HomeMy Public PortalAboutC-21-153 - STAGELINE MOBILEPURCHASE AGREEMENT
BY AND BETWEEN
THE CITY OF CARSON AND
STAGELINE MOBILE STAGE, INC.
h
THIS PURCHASE AGREEMENT ("Agreement") is executed this day of
2021 ("Effective Date"), by and between the CITY OF CARSON, a
California municipal corporation ("City"), and STAGELINE MOBILE STAGE, INC., a Quebec
corporation ("Seller"). City and Seller may be referred to, sometimes individually or collectively,
as "Party" or "Parties."
1. Purchase and Sale of Goods. On and subject to the terms and conditions set forth
in this Agreement, Seller agrees to sell and deliver to City and City agrees to purchase and accept
from Seller the mobile stage and related equipment/accessories and services described herein and
specified in Exhibit "A" attached hereto and incorporated herein by this reference ("Goods"), for
the total purchase price ("Purchase Price") set forth in Section 3.
2. Description of Goods. The Goods being sold by Seller to City consists of the
mobile stage and related equipment/accessories, together with ancillary delivery, training,
warranty and customer support services related thereto, as described herein and as specified in
Exhibit "A." As part of the Goods, Seller will provide Buyer with a 3 -day comprehensive training
program regarding use of the mobile stage and related equipment/accessories. The training
program shall be provided to City staff designated by the Contract Officer and shall consist of
three (3) consecutive days of training unless otherwise agreed to by the Contract Officer. The
training shall be conducted at City facilities as specified by the Contract Officer and at times
requested by the Contract Officer between the hours of 8:00 a.m. — 4:00 p.m. PST on City business
days (Monday through Thursday, excluding holidays), and shall be completed within two (2)
weeks following delivery of the mobile stage and related equipment/accessories. The Parties agree
that the specimen warranty page included in Exhibit "A" will be replaced with a final version
following completion of the training program, without the need for a formal amendment to this
Agreement. However, failure to do so shall not affect the validity or effectiveness of the warranty.
3. Purchase Price. The total Purchase Price which City agrees to pay to Seller for
purchase and sale of the Goods is not to exceed One Hundred Ninety -Nine Thousand Seven
Hundred Twenty -Three Dollars ($199,723), as provided in further detail in Exhibit "A."
4. Term. The term of this Agreement shall expire after City's acceptance of the Goods
and City's payment therefor following Seller's submission of the requisite invoice, and subject to
the continued three-year warranty period from the date of completion of the training program, as
specified in Section 2 and Exhibit "A."
5. Representations and Warranties of Seller. Seller makes the following
representations and warranties to City:
01007.0001/734764.4 EXHIBIT 3
5.1. Authority and Consents. Seller has the right, power, legal capacity and
authority to enter into and perform its obligations under this Agreement. No approvals or consents
of any persons are necessary in connection with Seller's execution, delivery, and performance of
this Agreement, except for such as have been obtained on or prior to the date hereof. The execution,
delivery, and performance of this Agreement by Seller have been duly authorized by all necessary
action on the part of Seller and constitute the legal, valid and binding obligations of Seller,
enforceable against Seller in accordance with their respective terms.
5.2. Title and Operating Condition. Seller has good and marketable title to
the Goods. The Goods are flee and clear of any restrictions on or conditions to transfer or
assignment, and City will acquire absolute title to the Goods flee and clear of mortgages, liens,
pledges, charges, encumbrances, equities, claims, covenants, conditions and restrictions except for
such as may be created or granted by City. The Goods are in conformity with the manufacturer's
specifications, descriptions, representations and warranties. Seller is aware that City is purchasing
the Goods for use in City's operations and that City is relying on Seller's warranties that the Goods
are fit for this pin -pose and the ordinary purposes for which the Goods are normally used.
6. Time of Delivery. The date and time of delivery of the mobile stage and related
equipment/accessories specified in Exhibit "A" shall be no later than si days following issuance
of a Notice to Proceed by City's Contract Officer, or as otherwise requested by the City, during
City's business hours which are Monday through Thursday 7:00 am to 3:30 pm. City will provide
Seller with a scheduled delivery date for the site listed in Section 7.
7. Place of Delivery. The mobile stage and related equipment/accessories specified
in Exhibit "A" shall be delivered to the City's Corporate Yard Receiving Warehouse — Building
C, 18620 S. Broadway, Carson, CA 90248.
8. Title and Risk of Loss; Payment and Invoicing. Title to and the risk of loss,
damage and destruction of the Goods shall remain with the Seller until after inspection and
acceptance of the Goods by City, and payment by City of the Purchase Price. Seller shall invoice
City in the amo>_mt of the Purchase Price for purchase of the Goods, and City shall remit payment
by no later than forty-five (45) days after City's acceptance of the Goods.
9. Inspection. After delivery of the Goods, City shall inspect the Goods within a
reasonable time not to exceed thirty (30) days and provide written notice to the Seller specifying
any defects or other objections, unless City intends to accept the Goods in whole, in which case
no notice will be necessary. Acceptance of the Goods, whether in whole or in part, shall not be
deemed a waiver of any defects identified by the City, nor any defects later discovered by the City,
and specified to the Seller in writing.
10. No Replacements or Cures. This Agreement calls for strict compliance. Seller
expressly agrees that both the Goods tendered and the tender itself will conform fully to the terins
and conditions of the Agreement on the original tender. In the event of rejection by City of the
whole of the Goods or any part thereof, City may, but is not required to, accept any substitute
01007.0001/734764.4
performance from Seller or engage in subsequent efforts to effect a cure of the original tender by
Seller.
11. Insurance Coverages.
11.1 Types of Coverages. Seller shall procure and maintain, at its sole cost and
expense, in a form and content satisfactory to City, during the entire term of this Agreement
including any extension thereof, the following policies of insurance which shall cover all elected
and appointed officers, employees and agents of City:
(a) Commercial General Liability Insurance. A policy of
comprehensive general liability insurance written on a per occurrence basis for bodily injury,
personal injury and property damage. The policy of insurance shall be in an amount not less than
$1,000,000.00 per occurrence or if a general aggregate limit is used, either the general aggregate
limit shall apply separately to this contract/location, or the general aggregate limit shall be twice
the occurrence limit.
(b) Worker's Compensation Insurance. A policy of worker's
compensation insurance in such amount as will fully comply with the laws of the State of
California and which shall indemnify, insure and provide legal defense for Seller against any loss,
claim or damage arising from any injuries or occupational diseases occurring to any worker
employed by or any persons retained by Seller in the course of carrying out the work or services
contemplated in this Agreement.
(c) Automotive Insurance. A policy of comprehensive automobile
liability insurance written on a per occurrence for bodily injury and property damage in an amount
not less than either (i) bodily injury liability limits of $100,000 per person and $300,000 per
occurrence and property damage liability limits of $150,000 per occurrence or (ii) combined single
limit liability of $1,000,000. Said policy shall include coverage for owned, non -owned, leased,
hired cars, and any other automobile.
(d) Subcontractors. Seller shall include all subcontractors as insureds
under its policies or shall furnish separate certificates and certified endorsements for each
subcontractor. All coverages for subcontractors shall be subject to all of the requirements stated
herein.
(e) Broader Coverages and Higher Limits. Notwithstanding anything
else herein to the contrary, if Seller maintains broader coverages and/or higher limits than the
minimums shown above, the City requires and shall be entitled to the broader coverages and/or
higher limits maintained by Seller.
