HomeMy Public PortalAboutC-23-081 - JUAN CARLOS REYNOSO - '23 CINCO DE MAYO MUSIC SPACity of Carson
Community Services Department
Service Provider Application Agreement
Check one (staff use):
[| Carson Event Center| | Human Services Recreation [ Transportation
_Carson Park May 6, 202. Cinco de Mayo ent: y Event Location: Event Date: Ev
Name of Service Provider: Carlos y Charlos
Business Form/Entity Type (if individual, sole proprietorship, corporation, or limited liability
company, specify here):
Individual w (A
Business Form/Entity Type (if general partnership, limited partnership, limited liability partnership,
or other, specify here):
N (A
Business Entity State of Incorporation (if applicable):
T y p e o f S e r v i c e : L i v e M u s i c
Carlos Reynoso (323) 893-0309
Contact Person: Phone #: ( )
Emer. Contact: Patrick Morrison Phone #: ( (818) 517-2528
Billing Address: 18703 Cairo Ave
Number Street
Carson CA 90746
City State ZIP
Proof of Insurance (check one)? [les A
If no, would you like to purchase special event insurance through the City (check one)? [_}ves de
Special Instructions / Notes: w In
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:
N |p
$750 Total Service Fee
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]
532227.5 CFN 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 Agrecment, 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 shall at any time 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 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 shal! 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):
Carlos y Charlos
SERVICE PROVIDER:
3/28/23
(Signapdfe of Service Provider’s Authorized Representative) (Date)
Juan Carlos Reynoso
(Printed Name of Service Provider's Authorized Representative)
(Space below this line for City use only)
APPLICATION APPROVAL:
CITY OF CARSON . Cy os es
Ae — MiieatnL Whiner, NZ , +] 8/2022
pen ature of City Manager or Designee) * (Date)
532227.5 CFN AS OF 4-11-2022
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 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 premiscs 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 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 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.
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 4-11-2022
Waiver, Release, Hold Harmless, Agreement Not to Sue and Indemnification 10
1,Carlos Reynoso » (“individual”) [on behalf of
Carlos vy Charlos (“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 City of Carson-Cinco de Mayo Celebration (“Event”) on__ 5/6/23 (“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 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 entity, including but not limited to claims or liabilities for bodily injury, illness, death, or property damage, arising out of or connected in any way with Signatory’s participation in, presence at, or performance of services at or for the Event, even though that ability 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 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.
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 to claims that the creditor 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 inducements, 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
to its terms.
By signing below, Signatory acknowledges and represents that it has read and understands the above, and that is voluntarily
agrees to its terms.
SIGNED: Baers
NAME:Juan Carlos Reynoso
ORGANIZATION:Carlos y Charlos
DATE: 3/28/23
01007.0001/78 1805.1 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. [Lam an entertainer that will perform at the City of Carson (Cinco de Mayo Celebration) event.
2. lam confirming that | 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 (Cinco de
Mayo Celebration) event.
3. [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. | 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. | will cooperate in every way with the said recovery efforts.
5. The City of Carson may approve this request or may reject it at its discretion
Print: Juan Carlos Reynoso Signed: Du
ate: 4/5/23
ron W-Q
(Rev. January 2011)
Department of the Treasury
Internal Revenue Service
Request for Taxpayer
Identification Number and Certification
Give Form to the
requester, Do not
send to the IRS.
Name (as shown on your income tax return)
Juan Carlos Reynoso
Business name/disregarded entity name, if different from above
Check appropriate box for federal tax
classification (required): [¥] individual/sole proprietor
Print
or
type
CI Other (see instructions) >
C] C Corporation
CJ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) »
CT S Corporation CT] Partnership Oo TrusVestate
Cc Exempt payee Address (number, street, and apt. or suite no.)
18703 Cairo Ave
Requester's name and address (optional)
City, state, and ZIP code
Carson CA 90746 See
Specific
Instructions
on
page
2.
List account number(s) here (optional)
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on the “Name” line to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part | instructions on page 3. For other 6);2/}4] -|3/6] -|918/8]8 entities, it is your employer identification number (EIN). If you do not have a number, see How to geta TIN on page 3.
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter.
Social security number |
| Employer identification number |
Eg 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. | am not subject to backup withholding because: (a) | am 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. lamaU.S. citizen or other U.S, person (defined below).
Certification instructions. You must cross out item 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 and 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 on page 4, : a S
Sign Signature of <\? Here | uss. person® >< Beier ~
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Purpose of Form
A person who is required to file an information return with the IRS must
obtain your correct taxpayer identification number (TIN) to report, for
example, income paid to you, real estate transactions, mortgage interest
you paid, acquisition or abandonment of secured property, cancellation
of debt, or contributions you made to an IRA.
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN to the person requesting it (the
requester) and, when applicable, to:
1. Certify that the TIN you are giving is correct (or you are waiting for a
number to be issued),
2, Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S. exempt
payee. If applicable, you are also certifying that as a U.S. person, your
allocable share of any partnership income from a U.S. trade or business
is not subject to the withholding tax on foreign partners’ share of
effectively connected income.
Date» 3/29/23
Note. If a requester gives you a form other than Form W-9 to request
your TIN, you must use the requester’s form if it is substantially similar
to this Form W-9.
Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
* An individual who is a U.S. citizen or U.S. resident alien,
* A partnership, corporation, company, or association created or
organized in the United States or under the laws of the United States,
¢ An estate (other than a foreign estate), or
* A domestic trust (as defined in Regulations section 301.7701-7).
Special rules for partnerships. Partnerships that conduct a trade or
business in the United States are generally required to pay a withholding
tax on any foreign partners’ share of income from such business.
Further, in certain cases where a Form W-9 has not been received, a
partnership is required to presume that a partner is a foreign person,
and pay the withholding tax. Therefore, if you are a U.S. person that is a
partner in a partnership conducting a trade or business in the United
States, provide Form W-9 to the partnership to establish your U.S.
status and avoid withholding on your share of partnership income.
Cat. No, 10231X Form W-9 (Rev. 14-2011)
Carlos y Charlos -Invoice
Invoice #68
Invoice Date: 5/6/2023
Bill to:
Christina Herrera
City of Carson
Community Services Department
Payable to:
Juan Carlos Reynoso
18703 Cairo Ave
Carson Ca 90746
Description Performance - Duration Price Date cE RECS en eer
Live Music Cinca De Mayo Celebration 9/6/23 1 hour $750.00
$750.00