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HomeMy Public PortalAboutC-23-086 - CRAIG TAFUA - SHD CELEBRATION ENTERTAINMENT SPAMikes City of Carson Community Services Department ey \ 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: Janny Noa (Event Coordinator’s Name) 23410 Catskill Ave., Carson, Ca 90745 (Enter Event Coordinator’s address (i.e., city hall, corporate yard, or specific park address) Email: Jnoa@carsonca.gov (Enter event coordinator’s email address) Should you have any questions, please feel free to contact the staff member listed below . Truly, Janny Noa (Name) Sr. Recreation Center Supervisor (Title) 6292976 CoM acncaitaln2 / 03/18/23 (Date) FORTI (Company) 1520 S. Pearl Ave (Company Address) Compton,CA.90221 (City, State ZIP) Insurance Requirements Dear , (Enter Provider’s Name) Please be advised pursuant to your desire to work with the City of Carson, you are required to submit the following: ¥ Compliant Certificates of Liability Insurance (to be maintained for the duration of services against claims 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. The City of Carson reserves the right to modify these requirements based on the nature of the risk, prior events, insurance coverage, or other special requirements. ' MINIMUM SCOPE AND LIMIT OF INSURANCE General Liability Insurance: Coverage shall be at least as broad as Insurance Services Form CG 00 OI covering CGL on an “occurrence” basis, including property damage, bodily injury and personal & advertising injury with limits no less than $1,000,000 per occurrence and $2,000,000 aggregate. Additional Insured Status The City of Carson, and its elected and appointed officials, employees, volunteers and agents, are to be covered as additional insureds with respect to liability arising out of their work or operations performed at or on behalf of the City-sponsored event including materials, parts, or equipment furnished in connection with the event. BI7997 RF ecat Ac nc2Malwnt2 City of Carson Community Services Department Service Provider Application Agreement Check one (staff use): [ Carson Event Center| _| Human Services Recreation [| Transportation Beant: Samoan Heritage Day Celebration Fenn Lacatlon Foisia Park vant Date: 08 (24/23 Name of Service Provider: Cuuhraig Polynesian Rap Artist Business Form/Entity Type (if individual, sole proprietorship, corporation, or limited liability company, specify here): Forti Ilc Business Form/Entity Type (if general partnership, limited partnership, limited liability partnership, or other, specify here): Business Entity State of Incorporation (if applicable): Nevada Type of Service: Performing Artist for 60 minutes Contact Person: Siaki Tafua Phone #: (310 ) 122-5790 Emer. Contact: Phone #: ( ) Billing Address: 1520 S. Pearl Ave Number Strect Compton CA 90221 City State ZIP Proof of Insurance (check one)? [Ives [VlNo If NO, please complete the attached insurance waiver form. Special Instructions/Notes: RIIVI7R CCA Re nc aha. 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 1 of this application: Total Service Fee $6,000. 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] £99997 8 COA Ag Ne 3W/1A/INI 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 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 G27997 RE CCA ACNE? 14 INI 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): SERVIC PROVIDER: Sikh 3/at/23 . Sigahs of Servis er}s Authorized Representative) (Date) lala __| Mel br (Printed Name of fervice Provider’s Authorized Representative) (Space below this line for City use only) APPLICATION APPROVAL: CITY OF CARSON 5/o\ } 2023 — of City Manager or Designee) (Date) OG) £29797 Een AS AED 14-9002 Waiver, Release, Hold Harmless, Agreement Not to Sue and Indemnification 10 {, Cuuhraig , (“individual”) [on behalf of Cuuhralg (“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 Samoan Heritage Day Celebration (“Event”) on Saturday June 24, 2023 (“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 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 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 belo at tory iy and represents that it has read and understands the above, and that is voluntarily agrees to its te: SIGNED: NAME: Ke ye ORGANIZA fart Ue DATE:_4 i nat G> ( '/ NINAT AANTMOTONE 1 2c an? 14.9077 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. Signed: Date: lam an entertainer that will perform at the City of Carson Samoan Heritage Day Celebration event. | am 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 Samoan Heritage Day Celebration event. | 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. | 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. prove this request or may reject it at its discretion. Lemur. foi Give Form to the requester. Do not send to the IRS. rom W-9 (Rev. December 2014) Department of the Treasury Internal Revenue Service 1 Name (as shown on your income tax retum). Name is required on this line; do not leave this line blank. Craig Herman Tafua 2 Business name/disregarded entity name, if different from above Request for Taxpayer