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HomeMy Public PortalAboutC-21-164 - TRACKLESS TRAIN - 2021 WINTERFEST SPACity of Carson Community Services Department Service Provider Application Agreement Check one (staff use): |Carson Event Center|]Human Services [|Recreation [|Transportation Event:WinterFest Event Location:Carson Event Center Event Date:12/18/21 The Trackless TrainNameofServiceProvider: Business Form/Entity Type (if individual,sole proprietorship,corporation,or limited liability company,specify here): LLC Business Form/Entity Type (if general partnership,limited partnership,limited liability partnership, or other,specify here): General Partnership Business Entity State of Incorporation (if applicable):California Entertainment Clifton Burnley Phone #:(310)967-2647 Type of Service: Contact Person: Emer.Contact:Phone #:() Billing Address:409 E.Gardena Blvd.Suite C Number Street Gardena CA 90248 City State ZIP Proof of Insurance (check one)?[Vlyes [Ino If no,would you like to purchase special event insurance through the City (check one)?[_les VINo Special Instructions /Notes: 532227.5 CEN AS OF 1-22-2020 If Service Provider wishes to request any special accommodation needed to facilitate provision of the services,please identify it here or contact the staff member referenced on Page |of this application: Total Service Fee $538.19 NOTE:If service provider is unable to provide the services as proposed or requested or the City of Carson cancels the service for any reason,the associated fees will not be paid. [remainder ofpage intentionally left blank] 532227.5 CFN AS OF 1-22-2020 Further Terms of Service Provider Application Agreement: The undersigned signatory of Service Provider (Service Provider being the above-referenced 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 approvalor authorization for Service Provider to perform or 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 memberof a joint enterprise with the City.Neither Service Provider nor any of its agents or employees shall at anytime or in any manner represent that Service Provider or 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 event that part of this Agreement is declared invalid or unenforceable by a valid judgment or decree of a court of competent jurisdiction,such invalidity or unenforceability shall not affect any of 532227.5 CFN AS OF1-22-2020 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 warrants that 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 PRovipER:|he Trackless Train CLAFION BUMNMLCY 12/14/2021 (Signature of Service Provider’s Authorized Representative)(Date) Clifton Burnley (Printed Nameof Service Provider’s Authorized Representative) (Space belowthis line for City use only) APPLICATION APPROVAL: CITY OF C ON,:/>Lie)Dy (Signature of City Manager or Designee)(Date) 532227.5 CFN AS OF 1-22-2020 Service Provider Rules &Regulations 1.SERVICE PROVIDER APPLICATION:Upon acceptance,approval,and execution of a service provider application by the City of Carson (“City”),these rules and provisions shall become binding and part of the Service Provider Application Agreement between the applicant (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 the City,on the other hand.Any additions and amendments thereto that may be established or put into effect by the City,and provided in writing to the Provider,shall also become binding and a part of the Service Provider Application Agreement. 2.PAYMENT/CANCELLATION:If the Provider is unable to perform or cannot provide the services as requested,or the City cancels the service for any reason,the associated fees for service will not be paid. 3,CANCELLATION:No refunds will be given unless the subject event is cancelled by the City’s Community Services Department.Applications may be denied or events cancelled in favor of City programs. 4.PROPERTY LOSS OR DAMAGES:TheCity is not responsible for any damageto,loss or theft of the Provider’s property,or that of Provider’s agents,employees orinvitees. 5.CHARACTER OF ENTERTAINMENT:TheProvider shall observe,obey and comply with all applicable local,state and federal laws,and all applicable policies,rules,regulations and terms and conditions governing use of City facilities.The Provider will forfeit all rents or other fees paid if ejected from premises for violations of same.Ejection shall not release Provider from any obligations for the payment of rents or other fees not yet paid under such permit or additionally incurred.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 to change without notice to Provider unless the change affects a permit already issued to Provider. Provider shall be solely responsible for the orderly conduct of all persons using the premises by its invitation,either expressed or implied,during all times covered by the Service Provider Application Agreement.The City reserves the right to eject or cause to be ejected from the premises any person or persons due to unlawful conduct. 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 the event is officially over.Please note that these times are subject to change. 8.SAFETY:Standing on chairs,tables or other rental equipment is prohibited.This equipment is not engineered to support your weight.The City of Carson,its employees,agents,or officers will not be responsible for injuries or falls caused by the improper use of furniture.Please assist in our efforts to provide a SAFE WORKING ENVIRONMENT. 532227.5 CFN AS OF 1-22-2020 9.VOLUME/LIGHT CONTROL:The City reserves the right to regulate the volumeor intensity of any andall 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 be fireproof or of fire retardant materials,must meet City requirements and are subject to removal. Candles and other open flame devices will not be permitted except as authorized on this agreement;subject to Fire Departmentregulations. 