11.2 General Insurance Requirements. All of the above policies of insurance
shall be primary insurance and shall name the City, its elected and appointed officers, employees
and agents as additional insureds and any insurance maintained by City or its officers, employees
or agents may apply in excess of, and not contribute with Seller's insurance. The insurer is deemed
hereof to waive all rights of subrogation and contribution it may have against the City, its officers,
employees and agents and their respective insurers. The insurance policy must specify that where
01007.0001/734764.4
the primary insured does not satisfy the self-insured retention, any additional insured may satisfy
the self-insured retention. All of said policies of insurance shall provide that said insurance may
not be amended or cancelled by the insurer or any party hereto without providing thirty (30) days
prior written notice by certified mail return receipt requested to the City. In the event any of said
policies of insurance are cancelled, Seller shall, prior to the cancellation date, submit new evidence
of insurance in conformance with this Section to the Contract Officer. No work or services under
this Agreement shall commence until Seller has provided the City with Certificates of Insurance,
additional insured endorsement forms or appropriate insurance binders evidencing the above
insurance coverages and said Certificates of Insurance or binders are approved by the City. City
reserves the right to inspect complete, certified copies of and endorsements to all required
insurance policies at any time. Any failure to comply with the reporting or other provisions of the
policies including breaches or warranties shall not affect coverage provided to City. The insurance
required by this Agreement shall be satisfactory only if issued by companies qualified to do
business in California, rated "A" or better in the most recent edition of Best Rating Guide, The
Key Rating Guide or in the Federal Register, and only if they are of a financial category Class VII
or better, unless such requirements are waived by the City's Risk Manager or other designee of
the City due to unique circurnstances.
12. Indemnification. Seller agrees to defend, indemnify, protect and hold harmless
the City, its officers, officials, employees, agents and volunteers from and against any and all
claims, demands, losses, damages, costs and liability of any kind or nature (including reasonable
attorney's fees) which the City, its officers, officials, employees, agents or volunteers may sustain
or incur or which may be imposed upon them for injury to or death of persons, or damage to
property (i) arising out of or from the Goods or delivery of the Goods, and (ii) to the extent arising
from (a) Seller's negligent acts, omissions or willful misconduct, (b) Seller's ownership or
possession of the Goods during any period ending on or prior to the Effective Date, (c) Seller's
replacement of the Goods or any part thereof pursuant to this Agreement, and (d) Seller's breach
of any of its representations, warranties or covenants under this Agreement.
13. Remedies. The remedies and rights conferred on the City by this Agreement are
in addition to and cumulative with all other remedies and rights accorded the City under law or
equity. Without limiting the generality of the foregoing, Seller agrees that if there is any defect in
the Goods, as determined in City's sole and absolute discretion, and upon written notice thereof
given to Seller, Seller shall replace the defective Goods without delay or cost to the City. In the
event of Seller's failure to replace the Goods within ten (10) calendar days after being notified of
such defects, City is hereby authorized to contract with another party for the purchase of
replacement of Goods, and Seller shall reimburse City for all such costs immediately upon
demand.
14. Survival of Representations and Warranties. All representations, warranties,
covenants and agreements of the Parties contained in this Agreement shall survive the execution,
delivery and performance of this Agreement.
15. Assignment. This Agreement may not be assigned by Seller without the express
written consent of City. This Agreement shall be binding on, and shall inure to the benefit of, the
01007.0001/734764.4
Parties to it and their respective heirs, legal representatives, successors and assigns. All Goods
manufacturer's warranties shall be assigned to and turned over to the City.
16. Severability. If any provision of this Agreement is held invalid or unenforceable
by any court of final jurisdiction, it is the intent of the Parties that all other provisions of this
Agreement be construed to remain fully valid, enforceable, and binding on the Parties.
17. Entire Agreement: Modification: Waiver. This Agreement constitutes the entire
agreement between the Parties pertaining to the subject matter hereof and thereof and supersedes
all prior and contemporaneous agreements, representations and understandings of the Parties,
whether oral or written. No supplement, modification or amendment of this Agreement shall be
binding unless executed in writing by all the Parties. No waiver of any of the provisions of this
Agreement shall be deemed, or shall constitute, a waiver of any other provision, whether or not
similar, nor shall any waiver constitute a continuing waiver. No waiver shall be binding unless
executed in writing by the Party making the waiver.
18. Contract Officer. Robert Lennox, Community Services Director, or such person
as may be designated by the City Manager is hereby designated as being the representative of the
City authorized to act on its behalf with respect to this Agreement and to make all decisions in
connection therewith ("Contract Officer").
19. Notices. All notices, requests, demands, and other communications under this
Agreement shall be in writing and shall be deemed to have been duly given on the date of service
if served personally on the Party to whom notice is to be given, or on the third day after mailing if
mailed to the Party to whom notice is to be given, by first class mail, registered or certified, postage
prepaid, and properly addressed as follows:
To Seller at: Stageline Mobile Stage Inc.
700 Marsolais, L'Assomption,
Quebec, Canada J5 W 269
Attn: Pierre -Luc Rompr6
To City at: City of Carson
701 East Carson Street
Carson, CA 90745
Attn: City Manager
Any Party may change its address for purposes of this paragraph by giving the other Party written
notice of the new address in the manner set forth above.
20. Effects of Headings. The subject headings of the sections and subsections of this
Agreement are included for convenience only and shall not affect or be considered in the
construction or interpretation of any of its provisions.
01007.0001/734764.4
21. Counterparts. This Agreement may be executed simultaneously in one or more
counterparts, each of which shall be deemed an original, but all of which together shall constitute
one and the same instrument. Facsimile and electronic signatures shall be deemed the same as
original signatures.
22. Governing Law. This Agreement shall be construed in accordance with, and
governed by, the laws of the State of California as applied to contracts that are executed and
performed entirely in California.
23. Termination. City may terminate this Agreement for any reason whatsoever, prior
to delivery of the Goods and City's payment of the Purchase Price therefor as set forth herein.
24. Venue. All proceedings involving disputes over the terms, provisions, covenants
or conditions contained in this Agreement and all proceedings involving any enforcement action
related to this Agreement shall be initiated and conducted in the applicable court or forum in Los
Angeles County, California.
[SIGNATURES ON FOLLOWING PAGE]
01007.0001/734764.4
IN WITNESS WHEREOF, the Parties to this Agreement have duly executed in on the day
and year first above written.
ATTEST:
trgLr~�.,`ti,
qf .17 s ��
leJoKn W. Carroll, Sr.
Chief Deputy City Clerk
APPROVED AS TO FORM:
AL I & WYNDER, LLP
Sunny olta City ttorney
CITY:
CITYAF CARSON, a municipal corporation
41a Davis -Holmes, Mayor
r /
1
SELLER:
STAGELINE MOBILE STAGE, INC.
By:
Name: Pi /, ..-- Pz � Pre—
e:
By:
Name: 19,oi.x,;0.0 110S.Se
Title: AGGo0kN5 pFF'cE'-
Two corporate officer signatures required when Seller is a corporation, with one signature required from each
of the following groups: 1) Chairman of the Board, President or any Vice President; and 2) Secretary, any
Assistant Secretary, Chief Financial Officer or any Assistant Treasurer. SELLER'S SIGNATURES SHALL
BE DULY NOTARIZED, AND APPROPRIATE ATTESTATIONS SHALL BE INCLUDED AS MAY BE
REQUIRED BY THE BYLAWS, ARTICLES OF INCORPORATION, OR OTHER RULES OR
REGULATIONS APPLICABLE TO SELLER'S BUSINESS ENTITY.
01007.0001/734764.4
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the trutlif ilness, accuracy or validity of that document.
STATE OF CALIFORNIA
COUNTY OF LOS ANGELES
i
On ' �� 6e,- / , 2021 before me, (RAA, -G Ltl. heck , personally appeared i ,,?2c) L upc_' , proved to nre on the
basis of satisfactory evidence to be the person(s) whose names(s) is/are subscribed to the within instrument and
acknowledged to me that lie/she/they executed the same in his/her/their authorized capacity(ies), and that by
his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted,
executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true
and correct.
WITNESS my hand aro-of�icial seal.
Sign
# '10 o67
Though the data below is not required by law, it may prove valuable to persons relying on the document and could
prevent fi•audulent reattachment of this form.
CAPACITY CLAIMED BY SIGNER
❑
❑
INDIVIDUAL
CORPORATE OFFICER
TITLE(S)
❑
PARTNER(S) ❑ LIMITED
❑ GENERAL
❑
ATTORNEY-IN-FACT
❑
TRUSTEE(S)
❑
GUARDIAN/CONSERVATOR
❑
OTHER
SIGNER IS REPRESENTING:
(NAME OF PERSON(S) OR ENTITY(IES))
01007.0001/734764.4
DESCRIPTION OF ATTACHED DOCUMENT
TITLE OR TYPE OF DOCUMENT
NUMBER OF PAGES
DATE OF DOCUMENT
SIGNERS) OTHER THAN NAMED ABOVE
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy or validity of that document.
