Loading...
HomeMy Public PortalAboutC-23-089 - BIG EAR AUDIO - 2023 CARSON STREET FAIR SPACity of Carson Community Services Department 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: Kelsie Mitchell 18601 S. Main Street, Carson, CA 90248 Email: kmitchell@carsonca.gov Should you have any questions, please feel free to contact the staff member listed below . Truly, Bobby Grove Community Services Superintendent 532227.5 CFN Before submitting your application packet make sure each of the below indicated items have been attached or completed. oJ. Service Provider Application Agreement af Invoice for Future Event Date! __N/A __ Business License (if applicable) / Proof of Insurance/Certificate of Insurance Waiver, Release, Hold Harmless, Agreement Not to / Sue, Indemnification, and Photo Release Current Copy of W-9 Form (if not on file already) 1 The date of the Event shall be listed on the Invoice for Future Event Date (IFED). if the Service Provider Application is approved, then the IFED will be processed as an invoice for services rendered for the Event. No payment will be made until the conclusion of the Event, at earliest. 532227.5 CFN [Enter Date] [Enter Company Name] [Enter Company Address] [Enter 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 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 O1 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. 532227.5 CEN City of Carson Community Services Department Service Provider Application Agreement Check one (staff use): _X Carson Event Center_ Human Services Recreation__— Transportation Event:Street Fair Event Location: Carson Event Center Event Date:July 29, 2023 Name of Service Provider : is, 4) Ear & vaio C-L. C Business Form/Entity Type (if individual, sole proprietorship, corporation, or limited liability company, specify here): Lec J S Coc. Business Form/Entity Type (if general partnership, limited partnership, limited liability partnership, or other, specify here): CCC Business Entity State of Incorporation (if applicable): CA. Type of Service: FE ent eA S . . ae cS ? Contact Person: Lau Fee & She. ld 0% Phone #: ( $23 ) Y » O-"7o § & Emer. Contact: S Aon t Phone #: ( ) Billing Address: _\ SS% F (SO ANTS Ave a Number Street . 2igersicle CA. GRO City State ZIP Proof of Insurance (circle one)? Yes PANol_| If no, would you like to purchase special event insurance through the City (circle one)? ved Not Special Instructions / Notes: 532227.5 CFN 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: Ss G, é uw Cs LP A be Ato ~~ Al ee dect So ian From STA Ge jo : oa Total Service Fee ty ; 7 Coe 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 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 532227.5 CFN 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: “ —— a [cK U fp6/2 Signature of Service Provider sAtithorized Representative Date Laorence W - Sheldor TL Printed Name of Service Provider’s Authorized Representative (space below this line for City use only) APPLICATION APPROVAL: aati) aves 5.4.23 Aina of City Magtigs er or Designee Date 532227.5 CFN 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 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 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 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 10 Waiver, Release, Hold Harmless, Agreement Not to Sue, Indemnification, and Photo Release L bavrerce Sheldea IE , (“individual”) fon behalf of ts Ae ave, Avdig E06¢. (“Service Provider”), and as a bona fide agent of Service Provider duly authorized to execute this Waiver, Release, Hold Harmless, Agreement Not to Sue and Indemnification agreement (“Agreement”) on behalf of Service Provider] (individual and Service Provider hereinafter collectively referred to as “Signatory,” and the term “Signatory” includes Service Provider’s officers, officials, employees, agents and volunteers), seek acceptance by the City of Carson of an application to provide services — in/at C Me Puerta (“Event”) on SVbY 24, 20a Ss (“Date”). Signatory understands that accidents 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 any and all claims for damages for death, personal injury, or property damage which Signatory may have, or which hereafter accrue to Signatory, against the City of Carson, its elected and appointed officers, officials, employees, agents and volunteers (collectively “City”), and from and against any and all liability arising out of or connected in any way with Signatory’s participation in or presence at the Event, even though that liability may arise out of negligence or carelessness on the part of City. It is further understood and agreed that this Agreement is to be binding on Signatory’s heirs and assigns. Signatory hereby grants City the right to photograph or video-record Si gnatory 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. The rights granted by Signatory hereunder shall not expire. Signatory further agrees to indemnify, defend and hold harmless City 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 service providers 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. By signing below, I acknowledge and represent that I have read and understand the above, and that I voluntarily agree to i Ss. . sone 2 BL NAME: CA’ ene it Sheldon "al ORGANIZATION: (Sig zee Avel LC. Date: U / 2) (2. $ 532227.5 CFN ——, / BIGEARA-01 REYNA ACORD CERTIFICATE OF LIABILITY