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HomeMy Public PortalAboutC-23-133 - MAD TEA INC - 2023 CARSON STREET FAIR SPA City of Carson i Community Services Department . Be Y Service Provider Application Dear Applicant, On behalf of the City of Carson, I would like to thank you for taking the porn SE NS at opportunities with the City by applying to provide services for an event at a - : Submission of our application process, you must complete, sign, and return the following fai ou seek of these forms does not guarantee that you will be provided the business oppo é ty tor list md Your prompt assistance in submitting the requested documentation to the City staff mem end your below will be appreciated and will help expedite the application process. Please s y completed application and attachments directly to the following address: City of Carson Attn: Amanda Valorosi (Event Coordinator’s Name) 801 E. Carson St. Carson, California 90745 (Enter Event Coordinator’s address (i.e., city hall, corporate yard, or specific park address) Email: 4valorosi@carsonca.gov (Enter event coordinator’s emai} address) Should you have any questions, piease séel free to contact the staff member listed below . Truly, Amanda Valorosi (Name) Human Services Supervisor (Title) 532227.5 CEN 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) AI Service Provider Application Agreement —7 i Invoice for Future Event Date! _NWZJA_ Business License (if applicable) _[] _ Proof of Insurance/Certificate of Insurance OR Waiver Requested Waiver, Release, Hold Harmless, Agreement Not to Sue, Indemnification, and Photo Release oe 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 AS OF 6-14-2023 ate Miho Ted lac OBA freshae Paivcess CC (Company) AOS/ Py. Qn. MW. (Company Address) Lormuta (4 FOTN (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 piace, unless a waiver of insurance requirements is requested (by checking the box in ‘he application below) and approved by the City’s Risk Manager in his or her sole discretion. Failure to submit such required forms or obtain waiver approval shall be cause for City of Carson to reject or terminate any service provider application agreement. The City of Carson reserves the right to modify these requirements based on the nature of the risk, prior events, insurance coverage, or other special requirements. The City’s Risk Manager, in his or her discretion, may waive these requirements on a case-by-case basis, but the City cannot and will not add entertainers (i.e., persons, such as singers, dancers, or comedians, whose job is to entertain others) as additional insureds on the City’s insurance (regardless of whether or not a waiver is granted), and therefore City’s insurance will not cover any liability of entertainers in the event of a loss. Entertainers: By submitting this application, you: (i) acknowledge that the City’s insurance will not cover your or your business’ liability in the event of a loss; (ii) assume the risk of performing services without City’s insurance coverage, and without any insurance coverage in the event City grants you a waiver of the service provider insurance requirements. below or you fail to comply with such requirements; and (iii) agree to release and hold harmless the City from any claims or liability related to same. MINIMUM SCOPE AND LIMIT OF INSURANCE 6-14-2023 532227.5 CFN AS OF 4 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 with the event. 532227.5 CFN AS OF 6-14-2023 City of Carson Community Services Department Service Provider Application Agreement Check one (staff use): [ ] Carson Event Center|] Human Services [ ] Recreation [| Transportation _ Senior Information & Resource Fair . Carson Event Center . 