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HomeMy Public PortalAboutC-23-072 - sy supply (MAURICIO PINZON) 2023 CINCO DE MAYO SPACity of Carson Community Services Department Service Provider Application Agreement Check one (staff use): [| Carson Event Center|_| Human Services Recreation [ Transportation even. CINCO De Mayo gvent Location: CATSON PAK pent Date 9/6/23 Name of Service Provider: S & Y Supply Business Form/Entity Type (if individual, sole proprietorship, corporation, or limited liability company, specify here): N/A Business Form/Entity Type (if general partnership, limited partnership, limited liability partnership, or other, specify here): H [hs Business Entity State of Incorporation (if applicable): Entertainment Type of Service: Contact Person. Mauricio Pinzo Phone #: (760) 481-4183 Emer. Contact: Phone #:(__) Billing Address; 24463 Citrus Hill Rd Wildomar, Ca 92595 oy Sa wap Proof of Insurance (check one)? [les [VINo If no, would you like to purchase special event insurance through the City (check one)? [ Wes VINo Special Instructions / Notes; “A SONOra Dinamita with Vilma will perform an hour set from 12:45-1:45pm $32227.5 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: NIA $5,500 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. Total Service Fee [remainder of page intentionally left blank] 532227.5 CFN AS OF 4-11-2022 6 Serv: “rovider and City have executed this Agreement on the dates written below SER’ PROVIDE r, Entertainment . Seite V Ltn Se c Signature of Service Proyider’s Authorized Representative _ MAveR cio f/N 20N Printed Name of Service Provider's Authorized Representative Choe JAGARSON ( f c i ee ow) Vt "een . a : é Tow fe Coy VE~ Pb &) Signature of City Manager or Designee Date cab AN CUE #1 8-18 Service Provider Rules & Regulations OANICE PROVIDER APPLICATION: Upon acceptance of a service provider application o City of Carson (“City”), these rules and provisions shall become binding and a part of the c Provider Agreement between the applicant (being the entity providing a specified service }, including its officers employees and agents (“Provider”), on the one hand, and the City, we other hand. Any additions and amendments thereto that may be established or put into «by the City, and provided in writing to the Provider, shall also become binding and a part ervice Provider Agreement. MIENT/CANCELLATION: If the Provider is unable to perform or cannot provide the us as requested, or the City cancels the service for any reason, the associated fees for > will not be paid. .'CELLATION: No refunds will be given unless the subject event is cancelled by the “community Services Department. Applications may be denied or events cancelled in City programs. en ARTY LOSS OR DAMAGES: The City is not responsible for any damage to, loss or ~\ie Provider's property, or that of Provider’s agents, employees or invitees. “ACTER OF ENTERTAINMENT: The Provider shall observe, obey and comply with “euble local, state and federal laws, and all applicable policies, rules, regulations and | conditions governing use of City facilities. The Provider will forfeit all rents or other if ejected from premises for violations of same. Ejection shall not release Provider » obligations for the payment of rents or other fees not yet paid under such permit or <ly incurred. The policy of the City is to serve the public in the best possible manner. “vider shall at all times cooperate to this end. ies, rules, regulations and conditions governing use of City facilities are subject to i{hout notice to Provider unless the change affects a permit already issued to Provider. ehall be solely responsible for the orderly conduct of all persons using the premises by <5on, cither expressed or implied, during all times covered by the Service Provider “it. The City reserves the right to eject or cause to be ejected from the premises any ' "persons due to unlawful conduct. INSIBILITY: The Provider shall provide all material, equipment, and personnel IP ‘~~ tor provision of the service described in this agreement. “-IN/MOVE-OUT: Move-in to the event area will be set for each venue. Unless ( ' stated, Provider will be required to keep its area fully set up and manned until the e ~Hcially over. Please note that these times are subject to change. ~ ‘(: Standing on chairs, tables or other rental equipment is prohibited. This equipment is 1 -ered to support your weight. The City of Carson, its employees, agents, or officers will D _ -sonsible for injuries or falls caused by the improper use of furniture. Please assist in ¢ “ta provide a SAFE WORKING ENVIRONMENT. iME/LIGHT CONTROL: The City reserves the right to regulate the volume or intensity ~ad all noise or light generating mechanisms (including, but not limited to, loudspeakers, “clevision sets, musical instruments, entertainers, or blinking or flashing lights) in the “se judgment of the City. ~ MMABLE MATERIALS — All decorations, props and electrical equipment must be ov of fire retardant materials, must meet City