Loading...
HomeMy Public PortalAboutC-23-174 - LUIS GOMEZ - 2023 FAMFEST SPA Par City of Carson ake ‘Community Services Department Ue, i Service Provider Application Better: 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: Kenny Harris (Event Coordinator’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 . Truly, Kenny Harris (Name) RCS. Il (Title) 5322275 CFN AS OF 3/14/2023 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) X Service | me Xr Business | XiVover ee ts 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. 5322275 CFN AS OF 3/14/2023 7/14/23 (Date) Fullrange Productions (Company) 9760 Jersey Ave Unit 171 (Company Address) Santa Fe Springs CA 90670 (City, State ZIP) Insurance Requirements Insurance Canopy Dear j (Enter Provider's Name) Please be advised pursuant t o your desire to work with the City of Carson, you are required to submit the following: Y 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 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 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. ’ 5322275 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 Event Famfest 2023 Event Location: Stevenson Park 5. 6 pyat~. 8/26/2023 Fullrange Productions Name of Service Provider: Business Form/Entity Type (if individual, sole proprietorship, corporation, or limited liability company, specify here): Sole Proprietorship Business Form/Entity Type (if general partnership, limited partnership, limited liability partnership, or other, specify here): N/A CA Business Entity State of Incorporation (if applicable): Providing Audio Equipment, Sound Tech's, Engineers and Backline Gear. Type of Service: Contact Person: LUIS Gomez Phone #: (562) 922-0374 Emer. Contact: N/A Phone#:( _) N/A Billing Address 9760 Jersey Ave. Unit # 171 Santa Fe Springs CA. “ 90670 City Siate ZP Proof of Insurance (check one)? [WV] yes L_INo If NO, please complete the attached insurance waiver form. Special Instructions/Notes: (Full Productions) will provide all sound for stage and house for event mentioned above. (Full Range Prod.) will also provide Backline that can accommodate all Bands at said event. Load-in and Set should done with enough time for sound check at 10 am on day of event 8/26/2023. (Day before set up is an option) Please be advise that payment will be paid on the day of the 5322275 CFN AS OF 3/14/2023 85 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: N/A $4,800.00 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 5-25-2023 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, 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 5322275 CFN AS OF 3-14-2023 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: Full Range Productions 7/14/23 (Sighaturedf Service Provider’s Authorized Representative) (Date) s Gome. (Printed Name of Service Provider’s Authorized Representative) (Space below this line for City use only) APPLICATION APPROVAL: CITY OF CARSON _// | h e b F i s | u f o s ce << ( 7 (Signature of City Manager or Designee) ~ (Date) “G 5322275 CFN AS OF 3-14-2023 S erv i ce P r o v i d e r Ru le s & R e g u l a t i o n s 1 . SERV ICE PRO VID ER APPLICAT ION: Upo n acc e pta n ce, app rov al , and execution of a ser v ice pro v ider app li catio n by th e C i t y of C arson (“Cit y”), th e se rule s and pro v isio n s s ha ll b e come bindin g a nd a pa rt o f t he Se rv ic e P rovider Appli ca tio n Agreement b etwee n t h e app l i c ant (b eing t he e n t i t y p rov idi ng a se rvi ce t o City a s s pecified in the s erv i ce pro vide r applic a t i o n), including i ts o ffi cer s , e m p loyees, a g ents an d v oluntee rs (“P rov ide r”), o n t he o ne h a n d, an d t he Cit y , on the o t her ha nd . Any a ddit i ons an d a mendments th er et o th at m ay b e e sta bli she d o r put in to e ffe c t b y t he City, a nd pr ov ided i n w r iting t o t he Pr ov id er , s hall also bec ome bi nding an d a part o f the Service Provider Appli catio n Ag reement. 2. PAYMENT/CANCELLATION: If the Pr ovider i s unabl e t o pe r form or cann ot prov ide th e services as req uested, or th e C i t y cance ls the serv ice f or a ny re a son, the associated fees for serv ice will not b e pai d. 3. CANCELLATION: No refunds w i ll be given unle ss the City’s Community Services Department. Applications may favor of City programs. 4. PROPERTY LOSS OR DAMAGES: The City is not respon theft of the Provider’s property, or that of Provider’s agents, emp 5. CHARACTER OF ENTERTAINMENT: The Pr ovider sh all observe, obe y and com ply wit h a ll appli cab le l oca l, s ta t e an d f e d e r a l laws, and all app l ica b le p o l i c i e s , r ule s, r e g u l ations an d te rm s and conditions gover ning us e of City fa cil it ies. The Provi de r wi ll for feit all r ent s or ot h er fee s p a i d i f eject ed from p remises for violation s of same. E j ection shall not release Pro v ider from a n y obligat ions for th e payme nt of ren ts or other fee s not y et pa id un der su ch perm it o r addi tionally incurred. The p olicy o f th e C i t y i s to serve the public in t he b es t po ssib le ma nner . The Provider shall at all times cooperate to this end. d conditions governing use of City facilities are subject to nl ess th e change affects a permit already issued to Provider. sub j e c t e ve nt i s c a n c ell e d b y t h e be deni e d o r e v en ts cancelled i n sibl e f or a n y dama ge to, lo ss o r l oy ee s o r i n v i t ee s . The policies, rules, regulations an change without notice to Provider u 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 ASOF 3-162 . 