7/ 29/ 23 : Event Location: Event Date: Name of Service Provider: HY TE A [ Me 2 BA ii eshige Lanwess CC. Business F orn/Entity Type (if individual, sole Proprichrsie Corporatio limited liability company, specify here): Business F ornvEntity Type (if general partnership, limited partnership, limited liability partnership, or other, specify here): Business Entity State of Incorporation (if applicable): A Type of Service: Cha Li acter Cnet Be fea Vt Contact Person: ky Len Lbilass Phone #:(3/D_ KSR- FZ LZ Emer. Contact: Leolly Dol urss Phone #: G@/0) ¢G¢ZO — FSO] Billing Address: AOS / falts Vorples Li M Street 01007.0001/532227.8 Lorta CA 9D7 )77 City State ZIP 7 Proof of Insurance (check one)? Yes No If no, you must request a waiver of insurance requirements. Do you request a waiver of insurance requirements? (check yes if you checked no in the two boxes above) Yes AJ No Special Instructions / Notes: AS OF 6-14-2023 532227.5 CEN If Service Provider wishes to request any special accommodation needed to facilitate provision of the services, please identify it here or contact the staff member referenced on Page 1 of this application: $385.00 Total Service Fee NOTE: If service provider is unable to provide the services as proposed or requested or the City of Carson cancels the service for any reason, the associated fees will not be paid. [remainder of page intentionally left blank] 532227.5 CFN AS OF 6-14-2023 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, 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, and Indemnification” agreement submitted concurrently herewith, which is incorporated herein by reference. 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 AS OF 6-14-2023 the Temaini . . aining portions of this Agreement which are hereby declared as severable and shall be interpret i ‘preted to carry out the intent of the parties hereunder. Service Provider's Service Prov; application topo = Wledges that the City of Carson’s consideration of “der Tepresents and Warant above-referenced services is on the express condition that Service Provi Of intellectual pro s that it is and will be in compliance with all applicable restrictions on the “ Provided. Service a nae including Copyright laws, in connection. with the services proposed to € claims, or liabiliti /\der shall indemnify, defend, and hold harmless the City against any penalties, th lites arising from or in connection with Service Provider’s noncompliance with same. © undersigned, on behalf of Service Provider, agrees that Service Provider seeks and is willing to Provide the a - : bove-referenced service(s) on the date and time of the above-referenced event. This Servi : ae ce Provider Application Agreement has been executed on the dates written below. Icy ie he aa ny APPLICA TION SUBMISSION (wet signature required; no electronic signatures): L Cc CLSS er MAD TEA Ic DBA Mest 9¢ | cin 7-107 FO2S (ate) SERVICE PR oS (Sigrfature of Service Provider's Authorized Representative) /I ‘ ‘cf oe ec ie ee ew le ee en i eee AE EE On ES RS eeawe em eee meee ee et A PPLIC ATION APPRO VAL : C I T Y O F C A R S O N Z of (Date) AS OF 6-14-2023 6 3 222 7 5 C F N 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 AS OF 6-14-2023 10 9. VOLUME/LIGHT CONTROL: The City reserves the right to regulate the volume or intensity of any and all noise or light generating mechanisms (including, but not limited to, loudspeakers, radios, television sets, musical instruments, entertainers, or blinking or flashing lights) in the reasonable judgment of the City. 10. FLAMMABLE MATERIALS - All decorations, props and electrical equipment must be fireproof or of fire retardant materials, must meet City requirements and are subject to removal. Candles and other open flame devices will not be permitted except as authorized on this agreement; subject to Fire Department regulations. 11. COPYRIGHT INFORMATION: Provider is responsible for licensing fees as required by law. Provider may be subject to legal action for the use, display or sale of any item using any copyrighted and/or trademarked name or logo which has not been specifically authorized under license from the trademark holder. 12. PERMITS AND LICENSE: Provider shall procure at its own cost and expense all the required licenses and permits applicable to Provider’s use or activity . 13. OBLIGATION FOR CLEANLINESS: Provider agrees that the facility and any other surrounding City property (including parking lots) used by the Provider must be left in a clean and orderly condition (equal to or better than the condition existing prior to the event). If additional maintenance is required, other than the normal cleaning process, the Provider will be charged additional fees based on the cost of such maintenance. 