STATE OF CALIFORNIA
COUNTY OF LOS ANGELES
OnOZ/�,,,r /9, 2021 before me,!�n,,.�_�,r�4,personally appeared k , , ?jc�sse, proved tome on the
basis of satisfactory evidence to be the person(s) whose names(s) is/are subscribed to the within instrument and
acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by
his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted,
executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true
and correct.
WITNESS my hand and official seal.
Signature:
OPTIONAL
Though the data below is not required by law, it may prove valuable to persons relying on the document and could
prevent fraudulent reattachment of this form
CAPACITY CLAIMED BY SIGNER
❑
INDIVIDUAL
❑
CORPORATE OFFICER
TITLES)
❑
PARTNER(S) ❑ LIMITED
❑ GENERAL
❑
ATTORNEY-IN-FACT
❑
TRUSTEE(S)
❑
GUARDIAN/CONSERVATOR
❑
OTHER
SIGNER IS REPRESENTING:
(NAME OF PERSON(S) OR ENTITY(IES))
01007.0001/734764.4
DESCRIPTION OF ATTACHED DOCUMENT
TITLE OR TYPE OF DOCUMENT
NUMBER OF PAGES
DATE OF DOCUMENT
SIGNER(S) OTHER THAN NAMED ABOVE
EXHIBIT A
DESCRIPTION OF GOODS AND PRICING
Stageline SLI DO Sales Quote 2021
6 -Oct -21 City of Carson, CA - Suggested package REV. 3
Stageline SL100 Mobile Stage
Flom Si -24'x 20'
/end Rosi: ,.— 115mp h wtnM mndwift 1 �'
Trade Weigh':
9,990 io
i
Standard Equipment' ...............
$ 122,500
Options & accessories ...............
$ 44,490
Services ...............
$ 16,166
Discount
$ 2,000
Sub -Total ...............
$ 181,166
Carson City Sales Tax (10.25%) ................
$ 18,668
Total ...............
$ 199,723
Al prices are in USD
Tpus rpriv axfed (f sppk.M)
"flV—t temp: 30% to =rmk bakes prior m depmire
ADDroval
Data;
Signature:
Name:
EW tl if applicable):
ROOF STRUCTURE & RIGGING
4 Buikfi busses I aluminum 2' diameter tube trussing
Compatible with industry damps
24 &nNn riq-gihq points -4 movable r4. qM. brackets included
Capacity: up to 1,5006
tugging bar 114'- spans 2 rigging points from left to right
Capacity: 30 lb / it
2 side overhang ngginq trusses G
Capacity: 1500 lb per side
fagging points in front of comer posts
Capacity 1500 lb per side
4 Aluminum caner posts
Added roof stability and safety
Fiberglass roof molded and wrapped around structure - black roof
flogging bad capacity tested at twice the working bad
Total roof bad capacity with sound wings:
11.4001b
Gatvan-sed steel column -ane on each side
System safely, hoists rigged bads
Reversbk as standard
Dahnstage will reverse in difficult to access venues
HYDRAULICS
Double mast rffi g mechanism (for a"hydraulic set up of the stage,
Liftig Capacity 3,800 b - balanced bad
roof, sound, fghtinq and other equipment)
Nigh power integrated hydraulic system
Equipped with safety valves on all cylinders
4 Hydraulic stabilizers / stage levels from 3'6" to 4'3"
No took required
Vertical support capacity (each): 15,000 b
Lateral support capacity (each): 2,000 b
Gas engine
No other power source required
STAGE
Pynood, black finish, non slip I quick levelling legs
24' x 20'
Mu97unctional extruded aluminum deck edges
To install decks, skirts, guardrails & staircases
Guardrails (stage model / alumnum
5 x 5`9' + 2 x 7 8'
Support brackets buitih for StageSne datfonms
Ful perimeter
Aluminum stairway -7 steps - adjustable -3S wide -with handrails
4 LED work lights
2 in the roof, 2 on the chassis
TRAILER
Draebar with pintie eye
2 Leaf spring axles
Capacity: 14,990 b
4 Tres
0.40 m (16')
Electric brakes on all wfeek
Emergency breakaway system
DOT requirement
Storage compartment
14' x 16' x 36"
Spare wfeel / h &sae rim / integrated storage
2 Storage bumpers
Protects structure
10 Equipment tie -dawns
Storage weight capacity
GVWR:15,000 b - adaptable to your requirements
Storage space capacity
23' 10"x 56"x S 6"= 720 ft'
STA14DARDS 8 CERTIFICATIONS
Applicable regulations
IBC, SAE, DOT, NFPA, CBC, NBC & C%VB
Vertical bad:
Floor. 7.18 KPa (150 psQ I Root. 1 KPa (20 psQ
Wind resistance:
115 mph witout windwalk
77 mph with wihdxaik
Certificate stamped by professional engineers
AJ technical documents supplied
2417 service support +1(800) 267-8243
01007.0001/734764.4 09999/0001/63760.01
Stageline it Sales Quote 2021
6 -Oct -21 City of Carson, CA - Suggested package REV. 3
A WINDWALLS- SKIRTS
of Upstage to retardant wincivrA - 44'" x full height (with doors) (keder afu
system for easy installation) - black
32 Backdrop (with doors) - 24'x 15 - black
33 Downstage windital extensions - IT 3' x 15' (with doors)- (Set of 2) - black
04 Skirling -40'x4'9" -black
as Skirt extension - 8' 6"- black - (set of 2)
•kropfions ofto a5, selectmateriel- also avaibbkn prey-febrItab tdelay
• ifopfion a3 sekUed, It Ikeder Jor wi&4"Os on downstage moJparrcA:) most be selected
B SOUND WINGS & RIGGING
bf Extension platforms (black non-sfp) & accessories - 4'x 8'- (suagg'td
b2 Guardrails (platform model) Ialuminum -38"-(suggIdof. 8)
b3 Reinforced ftybays with line array and screen rigging fonts (set of 2)
W FOHpipes -capaW-700lb-(set of 2)
b5 Movable rigging brackets - (set of 2)
b6 2 Cylinder kicks (cooler post subaHute)
U PA Extension bars (set of 2)
of Rooftop banner support posts - 3r x 4'
C2 BannerUamingbars
C3 Lateral banner supports - 6' x 15' 10' - includes pulley rigging points for retractable banner
system
lot Lateral bars at stage level / keeps lateral banilers taut
TIN Price (USD) Quantity
Price
1 $ 8001 1) s 800 1
d1 3 Extension platforms & accessories -4' x 24' - upstage $ 2,9101
d2 8 Guardrails (platform model) I alumnus - 3' 8' - upstage 5 1,440
d3 Bracing system for extension platforms -Upstage $ 810
d4 Wndwal to cover increased area -upstage S 5401 1
ds Roof extension - vinyl canopy & hardware - 4' 9"1 downstage 5 3,2001 1
it Keder for wndvalls on downstage roof panels S
* Mut&purpose, heavy-duty structural connectors for side overhang rigging beams and lateral 5 2,
banners. FOH pipe siders included.