INSURANCE pare anor THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: lf the certificate hofder is an ADDITIONAL INSURED, the policy({ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Snapp & Associates Insurance Services, LLC 3838 Camino Del Rio, N. Ste. 310 San Diego, CA 92108 CONTACT NAME: (Ae, No, ext); (619) 908-3100 SMe ss: Service@snappins. com FAS noy:(619) 908-3410 NAIC # . INSURER(S) AFFORDING COVERAGE _ insurer A: Atlantic Specialty Ins Co 27154 INSURED INSURER B: State Compensation Ins Fund 35076 Big Ear Audio, LLC INSURER C : : 18597 Granite Ave. INSURER D: Riverside, CA 92508 — INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Ine TYPE OF INSURANCE Art SveR POLICY NUMBER Foe ey ubayrey) LIMITS AX _COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE § 1,000,000 _ X X GL0624300 2/20/2023 2/20/2024 PREMIER es occurence) § 500,000 _ MED EXP (Any one person) $ 5,000 ae ss nuntannnenasacon | PERSONAL & ADV INJURY $ 1,000,000 _GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X poucy, SRG koe “PRODUCTS-compropacs = __ 2,000,000 __ OTHER: $ A AUTOMOBILE LIABILITY _ EOMBINED SINGLE LIMIT § 1,000,000 ANYAUTON 7400429210000 2/20/2023 2/20/2024 _poni.y INJURY (Per person) § " OWNED xX } SCHEDULED : _ AUTOS ONLY _, AUTOS BODILY INJURY (Per accident) | $ PROPERTY DAMAGE AUTSS onty 198 Nika (Fer accident) $ $ UMBRELLALIAB = OCCUR EACH OCCURRENCE 5 EXCESS LIAB CLAIMS-MADE AGGREGATE § DED _ RETENTIONS $ B WORKERS COMPENSATION / PER , QTH- AND EMPLOYERS’ LIABILITY VIN X STarute. ER ANY PROPRIETOR/PARTNER/EXECUTIVE 925398622 5/14/2022 5/14/2023 2) cacu acciDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? Y N/A : : 4.000.000 (Mandatory in NH) E.L. DISEASE - EAEMPLOYEE $ ue If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT UY, A Equipment Floater 7100429220000 2/20/2023 2/20/2024 Misc. Equipment 441,210 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Operations of the named insured subject to the terms and conditions of the policy. The City of Carson, and its elected and appointed officials, employees, volunteers and agents are named as additional insured per the attached endorsement. Waiver of subrogation applies with respects to the General Liability policy per the attached endorsement. 30* days’ notice of cancellation, 10* days' notice of cancellation in the event of nonpayment of premium. CERTIFICATE HOLDER CANCELLATION City of Carson 801 E. Carson Street Carson, CA 90745 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Banndliggr ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GL06243-00 COMMERCIAL GENERAL LIABILITY CG 20 26 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s} Or Organization(s): Organizations as required by written contract executed prior to the date of an "Occurrence" solely and directly arising from the actions of the named insured Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section Il - Who Is An Insured is amended to B. With respect to the insurance afforded to these CG 20 26 1219 include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. © Insurance Services Office, Inc., 2018 additional insureds, the following is added to Section Ill — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 1 of 1 Policy Number: COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BROAD FORM GENERAL LIABILITY ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART This endorsement extends certain coverages. The following listing and the headers in this endorsement are only for convenience. Provisions in this endorsement might be modified by other endorsements. Read the entire policy carefully to determine rights, duties and what is and is not covered. A. Section | ~ Coverages 4. Incidental Malpractice by Employed 1. Expected or Intended Injury 5 eee ee ENTS and Paramedics (Property Damage) 6. Newly Acquired or Formed Organizati 2. Non-Owned Aircraft and . y Acquired or Formed Organizations Watercraft Under 55 Feet C. Section tll ~ Limits of Insurance — 3. Alienated Premises Aggregate Limit Per Location 4. Broadened Property Damage — . D. Section IV — Commercial General Rented Premises, Borrowed Equipment and Liability Conditions Use of Elevators 5. Personal and Advertising Injury 1. Duties in Event of Occurrence, Offense, a. Non-Employment Related Discrimination Claim or Suit b. Limited Contractual Liability Coverage 2. Waiver of Subrogation When Required by 6. Medical Payments — Written Contract or Agreement Increased Limits and Time Period E. Section V — Definitions 7. Product Recall Expense Coverage ; . . 8. Supplementary Payments — 1. Bodily injury ~ Includes Mental Anguish Cost of Bail Bonds and Loss of Earnings 2. Coverage Territory — Worldwide . . 3. Mobile Equipment — Self-Propelled Snow B. Section Il - Who is an Insured Removal, Road Maintenance and Street 1. Broadened Named Insured Cleaning Equipment Less than 1,000 Pounds 2. Additional Insured — Broad Form Vendor Gross Vehicle Weight 3. Additional Insured — Written Contract, Agreement, Permit or Authorization A. Section | -— Coverages 1. 