayeridentification number (ATIN},or employeridentification number(EIN),to report on an information return the amount paid to you,or otheramountreportableananinformationreturn,Examples of informationreturnsinclude,but are notlimited to,the following.*Form 1099-INT(interest earned-or paid)
Cat.No.10231X
proceeds)
*Form 1089-8 (stock or mutual fund sales and certain othertransactionsbybrakers)
*Form 1699-S (proceeds from real estate transactions)*Form 1099-K (merchant card and third party network transactions)*Form 1098 (horne mortgage interest),1098-E (studentloan 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 residentalien),to provide your correct TIN.
ifyou do not retum Form W-9to the requester with a TIN,you mightbesubjecttobackupwithholding.See Whatis backup withholding,later.
Form W-9 ev.10-2038)
THE,i MUSIC COMPANYPahetie
BILL TO
Jose Pina
City Of Carson
21330 Sante Fe Ave
Carson,CA 90810
The Teahouse Company LLC
15030 Ventura Bivd #623
Sherman Oaks,CA 91403 US
818-497-6285
kevinmwest@outlook.com
INVOICE 112021
DATE 10/20/2021 TERMS Net 30
DUE DATE 71/06/2021
Private Events
11/20/21 1,500.00
TOTAL DUE $1,500.00