t3 Reinforced 6' 8ybay busses (b3) with al hinged and articulated components on
upstage roof panel (set of 2) — IT required 5 4;
Note. Options It, 12 and f3 need to be selected fw AA reversMy
H
TRAILER HITCH
Price USDguantity
hl
Gooseneck / kingpin for 5th wheel hookup (instead of drawbar with pintle eye)
S
2.100
h2
Gooseneck/ 2 5116" ball hitch hookup (instead of dra%tarwith pntle eye)
h3
Bal hitch (attachment only)
M
Drawbar / pntle hitch [n addition to gooseneck)
115
Hydrau5c foldable gooseneck for kingpin or ball hitch (instead of drawbar with pinda eye)
h6 Dra,,War/25/16' ball wupier(insteadofdraai)arwdhpindeeye)
I ACCESSORIES
it Aluminum stairway -7steps - adjustable -35"wide-with handrails
12 Loading ramp / aluminum - 3' x 12'
13 Underfloor storage for loading ramp
14 ADA aft - up to 3 - 600 lb matt bad - portable - access from all sides
Is Extension platform (black non -sip) & accessories - 4' x 8'
Fir Extension pbtfoml (black non -sip) & accessories -4' x 4'
rr Guardrail (platform model) / aluminum -Ta"
is Guardrail (stage model) / aluminum -78"
19 Guardral (stage modeo / aluminum - 5' 9'
i10 Guardral(stage modeo/akimiaum-5x5'9'+2x78'
ill Quick shelter. polyester roof and vials - & x 8
02 Quick shelter. polyester roof and walls -10' x 10'
03 Storage compartment i aluminum checker plate -14" x 16'x36"- upto 3
il4 Spares kit
05 Underfloor storage system for options and accessories
116 SkKWskis
117 Aluminum mags -16" x 6" 816.5 bolt pattern
11
01007.0001/734764.4 09999/0001/63760.01
lir
ria --
li
ori _—
Stageline SI -1 tl Sales Quote 2021
6 -Oct -21 City of Carson, CA - Suggested package REV. 3
8 x LED Par64 Par cans - DMX conbolable - 1 x DMX lighting controller, all clamps,
plugs and cables
Basic sound system
2 x active 550 watt 2 way PA speaker system with stands 9 cables 7 i z 6 channel
analog mixer with cables, 2 x unidirectional microphones with stands 8 cables
Power distribution - portable - 50 amp for basic sound and fighting package
Generator - portable 4,500 watt - powers sound and fighting (65 dB 24')
Road Cases - options:
Basic fighting package
Basic sound system package
Basic fighting and sound system package
5 2,3501
S 4.99-51S 1 1 5 4995
$ 975
1 1
5 1,6001
$ 2,4501
K TRAILER GRAPHICS Price (USDI Quantity
k1 Logo only I TBD
k2 Full graphic tmilerwrap-(2 x(24'7"x7'2")-2x(4'11'x7')} I S 3,6751 1 Is 3,675
Customized scrim' banners - printed graphics - 4 color process
k3 Rooftop header banner -24'x3'10"
k4 Rooftop header banner - 3T x 3' 10" - spans lateral banners
k5 Lateral banners - G 6"x 15' 9" (Set or 2)
Its Rear banner- 23'4"x 127 11"- instals full sae, with or without backdrop
'aVadalYe in l:Ilyf-)]rIClS Valy
§ 970
5 1,390
1 $ 1,0451
I S 2,7251 1
L MISCELLANEOUS Price USD Quantity
11 - Black hberglaw 5 7501 1
12 We -2 TBD
Possible production delay
Total for Options & Accessories $ 44,490 1
m1 I ranter snnnK AT2p I S 700 1included
M2 Transport to Carson, CA S 10500 1 $ 10,500
m27. Transport to Champlain, NY - includes customs papemork $ 1 200
m3 Training course - 3 day comprehensive (subject to optiochosen) - maximum 4 technicians 5 2,4401 1 IS 2,440
ma Trainer expenses - to, in & from training site (Na when trailing given at Stagefne) I S 3,2251 1 I S 3,225
Total for Servicesl $ 16,166
tt Quote 2021
Costs related to transportation, training and Vainerexpenses (travel, accommodation and per diem) notincluded
EXYJ: L'AssomPSon, Quebec, Canada
Stageline Mobile Stage Inc. Tel.: (450) 589-1063, Fax: (450) 5894711
700 Mamolais Street, CAssomption, Quebec, Canada JSYJ 2G9 v .stageline.com
Stageline Mobile Stage Inc. Page 3 / 3
As part of the Goods, Stageline is available for customer support assistance 24/7 through its
emergency service line.
12
01007.0001/734764.4 09999/0001/63760.01
The setter represents and warrants that the Stageline SL100 stage will be under the
§jW,P,1ft stage care program,wi#h the following coverage:
3 YEARS
Standard coverage_ free frorTl and labor from the date of
delivery.
3 YEARS
Extended coverage: all aluminum welded structures inclgCj[ P chassis.
S YEARS
Extended coverage: fiberiqgoof erifw
IN THE EVENT AW..A MATERIAL DEFECTW"114 THE PRESGROED WARRANTY PERIOLI SELLER WILL REPA69 THE STAGE
SELLER SHALL91r$OL$LY RESPONSIBLE FOR THE C0tt0F ALL WARRANTY PARTS AND LAHOR. Na WARRANTY IS GIVEN
BY SELLER WITHRESPECT TO FABRICS: ARES OR THE RWOER ROOF J0I147S, OR NORMAL WEAR AND TEAR.
Recording Date:., .E /.—
The warranty becomes effective immediately upon completion of the Stageline training program.
13
01007.0001/734764.4 09999/0001/63760.01
I
O
�
00
5
Q7
rb
rz!
to
O
C7,
I
j
91 d]�.
CERTIFICATE OF INSURANCE
This Certificate is issued as a matter of information only and confers no rights upon the Certificate Holder. This Certificate does not affirmatively or
negatively amend, extend or alter the coverage afforded by the policy(ies) below and does not constitute a contract between the issuing insurer(s),
authorized representative or producer, and the Certificate Holder.
Named Insured
Broker
Stageline Mobile Stage Inc.
HUB International Quebec Limited
700 Marsolais Street
8500 Decarie Blvd, 51h Floor
L'Assomption QC Canada J5W2G9
Montreal, QC H4P 2N2
�eluncale ivumoer: z -I -4t Revision Number: Date (vvvv-mm-(1rI) 9ro1_1n_,)1
ertify that the policies of insurance listed below have been issued to the Named Insured herein for the policy period indicated. Notwithstanding
term or condition of any contract or other document with respect to which this Certificate may be issued or may pertain, the insurance
y the policies described herein is subject to all the terms,
Fanyrequirement,
conditions and exclusions of such policies.. Limits shown may have been reduced by
s.
Type of Insurance
Insurer
Effective Date
Policy Number
Expiry Date
Limits of Insurance
Commercial General Liability
701 E Carson Street,
Each Occurrence Limit
$2,000,000
❑ Claims -Made ® Occurrence
representative.
Personal & Advertising
AUTHORIZED REPRESENTATIVE
Injury Limit
$2,000,000
® Non -Owned Automobile (Q.P.F. No. 6)
AIG Insurance
Company of
2021-03-31
General Aggregate Limit
$2,000,000
® Additional Insured — Vendors Broad Form
Canada
to
2022-03-31
Products -Completed
066458326
Operations Aggregate Limit
$2,000,000
® Contingent Employer's Liability — Canada
Tenants' Legal Liability Limit
$2,000,000
Medical Expense Limit
$10,000
Automobile Liability (Q.P.F. No. 1)
❑ Non -Owned Autos ❑ All Owned AutosCompany
AIG Insurance
of
2021-01-31
Civil Liability — Property
Y
®Scheduled Autos ❑ Hired Autos
Canada
to
2022-01-31
damage of bodily injury to
another
$2,000,000
66458343
person
❑ Any Auto
❑ Claims -Made
❑ Claims -Made
Ila VCI 11 l4OlG 1J !DDUCu nl relerence [o:
Sale of stage (SL100)
—1-110111IJUICU.
If required by written contract, City of Carson are added as Additional Insured to the Commercial General Liability policy identified above, but only with
respect to liability arising out of the "product" or "work" of the Named Insured. Waiver of subrogation included.
Certificate Holder
Cancellation
Should any of the above described policy(ies) be cancelled before the
expiration date thereof, the issuing company will endeavor to mail 30 days
City of Carson
written notice to the Certificate Holder, but failure to mail such notice shall
701 E Carson Street,
impose no obligation or liability of any kind upon the company, its agents or
Carson, CA, USA, 90745
representative.
AUTHORIZED REPRESENTATIVE
Form W-88EN-E
(Rev. July 2017)
Department of the Treasury
Internal Revenue Service
Certificate of Status of Beneficial Owner for
United States Tax Withholding and Reporting (Entities)
► For use by entities. individuals must use Form W -BEEN. ► Section references are to the Internal Revenue Code.
► Go to www.'rs.gov/FormWBBENE for Instructions and the latest information.
► Give this form to the withholding agent or payer. Do not send to the IRS.