2. Expected or Intended Injury (Property Damage) The following is added to Exclusion 2.a. Expected Or Intended Injury of Section |— Coverages — Coverage A — Bodily Injury and Property Damage Liability: This exciusion does not apply to “property damage” resulting from the use of reasonable force to protect persons or property. Non-Owned Aircraft and Watercraft Under 55 Feet a. The following is added to Exclusion 2.g. Aircraft, Auto or Watercraft of Section |— Coverages — Coverage A — Bodily Injury and Property Damage Liability: This exclusion does not apply to an aircraft that is: (a) Hired, chartered or loaned with a paid crew; and (b) Not owned by any insured. b. The following replaces Exclusion 2.g.(2}(a) of Section | - Coverages — Coverage A — Bodily Injury and Property Damage Liability: (a) Less than 55 feet long; and VCG 205 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 9 Copyright 2017, INSURED c. The following is added to Paragraph b.(1) in Paragraph 4. Other Insurance of Section IV - Commercial General Liability Conditions: This insurance is excess over any of the other valid and collectible insurance available to the insured that provides coverage for aircraft or watercraft not owned by any insured, whether such insurance is primary, excess, contingent or on any other basis. 3. Alienated Premises The following replaces Exclusion 2.j.(2) of Section | - Coverages — Coverage A — Bodily Injury and Property Damage Liability: (2) Premises you sell, give away or abandon, if the “property damage” arises out of any part of those premises and occurs from hazards that were known to you, or should have been known to you, at the time the property was transferred or abandoned; 4. Broadened Property Damage — Rented Premises, Borrowed Equipment and Use of Elevators a. The following is added to Exclusion 2.j. Damage To Property of Section | - Coverages — Coverage A — Bodily Injury and Property Damage Liability: Paragraph (1) of this exclusion does not apply to “property damage” to real property you rent or temporarily occupy with permission of the owner. Paragraph (4) of this exclusion does not apply to “property damage” to equipment you borrow while at a job site if the equipment is not being used by anyone to perform work or operations at the time of loss. Paragraphs (3), (4) and (6) of this exclusion do not apply to “property damage” arising out of the use of elevators at premises you own, rent, lease or occupy. b. The following replaces Paragraph 6. of Section Ill — Limits Of Insurance: 6. Subject to Paragraph 5. above, the Damage to Premises Rented to You Limit shown in the Declarations is the most we will pay under Coverage A for damages because of “property damage” to any one premises while rented to you or occupied by you with permission of the owner. If a Damage to Premises Rented to You Limit is not shown in the Declarations, that Limit will be $500,000. c. The following is added to Paragraph b.(1) of Paragraph 4. Other Insurance of Section IV - Commercial General Liability Conditions: This insurance is excess over any of the other valid and collectible insurance available to the insured that provides coverage for real property you rent or temporarily occupy with the permission of the owner, borrowed equipment or use of elevators, whether such insurance is primary, excess, contingent or on any other basis. 5. Personal and Advertising Injury a. Non-Employment Related Discrimination The following is added to the Paragraph 14. “personal and advertising injury” of Section V — Definitions, but only if Coverage B is not otherwise excluded by the provisions of this Coverage Part or any endorsement: “Personal and advertising injury” includes injury, including consequential “bodily injury”, arising out of discrimination because of race, color, creed, national origin, age, sex or physical disability, where such insurance is not prohibited by law, but only if the discrimination is: (1) Not done intentionally by or at the direction of: (a) The insured; or (b) Any “executive officer’, director, stockholder, partner, member, manager or “employee”; and (2) Not directly or indirectly related to the employment, prospective employment or termination of employment of any person by any insured. This insurance afforded for discrimination does not apply to fines or penalties, or that portion of any award or judgment resulting from the multiplied portion of any damages under state or federal law. VCG 205 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 9 Copyright 2017, b. Limited Contractual Liability Coverage The following is added to Exclusion 2.e. Contractual Liability of Section | - Coverages — Coverage B — Personal and Advertising Injury Liability: This exclusion does not apply to liability for damages assumed in a written contract or agreement if the liability assumed pertains to your business and is the tort liability (meaning liability that would be imposed by law in the absence of contract or agreement) of another party to pay for "personal and advertising injury" to a third person or organization, provided the “personal and advertising injury”: (1) Occurs after the execution of the contract or agreement; and (2) Arises out of the offense of false arrest, detention or imprisonment. 6. Medical Payments — Increased Limits and Time Period The following provisions are modified only if Coverage C is not otherwise excluded by the provisions of this Coverage Part or any endorsement. a. The following replaces Paragraph a.(3)(b) in Paragraph 1. Insuring Agreement of Section I -— Coverage C — Medical Payments: (b) The expenses are incurred and reported to us within three years of the date of the accident; and b. The following is added to Paragraph 7. of Section Ill — Limits Of Insurance: The Medical Expenses Limit for Coverage C is the greater of $15,000 per person or the amount shown in the Declarations. 