Loading...
HomeMy Public PortalAboutC-23-137 - KEVIN JONES - 2023 CARSON STREET FAIR SPA i | City of Carson Ph] 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 vou 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: Kenny Harris {Event Cocordinator’s Name) 18601 S. Main Street. Carson Ca. 90248 (Enter Event Coordinator’s address (i.e., city hall, corporate yard, or specific park address) Email: kharris@carsonca.gov (Enter event coordinator’s email address) Should you have any questions, please feel free to contact the staff member listed below . EY. Kenny Harris (Name) RCS. II “ Title) 532227.5 CFN AS OF 3/14/2023 NO 7 48 . ie ‘ = _ neciKilist Before submitting your application packet make sure each of the below indicated items have been attached or completed. (FOR COMMUNITY SERVICES OFFICE USE ONLY) XD Service Provider Application Agreement xX Invoice for Future Event Date! MIA Business License (if applicable) \Woever Proof of Insurance/Certificate of Insurance X iG) Waiver, Release, Hold Harmless, Agreement Not to Sue, Indemnification, and Photo Release x Current Copy of W-9 Form (if not on file already) * 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 wiil 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 3/14/2023 Uo Fld fz | (Date) - Cs erer cjenes (Company) ‘VS Bex +z61a| Company Address) (Cit State ZIP) Insurance Requirements Dear Kei w <y2 Wwe (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 amy services are provided or the event takes place. Failure to submit such required forms shall be cause for City of Carson to reject or terminate any service provider application agreement. The City of Carson reserves the right to modify these requirements based on the nature of the risk, prior events, insurance coverage, or other special requirements. MINIMUM SCOPE AND LIMIT OF INSURANCE General Liability Insurance: Coverage shall be at least as broad as Insurance Services Form CG UU U1 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 3/14/2023 City of Carson Community Services Department Service Provider Application Agreement Check one (staff use): [| Carson Event Center _| Human Services Recreation [ | Transportation 55ih Anniversary Streetfest Carson and Borita intersection 7/29/2023 Event: Event Location: Event Date: Name of Service Provider: Now ThenNothi Ng Ventures Business Form/Entity Type (if individual, sole proprietorship, corporation, or limited liability company, specify here): LLC Business Form/Entity Type (if general partnership, limited partnership, limited liability partnership, or other, specify here): LEC Business Entity State of Incorporation (if applicable): (S i Type of Service: Live Vocal Performance with Band Contact Person; Kevin Jones Phone #: (404) 988-5664 Emer. Contact: \Jolwwie, (Covi Phone #: (FB 4Y2--3 2X1 Billing Address: PO Box 420191 ‘Ailanta Georgia, "303342 3o03¢+1 City Siate ZiP Proof of Insurance (check one)? [Wes [V]No it NO, please complete the attached insurance waiver torm.. Special Instructions/Notes: (NowThenNothing Ventures LLC) will perform one 45 min live music set with band. (NowThenNothing Ventures LLC) and band should arrive 1.5 hours prior fo schedule performance time of (1:30 pm) for load in and check. Backline and Line check will be provided. Please please be advised that payment will be made to 532227.5 CFN AS OF 3/14/2023 name listed above in Check form on the day of the event. Please list any special request in highlighted section below. If Service Provider wishes to request any special accommodation needed to facilitate provision of the services, please identify it here or contact the staff member referenced on Page 1 of this application: Total Service Fee $4000.00 | 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] $32227.5 CFN AS OF 3/14/202= 6 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 532777.5 CEFN AS OF 3-14-2022 ~] 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 PRovipER: NowThenNothing Ventures LLC ) 4: up / 2OV Cc” \) Wo re of § r" Reayider? Authorized Representative) (Date) Kevir “jones (Printed Name-f Service Provider’s Authorized Representative) (Space below this line for City use only) APPLICATION APPROVAL: CITY OF CARSON f (Signature of a A iancoor St Designed / (Date) 532227.5 CFN AS OF 3-14-2023 Service Provider Kules & Kegulations 1. SERVICE PROVIDER APPLICATION: Upon acceptance, approval, and execution of a service provider application by the City ot 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 otficers, 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 1s 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. 9. 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 tees paid if ejected trom premises for violations ot 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 mvitation, either expressed or implied, during all tmes 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. 532997 5 CEN AS OF 2-14-7072 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 — AI 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. =22227.5 CFN AS OF 3-14-2023 Please note: The City of Carson’s own insurance will cover the City’s liability but will not cover an Entertainer’s liability. All service providers (including entertainers) are still required to carry insurance. We must require this because it is a condition of the City’s Excess insurance policy. Acknowledgement: 1. 