OMB No. 1545-1621
Do NOT use this form for:
• U.S. entity or U.S. citizen or resident Instead use Form:W 9
or For
• A foreign individual W-8BEN (Individual)m 8233
• A foreign individual or entity claiming that income is effectively connected with the conduct of trade or business within the U.S.
(unless claiming treaty benefits) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8ECI
• A foreign partnership, a foreign simple trust, or a foreign grantor trust (unless claiming treaty benefits) (see instructions for exceptions) . . W-81MY
• A foreign government, international organization, foreign central bank of issue, foreign tax-exempt organization, foreign private foundation, or
government of a U.S. possession claiming that income is effectively connected U.S. income or that is claiming the applicability of section(s) 115(2),
501(c), 892, 895, or 1443(b) (unless claiming treaty benefits) (see instructions for other exceptions) . . . . . . . . . W-8ECI or W-8EXP
• Any person acting as an intermediary (including a qualified intermediary acting as a qualified derivatives dealer) . . . . . . . . . W-81MY
of Beneficial Owner
1 Name of organization that is the beneficial owner 2 Country of incorporation or organization
rAGELINE MOBILE STAGE INC CANADA
3 Name of disregarded entity receiving the payment (if applicable, see instructions)
4 Chapter 3 Status (entity type) (Must check one box only): 0 Corporation ❑ Disregarded entity ❑ Partnership
❑ Simple trust ❑ Grantor trust ❑ Complex trust ❑ Estate
❑ Government
❑ Central Bank of Issue ❑ Tax-exempt organization ❑ Private foundation ❑ International organization
If you entered disregarded entity, partnership, simple trust, or grantor trust above, is the entity a hybrid making a treaty
claim? If "Yes" complete Part III. ❑ Yes ❑ No
5 Chapter 4 Status (FATCA status) (See instructions for details and complete the certification below for the entity's applicable status.)
❑ Nonparticipating FFI (including an FFI related to a Reporting IGA ❑ Nonreporting IGA FFI. Complete Part XII.
FFI other than a deemed -compliant FFI, participating FFI, or ❑ Foreign government, government of a U.S. possession, or foreign
exempt beneficial owner). central bank of issue. Complete Part XIII.
❑ Participating FFI.
❑ Reporting Model 1 FFI.
❑ Reporting Model 2 FFI.
❑ Registered deemed -compliant FFI (other than a reporting Model 1
FFI, sponsored FFI, or nonreporting IGA FFI covered in Part XII).
See instructions.
❑ Sponsored FFI. Complete Part IV.
❑ Certified deemed -compliant nonregistering local bank. Complete
Part V.
❑ Certified deemed -compliant FFI with only low -value accounts.
Complete Part VI.
❑ Certified deemed -compliant sponsored, closely held investment
vehicle. Complete Part VII.
❑ International organization. Complete Part XIV.
❑ Exempt retirement plans. Complete Part XV.
❑ Entity wholly owned by exempt beneficial owners. Complete Part XVI.
❑ Territory financial institution. Complete Part XVII.
❑ Excepted nonfinancial group entity, Complete Part XVIII.
❑ Excepted nonfinancial start-up company. Complete Part XIX.
❑ Excepted nonfinancial entity in liquidation or bankruptcy.
Complete Part XX.
❑ 501(c) organization. Complete Part XXI.
❑ Nonprofit organization. Complete Part XXII.
❑ Publicly traded NFFE or NFFE affiliate of a publicly traded
corporation. Complete Part XXIII.
❑ Excepted territory NFFE. Complete Part XXIV.
❑ Certified deemed -compliant limited life debt investment entity. Active NFFE. Complete Part XXV.
Complete Part VIII. ❑ Passive NFFE. Complete Part XXVI.
❑ Certain investment entities that do not maintain financial accounts. ❑ Excepted inter -affiliate FFI. Complete Part XXVII,
Complete Part IX. ❑ Direct reporting NFFE.
❑ Owner -documented FFI. Complete Part X. ❑ Sponsored direct reporting NFFE. Complete Part XXVIiI.
❑ Restricted distributor. Complete Part XI. ❑ Account that is not a financial account
6 Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in -care -of address (other than a registered address).
700 Rue Marsolais
City or town, state or province. Include postal code where appropriate.
fS
2139
Mailing address (if different from above)
,ay U1 wwr 1, trace or province. mcluce postal code where appropriate.
Country
Country
8 U.S. taxpayer identification number (rIN), if required( 9a GIIN b Foreign TIN
98-1271085
10 Reference number(s) (see instructions)
Note: Please complete remainder of the form including signing the form in Part XXX.
For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 59689N Form W-8BEN-E (Rev. 7-2017)
Form W-8BEN-E (Rev. 7-2017) Page 2
EjEM Disregarded Entity or Branch Receiving Payment. (Complete only if a disregarded entity with a GIIN or a
branch of an FFI in a country other than the FFI's country of residence. See instructions.)
11 Chapter 4 Status (FATCA status) of disregarded entity or branch receiving payment
❑ Branch treated as nonparticipating FFI. ❑ Reporting Model 1 FFI. ❑ U.S. Branch.
❑ Participating FFI. ❑ Reporting Model 2 FFI.
12 Address of disregarded entity or branch (street, apt. or suite no., or rural route). Do not use a P.O. box or in -care -of address (other than a
registered address).
L,uy or town, siaie or province. incwce postai code where appropriate.
i.ouniry
ro kwm pr any)
Claim of Tax Treaty Benefits (if applicable). (For chapter 3 purposes only.)
14 1 certify that (check all that apply):
a E The beneficial owner is a resident of Canada within the meaning of the income tax
treaty between the United States and that country.
b El The beneficial owner derives the item (or items) of income for which the treaty benefits are claimed, and, if applicable, meets the
requirements of the treaty provision dealing with limitation on benefits. The following are types of limitation on benefits provisions that may
be included in an applicable tax treaty (check only one; see instructions):
❑ Government ❑ Company that meets the ownership and base erosion test
❑ Tax exempt pension trust or pension fund ❑ Company that meets the derivative benefits test
❑ Other tax exempt organization ❑ Company with an item of income that meets active trade or business test
❑ Publicly traded corporation ❑ Favorable discretionary determination by the U.S. competent authority received
❑ Subsidiary of a publicly traded corporation ❑ Other (specify Article and paragraph):
c ❑ The beneficial owner is claiming treaty benefits for U.S. source dividends received from a foreign corporation or interest from a U.S. trade
or business of a foreign corporation and meets qualified resident status (see instructions).
15 Special rates and conditions (if applicable—see instructions):
The beneficial owner is claiming the provisions of Article and paragraph V and VII
of the treaty identified on line 14a above to claim a 0 % rate of withholding on (specify type of income): See attached doc
Explain the additional conditions in the Article the beneficial owner meets to be eligible for the rate of withholding: See attached document
Sponsored FFI
16 Name of sponsoring entity:
17 Check whichever box applies.
❑ 1 certify that the entity identified in Part I:
• Is an investment entity;
• Is not a QI, WP (except to the extent permitted in the withholding foreign partnership agreement), or WT; and
• Has agreed with the entity identified above (that is not a nonparticipating FFI) to act as the sponsoring entity for this entity.
❑ I certify that the entity identified in Part I:
• Is a controlled foreign corporation as defined in section 957(a);
• Is not a QI, WP, or WT;
• Is wholly owned, directly or indirectly, by the U.S. financial institution identified above that agrees to act as the sponsoring entity for this entity; and
• Shares a common electronic account system with the sponsoring entity (identified above) that enables the sponsoring entity to identify all
account holders and payees of the entity and to access all account and customer information maintained by the entity including, but not
limited to, customer identification information, customer documentation, account balance, and all payments made to account holders or
payees.