7. Product Recall Expense Coverage a. The following is added to Section I - Coverages: Product Recall Expense Schedule Product Recall Aggregate Limit $ 50,000 Each Product Recall Limit § 25,000 Each Product Recall Deductible $1,000 The limits and deductible in this Schedule apply to Product Recall Expense Coverage unless other amounts are shown in the Declarations. PRODUCT RECALL EXPENSE COVERAGE We will pay “product recall expense” incurred by you or on your behalf for a “covered recall” to which this insurance applies. This insurance applies to “product recall expense” for a “covered recall’ that takes place in the “coverage territory” and during the policy period. The amount we will pay for “product recall expense” is limited as described in Section lil — Limits Of Insurance. We will only pay the amount of “product recall expense” in excess of the Each Product Recall Deductible shown in the Schedule above. You must pay the Each Product Recall Deductible for each “covered recall” that is initiated. b. The following is added to Section II — Limits Of Insurance: The Product Recall Aggregate Limit shown in the Schedule above is the most we will pay for the sum of all “product recall expense” incurred for all “covered recalls” initiated during the policy period. Subject to the Product Recall Aggregate Limit, the Each Product Recail Limit shown in the Schedule above is the most we will pay for all “product recall expenses” arising out of any one “covered recall” for the same defect or deficiency. c. The following is added Section IV - Commercial General Liability Conditions: Duties In The Event Of “Covered Recall” 1. You must report a “covered recall” to us as soon as practicable and no later than 30 days after you discover or are made aware of such recall. 2. No insured will, except at that insured’s own cost, voluntarily make a payment, assume any obligation, or incur any expense, other than for first aid, without our consent. VCG 205 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 9 Copyright 2017, 3. You must see to it that the following are done as soon as practicable after an actual or anticipated “covered recall” that may result in “product recall expense”: (a) Give us notice of any discovery or notification that “your product” must be withdrawn or recalled, including a description of “your product” and the reason for the withdrawal or recall; (b) Cease any further release, shipment, consignment or any other method of distribution of such product, as well as any similar products, until it has been determined that all such products are free from defects that could result in “product recall expense’; (c) As often as may be reasonably required, permit us to: (1) Inspect “your product” and take damaged and undamaged samples of “your products” for inspection, testing and analysis; and (2) Examine and make copies from your books and records; (d) Within 60 days of our request and providing you the necessary forms, send us a signed, sworn proof of loss containing the information we request to settle the claim; and (e) Permit us to examine any insured under oath, while not in the presence of any other insured, at such times as may reasonably be required, about any matter relating to this insurance or your claim, including an insured's books and records. An insured’s answers to the examination must be signed. d. The following are added to Section V — Definitions: “Covered recall” means a recail of “your product” made necessary because the insured or a government entity has determined that a known or suspected defect, deficiency, inadequacy or dangerous condition in “your product” has resulted in, or will result in, “bodily injury” or “property damage”. “Product recall expense”: a. VCG 205 06 18 Means the following necessary and reasonable extra expenses incurred by you or on your behalf exclusively for the purpose of recalling “your product”: (1) Expenses for communications, including broadcast announcements or printed “advertisements” and associated stationery, envelopes and postage; (2) Expenses for shipping the recalled products from any purchaser, distributor or user to the place or places designated by you; (3) Expenses for overtime paid to your regular non-salaried “employees”; (4) Expenses for hiring “temporary workers”; (5) Expenses incurred by “employees”, including transportation and accommodations; (6) Expenses to rent additional warehouse or storage space; or (7) Expenses for proper disposal of “your product” if the disposal is necessary to avoid “bodily injury” or “property damage” and is other than regularly used to discard, trash or dispose of “your product”. Does not include the following: (1) Damages, fines or penalties; (2) Defense expenses; (3) The cost of regaining your market share, goodwill, revenue or profit; or (4) Any expenses resulting from: (a) Failure of any product to accomplish its intended purpose; (b) Breach of warranties of fitness, quality, durability or performance; (c) Loss of customer approval, or any cost incurred to regain customer approval: (d) Redistribution or replacement of “your product” that was recalled with like products or substitutes; (e) The insured’s caprice or whim; Includes copyrighted material of Insurance Services Office, inc., with its permission. Page 4 of 9 Copyright 2017, (f} A condition any insured knew, or had reason to know, of at the inception of this insurance that was likely to cause loss; or (g) Recall of “your products” that have no known or suspected defect solely because a known or suspected defect in another of “your products” has been found. 