requirements and are subject to removal, snd other open flame devices will not be permitted except as authorized on this “i; subject to Fire Department regulations. _ RIGHT INFORMATION: Provider is responsible for licensing fees as required by ~ vider may be subject to legal action for the use, display or sale of any item using any sod and/or trademarked name or logo which has not been specifically authorized under ~cim the trademark holder. EDS AND LICENSE: Provider shall procure at its own cost and expense all the “censes and permits applicable to Provider’s use or activity . ‘GATION POR CLEANLINESS: Provider agrees that the facility and any other “sg, City property (including parking lots) used by the Provider must be left in a clean “ty condition (equal to or better than the condition existing prior to the event). If ' maintenance is required, other than the normal cleaning process, the Provider will be ‘ditional fees based on the cost of such maintenance. TES: All points not covered by the Service Provider Rules & Regulations are subject sion of the appropriate City representative. “8 MANAGEMENT: The City will appoint a Floor Manager who is authorized to sé rules and regulations. ‘L ASSIGNMENT: Event space is assigned to providers at the sole discretion of the ‘corns regarding competitive or specific types of providers should be communicated to : the time of application. "CHANGES: The City reserves the right to make reasonable changes to the foregoing 4? hours and move-in/move-out arrangements at any time without notice to Provider, ‘change affects a permit already issued to Provider. peep AS OE SES. 4) 9 iver, Release, Hold Harness, Agreement Not to Sue, Indemnification, and Photo Release os Pinzon ; (“individual”) [on behalf of i Dinamita (“Service Provider”), and as a bona fide agent of Service Provider vnortzed to execute this Waiver, Release, Hold Harmless, Agreement Not to Sue and Indemnification { (“Agreement”) on behalf of Service Provider] (individual and Service Provider hereinafier ‘y referred to as “Signatory,” and the term “Signatory” includes Service Provider’s officers, officials, s, agents and volunteers), seek acceptance by the City of Carson of an application to provide services > de Mayo at Carson Park (“Event”) on May 6, 2023 (“Date”). understands that accidents and injuries can arise out of the Event; knowing the risks, nevertheless, : consideration of the acceptance of an application to provide a service at the Event on the Date, . hereby waives, releases and discharges any and all claims for damages for death, personal injury, or P vanage which Signatory may have, or which hereafter accrue to Signatory, against the City of ‘elected and appointed officers, officials, employees, agents and volunteers (collectively “City”), ‘id against any and all liability arising out of or connected in any way with Signatory’s participation i ~ crice at the Event, even though that liability may arise out of negligence or carelessness on the part of ‘ “urther understood and agreed that this Agreement is to be binding on Signatory’s heirs and assigns. vereby grants City the right to photograph or video-record Signatory during or in connection with ind to use Signatory’s photographed or video-recorded likeness, and any image, silhouette, or of the voice or appearance of Signatory taken during or in connection with the Event i +"). for any purpose, including publicity and promotion of City and its events, and creation or materials in any form for such purpose, with no claim of entitlement to any license fee or royalty - trom City. Signatory hereby waives any right to the intellectual property of Signatory’s Likeness. cronted by Signatory hereunder shall not expire. “cther agrees to indemnify, defend and hold harmless City from and against any and all claims, osses, damages, expenses, and costs (including without limitation costs and fees of litigation) of ( ~ Uncluding, but not limited to, property damage, bodily injury, or death), whether imposed by law Co ~. sustained or alleged to be sustained by any person or entity (whether they be members of the : ‘ug the Event, employees of the City, other service providers at the Event, or otherwise), occurring i “om, or connected with Signatory’s preparation or performance of services at the Event, Signatory’s “ons, or use of facilities at the Event, or any equipment, machinery or items displayed or used by v “ator for the Event, except for such claim, liability, loss, damage, expense, or cost which was € “© sole negligence or willful misconduct of the City. cciow, fl acknowledge and represent that | have read and understand the above, and that I scree to its terms. ao : ee SSAA. S. =. ¥ api. Mauricio Pinzon ZC ANIZATION: /4 Sonora Dinamita 7 L 2x ZOE PF ; e: The City of Carson’s own insurance will cover the City's liability but will not cover an ars itability. All service providers (including entertainers) are still required to carry insurance. Ww 2 reauire this because it is a condition of the City's Excess