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HomeMy Public PortalAboutC-23-097 - KEVIN NICKERSON 2023 YOUTH CONFERENCE SPACity of Carson Community Services Department service Provider Application Dear Applicant, On behalf of the City of Carson, | would like to thank you for taking the time to explore business opportunities with the City by applymg 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 seck. Your prompt assistance in submitting the requested documentation to the City staff meniber 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 . Atta: Kevin Nickerson (Event Coordinator's Name} 226 E Dominguez St Carson, Ca 90745 (Enter Event Coordinatar’s address (.e., city hall, corpavaie yard, or specific park address) Ema: Knickerson@gqamebreakersacacemy.org (Enter event coordinator’s email address) Should you have any questions, please feel free to contact the staff member listed below . Traly, Carolyn Pele (ame) Parks and Recreation Supervisor (Tite) S32927.5 CEN AS OF 3/15/2023 ba a“ % 2 hfe G BG 1 RG. Ko (a7 its tbe hon RELATE TELLER EEE Before submitting your application packet make sure each of the below indicated items have been attached or completed. (POW, COM NEL TTY SERVICES GRIGCE USE OULY) service Provider Application Agreement : Invoice for Future Event Date’ NA Business License Gf applicable} NA. Proof of Insurance/Certificate of Insurance Waiver, Release, Hold Harmless, Agreement Not to Sue, Indemnification, and Photo Release Current Copy of W-9 Form Gf not on file already) * The date of the Event shall be listed on the Invoice for Future Event Bate (IFED). Hf the Service Provider Anplication is FED will be processed as an invoice for services rendered for the Svent. No payrnent will be rade approved, then the until the conclusion of che Event, at earliest. 522227. CEN AS OF 3/44/2023 ta? 5/6/23 (Date) BREAKTHROUGH ACADEMY (Company) 225 ©. DOMINGUE? ST. (Company Address} Carson, Ca 907445 (City, State ZIPS fusuvance Reguirements Dear Kevin Nickerson (Enter Provider's Narne} 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 chams which may arise from or in commection with the services}, evidencing the caverage(s} as mdicated below Certificates of insurance, as well as additional tmsured and waiver of subrogation endorsements in favor of the City, must be submitted in thelr entirety before any services are provided or the event takes place. Failure to submit such required forms shall be cause for Cily of Carson to reject or terminate any service provider application agreement, The City of Carson reserves the right ta modify these requirements based on the nature of the risk, prior events, insurance coverage, or other special requirements. MOUNIMUM SCOPE / WNOL IMYT OF PNSUB AIOE General Liability insurance: Coverage shall be at least as bread as lusurance Services form CG OG GO! covering CGL on an “occurrence” basis, including property damage, badily infury and personal & advertising injury with “mits ao fess than $1,000,000 per occurrence and $2,000, 000 aggregate. Additional Insured Status The City of Carson, and tis elected and anpainted officials, employees, volunteers aiul agents, are to be covered as additional insureds with respect to fiabilitv arising out of their wark or OOF GHONS per farmed ator an behalf af the City-sponsored event including materials. paris, or equip ene furnish ed in conection with the ever. 592227,.5 CEN AS QF 3/14/2023 City of Carson Community Services Department & Service Provider Application Agreement Check ane (staff use}: || Carson Event Center| | Human Services L/ Recreation Transportation ~,.2023 Youth Conference fs __. Carson Park ey, Mune 3, 202 Event: Event Location: Byent Date: Name of Service Provider: Kevin Nickerson Business Form/Entity Type Uf individual, sole proprietorship, corporation, or limited Hability company, specity here}: individual Business Form/Entity Type f general partnership, lnmited partnership, limited lability partnership, ar other, specify here}: Business Entity State of Incorporation (ifapplicabley on a... KeynGte speaker Pype of Service: y "PEE wa 4 evin Nickersa . a amok or Contact Person: Kevin Nickerson Phone #:( S1G. 508-0613 Emer. Contact: Esther Nickerson Phone #: (10) Si2-2192 Billing Address: 226 EF Dominguez St bhurnber Street Carson, Ga 90745 City Siate EXP Proof of Insurance (check one}? WK es No LP NO, please complete the attached insurance waiver form. Special Instructions/Notes: 5322278 CEN AS OF 3/45/2023 a If Service Provider wishes to request any special accoramodation needed to facilitate provision of the services, please identity it here or contact the staff member referenced on Page | of this application: $7000.00 ‘Yotal Service Fee 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 assaciated fees will not he paid. jremainder of page intentionally left blank} 5382227.8 CEN AS OF 3/18/2023 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, inchiding all its officers, agents, employees and vohmteers} 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. SELVICe 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 Mot to Sue, Indenmification, 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 meorporated 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 abilities paid under the terras 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. tn the event there is more than one person or entity named in this Service Provider Application Agreement as the Service Provider, then all obligations, abilities covenants and conditions hereunder shall be jomt 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 ner any of its agents or employees shall be deemed agents or emplovees of the City, nor a member of a joint enterprise with the City. Neither Service Provider nor any of ifs 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 requirernents 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 AS OF 3-14-2023 oO 3 z SBA227 AC the remaming 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 application to provide the above- ~referenced