8. Supplementary Payments — Cost of Bail Bonds and Loss of Earnings The following replaces Paragraphs 1.b. and 1.d. of Supplementary Payments — Coverages A and B in Section | —- Coverages: b. Up to $2,500 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $250 a day because of time off from work. B. Section Il — Who is an Insured 1. Broadened Named Insured Section Il - Who Is An Insured is amended to include as a Named Insured any legally incorporated entity in which you maintain ownership of more than 50 percent of the voting stock on the effective date of this endorsement, but only if there is no other similar insurance available to that organization. This insurance does not apply to any organization that is an insured under another policy or would be an insured under such policy but for its termination or the exhaustion of its limits of insurance. 2. Additional Insured — Broad Form Vendor a. Section Il -Who Is An Insured is amended to include as an additional insured any person or organization (referred to below as “vendor”) with whom you have agreed in a written contract or agreement to provide insurance, but only with respect to “bodily injury” or “property damage” arising out of “your products” that are distributed or sold in the regular course of the vendor's business. But none of these vendors are an additional insured: (1) (2) (3) (4) VCG 205 06 18 If the “products-completed operations hazard” is excluded under the Coverage Part or by endorsement; If the vendor is a person or organization from whom you have acquired the products, or any ingredient, part or container entering into, accompanying or containing those products; For “bodily injury” or “property damage” for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement unless that the vendor would have otherwise been liable for such “bodily injury” or “property damage” in the absence of that contract or agreement; or For “bodily injury” or “property damage” caused by or arising out of: (a) Any express warranty not authorized by you; (b) Any physical or chemical change in the product made intentionally by the vendor; (c}) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (d) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (e} Operations to demonstrate, install, service or repair, except those operations performed at the vendor's premises in connection with the sale of the product; (f} Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor, or (g) The sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behaif, unless such act or omission is: (i) In the course of repackaging “your products” in the original container after unpacking solely for the purpose of inspection, demonstration, testing or the substitution of parts under instructions from the manufacturer; Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 9 Copyright 2017, (ii) A demonstration, installation, servicing or repair operation of “your products” performed at the vendor's premises in connection with the sale of the product; or (iii) An inspection, adjustment, test or servicing of “your products” the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. b. The insurance afforded to such vendor under Paragraph a. above: (1) Applies only to the extent permitted by law; and (2) Will not be broader than that which you are required by the contract or agreement to provide to such vendor. The following is added to Section III —- Limits Of Insurance: The most we will pay on behalf of a vendor that qualifies as an additional insured is the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This provision does not increase the applicable Limits of Insurance shown in the Declarations. 3. Additional Insured — Written Contract, Agreement, Permit or Authorization a. Section Il - Who Is An Insured is amended to include as an additional insured any person or organization with whom you have agreed in a written contract, agreement, permit or authorization to provide insurance but only with respect to liability for injury or damage caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf for: ee. (1) “Bodily injury’, “property damage” or “personal and advertising injury” in the performance of your ongoing operations, and only until your operations are completed, for such person or organization at the location designated in the contract, agreement, permit or authorization; (2) “Bodily injury’, “property damage” or “personal and advertising injury” in the maintenance, operation or use of equipment leased to you by such person or organization; or ot (3) “Bodily injury’, “property damage” or “personal and advertising injury” in connection with premises you own, rent, lease or occupy. The insurance afforded to an additional insured under Paragraph a. above does not apply: (1) Unless: (a) The contract or agreement is executed, or the permit or authorization is issued, before the “bodily injury’, “property damage” or “personal and advertising injury” occurs; and (b) The contract, agreement, permit or authorization is in effect or becomes