14. DISPUTES: All points not covered by the Service Provider Rules & Regulations are subject to the decision of the appropriate City representative. 15. FLOOR MANAGEMENT: The City will appoint a Floor Manager who is authorized to enforce these rules and regulations. 16. SPACE ASSIGNMENT: Event space is assigned to providers at the sole discretion of the City. Concerns regarding competitive or specific types of providers should be communicated to the City at the time of application. 17. RULE CHANGES: The City reserves the right to make reasonable changes to the foregoing rules, event hours and move-in/move-out arrangements at any time without notice to Provider, unless the change affects a permit already issued to Provider. 532227.5 CFN AS OF 6-14-2023 Waiver, Release, Hold Harmless, Agreement Not to Sue and Indemnification 1] , individual’) (on behalf of . (“Exhibitor”), and as a bona fide agent of Exhibitor duly authorized to execute this Id Harmless. Apreement Not to Sue and Indemnification agreement (“Agreement”) on behalf of Exhibitor] Qndividual and Exhibi i clively referred to as “Signatory,” and the term “Signatory” includes Exhibitor's oflicers, » employees. agents and volunt i ect ecrs), seck acceptance by the City of Carson of an application to provide services in/at ay of Carson Sreet Fair (“Event”) on duly 29, 2029 (“Date™). ne Ac r c Signatory understands that accidents, illnesses, and injurics can arise out of the Event; knowing the risks. nevertheless, and in consideration of the acceptance of an application to i provide a service at the Event on the Date, Signatory hereby waives, releases and discharges the City of Carson, its clected and appointed officers, officials, employecs, 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 carclessness on the part of City, and Signatory agrees to waive its rights to make any such claims through any 5 ‘ ’ action or proceeding against the City or any City Party. However, Signatory understands thal this paragraph 's 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. ; aim, liability, loss, damage, expense, or cost which was caused by the sole negligence or willful misconduct of the City. If Signatory in an entertainer (i.¢., a person, such as a singer, dancer, or comedian, whose job is to entertain others), then Tegardless of whether any waiver of insurance requirements is granted, Signatory: (i) acknowledges and agrees that Signatory will not be added to City’s insurance as an additional insured, and therefore City’s insurance will not cover any liability of Signatory or Signatory’s business in the event of a loss; (ji) assumes the risk of performing services without City’s insurance coverage, and without any insurance coverage in the event City grants a waiver of the Service provider application agreement insurance Frequirements or Signatory fails to comply with such requirements; (ili) waives, releases and discharges the City and each City party from any claim related to same; and (iv) agrees to hold City and each City Party harmless from any claim or liability related to same. In giving the foregoing releases and waivers, Signatory expressly waives any and all rights conferred upon it by the provisions of California Civil Code Section 1542, which Signatory understands reads as follows: “A general release does not extend to claims that the credit al the time of executing the release and that. if known by debtor or released party.” or or releasing party does not know or 5 uspect to exist in his or her favor him or her, would have matenally affected his or her settlement with the This waiver shall be effective as a bar to any and all actions, fees, damages, losses, claims, liabilities and demands of whatsoever character, nature and kind, that are known or unknown. or Suspected or unsuspected, that may arise from or relate in any way to Signatory’s participation in the Event. This Agreement shall be binding on Signatory’s successors, | statements or inducements, apart from this wrilten form, have | portion of this form