HomeMy Public PortalAboutC-23-045 - PAST ACTION HEROES - '23 VOLUNTEER BANQUET ENT. SPA
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 seek. 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: Kenny Harris
(Event Coordinator's Name)
18601 S. Main Street. Carson, Ca. 90248
(Enter Event Coordinator's address (Le., city hall, corporate yard, or specific park address)
Email: kharris@carsonca.gov
(Enter event coordinator’s email address)
Should you have any questions, please feel free to contact the staff member listed below .
Truly,
Kenny Harris
(Name)
Recreation Center Supy.
(Title) i,
PRCKN AS OF 4-41-2022
Before submitting your application packet make sure each of the below
indicated items have been attached or completed.
(FOR COSIMIUNITY SERVICES OFFICE |
Service Provider Application Agreement
Invoice for Future Event Date’
Business License (if applicable)
Proof of Insurance/Certificate of Insurance
Waiver, Release, Hold Harmless, Agreement Not to
Sue, Indemnification, and Photo Release
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 (IFEQ). If the Service Provider Application is
approved, then the [FED will be processed as an invoice for services rendered for the Event. No payment will be made
until the conclusion of the Event, at earliest.
$32227.5 CEN AS OF 4-11-2022
(Enter Provider's Name)
uant to your desire to work with the City of Carson, you are required to
1
n ims 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.
MINIMUM SCOPE AND LIMIT OF INSURANCE
eral Liability Insurance: Coverage shall be at least as broad as fnsurance Services Form
CG U0 Of covering CGL on an “occurrence” basis, including property dantage, bodily injury
und personal d& advertising injury with limits no less than $1,000,000 per occurrence und * 32.
(HH OOO apuregite.
Additional Insured Status
fhe City of Carson, und its elected and appointed afficiuls, employees, volunteers und agents, are
das additional insureds with respect to liability arising out of their work ar
} vfarnied at or on behalf of the City-sponsored event including materials, parts, or
equipinent furnished in connection with the event.
AS OF 4-11-2022
City of Carson
Community Services Department
Service Provider Application Agreement
Check one (staff use):
[| Carson Event Center| Human Services Recreation [| Transportation
2023 Volunteer Banquet Event Location: Garson Event Center Event Date: 4/2028 Event:
Name of Service Provider: Past Action Heroes
Business Form/Entity Type (if individual, sole proprietorship, corporation, or limited lability
company, specify here):
Partnership
Business Form/Entity Type (if general partnership, limited partnership, limited liability partnership,
or other, specify here):
—_—e
Business Entity State of Incorporation (if applicable):
Live Music Performance with Band and DJ
Greg Revuelta Phone #: (826) 797-0892
Type of Service:
Contact Person:
Emer. Contact: Phone #: ( )
Billing Address; 008 N. Electric Ave. Unit A
Number Street
Alhambra Ca. 91801
Cty State Zip
Proof of Insurance (check one)? [Vlves [No
If no, would you like to purchase special event insurance through the City (check one}? L Wes [No
(PAH) will provide Live Music, Sound and Lighting Equipment, and DJ for upcoming
Special Instructions / Notes:
Volunteer Banquet. (PHA) should arrive allowing enough time for load in, set up, and sound check. Event start time is @ 6 pm
All components of (PHA) should be in place by this time.(PAH} should be prepared to perform 2 sets with DLJ. covering all seques and
transitions.Payment will be distributed on (4/4/2023). Payment will be in Check form made out to (Past Action Heroes/PAH) .
AS OF 4-11-2022 532227 5 CEN
Al “CDC GUIDELINES “ will be enforced on the Day of the Event per LA County and City of Carson.
“Please list any Special Request in section below
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:
os Dressing area that is not a public restroom, i if possible.
Total Service Fee $4000.00
NOTE: If service provider is unable to provide the services as proposed or requested or the City
of Carson cancels the service for any reason, the associated fees will not be paid.
[remainder of page intentionally left blank]
$32227.5 CEN AS OF 413-2022
Further Terms of Service Provider Application Agreement:
The undersigned signatory of Service Provider (Service Provider being the above-referenced person
or entity seeking lo provide services at the above-referenced event, including all its officers, agents,
employees and volunteers) hereby represents and warrants that he or she is duly authorized by
Service Provider to execute and deliver this application on behalf of Service Provider, and that by so
executing this application, and in consideration for the City’s review of this application, Service
,rovider 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
hereunder shall 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 docs not
constitute an approval or 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 member of a joint enterprise with the City. Neither Service Provider nor any of its
agents or employees shall at any Ume 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, iis 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
S32227.5 CEN AS OF 4-11-2022
wed
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 Habilities 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 PRoviner: Past Action Heroes
a
{ \. 3/7/2028 mmecinnesrsta
Sn Signature of Sonice.Pravider’s Authorized Representative) (Date)
Greg Revuelta (band rep)
iPrinted Name of Service Provider’s Authorized Representative)
(Space below this line for City use only}
APPLICATION APPROVAL:
CITY OF CARSON
i, / MW ihe {Sigrhture of City Manager or Designtey7~
532227.5 CEN AS OF 4-11-2022
Service Provider Rules & Regulations
I. 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 a 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: The City is not responsible for any damage to, loss or
theft of the Provider's property, or that of Provider’s agents, employees or invitees.