effective during the policy period. (2) To any: (a) Person or organization included as an insured under any other provision of this policy, including this or any other endorsement; (b) Lessor of equipment after the equipment lease terminates or expires; (c) Owner or other interests from whom land has been leased; (d) Manager or lessor of premises if: (i) The “occurrence” takes place after you cease to be a tenant in that premises; or 66 (ii) The “bodily injury", “property damage” or “personal and advertising injury” arises out of structural alterations, new construction or demolition operations performed by or on behalf of the manager or lessor; yt (e} Person or organization if the “bodily injury’, “property damage” or “personal and advertising injury” arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (i) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or VCG 205 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 9 Copyright 2017, (ii) Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the “occurrence” which caused the “bodily injury” or “property damage”, or the offense which caused the “personal and advertising injury”, involved the rendering of or the failure to render any professional architectural, engineering or surveying services; or (f} “Bodily injury” or “property damage” occurring after: (i) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behaif of the additional insured at the location of the covered operations has been completed; or (ii) That portion of “your work” out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. c. The insurance afforded to an additional insured under Paragraph a. above: (1) Applies only to the extent permitted by law; and (2) Will not be broader than that which you are required by the contract, agreement, permit or authorization to provide to such additional insured. d. With respect to the insurance afforded to an additional insured under Paragraph a. above, the following is added to Section III — Limits Of Insurance: The most we will pay on behaif of the additional insured is the amount of insurance: a. Required by the contract, agreement, permit or authorization; or b. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This provision does not increase the applicable Limits of Insurance shown in the Declarations. 4. Incidental Malpractice by Employed Physicians, Nurses, EMTs and Paramedics a. The following is added to Paragraph 2.a.(1)(d) of Section Il - Who Is An Insured: But an “employee” or “volunteer worker” employed or volunteering as a physician, dentist, nurse, emergency medical technician or paramedic is an insured if you are not engaged in the business or occupation of providing professional health care services. b. The following is added to Paragraph b.(1) in Paragraph 4. Other Insurance of Section IV - Commercial General Liability Conditions: This insurance is excess over any of the other valid and collectible insurance available to the insured for coverage for insured “employee” or volunteer worker who is a physician, dentist, nurse, emergency medical technician or paramedic, whether such insurance is primary, excess, contingent or on any other basis. 5. User of Covered Watercraft a. Section I! -Who Is An Insured is amended to include as an additional insured any person or organization who uses, or is responsible for the use of, a watercraft covered by this policy if the use is with your express or implied consent. But no such person or organization is an insured with respect to: a. “Bodily injury” to that person’s or organization’s “employee”; or b. “Property damage’ to property: (1) Owned, occupied or used by; or (2) In the care, custody or control of, rented to or over which physical control is being exercised for any purpose by; that person or organization. VCG 205 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 9 Copyright 2017, b. The following is added to Paragraph b.(1) in Paragraph 4. Other Insurance of Section IV - Commercial General Liability Conditions: This insurance is excess over any of the other valid and collectible insurance available to the insured for use of, or responsibility for use of, a watercraft covered by this policy, whether such insurance is primary, excess, contingent or on any other basis. 6. Newly Acquired or Formed Organizations The following replaces Paragraph 3.a. of Section Il — Who Is An Insured: a. Coverage under this provision is afforded only until the end of the policy period: C. Section Ill — Limits of Insurance — Aggregate Limit Per Location The following is added to Paragraph 2. of Section Ill — Limits Of Insurance: The General Aggregate Limit applies separately to each “location” of yours. As used in this provision, “location” means premises you own, rent or lease involving the same or connecting lots, or whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. D. Section lV ~ Commercial General Liability Conditions 1. Duties in the Event of Occurrence, Offense, Claim or Suit The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV - Commercial General Liability Conditions: The requirements that you must notify us of an “occurrence”, offense, claim or “suit”, or send us documents concerning a claim or “suit”, apply only if the “occurrence”, offense, claim or “suit” is known to: (1) You, if you are an individual: (2) A partner, if you are a partnership; (3) An “executive officer” or insurance