Identification Number and Certification 701 E. CARSON ST. CARSON, CA 90745 6 City, state, and ZIP code Compton,CA.90221 7 List account number(s) here (optional) N oO S ©] 3 Check appropriate box for federal tax classification; check only one of the following seven boxes: 4 Pemtons feoees are oaly to ; Scr eteeoaiater or [J CComoration [1] SCorporation [| Partnership 1 Trustestate iskyelnsateawes eanSE See ingle-mem . gs [[] Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) > Exempt payee (fany) & Note. For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for_| Exemption from FATCA reporting 2 the tax classification of the single-member owner. code (If any) & (J Other (see instructions) > (Appiies (0 accounts maintained outskte the U.S) 5 Address (number, street, and apt. or suite no.) Requester’s name and address (optional) 1520 S Pearl Ave CITY OF CARSON Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given online 1 to avoid _[ Social security number | backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part | instructlons on page 3. For other 6100/5} -|1)5) -1 3) 3/645 entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. or Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for {Employer identification number guidelines on whose number to enter. ea 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) | 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 fallure to report all interest or dividends, or (c) the IRS has notified me that | am no longer subject to backup withholding; and 3. |!am a U.S. citizen or other U.S. person defined 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 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, tem 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 3. Sign Signature of 4 Here | u.s. person> (iff General Instructiohs Section references are to the Internal Revénue Code unless otherwise noted. Future developments. Information about developments affecting Form W-9 (such as legisiailon enacted after we release it) is at www.irs.gov/fw9. Purpose of Form An Individual or entity (Form W-9 requester) who Is required to file an information retum with the IRS must obtain your correct taxpayer identification number (TIN) which may be your soclal security number (SSN), Individual taxpayer identification number (TIN), adoption taxpayer identification number (ATIN), or employer Identification number (EIN), to report on an information retum the amount paid to you, or other amount reportable on an information retum. Examples of information relums include, but are not limited to, the following: * Form 1099-INT (Interest eared or pald) * 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 1099-K (merchant card and third party network transactions) ower 2/04/07 ¢ Form 1098 (home mortgage fees 1098-E (student [oan Interest), 1098-T (tuition) * Form 1098-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 retum Form W-8§ to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding? on page 2. By signing the filled-out form, you: 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. Clalm 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, and 4. Certify that FATCA code(s) entered on this form (ff any) indicating that you are exempt from the FATCA reporting, is correct. See What is FATCA reporting? on page 2 for further information. Bet Ma 1nneiv Farm We-Q irow 19-9014) Forti LLC 1520 S Pearl Ave Compton, CA. 90221 310-722-5790 A4Fortient@gmail.com BILL TO City of Carson Janny Noa 23410 Catskill Avenue Carson, CA 90745 & 310-830-8310 (8 310-847-7683 jnoa@carsonca.gov INVOICE INVOOO1 DATE 03/24/2023 DUE On Receipt BALANCE DUE USD $6,000.00 DESCRIPTION RATE QTY AMOUNT Performance fee for Samoan Heritage Day on 6/24/23 TOTAL $6,000.00 BALANCE DUE 11hr $6,000.00 $6,000.00 USD $6,000.00 EEE Parks Recreation Division ake MATERIALS AND SUPPLIES REQUISITION patter! Forti LLC c/o 04/19/23 Vendor Name: Craig Herman Tafua Today’s Date: Address: 1520 S. Pearl Ave. Park/Area: Foisia Park Compton, Ca 90221 Staff Name: Janny Noa Phone: 310-722-5790 Deliver order to: Warehouse L_] City Hall [_] Will Call [_] SEE Unit Extended # Qty Unit Detailed Description of Item Price Amount 1 1 Lot Performing as the HEADLINER for Samoan Heritage Day | $6.000 $6.000 Event for (1) One Hour Session. Artist - Cuuhraig (Craig Herman Tafua) Performance Time to be coordinated with 2 Janny Noa, Sr. Recreation Center Supervisor Event date: Saturday June 24, 2023 Performance Time: Between tentatively sometime between 3 3-5p Location: Foisia Park 23410 Catskill Ave., Carson, Ca 90745 Date order should be delivered: | 6/8/23 Tax: - Quoted by: Invoice # INVO0001 Shipping: | - Justification/Event: Headliner for Special Event SHD Total: $6,000 Approval Initials No. | Account Number Object # | Event Ref Amount 1. 244-90-950-709 6009 23173 $6,000 Supervisor/Coordinator: Oye s 2. ( ( ? 3 Program Manager: 4. Superintendent: “6 2 7. Requisition Input 8. 9, Section: 10. Page & Item: 11. 12, Req No. Notes: 1. Don’t forget to EMAIL Invoice, flyers, W9 (if new company), etc. 2. Give detail information regarding event / services