Form W-8BEN-E (Rev. 7-2017)
Form W-813EN-E (Rev. 7-2017) Page 3
Certified Deemed-Compliant Nonregistering Local Bank
18 ❑ I certify that the FFI identified in Part I:
• Operates and is licensed solely as a bank or credit union (or similar cooperative credit organization operated without profit) in its country of
incorporation or organization;
• Engages primarily in the business of receiving deposits from and making loans to, with respect to a bank, retail customers unrelated to such
bank and, with respect to a credit union or similar cooperative credit organization, members, provided that no member has a greater than 5%
interest in such credit union or cooperative credit organization;
• Does not solicit account holders outside its country of organization;
• Has no fixed place of business outside such country (for this purpose, a fixed place of business does not include a location that is not
advertised to the public and from which the FFI performs solely administrative support functions);
• Has no more than $175 million in assets on its balance sheet and, if it is a member of an expanded affiliated group, the group has no more
than $500 million in total assets on its consolidated or combined balance sheets; and
• Does not have any member of its expanded affiliated group that is a foreign financial institution, other than a foreign financial institution that
is incorporated or organized in the same country as the FFI identified in Part I and that meets the requirements set forth in this part.
Certified Deemed-Compliant FFI with Only Low-Value Accounts
19 ❑ I certify that the FFI identified in Part I:
• Is not engaged primarily in the business of investing, reinvesting, or trading in securities, partnership interests, commodities, notional
principal contracts, insurance or annuity contracts, or any interest (including a futures or forward contract or option) in such security,
partnership interest, commodity, notional principal contract, insurance contract or annuity contract;
• No financial account maintained by the FFI or any member of its expanded affiliated group, if any, has a balance or value in excess of
$50,000 (as determined after applying applicable account aggregation rules); and
• Neither the FFI nor the entire expanded affiliated group, if any, of the FFI, have more than $50 million in assets on its consolidated or
combined balance sheet as of the end of its most recent accounting year.
Certified Deemed-Compliant Sponsored, Closely Held Investment Vehicle
20 Name of sponsoring entity:
21 ❑ 1 certify that the entity identified in Part I:
• Is an FFI solely because it is an investment entity described in Regulations section 1.1471-5(e)(4);
• Is not a QI, WP, or WT;
• Will have all of its due diligence, withholding, and reporting responsibilities (determined as if the FFI were a participating FFI) fulfilled by the
sponsoring entity identified on line 20; and
• 20 or fewer individuals own all of the debt and equity interests in the entity (disregarding debt interests owned by U.S. financial institutions,
participating FFIs, registered deemed-compliant FFIs, and certified deemed-compliant FFIs and equity interests owned by an entity if that
entity owns 100% of the equity interests in the FFI and is itself a sponsored FFI).
Certified Deemed-Compliant Limited Life Debt Investment Entity
22 ❑ I certify that the entity identified in Part 1:
• Was in existence as of January 17, 2013;
• Issued all classes of its debt or equity interests to investors on or before January 17, 2013, pursuant to a trust indenture or similar agreement; and
• Is certified deemed-compliant because it satisfies the requirements to be treated as a limited life debt investment entity (such as the
restrictions with respect to its assets and other requirements under Regulations section 1.1471-5(0(2)(iv)).
Certain Investment Entities that Do Not Maintain Financial Accounts
23 ❑ I certify that the entity identified in Part I:
• Is a financial institution solely because it is an investment entity described in Regulations section 1.1471-5(e)(4)(i)(A), and
• Does not maintain financial accounts.
Owner-Documented FFI
Note: This status only applies if the U.S. financial institution, participating FFI, or reporting Model 1 FFI to which this form is given has agreed that it will
treat the FFI as an owner-documented FFI (see instructions for eligibility requirements). In addition, the FFI must make the certifications below.
24a ❑ (All owner-documented FFIs check here) I certify that the FFI identified in Part I:
• Does not act as an intermediary;
• Does not accept deposits in the ordinary course of a banking or similar business;
• Does not hold, as a substantial portion of its business, financial assets for the account of others;
• Is not an insurance company (or the holding company of an insurance company) that issues or is obligated to make payments with respect to
a financial account;
• Is not owned by or in an expanded affiliated group with an entity that accepts deposits in the ordinary course of a banking or similar
business, holds, as a substantial portion of its business, financial assets for the account of others, or is an insurance company (or the holding
company of an insurance company) that issues or is obligated to make payments with respect to a financial account;
• Does not maintain a financial account for any nonparticipating FFI; and
• Does not have any specified U.S. persons that own an equity interest or debt interest (other than a debt interest that is not a'financial
account or that has a balance or value not exceeding $50,000) in the FFI other than those identified on the FFI owner reporting statement.
Form W-8BEN-E (Rev. 7-2017)
Form W-8BEN-E (Rev. 7-2017)
Owner -Documented FFI (continued) Page 4
Check box 24b or 24c, whichever applies.
b ❑ I certify that the FFI identified in Part I:
• Has provided, or will provide, an FFI owner reporting statement that contains:
01 The name, address, TIN (if any), chapter 4 status, and type of documentation provided (if required) of every individual and specified
U.S. person that owns a direct or indirect equity interest in the owner -documented FFI (looking through all entities other than specified
U.S. persons);
(ii) The name, address, TIN (if any), and chapter 4 status of every individual and specified U.S. person that owns a debt interest in the
owner -documented FFI (including any indirect debt interest, which includes debt interests in any entity that directly or indirectly owns
the payee or any direct or indirect equity interest in a debt holder of the payee) that constitutes a financial account in excess of
$50,000 (disregarding all such debt interests owned by participating FFIs, registered deemed -compliant FFIs, certified deemed -
compliant FFIs, excepted NFFEs, exempt beneficial owners, or U.S. persons other than specified U.S. persons); and
(iii) Any additional information the withholding agent requests in order to fulfill its obligations with respect to the entity.
• Has provided, or will provide, valid documentation meeting the requirements of Regulations section 1.1471-3(d)(6)(iii) for each person
identified in the FFI owner reporting statement.
c ❑ I certify that the FFI identified in Part I has provided, or will provide, an auditor's letter, signed within 4 years of the date of payment,
from an independent accounting firm or legal representative with a location in the United States stating that the firm or representative has
reviewed the FFI's documentation with respect to all of its owners and debt holders identified in Regulations section 1.1471-3(d)(6)(iv)(A)(2),
and that the FFI meets all the requirements to be an owner -documented FFI. The FFI identified in Part I has also provided, or will provide,
an FFI owner reporting statement of its owners that are specified U.S. persons and Form(s) W-9, with applicable waivers.
Check box 24d if applicable (optional, see instructions).
d ❑ I certify that the entity identified on line 1 is a trust that does not have any contingent beneficiaries or designated classes with unidentified
beneficiaries.
Restricted Distributor
25a ❑ (All restricted distributors check here) I certify that the entity identified in Part I:
• Operates as a distributor with respect to debt or equity interests of the restricted fund with respect to which this form is furnished;
• Provides investment services to at least 30 customers unrelated to each other and less than half of its customers are related to each other;
• Is required to perform AML due diligence procedures under the anti -money laundering laws of its country of organization (which is an FATF-
compliant jurisdiction);
• Operates solely in its country of incorporation or organization, has no fixed place of business outside of that country, and has the same
country of incorporation or organization as all members of its affiliated group, if any;
• Does not solicit customers outside its country of incorporation or organization;
• Has no more than $175 million in total assets under management and no more than $7 million in gross revenue on its income statement for
the most recent accounting year;
• Is not a member of an expanded affiliated group that has more than $500 million in total assets under management or more than $20 million
in gross revenue for its most recent accounting year on a combined or consolidated income statement; and
• Does not distribute any debt or securities of the restricted fund to specified U.S. persons, passive NFFEs with one or more substantial U.S.
owners, or nonparticipating FFIs.
Check box 25b or 25c, whichever applies.
I further certify that with respect to all sales of debt or equity interests in the restricted fund with respect to which this form is furnished that are made
after December 31, 2011, the entity identified in Part I:
b ❑ Has been bound by a distribution agreement that contained a general prohibition on the sale of debt or securities to U.S. entities and U.S.
resident individuals and is currently bound by a distribution agreement that contains a prohibition of the sale of debt or securities to any
specified U.S. person, passive NFFE with one or more substantial U.S. owners, or nonparticipating FFI.
c ❑ Is currently bound by a distribution agreement that contains a prohibition on the sale of debt or securities to any specified U.S. person,
passive NFFE with one or more substantial U.S. owners, or nonparticipating FFI and, for all sales made prior to the time that such a
restriction was included in its distribution agreement, has reviewed all accounts related to such sales in accordance with the procedures
identified in Regulations section 1.1471-4(c) applicable to preexisting accounts and has redeemed or retired any, or caused the restricted
fund to transfer the securities to a distributor that is a participating FFI or reporting Model 1 FFI securities which were sold to specified U.S.
persons, passive NFFEs with one or more substantial U.S. owners, or nonparticipating FFIs.