5, CHARACTER OF ENTERTAINMENT: The Provider 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 shal! 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 Provider shall at all times cooperate to this end.
The policies, rules, regulations and conditions governing use of City faciliies 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 SAF WORKING ENVIRONMENT.
$32227.5 CFN
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 judgment of 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 Department regulations.
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 lime without notice to Provider,
unless the change affects a permit already issued to Provider.
339227. 5 CPN AS OF 4-11-2023
Waiver, Release, Hold Harmless, Agreement Not to Sue and Indemnification 10
|, Gteg Reveetia , (“individual”) [on behalf of
(“Exhibitor”), and as a bona fide agent of Exhibitor duly authorized to execute this Waiver, Release, Hold Harmless, Agreement Not to Sue and Indemnification agreement (“Agreement”) on behalf of Exhibitor] (individual and Exhibitor hereinafter collectively referred to as “Signatory,” and the term “Signatory” includes Exhibitor's officers, oificials, employees, agents and volunteers), seek acceptance by the City of Carson of an application to provide services in/at 2028 Veluntowr Banquet CEveat”) on Ape. 20230 (“Date”).
Past Achon Homes
Signatory understands that accidents, illnesses, 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 the City of Carson, its elected and appointed officers, officials, employees, agents and volunteers (collectively “City,” and individually, “City Party"), and from and against any and all claims or liabilities to Signatory or any other person or enuty, including but not limited to claims or liabilities for bodily injury, Uiness, death, or property damage, arising out of ur connected in any way with Signatory's participation in, presence at, or performance of services at or for the Event, even though that liability may arise out of negligence or carelessness on the part of City, and Signatory agrees to waive its rights to make any such claims through any action or proceeding against the City or any City Party. However, Signatory understands that this paragraph is not intended to release any party from any act or omission of “gross negligence.”
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 entiement to any license fee or royalty of any kind from City. Signatory hereby waives any right to the intellectual property of Signatory’s Likeness.
Signatory further agrees to indemnify, defend and hold harmless City and each City Party 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 Exhibitors at the Event, or otherwise), occurring at, arising from, or connected with Signatory's preparation or performance of services 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.
In giving the foregoing releases and waivers, Signatory expressly waives any and all rights conferred upon it by the provisions of
California Civil Code Section 1542, which Signatory understands reads as follows:
“A general release does not extend (o claims that the ereditor or releasing party does not know or suspect to exist in his or her favor
at the time of executing the release and that, if known by him or her, would have materially affected his or her settlement with the
debtor or released party.”
This waiver shall be effective as a bar to any and all actions, fees, damages, losses, claims, liabilities and demands of whatsoever
character, nature and kind, that are known or unknown, or suspected or unsuspected, that may arise from or relate in any way to
Signatory’s participation in the Event.
This Agreement shall be binding on Signatory’s successors, heirs and assigns, and shall not expire. No oral representations,
statements or mducements, apart from this written form, have been made with regard to the subject matter of this form. If any
portion of this form is declared invalid by a court of competent jurisdiction, the remainder shall continue in full force and effect,
By signing below, Signatory acknowledges and represents that it has read and understands the above, and that it voluntarily agrees fo Hs terns.
By signing below, Signatory acknowledges and represents that it has read and understands the above, and that is voluntarily
agrees to its terms, reread
SIGNED:
ORGANIZATION: Past Action Heroes
DATE: 3/7/2023
AS OF 4-11-2022
Please note: The City of Carson's own insurance will cover the City's liability but will not cover an
Entertainer's liability. All service providers (including entertainers) are still required to carry insurance.
We must require this because it is a condition of the City's Excess insurance policy.
Acknowledgement:
1. I am an entertainer that will perform at the City of Carson (2023 VOLUNTEER Banquet) event.
2. I am confirming that I and my business do not have commercial general liability insurance as
required by the City of Carson but am still interested to provide services at the (2023 Volunteer
Banquet) event.
3. I acknowledge and agree that in the event of a loss the City of Carson or its insurance carrier will
not provide coverage to me or to my business.
4. I further acknowledge and agree that in the event of a loss resulting from my or my business'
wrongful or negligent acts, the City of Carson or its insurer will seek to recover its financial loss
from me or my business. 1 will cooperate in every way with the said recovery efforts.
S. Th Carson may approve this request or may reject it at its discretion.
Signed:
Thanks!
INVOICE
508 N Electric Ave Unit A Alhambra Ca 91801
T: 626-757-0892 Email: Pastactionheroes@gmail.com
March 7, 2023
Client: City of Carson
18601 S Main Street
Carson Ca 90248
Project: Live Musical Performance
Invoice #:040423
DESCRIPTION AMOUNT
Live musical entertainment: 6-10pm
Audio/visual provided by Artist
(PAH) will provide Live Music, Sound
and Lighting Equipment, and DJ for
upcoming. Volunteer Banquet. (PAH)
should arrive at 4pm for load in, set up,
and sound check. Event start time:6 pm.
$ 4,000.00
Event on: Friday April 4, 2023
Event: 2023 Volunteer Banquet
Payments made to: Past Action Heroes
BALANCE DUE $4,0 00 .00