11.COPYRIGHT INFORMATION:Provider is responsible for licensing fees as required by law.Provider may be subject to legal action for the use,display or sale of any item using any copyrighted and/or trademarked name or logo which has not been specifically authorized under license from the trademark holder. 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 other surrounding City property (including parking lots)used by the Provider must be left in a clean and orderly condition (equal to or better than the condition existing prior to the event).If additional maintenance is required,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 to enforce these rules and regulations. 16.SPACE ASSIGNMENT:Event space 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 |,Clifton Burnley ,(“individual”)[on behalf of The Trackless Train (“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 of an application to provide services in/at 2021 WinterFest (“Event”)on Saturday,December 18,2021 (“Date”). Signatory understands that accidents and injuries can arise out of the Event;knowing the risks,nevertheless, and in consideration of the acceptance of an application to provide a service at the Event on the Date, Signatory hereby waives,releases and discharges any andall 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 andall liability arising out of or connected in any way with Signatory’s participation in or presence at the Event,even thoughthatliability may arise out of negligence or carelessness on the part of City.It is further understood and agreed that this Agreementis to be binding on Signatory’s heirs andassigns. 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 of entitlement to any license fee or royalty of any kind from City.Signatory hereby waives any right to the intellectual property of Signatory’s Likeness. The rights granted by Signatory hereundershall not expire. Signatory further agrees to indemnify,defend and hold harmless City from and against any and all claims, liabilities,losses,damages,expenses,and costs (including without limitation costs and fees of litigation)of every nature (including,but not limited 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 members of 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 performance ofservices at the Event,Signatory’s actions,inactions,or use of facilities at the Event,or any equipment,machinery or items displayed or used by the Signatory at or for the Event,except for such claim,liability,loss,damage,expense,or cost which was caused by the sole negligence or willful misconduct of the City. By signing below,I acknowledge and represent that I have read and understand the above,and that I voluntarily agree to its terms.CLAFION BULA NAME:Clifton Burnley Signed: ORGANIZATION:The Trackless Train Date:12/14/2021 532227.5 CFN AS OF 1-22-2020 DATE4<Gsi?CERTIFICATE OF LIABILITY INSURANCE ers0r202' 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 POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSUREDprovisions or be endorsed. lf SUBROGATION IS WAIVED,subject to the terms and conditions ofthe policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in tieu of such endorsement(s). PRODUCER Contact Name:Todd Tyler Cossio Insurance Agency Phone (864)688-0121 ‘FaxPOBox 5987 (AIC,No,Ext):(AIC,No): Greenville,SC 29606 E-Mail:tammy@cossioinsurance.com(864)688-0121 ne fester nninenivninmneiney ne} INSURER(S)AFFORDING COVERAGE NAIC # INSURED INSURER A:[Nationwide Mutual Insurance Company 23787 The Trackless Train Party Services,LLC dba The Trackless Train INSURERB:Berkley Life &Health Insurance Company “164890 405 E.Gardena Blvd.Suite C Gardena,CA 90248 INSURER C: INSURER D: INSURERE:i COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAID CLAIMS. INSR TYPE OF POLICY ADDL SUBR POLICY NUMBER POLICY EFF =POLICY EXP LIMITSLTRINSRWVD(MM/DD/YY)(MMIDDIYY). X COMMERCIAL GENERAL LIABILITY General Agg (Other than Products-Co $2,000,000 7 Cy CLAIMS MADE x OCCUR Each Occurrence $1,000,000 :x Products and Completed Operations $1,000,000 cd ee Personal and Advertising Injury $1,000,000 A i”x FWC0000031814900 8/18/2021 8/18/2022 Legal Liability to Participants $1,000,000 Professional Liability (for Event Plann $1,000,000GEN'L AGGREGATE LIMIT APPLIES PER .Damages to Premises Rented to You $300,000xPolicy[_|pRovectT [Loc font Participant Accident -Excess Medical $10,000|_|OTHER:Deductible $0 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $(Ea accident)PF]any auTo ro)ALL OWNED —SCHEDULED BODILY INJURY(Per Person)$ ‘AUTOS Li AUTOS cy HIRED AUTOS NON-OWNED BODILY INJURY(Per accident)$ AUTOS r][|PROPERTY DAMAGE $ :{Per accident) (|UMBRELLALIAB [|OCCUR [_]EXCESS LIAB [_|CLAIMS-MADE WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNERIEXECUTIVE yyOFFICER/MEMBER EXCLUDED?N/A {Mandatory in NH)| If yes,describe underDESCRIPTIONOFOPERATIONS below Total Benefit Maximum for all Accident M $25,000 Class 1 Principal Sum $25,000 B Accident Medical PAI L012010622904 8/18/2021 8/18/2022 Benefit Maximum $500,000 Accident Medical Deductible $100 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD101,Additional Remarks Schedule,may be attached if more space is required) Party Equipment Rentals Operations located at 405 East Gardena Boulevard,Suite C Gardena,CA 90248.Certificate Holder is listed as additional insured per form CG2011 when required by written contract.The certificate holder is added as an additional insured,but only for liability caused,in whole or in part,by the acts or omissions of the named insured. Amusement devices on file with the company for special event(s)dated 8/30/2021 to 8/17/2022 located at various parks throughout the City of Carson,CA. CERTIFICATE HOLDER:CANCELLATION City Of Carson ‘SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE2400EastDominguezStreetTHEEXPIRATIONDATETHEREOF,NOTICE WILL BE DELIVERED INCarson,CA 90810 ACCORDANCE WITH THE POLICY PROVISIONS.My ‘AUTHORIZED REPRESENTATIVE 4ii ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD APPROVED 12/15/2021