is declared invalid by a court of competent j heirs and assigns, and shall not expire. No oral representations, been made with regard to the subject matter of this form. Lf any urisdiction, the remainder shall continue in full force and effect. By signing below, Signatory acknowledges and re presents that it has read and understands the above, and that it voluntarily agrecs to ils terms. By signing below, Signatory acknowledges and represents that it has read and understands the above,, and that is voluntarily agrees toi NAME: eee Valuis: 0 DATE: Hz 2 01007 0001/78 isos 4 AS OF 6-14-2025 ts terms. . SIGNED: BN SE ORGANIZATION: f reatig.c fn Ne met ee e e e ———— oo S E Q U O I A I N S U R A N C E C O M P A N Y 4 777 1 C o w a n A v e n u e ] [ S u i t e 1 00 I r v i n e , C A 9 2 6 1 4 W O R K E R S ' C O M P E N S A T I O N a n d E M P L O Y E R S ’ L I A B I L I T Y I N S U R A N C E P O L I C Y a u s e d t h i s p o l i c y t o b e e x e c u t e d a n d a tt e s t e d . | [ A u d | [ B a rr y D o v Z y s k i n d , P r e s i d e n t | I n W i t n e ss W h e r e o f , w e h a v e C c b a w [ S t e p h e n U n g a r , S e c r e t a r y | T o o b t a i n i n f o r m a t i o n , p l e a s e c o n t a c t y o u r a g e n t o r S e q u o i a I n s u r a n c e C o m p a n y a t 8 3 1 - 6 5 7 -4 5 4 1 . Y o u m a y a l s o w r i t e S e q u o i a I n s u r a n c e C o m p a n y C o n s u m e r R e l a t i o n s a t : 8 00 S u p e r i o r A v e n u e E a s t , 2 1 s t F l oo r C l e v e l a n d , O H 44 11 4 W C 99 00 00 B INVOICE Mad Tea Inc D.B.A. Prestige Princess 2045 Palos Verdes Drive North, Lomita, CA 90717, UNITED STATES Tax ID: 82-2960806 prestigeprincesses@gmail.com; Website: www.prestigeprincess.com Invoice No#: 0081 Invoice Date: Jun 21, 2023 Due Date: Jun 21, 2023 $385.00 AMOUNT DUE BILL TO SHIP TO City of Carson City of Carson Raquel Rivera Raquel Rivera rrivera@carsonca.gov Phone: +1 323-797-1958 # DATE ITEMS & DESCRIPTION PRICE AMOUNT(S) 1 Jul 29,2023 Ariel & Spider-man 7/29/23 1-3pm $485.00 $485.00 meet & greet with pictures, walk around & interact with the kids Subtotal $485.00 Other discount -$100.00 TOTAL $385.00 USD NOTES TO CUSTOMER Please contact Ann for any questions at 310-832-9333 TERMS AND CONDITIONS Characters must not be subjected to any verbal or physical harm or be put in a situation where bodily injury can occur. Performers must receive two 15 minute breaks to allow them to cool down and rehydrate if necessary. Our costumes and wigs, while very realistic and always beautifully kept up can be very hot and the performer's range of motion and sight can be hindered. Please keep this in mind when reserving our characters. RECREATION AND HUMAN SERVICES DIVISION MATERIALS AND SUPPLIES REQUISITION Better! Mad Tea Inc. D.B.A. Vendor Name: Prestige Princess C.C. Today’s Date: Address: 2051 Palos Verdes Drive North Park/Area: CS/Recreation Lomita, CA 90717 Staff Name: Kelsie Mitchell Phone: 310-832-9333 Deliver order to: [_] Warehouse [_] City Hall [_] Will Call x] SEE Unit Extended # Qty Unit Detailed Description of Item Price Amount 1 1 Lot Prestige Princess will provide (2) characters for entertainment $485.00 $485.00 2 From lpm-3pm at the 2023 Street Fair 3 (1) Little Mermaid 4 (1) Spider-Man 5 Please process payment for one check payment to: 6 Mad Tea Inc. D.B.A. 7 Prestige Princess C.C. 8 9 Staff Contact: Kelsie Mitchell 310-714-7977 10 Special Events Coordinator Date order should be delivered: | 7/27/23 Tax: $0.00 Discount Terms: Other discount (- Fide +S Shipping | $0.00 Quoted by: Mad Tea Inc. D.B.A. Prestige Princess C.C. Other: -$100.00 Justification/Event: 2023 Street Fair Total: $385.00 Approval Initials Account Object Event No. | Number Code Ref Amount Program Manager: g. , L Ls 1. 244-90-950-709 6009 23182 $385.00 jo? 2 Superintendent: 3. 4. Requisition Input ; : Section: 7. 8. Page & Item: cs 10. Req No: Notes: 1. Don’t forget to attach flyers, W9 (if new company), invoice, insurance, etc. | P.ONo: 2. Give detailed information regarding event / service . . 3. Any artwork must be approved by PIO. Please attach approval to req. 4. Don’t forget to log your requisition into the binder.