insurance policy. Joement: ‘an entertainer that will perform at the City of Carson (Cinco de Mayo Celebration) event. confirming that | and my business do not have commercial general liability insurance as ny the City of Carson but am still interested to provide services at the (Cinco de sleOration) event. ledge and agree that in the event of a loss the City of Carson or its insurance carrier will ii srovide coverage to me orto my business. vier acknowledge and agree that in the event of a loss resulting from my or my business “.3'for negligent acts, the City of Carson or its insurer will seek to recover its financial loss "or my business. | will cooperate in every way with the said recovery efforts. “i Carson may approve this request or may reject it at its discretion f fee ) po Print: PCE fit LOM, Signed: LEE: Lied ger / / of | Date:. eX /: COZ 3 | / (Rev. Octo i» Departmer: = * Internal Re ~ inf Print or type See Specific Instructions on page 3. ~ TIN, late Note: ! Numb: ~ Und: 1.7 2.la Ser. ne! B.tan 4. The Cero you ' acai: othe Fut rele: aft: u Anis ich (S Vendor (2 OT 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. toi wn on your income tax return). Name is required on this line; do not leave this line blank. PRICIO PINZON a entity name, if different from above Y SUPPLY in'2 box for federal tax classification of the person whose name is entered on line 1. Check only one of the | 4 Exemptions (cades apply only to an boxes, certain entities, not individuals; see instructions on page 3): w a cd ES) ’sole proprietor or CI C Corporation C] S Corporation Oo Partnership C] TrusVestate ELS LL Exempt payee code (if any) smany. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) » yprapriate box in the line above for the tax classification of the single-member owner. Do not check | Exemption from FATCA reporting sified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that sm the owner should check the appropriate box for the tax classification of its owner. code (if any) instructions) & {Applies to accounts maintained outside the U.S) ‘cher, street, and apt. or suite no.) See instructions. Requester’s name and address (optional) , CA 92595 here (optional) -y {cdentification Number (TIN) iate box. The TIN provided must match the name given on line 1 to avoid ‘uals, this is generally your social security number (SSN). However, for a or disregarded entity, see the instructions for Part |, later. For other 60/8) -|2'9] -12j'41:215 ntification number (EIN). ff you do not have a number, see How to get a | Social security number ] or -» than one name, see the instructions for line 1. Also see What Name and _| Employer identification number | ‘cr for guidelines on whose number to enter. . 3 ue sertify that: form is my correct taxpayer identification number (or | am waiting for a number to be issued to me); and ‘withholding because: (a) | am exempt from backup withholding, or (b) | have not been notified by the Internal Revenue ‘-ct to backup withholding as a result of a failure to report all interest or dividends, or {c) the IRS has notified me that 1 am : withholding: and - US. person (defined below); and -lon this form (if any) indicating that | am exempt from FATCA reporting is correct. ; Must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because Le ‘-<ost and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid. “7 +. cured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments =:, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part Il, later. | faut Ere Se Date 02 - 28 - 2023 “ons * Form 1099-DIV (dividends, including those from stocks or mutual funds) “ternal Revenue Code unless otherwise * Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) ‘= latest information about developments my “sructions, such as legislation enacted “a www. irs.gov/FormW9, « Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) « Form 1099-S (proceeds from real estate transactions) * Form 1099-K (merchant card and third party network transactions) 9 requester) who is required to file an ». must obtain your correct taxpayer h may be your social security number Bye “fication number (ITIN), adoption a » “\TIN), or employer identification number ™ “return the amount paid to you, or other : sation return. Examples of information e uiad to. the following. ved or paid) * Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) « Form 1099-C (canceled debt) * Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a 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) Sas La: 24.3 Wi Ph: E-r LA EA Phy . Th S AND Y SUPPLY ‘aamita - Representatives sill Red. ELS 9255 “STAT 83 -oradinamita@hotmail.com CELY OF CARSON JUNG Cristina Elerrera 348-830-4925 JOB INVOICE feed NO 02282023-1 PeATi Feb 28th / 2023 Sif ic) CRISTINA HERRERA cherrera@carsonca.gov PAYMENT TERMS DESCRIPTION © \ DINAMITA PERFORMANCE GPE 2023 - 12:45pm to 1:45pm “SCE, PRICE $5,500 K oayable to S and Y Supply . Makc all checks payable to S and Y Supply TOTAL _ $5,500 TOTALDUE =————Ss«S$5 0 THANK YOU FOR YOUR BUSINESS!