Form W-8BEN-E (Rev. 7-2017)
Form W-88EN-E (Rev. 7-2017) Page rJ
Nonreporting IGA FFI
26 ❑ I certify that the entity identified in Part I:
• Meets the requirements to be considered a nonreporting financial institution pursuant to an applicable IGA between the United States and
The applicable IGA is a ❑ Model 1 IGA or a ❑ Model 2 IGA; and
is treated as a under the provisions of the applicable IGA or Treasury regulations
(if applicable, see instructions);
• If you are a trustee documented trust or a sponsored entity, provide the name of the trustee or sponsor
The trustee is: ❑ U.S. ❑ Foreign
Mim Foreign Government, Government of a U.S. Possession, or Foreign Central Bank of Issue
27 ❑ I certify that the entity identified in Part I is the beneficial owner of the payment, and is not engaged in commercial financial activities of a
type engaged in by an insurance company, custodial institution, or depository institution with respect to the payments, accounts, or
obligations for which this form is submitted (except as permitted in Regulations section 1.1471-6(h)(2)).
International Organization
Check box 28a or 28b, whichever applies.
28a ❑ 1 certify that the entity identified in Part I is an international organization described in section 7701(a)(18).
b ❑ I certify that the entity identified in Part I:
• Is comprised primarily of foreign governments;
• Is recognized as an intergovemmental or supranational organization under a foreign law similar to the International Organizations Immunities
Act or that has in effect a headquarters agreement with a foreign government;
• The benefit of the entity's income does not inure to any private person; and
• Is the beneficial owner of the payment and is not engaged in commercial financial activities of a type engaged in by an insurance company,
custodial institution, or depository institution with respect to the payments, accounts, or obligations for which this form is submitted (except as
permitted in Regulations section 1.1471-6(h)(2)).
JIMIJEWL Exempt Retirement Plans
Check box 29a, b, c, d, e, or f, whichever applies.
29a ❑ 1 certify that the entity identified in Part I:
• Is established in a country with which the United States has an income tax treaty in force (see Part III if claiming treaty benefits);
• Is operated principally to administer or provide pension or retirement benefits; and
• Is entitled to treaty benefits on income that the fund derives from U.S. sources (or would be entitled to benefits if it derived any such income)
as a resident of the other country which satisfies any applicable limitation on benefits requirement.
b ❑ I certify that the entity identified in Part I:
• Is organized for the provision of retirement, disability, or death benefits (or any combination thereof) to beneficiaries that are former
employees of one or more employers in consideration for services rendered;
• No single beneficiary has a right to more than 5% of the FFI's assets;
• Is subject to govemment regulation and provides annual information reporting about its beneficiaries to the relevant tax authorities in the
country in which the fund is established or operated; and
(I) Is generally exempt from tax on investment income under the laws of the country in which it is established or operates due to its status
as a retirement or pension plan;
(i) Receives at least 50% of its total contributions from sponsoring employers (disregarding transfers of assets from other plans described
in this part, retirement and pension accounts described in an applicable Model 1 or Model 2 IGA, other retirement funds described in
an applicable Model 1 or Model 2 IGA, or accounts described in Regulations section 1.1471-5(b)(2)(i)(A));
(iii) Either does not permit or penalizes distributions or withdrawals made before the occurrence of specified events related to retirement,
disability, or death (except rollover distributions to accounts described in Regulations section 1.1471-5(b)(2)(i)(A) (referring to retirement
and pension accounts), to retirement and pension accounts described in an applicable Model 1 or Model 2 IGA, or to other retirement
funds described in this part or in an applicable Model 1 or Model 2 IGA); or
(iv) Limits contributions by employees to the fund by reference to eamed income of the employee or may not exceed $50,000 annually.
c ❑ I certify that the entity identified in Part I:
• Is organized for the provision of retirement, disability, or death benefits (or any combination thereof) to beneficiaries that are former
employees of one or more employers in consideration for services rendered;
• Has fewer than 50 participants;
• Is sponsored by one or more employers each of which is not an investment entity or passive NFFE;
• Employee and employer contributions to the fund (disregarding transfers of assets from other plans described in this part, retirement and
pension accounts described in an applicable Model 1 or Model 2 IGA, or accounts described in Regulations section 1.1471-5(b)(2)0)(A)) are
limited by reference to eamed income and compensation of the employee, respectively;
• Participants that are not residents of the country in which the fund is established or operated are not entitled to more than 20% of the fund's assets; and
• Is subject to government regulation and provides annual information reporting about its beneficiaries to the relevant tax authorities in the
country in which the fund is established or operates.
Form W-8BEN-E (Rev. 7-2017)
Form W-8BEN-E (Rev. 7-2017) Page 6
Exempt Retirement Plans (continued)
d ❑ I certify that the entity identified in Part I is formed pursuant to a pension plan that would meet the requirements of section 401(a), other
than the requirement that the plan be funded by a trust created or organized in the United States.
e ❑ I certify that the entity identified in Part I is established exclusively to earn income for the benefit of one or more retirement funds
described in this part or in an applicable Model 1 or Model 2 IGA, or accounts described in Regulations section 1. 1471 -5(b)(2)(i)(A) (referring to
retirement and pension accounts), or retirement and pension accounts described in an applicable Model 1 or Model 2 IGA.
f ❑ I certify that the entity identified in Part I:
• Is established and sponsored by a foreign government, international organization, central bank of issue, or government of a U.S. possession
(each as defined in Regulations section 1.1471-6) or an exempt beneficial owner described in an applicable Model 1 or Model 2 IGA to provide
retirement, disability, or death benefits to beneficiaries or participants that are current or former employees of the sponsor (or persons
designated by such employees); or
• Is established and sponsored by a foreign government, international organization, central bank of issue, or government of a U.S. possession
(each as defined in Regulations section 1.1471-6) or an exempt beneficial owner described in an applicable Model 1 or Model 2 IGA to provide
retirement, disability, or death benefits to beneficiaries or participants that are not current or former employees of such sponsor, but are in
consideration of personal services performed for the sponsor.
Entity Wholly Owned by Exempt Beneficial Owners
30 ❑ 1 certify that the entity identified in Part I:
• Is an FFI solely because it is an investment entity;
• Each direct holder of an equity interest in the investment entity is an exempt beneficial owner described in Regulations section 1.1471-6 or in
an applicable Model 1 or Model 2 IGA;
• Each direct holder of a debt interest in the investment entity is either a depository institution (with respect to a loan made to such entity) or an
exempt beneficial owner described in Regulations section 1.1471-6 or an applicable Model 1 or Model 2 IGA.
• Has provided an owner reporting statement that contains the name, address, TIN (if any), chapter 4 status, and a description of the type of
documentation provided to the withholding agent for every person that owns a debt interest constituting a financial account or direct equity
interest in the entity; and
• Has provided documentation establishing that every owner of the entity is an entity described in Regulations section 1.1471-6(b), (c), (d), (e),
(f) and/or (g) without regard to whether such owners are beneficial owners.
Territory Financial Institution
31 ❑ I certify that the entity identified in Part I is a financial institution (other than an investment entity) that is incorporated or organized under
the laws of a possession of the United States.
Excepted Nonfinancial Group Entity
32 ❑ I certify that the entity identified in Part 1:
• Is a holding company, treasury center, or captive finance company and substantially all of the entity's activities are functions described in
Regulations section 1.1471-5(e)(5)(i)(C) through (E);
• Is a member of a nonfinancial group described in Regulations section 1.1471-5(e)(5)(j)(B);
• Is not a depository or custodial institution (other than for members of the entity's expanded affiliated group); and
• Does not function (or hold itself out) as an investment fund, such as a private equity fund, venture capital fund, leveraged buyout fund, or any
investment vehicle with an investment strategy to acquire or fund companies and then hold interests in those companies as capital assets for
investment purposes.