or risk manager, if you are a corporation; or (4) A manager, if you are a limited liability company. The requirement that you must notify us as soon as practicable of an “occurrence” or an offense that may result in a claim does not apply if you report the “occurrence” or offense to your workers’ compensation insurer and that “occurrence” or offense later develops into a liability claim for which coverage is provided by this policy. But as soon as you become aware that an “occurrence” or offense is a liability claim rather than a workers’ compensation claim, you must comply with all parts of Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV ~ Commercial General Liability Conditions. Waiver of Subrogation When Required by Written Contract or Agreement The following is added to Paragraph 8. Transfer of Rights of Recovery Against Others to Us of Section IV ~ Commercial General Liability Conditions: We will waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of your ongoing operations or “your work" included within the “products-completed operations hazard” if the operations or work is done under a written contract or agreement with that person or organization, but only if the contract or agreement is executed before the “bodily injury" or “property damage” occurs and requires you to waive your rights of recovery. E. Section V — Definitions 1. Bodily Injury — Includes Mental Anguish The following is added to Paragraph 3. of Section V — Definitions: “Bodily injury” includes mental anguish resulting from bodily injury, sickness, or disease sustained by a person at any time. 2. Coverage Territory — Worldwide The following replaces Paragraph 4. of Section V — Definitions: 4. “Coverage territory” means anywhere other than a country or jurisdiction that is subject to trade or other economic sanction or embargo by the United States of America. But the insured's responsibility to pay damages must be determined in a settlement we agree to or in a “suit” on the merits brought within the United States of America (including its territories and possessions), Puerto Rico or Canada. VCG 205 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 8 of 9 Copyright 2017, 3. Mobile Equipment — Self-Propelled Snow Removai, Road Maintenance and Street Cleaning Equipment Less than 1,000 Pounds Gross Vehicle Weight The following is added after Paragraph 12.f.(1) of Section V — Definitions: But a self-propelled vehicle of less than 1,000 pounds gross vehicle weight that is maintained primarily for purposes other than transportation of persons or cargo with permanently attached equipment for snow removal, road maintenance (other than construction or resurfacing) or street cleaning will be considered “mobile equipment” and not an “auto”. VCG 205 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 9 of 9 Copyright 2017, | Request for Taxpayer | Give Form ta the . identification Number and Certification requester. Oo not Cenc EAI senel to the IAS. Spare Baars vine & Go lo wean. goviFomw? far i instructors aed the bitest information, ve Seber, O& Some las aces Tet OR ODOT Uke return, Nemes ip eeguaeidd cee thie ier dig meg leave Ihe OWS rebneregared daily tess, 4 ereenent ima shun Big Ear Audio LLC & (Cheech eppropriges tere tor hoard toe caneticaton uf es parative veut: 6. semenert gn dee 1, hack cody nneal Ge | 2 Exemptions (ood PONT TRON seria Breton ta aidvathens cn gtepe Sc LE Parmernia [T) trustistai C Garpesition LI} aS Doeynte LOU ay er Limaneet betty Gompary. Ertir the Six clsssticaton (G-G aamemyion, Sol coat, Pattrrencepi me __ 9 fae we wer Danutoheck | byempsan tac PATA reporiang . ade Late 2 noche [F gery] Print or type. Bee Specii i c instructions sn caqn & BE Rs Panera eee perc. Khaki ok z ben, aust, wad aph a Regnecion's nome and 18597 Granite. Ave € City, stain. and 2 cate Riverside CA 32508 T LIS ascuyet cusmberts: 2" Sano fa) Sees retuctians, gears) “Taxpayer identification Number (TIN) Eater your Tin in the aperopriate box, Tink TIN grcavikfert must mistch the reine grean on fee tie ceeoic | Social wecurity senor beckup whboling. For indiaduads, thin. Qicerally your social seeweity purer GML Henwaver, fer a resivkant abe, oe proprigtor, ar Ser spardod entity, se8 the gretructions for Pret f, later, Fer cener - - entiGes, a in your erployer inectificaian rumber (EIN). Hyms do fot hove 1 nummer, sen Hoe to gata FIN later, oe Note: if the account 3 jn mon than one names, son the eystnuctioens foc line: 1. Absa $06 SWhat Mane anc Erngnyeer nleshtication Sharebee thovsher To Give the Raquester for gidaines on whose maminer ta ord i Gees Certification Under panuiting of perjury, | certify thie: 1. Pre tether shown on. thes toe i ie riy COmect tapayer Wemificution number for lam wailing for a nurier ter be imuned to nek and 2. i ani not oijecd to bask wwithhedding Bee nas: font meth iter Backus withheddi, oe 4) i hone not beer aceite? by the internal Reyer Si thal tam subject to backup waehholding 8 3 result of a taken io rapert af interest or idends, or fc] the IRS has rentifind me that | men: Siabject to backup withhevrling: anc Hikes of otter U5, percon (defines Dokowl gre 4, The FATS cectetsl eriterect on this tren [il arty} indicating that [ast axernet from FATOA reporting ss correct. i i Cartlisation @ inshriactons. rast, Out ign 2 Sows € you hae bee eeitifiedd by the: IB thee yO de cumumtiy cage! he beech