5. smn eT y } Date: | am an entertainer that will perform at the City of Carson 55th Anniversary Streetfest event. ! am confirming that | and my business do not have commercial general liability insurance as required by the City of Carson but am still interested to provide services at the 55th Anniversary Streetfest event. | acknowledge and agree that in the event of a loss the City of Carson or its insurance carrier will not provide coverage to me or to my business. | further acknowledge and agree that in the event of a loss resulting from my or my business’ wrongful or negligent acts, the City of Carson or its insurer will seek to recover its financial loss from me or my business. | will cooperate in every way with the said recovery efforts. The City of Carson ma / pprove this requ reject it at its discretion. isccemepcnemcel Ow 4 Mov a com WY © Request for Taxpayer Give Form to the (Rev. October 2018) Identification Number and Certification requester. Do not Department of the Treasury . | . send to the IRS. internal Revenue Service > Go to www.irs.gov/FormW9 for instructions and the latest information. CPA VV SN OWVER 2 Business name/disregarded entity name, if different from above Ow Them TN (as shown on your Income tax return). Name is required on this line; do not leave this line blank. following seven boxes. single-member LLC oO Other (see instructions) > BE indivicuat’sote Proprietor or O C Corporation 0 S Corporation cE] Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) > Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting LLC if the LLC is classified as a single-member LLC that Is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that ls disregarded from the owner should check the appropriate box for the tax classification of its owner. 3 Check appropriate box for federal tax classification ofthe Person whose name is entered on line 1. Check only one of the | 4 Exemptions (codes apply only to certain entitles, not individuals; see instructions on page 8): C) Parinership L] trustestate Exempt payee code (if any) code (if any) (Applies to accounts maintained outside the U.S.) 5 Address (number, street, and apt. or suite no.) See instructions. © Pox. 4POS4q Print or type See Specific Instructions on page 3. Requester’s name and address (optional) 6 City, state, and ZIP code ‘itaewmis, GA 30347 7 List account number(s) here (optional) [E20 _ Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part i, later. For other - - entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN inter Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester tor guidelines on whose number to enter. | Social security number 4 F2ele Certification Under penalties of perjury, | certify that: 1. The number shown on this form is my correct taxpayer identification number (or 1 am waiting for a number to be issued to me); and 2. 1am not subject to backup withholding because: (a) 1am exempt from backup withholding, or (b) | have not been notified by the Internal Revenue Seruina 1 RS) that lam sublent in hadiain withhalding as a reault af a failure ta rannrt all interest or dividends. ar fc} the IAS has nntified me that | am no longer subject to backup withholding; and 3. fam a U.S. citizen or other U.S. person (defined below); and 4. Fhe EATEA easels) anterert nn this farm ff anv) indieatina that fam evamnt from EATFCA renarting ie earrent Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report ail interest and dividends on your tax retum. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments ather than interest and divirlends van are not recuired to sian tha certification hit van must nrqvidie uns Weoorect TIN See the instructinns fer Dart I later Sign | signature of Here US. person P General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-@ and its instructions, such as legislation enacted after they were published, go to www. irs.gov/FormW9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an infarmatinn retirn with the IRS must ohtain vaur enrrect tayvnaver identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (FIN, te renert on an infarmation retim the amount naid ta var ar other amount reportable on an information return. Examples of information retums include, but are not limited to, the following. ° Form 1099-INT (interest earned or paid) Date > © Form 1099-DIV (dividends, including those from stocks or mutual funds) © Form 1099-MISG (various types of income, prizes, awards, or gross orarceeadis) e Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) e Farm 1199-S forneeeds from real estate transactions) ° Form 1099-K (merchant card and third party network transactions) ¢ Form 1098 (home mortgage interest}, 1098-E (student loan interest), 1098-T (tuition) e Form 1099-C (canceled debt) ¢ Form 1099-A (acquisition or abandonment of secured property} Use Form W-9 only if vau are a U.S. nerson fincludina a resident alien), to provide your correct TIN. if you do not retum Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, Intar at Na 1NOAty Fare WI-Q mew to-onia\