Excepted Nonfinancial Start -Up Company
33 ❑ I certify that the entity identified in Part 1:
• Was formed on (or, in the case of a new line of business, the date of board resolution approving the new line of business)
(date must be less than 24 months prior to date of payment);
• Is not yet operating a business and has no prior operating history or is investing capital in assets with the intent to operate a new line of
business other than that of a financial institution or passive NFFE;
• Is investing capital into assets with the intent to operate a business other than that of a financial institution; and
• Does not function (or hold itself out) as an investment fund, such as a private equity fund, venture capital fund, leveraged buyout fund, or any
investment vehicle whose purpose is to acquire or fund companies and then hold interests in those companies as capital assets for investment purposes.
ExceDted Nonfinancial Fntity in t inniriatinn ~ P.nllw.n+...,
34 ❑ I certify that the entity identified in Part is
• Filed a plan of liquidation, filed a plan of reorganization, or filed for bankruptcy on
• During the past 5 years has not been engaged in business as a financial institution or acted as a passive NFFE;
• Is either liquidating or emerging from a reorganization or bankruptcy with the intent to continue or recommence operations as a nonfinancial
entity; and
• Has, or will provide, documentary evidence such as a bankruptcy filing or other public documentation that supports its claim if it remains in
bankruptcy or liquidation for more than 3 years.
Form W -$BEN -E (Rev. 7-2017)
Form W-8BEN-E (Rev. 7-2017) Page 7
501(c) Organization
35 ❑ I certify that the entity identified in Part I is a 501(c) organization that:
• Has been issued a determination letter from the IRS that is currently in effect concluding that the payee is a section 501(c) organization that is
dated ; or
• Has provided a copy of an opinion from U.S. counsel certifying that the payee is a section 501(c) organization (without regard to whether the
payee is a foreign private foundation).
Nonprofit Organization
36 ❑ I certify that the entity identified in Part I is a nonprofit organization that meets the following requirements.
• The entity is established and maintained in its country of residence exclusively for religious, charitable, scientific, artistic, cultural or educational purposes;
• The entity is exempt from income tax in its country of residence;
• The entity has no shareholders or members who have a proprietary or beneficial interest in its income or assets;
• Neither the applicable laws of the entity's country of residence nor the entity's formation documents permit any income or assets of the entity
to be distributed to, or applied for the benefit of, a private person or noncharitabie entity other than pursuant to the conduct of the entity's
charitable activities or as payment of reasonable compensation for services rendered or payment representing the fair market value of property
which the entity has purchased; and
• The applicable laws of the entity's country of residence or the entity's formation documents require that, upon the entity's liquidation or
dissolution, all of its assets be distributed to an entity that is a foreign government, an integral part of a foreign government, a controlled entity
of a foreign government, or another organization that is described in this part or escheats to the government of the entity's country of
residence or any political subdivision thereof.
Publicly Traded NFFE or NFFE Affiliate of a Publicly Traded Corporation
Check box 37a or 37b, whichever applies.
37a ❑ [certify that:
• The entity identified in Part I is a foreign corporation that is not a financial institution; and
• The stock of such corporation is regularly traded on one or more established securities markets, including
(name one securities exchange upon which the stock is regularly traded).
❑ I certify that:
• The entity identified in Part I is a foreign corporation that is not a financial institution;
• The entity identified in Part I is a member of the same expanded affiliated group as an entity the stock of which is regularly traded on an
established securities market;
• The name of the entity, the stock of which is regularly traded on an established securities market,
• The name of the securities market on which the stock is regularly traded is
38 LJ I certify that:
and
• The entity identified in Part I is an entity that is organized in a possession of the United States;
• The entity identified in Part I:
() Does not accept deposits in the ordinary course of a banking or similar business;
(ii) Does not hold, as a substantial portion of its business, financial assets for the account of others; or
(iii) Is not an insurance company (or the holding company of an insurance company) that issues or is obligated to make payments with
respect to a financial account; and
• All of the owners of the entity identified in Part I are bona fide residents of the possession in which the NFFE is organized or incorporated.
Active NFFE
39 El I certify that:
• The entity identified in Part I is a foreign entity that is not a financial institution;
• Less than 50% of such entity's gross income for the preceding calendar year is passive income; and
• Less than 50% of the assets held by such entity are assets that produce or are held for the production of passive income (calculated as a
weighted average of the percentage of passive assets measured quarterly) (see instructions for the definition of passive income).
40a
F
I certiry tnat the entity identified in Part I is a foreign entity that is not a financial institution (other than an investment entity organized in a
possession of the United States) and is not certifying its status as a publicly traded NFFE (or affiliate), excepted territory NFFE, active
NFFE, direct reporting NFFE, or sponsored direct reporting NFFE.
Check box 40b or 40c, whichever applies.
b ❑ I further certify that the entity identified in Part I has no substantial U.S. owners (or, if applicable, no controlling U.S. persons); or
c ❑ 1 further certify that the entity identified in Part I has provided the name, address, and TIN of each substantial U.S. owner (or, if applicable,
controlling U.S. person) of the NFFE in Part XXIX.
Form W-8BEN-E (Rev. 7-2017)
Form W-88EN-E (Rev. 7-2017)
8
Excepted Inter-Affiliate FFI Page
41 ❑ I certify that the entity identified in Part I: —
• Is a member of an expanded affiliated group;
• Does not maintain financial accounts (other than accounts maintained for members of its expanded affiliated group);
• Does not make withholdable payments to any person other than to members of its expanded affiliated group;
• Does not hold an account (other than depository accounts in the country in which the entity is operating to pay for expenses) with or receive
payments from any withholding agent other than a member of its expanded affiliated group; and
• Has not agreed to report under Regulations section 1.1471-4(d)(2)(ii)(C) or otherwise act as an agent for chapter 4 purposes on behalf of any financial
institution, including a member of its expanded affiliated group.
Sponsored Direct Reporting NFFE (see instructions for when this is permitted)
42 Name of sponsoring entity.
43 LJ I certlfv that the
Identified in Part I is a direct
S. Owners of Passive
NI -I -t that is sponsored by the entity identified on line 42.
As required by Part XXVI, provide the name, address, and TIN of each substantial U.S. owner of the NFFE. Please see the instructions for a definition of
substantial U.S. owner. If providing the form to an FFI treated as a reporting Model 1 FFI or reporting Model 2 FFI, an NFFE may also use this part for
reporting its controlling U.S. persons under an applicable IGA.
Certification
Under penalties of perjury, I declare that I have examined the infon-nation on this form and to the best of my knowledge and belief it is true, correct, and complete. i further
certify under penalties of perjury that:
• The entity identified on line 1 of this form is the beneficial owner of all the income to which this form relates, is using this form to certify its status for chapter 4
purposes, or is a merchant submitting this form for purposes of section 6050W;
• The entity identified on line 1 of this form is not a U.S. person;
• The income to which this form relates is: (a) not effectively connected with the conduct of a trade or business in the United States, (b) effectively connected but is
not subject to tax under an income tax treaty, or (c) the partner's share of a partnership's effectively connected income; and
• For broker transactions or barter exchanges, the beneficial owner is an exempt foreign person as defined in the instructions.
Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of which the entity on line 1 is the beneficial
owner or any withholding agent that can disburse or make payments of the income of which the entity on line 1 is the beneficial owner.
1 agree that I will submit a new form within 30 days if any certification on this form becomes incorrect
Sign Here' Pierre -Luc Rompre
- 06-15-2021
S orized to sign for beneficial owner Print Name Date (MM-DD-YYYY)
E I certify that 1 have the capacity to sign for the entity identified on line 1 of this form.
Form W-8BEN-E (Rev. 7-2017)
W BBEN-E (Part N line 15):
Sale of equipment, training, inspection, repairs, transport and sale of parts.
The taxpayer is a resident of Canada under the Canada -US Tax Treaty ("Treaty'). The taxpayer
does not earn business profits attributable to a permanent establishment in the US pursuant to
Articles Vli and V of the Treaty and as such is not subject to US Federal income tax.
Stagellne Mobile Stage Inc.
700 Marsolais, L'Assompllon, Quebec, Canada J5W 2G9 • Tel: 450.589 -1063.1 -800 -26 -stage (North America) - Fax 450-589-1711
Web: hllp://www.stagellne.com - E-mail: into@stageline.com