services is on the express condition shat Service Provider ervice Provider's represents and warrants that i 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 agammst any penalties, clanms, or liabilities arising from or in comnection 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 PROVIDER: i Kevin Nickerson I? fo f : ey ’ i B/SIAR (Signature of Service Provider's Authorized Representative} {Date} (Printed Mame of Service Provider’s Authonzed Representattye) {Space below this ine Ru Cry use only} ° APPLICATION APPROVAL: CYPDy OF CARSON _.. _ ery - 7 snaaaeor ( (Signanire of City Manager or Desiznes) 5322275 CEN BS OF 3-34-2023 Service Provider Rules & Regulations 1, SERVICE PROVIDER APPLICATION: Upon acceptance, approval, and execution of a service provider appheation by the City of Carson (°Citv’), these rules and previsions 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, eraployees, agents and velunteers (“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 alsa become binding and 4 nart of the Service Provider Application Apreement. 2. PAYMENT/CANCELLATION: [€ the Provider is unable te perform or cannol provide the services as requested, or the City cancels the service for any reason, the associated fees for service wul not be paid, 3. CANCELLATION: No refunds will be given untess the subject event is cancelled by the City’s Community Services Department. Applications may be denied ar events cancelled in favor of City programs. 4. PROPERTY LOSS OR DAMAGES: The City is nat responsible e for any damage to, loss or theft of the Provider’s property, or that of Provider's agents, employees or invitees. 5S. CHARACTER OF ENTERTAINMENT: The Provider shall observe, obey and comply wath all appheable local, state and federal Jaws, and all applicable policies, rides, regulations and terms and conditions governing use of City facilities. The Provider will forfeit all rents or other fees paid if ejected fromm 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 pohetes, rules, regulations and conditions governing use of City facilities are subject to change without notice to Provider unless the change affects a permit alroady issued to Provider. Provider shall be solely responsible for the orderly conduct of all persons using the premises by its imvilation, either expressed or implied, during all times covered by the Service Provider Appheation Agreement. The City reserves the right to eject or cause to be ejected from the premises any person or persons due to unlawful conduct, 5. RESPONSIBILITY: The Provider shall provide all maternal, equipment, and personnel necessary for provision of the service described in this agreement. MOVE-TS/MOVE-OUT, Move-in to the event arca will be set for cach venue. Uniess 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. &. SAFETY: Standing on chairs, tables or other rental equipment is prohibited. This equipment is not engineered fo su ipport your weight, The City of Carson, its employees, agents, or officers will not be responsible for myumies or falls caused by the tmproper use of furniture, Please assist in our efforts fo provide a SAFE WORKING ENVIRONMENT, BS OF 3-24-2023 G 9. VOLUIME/LIGHT CONTROL: The City reserves the right to regulate the volume or intensity of any and all noise or light generating mechanisms Gncluding, but not limited to, loudspeakers, radios, television sets, musical tmstraments, entertainers, or blinking or flashing lights} m the reasonable judgment of the City. 10. FLAMMABLE MATERIALS ~ All decorations, props and electrical equipment must be tireproof 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. LL COPYRIGHT INFORMATION: Provider is responsible for licensing fees as required b law. Provider may be subject ta 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 frorn the trademark holder. 12, PERMITS AND LICENSE: Provider shall procure at Hs Own cost and expense all the required licenses and permits applicable to Provider’s use or activity . 13. OBLIGATION FOR CLEANLINESS: Pravider 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 (exual to or better than the condition existing prior to the event}. TP additional maintenance is required, other than the normal cleaning process, the Provider will be charged additional fees based on the cost of such maimtenance. 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 cormmunicated ta the City at the time of appheation. i7, RULE CHANGES: The City reserves the right to make reasonable changes to the foregoing rules, event hours and move-in/move-oul arrangements al any fine without notice to Provider, unless the change affects a permit already issued to Provider. BS GF 3-34-2023 Waiver, Release, Hold Harmless, Agreement Not to Sue and Indemnification 10 > < ay | N Aer! ¢ , (individual”) [on behalf of (“Exhibitor”), and as a bona fide agent of Exhibitor duly authorized to execute this Waiver, Release, Hold Harmicss, 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 Wa Coliees and volunteers), seck acceptance by the City of Carson of an application to provide services in/at wi (“Event”) on Si AT: | AVNe 3 (“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 lability 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 indemnily, 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 cxpressly 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 Signatary’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 terins. cy By signing below, Signatory, acknowledges and represents that it has read and understands the above, and that is voluntarily agrees to its terms. SIGNED Kevin Nickerson ORGANIZATION: DATE: bn 6 [dD 0} 01007.000 1/78 1805.1 AS OF 3-14-2023 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 provicers {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 City of Carson Youth Conference 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 City of Carson Youth Conference 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. The City of Carson may approve this‘request or may reject it at its discretion. fo 7, poo 5/6/23