HomeMy Public PortalAboutC-23-071 - Dimension Publicitaria - 2023 CINCO DE MAYO SPACity of Carson
Community Services Department
vicer Application Agreement
Service |
, Check one (staff use):
[ | Carson Event Center _| Human Services Recreation [] Transportation
Cinco De Carson Park 5/6/2023 Event Location: Event Date:
Name of Service Provider: SASS OAS PUBNCITARIA LNC.
Event:
Business Form/Entity Type (if individual. sole proprietorship, corporation, or limited liability
company, specify here):
CORPORATION
Business Form/Entity Type (1f general partnership, limited partnership, limited liability partnership,
or other, specify here):
NIK
Business Entity State of Incerporstion (if applicable): N (
Type of Service: sy. : eo TF) WS fh f foe é
Contact Person: _DERE16 ADD Ee Phone #: (G26) 7OS-2O0SO
ee ?
Emer.Contact: —i—iss—‘lél CPM One #: ( )
Billing Address; _/7O/ 7 OQ 7 ST.
Number Street
WES? OMA CA WI Cily — State “IP
Proof of Insurance (check oie}: Wes LXINo
If no, would you like to purcna:
Special Instructions / Notes: |
3-4pm on Satuc
§ Mey 6. 2028. ‘ 3
A
e
532227.5 CFN AS OF 4-11-2022
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:
wlA
Total Service Fee 4, 900
NOTE: [f 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]
532227.5 CEN AS OF 4-11-2022
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, 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
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
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 does 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 shal! at any time or in any manner represent that Service Provider or any of its
agents or employees are azents 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 conirol 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 OF 4-11-2022
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 conneciion 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.
3. 30-2023
(Date)
DER Gd C2 mb. , :
(Printed Name of Service ProvidéR Authorized Ry epresentative)
(Space below this line for City use only)
APPLICATION APPROVAL:
CITY OPCARSON —/ oN i f \ ad if CQ ep i we ~ £4. 7S { AA wh A\ A we 7} f.? >
rd (Signature of Citydefinager or Designee) (Date)
1G Ves
532227,5 CFN AS OF 4-11-2022
Service Provider Rules & Regulations
|. 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 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 Provider shall 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 unlawtul 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 ciher 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 4-11-2022
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.
ii, 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 ovo 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: Ail 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 4-11-2022
Waiver, Release, Hold Harmless. Agreement Not to Suc and Indemnification 10
L QUE ANSIOL 2 bel cerese1sTeinaivions ) fon behalf of
ADA LYE Vol Uf (“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,
officials, employees, agents and volunteers), seek acceptance by the City of Carson of an application to provide services in/at
(“Event”) on Date”).
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 at Carson, its elected and appointed olficers. officials, employees. agents and voluntecrs (collectively
“City.” and individually. “City Party”), and from and agvinst any and all claims or liabilities to Signatory or any other person or
entity, including but noi limited to claims or Habilities for bodily injury. illness. death. or property damage, arising out of or
connected in any way with Signatory’s participation m. presence at. or performance of services al or for the Event, even though
that liability may arise ou 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 Ci iv or any City Party. Towever, Signatory understands that this paragraph
is nol intended ta 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, andl any image, silhouetle, 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 royally ef any kind from City. Signatory hereby waives anv right to the intellectual property of Signatory’s Likeness.
Signatory further agrecs to indemnify, defend and hold harmiess City and cach City Party from and against any and all claims,
liabilities, losses, damages, expenses, and costs (including withaut limitation costs and fees of tigation) of every nature (including,
but not lintited to. property damage, bodily injury, or death}. whether imposed by law or otherwise, sustained or alleged to be
sustained by any person ar entity Qwhether they be members of the public visiting the Event, employees of the City, other Exhibitors
at the Pvent. or otherwise), occurring at, arising from, or connected with Signatory’s preparation or performance of services at the
Event. Signalory’s actions, inactions, or use of F facilit at the Event, or any equipment, machinery or items displayed or used by
the Signatory at or for the Event, except for such claim. Nability. lass, damage, expense, or cost which was caused by the sole
negligence or willful miscanduct of the City.
In wiving the foregoing
California Civil Code
‘ieases and waivers, Signatory exsly waives any and all rights conferred upon it by the provisions of
cuion 1542, which Signatory understands reads as follows:
“A general release does not extend to claims that the creditor or releasing party does nol know or suspect lo exist in his or her favor
al the lime of executing the re lease 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 participatcon in the vent.
This Agreement shall be binding, yn Signatory’s successors. heirs and assigns, and shall not expire. No oral representations,
statements or inducement ft frdm this written form. have been made with regard to the subject matter of this form. If any
portion af this forni is declared i valid, by a courtLof compcient jurisdiction, the remainder shall continue in full force and effect. .