elihhnading basause zt ve Inked In peneel af iigrest and chcloends ani you TENT, Por shal arian transactions, heen 2 dees not apply. For BOQUESIO of abandon Teen of secured progperty, cancellation of ehL cortices to an indhicked merement Setarigeraest (ALA, aie [hari inkesaed anc! Sovidenats, YOU BPS reyt regu So Sgt hg Geetifigation, but you must peovide wour cermtt TIN, Sae ihe instructs a Hagnasune of ae Ld 6/z \ : us page oe: een i Date » oF i 'F6 eo F SELEY drat at % fiz General Insirt uctions i oe 1OS8-DIV (dividends, netucinng tees fom atnckes or mutual Sectan mfareges are bo ie interasl Revenge Goda unkes. athernwise * Bar 1095-MiSC jancns types of income, prizes. Avenily, oe prose: raed, proceeds) * Future deusepments. Far the best evformation about Gewonments + Porn 1098-8 Istes or etutual fund sales aro ceetah other fohtad tn Poerh 00-9 wid 25 iietructions, such as lngisintion esacied transactions by beesecrs} after they wert published, go to wae ie pow Porn ve. " * . ; pe Bam Oni * Form TOES ipeoceuds from real estate transwections Purpose of Form + Fore 10G9-K (merchars qird aed third marty network teareksctions An individiad of aatity Porm W-8 requesbet wl ie mequinad to hin fey « Form 1088 fhoene mortgage mterestt, 1060-E istudent informaiton return anth the tS enust abten your correct lapse TOS6-7 [buttiars igendiligation rumbur (TIAL which Foay be your sone seurty number + Poon 1080-0 (rancelad sett $S5re, anaes Aa pawer Inteacalion qurtiber (TING, asaption: taxpayer deniiticaticg number GATING, oF eraptoyer iSentiicatian: sumber ; SSA) i repurt on an ntonigtign exturn tie amount paid to you, or other Use Form W-9 only if yop gree WS. perpen fe = Form 180-4 (waqubetien oc abandonment ad secured property) erway ib resident cencnind feoortalde on an sinematios sete Exarneen: ot intornnasaan aber), bo petrvide your camerd TIM, febaene nickice, bul ere nat amited to, the tudlesingg, iP yee do oat aot Paros 8-9 to the mvpoxiar with a TIN, you migh * Porn VOSO-INT Gniterest coened or pecll be Suifect Jo backogn wt Ahiealdtig, Gow yinat 2 hacks with ning, fete, Cat. dae Foon Wie ey, eon Big Ear Audio LLC 18597 Granite Ave Riverside, CA 92508 Bill To: Invoice #: 00001876 Date: 3/22/2023 City of Carson Page: 1 701 E. Carson ST Carson, CA 90745 DATE UNITS NOTES RATE AMOUNT 7/29/2023 11 SL100 Mobile Stage 24x20 $3,900.00 $3,900.00 Max Floor Load 100 Ibs per. sq. ft -Max Roof lifting load 3800 Ibs Included: black Backdrop scrim, Horizontal Banner supports, 3 side guard rails, 1 set of stairs with hand rails. 7/29/2023 1 | Concert Sound System $2,200.00 $2,200.00 4x JBL SRX 835 Mians 2X JBL SRX double 18 speaker 4x JBL PRX 812 Monitors 4x UXLD Shure Wireless 1x Workbox MISC Shure and Senheiser Mics, chords, DI's and stands for band 1X200amp Power Distro 1x Midas M32 console with ipad 1x 8x8 tech world tent with walls 7/29/2023 1 | Certified Stage Technican $500.00 $500.00 Deployment or Teardown LESSEE MUST PROVIDE (2) STAGEHANDS FOR THE DURATION OF THE SETUP AND TEARDOWN 7/29/2023 1 | FOH Engineer $500.00 $500.00 7129/2023 1 | Stage Delivery. $600.00 $600.00 On Site: 7/29/23 7:00 AM Strike: 7/29/23 5:00 PM Site Address: TBD Carson CA Onsite Contacts:Bobby Grove 310-919-7223 Lessee must make sure that the site has a cleared, no obstruction, full availability and easy access from the road where the stage SL100 will be placed; Length : 50', Width : 8' 6" Height : 12’ 7/29/2023 1 | Please Note: Client to provide 36KW Generator with 3 phase camiok to Comment: Sales Tax: Total Amount: Amount Applied: Balance Due: Terms: C.O.D. Big Ear Audio LLC 18597 Granite Ave Riverside, CA 92508 Bill To: City of Carson 701 E. Carson ST Carson, CA 90745 Invoice #: 00001876 Date: 3/22/2023 Page: 2 DATE UNITS NOTES RATE AMOUNT 7/29/2023 the upstage edge. A 50% non refundable deposit is required to hold any and all dates with balance due via cash or check upon arrival. Your stage is not confirmed for your event until Big Ear Audio receives a signed copy of the invoice and the 50% deposit. We work off a ist come 1st serve basis. lf your date is being challenged, you will receive one notification at which time you will have 24 hours to complete the confirmation process. Customer Indemnity: All Permits and parking are the responsibility of Client. Customer Will indemnify Big Ear Audio LLC, its employees, sub-contractors and agents against any cliam, liability, or cost arising from this agreement or the use of the equipment, including property damage and personal injuries, except to the extent that such claims, liabilities or costs are due to Big Ear Audio LLC's sole negligence. Customer is responsible for damage caused by fire, theft, negligence, abuse or vandalism and agrees to pay all costs and expenses necessary to restore or replace said equipment. After Use, Customer is responsible for making sure the stage is clean of trash and debris as well as any additional excessive elemnts such as mud or dirt or customer agrees to be subject to a $250 Comment: Sales Tax: Total Amount: Amount Applied: Balance Due: Terms: C.O.D. Big Ear Audio LLC 18597 Granite Ave Riverside, CA 92508 Bill To: Invoice #: 00001876 Date: 3/22/2023 City of Carson Page: 3 701 E. Carson ST Carson, CA 90745 DATE UNITS NOTES RATE AMOUNT cleaning fee. signature: Comment: Sales Tax: $0.00 Total Amount: $7,700.00 Amount Applied: $0.00 Balance Due: $7,700.00 Terms: C.0.D.