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HomeMy Public PortalAboutC-23-113 - JOSEPH FAAVAE - 2023 SAMOAN HERITAGE DAY SPA City of Carson Community Services Department Service Provider Application Dear Applicant, ee e 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: A h r e n s ect aetna es City of Carson Attn: JannyNoa (Event Coordinator’s Name) 23410 Catskill Ave., Carson, Ca 90745 a - (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) __ St. Recreation Center Supervisor (Title) : Checklist Before submitting your application packet make sure each of the below indicated items have been attached or completed. (FOR COMMUNITY SERVICES OFFICE USE ONLY) Yo Service Provider Application Agreement ye Invoice for Future Event Date’ {Pe Business License (if applicable) Np Proof of Insurance/Certificate of Insurance / Waiver, Release, Hold Harmless , Agreement Not to Sue, Indemptheation, and Phote Release. Lo. Lo : Given Copy ét w-9 Form Gia ot 0 on : until the ¢ conclusion of the Event, at 05/25/23 (ate) Island Block Radio (Company) Z372ZP GULF AVE (Company Address) Caps) CA PTYE™ (City, State ZIP) Insurance Requirements Dear KM Le , (Enter Provider’s Name) ‘City of Carson, you are required to Please be advised pursuant to your desire to work with the submit the following: v 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 tisk, 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 01 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 withthe event. = = ss City of Carson Community Services Department Service Provider Application Agreement Check one (staff use): [] Carson Event Center| | Human Services Recreation [| Transportation Event Date: 06/24/23 Event: ©2moan Heritage Day Event Event Location: FOlSia Park Name of Service Provider: Island Block Radio Business Form/Entity Type (if individual, sole proprietorship, corporation, or limited liability company, specify here): Linetfe LIABIUTY compen Business Form/Entity Type (if general partnership, limited partnership, limited liability partnership, or other, specify here): Business Entity State of Incorporation (if applicable): -_, Dd Services, Co-Master of Ceremonies Mz. Lulu, and Stage and Sound Support Type of Service: Contact Person:, Joe Savage "Faavae Phone #: (424 ) 224-1 898 t-ma fo ; 2 ma J OC AY Abo Canal. ¢Bidne #: (F24 224U-—l1ET& Emer. Contact: Billing Address: 24128 GULF AVE" Number Street CARS . A qoqds | Proof of Insurance (check one)? Yes te IN 0 oO If NO, please complete the attached insurance waiver form. Special Instructions/Notes: | Die =F i Total Service Fee $3, 000 ee _ _ NOTE: If se service provider is unable to provide the serv Tvices as proposed or requested ord eC ty on n cancels the service for any Teason, bog) associ: __ fremainder ee nally left bl Provider Application Agreement: — ions and wm consideration for the City’s review of this apeliention, Service these teriiis. ct clense City in 1 connection with its proposed services in the “Waiver, Release, Hold Harmless, Agreement Not to Sue, Indemnification, and bmitted concurrently herewith. maintain all sequen | insurance coverages and fompls with all ssopatcd iair 2ement yo rvice Provider to waive “all I tights of silicate and the City, its elected or appointed officers, officials, employees and agents, for all : ider the terms of any policy which arise from the activitie or operations 0) ned by, Service Provider, tegardiess of any prior, ee or subsequent or entity named in. this Service Bovide: Application S rvice Pr vider, then all obligations, liabilities Ss, ‘covenants | 7 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): SERVICE PROVIDER: _/@4~) Btact? 07H @ pnig@zs (se of Servigd Proyider's Authorized Representative) (Printed Name of Service Providers Authorized Representative) (Space below this line for City use only) oe at tn ho a a. i been ea as tags ce APPLICATION APPROVAL: N CHELATION: If the 6 Provider) is unable to peten or cannot provide the requested, or the City cancels the service for any reason, the associated fees for jaid. es ss the subject event is cancelled by the may be denied or events cancelled i in AGES: The City is not teapoleib’ for any ¢ yale st a r s property, or that of Provider’ 8 agents, employees or invitees | NFERTAINME IT: The Provider. shall observe, obey ond cor os with al, state aud federal laws, and ail applicable policies, rules, regulations and verning use of City facilities. The Provider will forfeit all rents or other oe oe for py tions of same. Pooh shall not oe Provider € Hole for licensing fees ag required by . Provider may be subject to legal action for the use, display or sale of any item using any ghted and/or trademarked name or logo which has mn: ; UY authorized under shall procure at its own cost and expense all the Provider's use or activity, =F VANLINESS: Provider agrees that the facility and a etty (including parking lots) used by the Provider must be left (equal to or better than the condition existing prior to the ev ie normal cleaning process, the Provider will. Waiver, Release, Hold Harmless, Agreement Not to Sue and Indemnification 10 — 1 SPY FAAVAE , (“individual”) fon behalf of - C Exhibitor”), and as a bona fide agent of Exhibitor duly authorized-to execute this Waiver, Release, Hold Harmless, Agreement Net 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 Samaon Herltege Day Cstebration (“Event") on 055723 (Date). Signatory understands that accidents, ilinesses, 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 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 cosis 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: tor or releasing party does not know or suspect to. exist in his or her favor “A general release does not extend to claims that the credi at, if known by him or her, would have materially affected his or her settlement with the at the time of executing the release and th ages, losses, claims, liabilities and demands of whatsoever debtor or released party.” This waiver shall be effective as a bar to any and all actions, fees, dam n, or suspected or unsuspected, that may arise from or relate in any way to character, nature-and kind, that are known or unknow! Signatory’s participation in the Event. heirs and assigns, and shall not expire. No oral representations, ave been made with regard to the subject matter of this form. If any This Agreement shall be binding on Signatory’s successors, Statements or inducements, apart from this written form, hi 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. Signatory acknowledges and represents that it has read and understands the above, and that is voluntarily By signing below, agrees to its terz: SIGNED: = | NAME: Wie oa / 6 — | onGaNIeAnION:” (ELATD [ytsele LAS is Ue DATE: Please note: The City of Carson’s own insurance will cover, the City’s liability but willenot:cover an Entertainer’s liability. All service providers (including. entertainers) are still required to carry insurance. We miist require this because it is a condition of the City’s Excess insurance policy. Acknowledgement: 1. lam an entertainer that will perform atthe City of Carson Sanisw/ (Pater THE E Day EUR eave event. 2. 1am 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 SAptcta/ feet taee. p44 El Bray — event. 3. lacknowledge 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. 1 further acknowledge and agree that in the event of a loss Fesulting from “ or my business’ wrongful or negligent acts, the City of Catson or its insurer will seek to recover its financial loss. _from me or my business. | will cooperate in every way with the said n recovery efforts.