By signing below, Sigaaiory ¢ edwes an/reprdsents tha! it has read and understands the above, and that it voluntarily agrees
to its terms, /
By signing below, Sign:
agrees to [ts terms. S
Siem |
/ » [Moos
DAK:
OLO07, OO01/781805.1 AS OF 4-11-2022
Please note: The City of Carson's own insurarice 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. {aman entertainer that will perform at the City of Carson (Cinco de Mayo Celebration) event.
2. |am confirming that! and my business co not have commercial general liability insurance as
required by the City of Carson but am still interested to provide services at the (Cinco de
ayo Celebration) event.
3. lacknowiedgeand agree that in the event of a loss the City of Carson or its insurance carrier will
noi provide coverage to me orto my business.
4, | further acknowledge and agree that in the event of a loss resulting from my or my business
wrongful or negligent a ts-the City of Carson or its insurer will seek to recover its financial loss
fromame or my bug KY _l will cboperate in every way with the said recovery efforts.
5. The Cily of Carson rhayNa her
‘
Print:
Date: 3 DC. RO Ad,
Form W-9
(Rev. October 2018)
Department of the Treasury Internal Revenue Service
Request for Taxpayer
identification Number and Certification
& Go to www.irs.gov/FormW9 for instructions and the latest information.
Give Form to the
requester. Do not
send to the IRS.
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank,
Dimension Publicitaria Inc / DBA - Optimum Design Promotion
2 Business name/disregarded entity name, if different from above
following seven boxes.
O Individual/sole proprietor or fc Corporation
single-member LLC
(_] Other (see instructions) ®
] S Corporation
Cl] Limited liability company. Enter the lax classification (C=C corporation, S=S corporation, P=Partnership) >
Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting
LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is
another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
3 Check appropriate box for federal tax classification of the person whose name is entered on jine 1, Check only one of the | 4 Exemptions (codes apply only to
certain entities, not individuals; see
instructions on page 3):
C Partnership CJ Trust/estate
Exempt payee code (if any}
code (if any) {Applies to accaunts maintained outside the U.S.)
5 Address (number, street, and apt. or suite no.) Sce instructions.
1701 E. Cortez St.
Print
or
type
See
Specific
instructions
on
page
3.
Requester's name and address (optional)
6 City, state, and ZIP code
West Covina, Ca. 91791 7 List account number(s) here (eptional)
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box, The TIN provided must match the name given on line 1 to avoid
backup withholding. For individuals, this is generally your social security number (SSN), However, for a
resident alien, sole proprietor, or disregarded entity, see the instructions for Part |, later. For other - ~
entities, it is your employer identification nurnber {EIN}. If you do not have a number, see How to get a
TIN, later.
Note: If the account js in more than one name, see the instructions for line 1. Also see What Name and
Number To Give the Requester for guidelines on whose number to enter,
| Social security number
or
| Employer identification number |
9/5) -|4)8)1};0/1/3]4 GERM) Certification
Under penalties of perjury, | certify that:
1. The number shown on this form is my correct taxpayer identification number (or | am waiting for a number to be issued to me); and
2. 1am not subject to backup withholding because: {a) lam exempt from backup withholding, or (b) | have not been notified by the Internal Revenue
Service (IRS) that | am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that | am
no longer subject to backup withholding: and
3. lama US. citizen or other U.S, person (delined below); and
4, The FATCA code(s) entered on this form (if any) indicating that | am exempt from FATCA reporting is correct.
Certification instructions. You musi cross oul ilem 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest arid dividends on your tax return, For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part tl, later.
Sign Signature of
Here U.S. person & bate» 2/27/23
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted,
Future developments, For the iatcst information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FormW9,
Purpose of Form
An individual or entity (Form W-9 requester) who is required Lo file an
information return with the IRS musi oblain your correct taxpayer
identification number (TIN) which may be your social securily number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or erriployer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return, Examples of information
returns include, but are not limited to, the following.
¢ Form 1099-iNT (interest earned or paid)
* Form 1099-DIV (dividends, including those from stocks or mutual
funds)
* Form 1099-MiISC (various types of income, prizes, awards, or gross
proceeds)
* Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
* Form 1099-S (proceeds from real estate transactions)
¢ Form 10998-K (merchant card and third party network transactions)
* Form 1098 (home mortgage interest), 1098-E (student loan interest),
1098-T (tuition)
* Farm 1099-C (canceled debt}
* Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
if you do not return Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What is backup withholding,
later.
Cat. No. 10231X Form W-9 (Rev. 10-2018)
Dimension Publicitaria LNC.
701 E. Cortez Street, West Covina, Ca 91791
626-705-3050
INVOICE # 5623
Date: 4/1/23
BILL TO FOR
City of Carson Entertainment
701 E. Carson Street, Carson Ca 90745
310-830-7600
Banda Maguey Performance, Event May 6, 2023 $9,000.00
3-4pm
Subtotal $9,000.00
Tax rate
Additional costs
Make all checks payable to Dimension Publicitaria, Inc.
THANK YOU FOR YOUR BUSINESS!