023 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 s h a ll procure a t 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. 5322275 CFN AS OF 3-14-2023 Waiver, Release, Hold Harmless, Agreement Not to Sue and Indemnification 10 " = ae , (“individual”) [on behalf of Range Productions (“Exhibitor”), and as a bona fide agent of Exhibitor duly authorized to execute this Waiver, Release, Hold Harmless, Agreement Not to Sue and Indemnification agreement (“Agreement”) on behalf of Exhibitor] (individual and Exhibitor hereinafter collectively referred to as “Signatory,” and the term “Signatory” includes Exhibitor’s officers, officials, employees, agents and volunteers), seek acceptance by the City of Carson of an application to provide services in/at 2nd Annual FamFest 2023 (“Event”) on 86/2023 (“Date”). Signatory understands that accidents, illnesses, and injuries can arise out of the Event, knowing the risks, nevertheless, and in consideration of the acceptance of an application to provide a service at the Event on the Date, Signatory hereby waives, releases and discharges the City of Carson, its elected and appointed officers, officials, employees, agents and volunteers (collectively “City,” and individually, “City Party”), and from and against any and all claims or liabilities to Signatory or any other person or entity, including but not limited to claims or liabilities for bodily injury, illness, death, or property damage, arising out of or connected in any way with Signatory’s participation in, presence at, or performance of services at or for the Event, even though that liability may arise out of negligence or carelessness on the part of City, and Signatory agrees to waive its rights to make any such claims through any action or proceeding against the City or any City Party. However, Signatory understands that this paragraph is not intended to release any party from any act or omission of “gross negligence.” Signatory hereby grants City the right to photograph or video-record Signatory during or in connection with the Event, and to use Signatory’s photographed or video-recorded likeness, and any image, silhouette, or reproduction of the voice or appearance of Signatory taken during or in connection with the Event (“Likeness”), for any purpose, including publicity and promotion of City and its events, and creation or production of materials in any form for such purpose, with no claim of entitlement to any license fee or royalty of any kind from City. Signatory hereby waives any right to the intellectual property of Signatory’s Likeness. Signatory further agrees to indemnify, defend and hold harmless City and each City Party from and against any and all claims, liabilities, losses, damages, expenses, and costs (including without limitation costs and fees of litigation) of every nature (including, but not limited to, property damage, bodily injury, or death), whether imposed by law or otherwise, sustained or alleged to be sustained by any person or entity (whether they be members of the public visiting the Event, employees of the City, other Exhibitors at the Event, or otherwise), occurring at, arising from, or connected with Signatory’s preparation or performance of services at the Event, Signatory's actions, inactions, or use of facilities at the Event, or any equipment, machinery or items displayed or used by the Signatory at or for the Event, except for such claim, liability, loss, damage, expense, or cost which was caused by the sole negligence or willful misconduct of the City. In giving the foregoing releases and waivers, Signatory expressly waives any and all rights conferred upon it by the provisions of Califomia Civil Code Section 1542, which Signatory understands reads as follows: “A general release does not extend to claims that the creditor or releasing party does not know or suspect to exist in his or her favor at the time of executing the release and that, if known by him or her, would have matenally affected his or her settlement with the debtor or released party.” This waiver shall be effective as a bar to any and all actions, fees, damages, losses, claims, liabilities and demands of whatsoever character, nature and kind, that are known or unknown, or suspected or unsuspected, that may arise from or relate in any way to Signatory’s participation in the Event This Agreement shall be binding on Signatory’s successors, heirs and assigns, and shall not expire. No oral representations, statements or inducements, apart from this written form, have been made with regard to the subject matter of this form. If any portion of this form is declared invalid by a court of competent jurisdiction, the remainder shall continue in full force and effect. By signing below, Signatory acknowledges and represents that it has read and understands the above, and that it voluntarily agrees to its terms. By signing below, Signatory acknowledges and represents that it has read and understands the above, and that is voluntarily agrees to its te woes NAME: LuiS Gomez | Z ORGANIZATION: Fullrange Productions DATE: 7/14/23 01007.0001/78 1805.1 AS OF 3-14-2023 Please note: The City of Carson’s own insurance will cover the City’s Entertainers liability. All service providers (including entertainers liabi lity but will not cover an ) ar e st ill required to carry insurance. We must require this because it is a condition of the City’s Excess insurance policy. Acknowledgement: 1. 2. 5. | am an entertainer that will perform at the City of Carson event. 2nd Annual Famfest 2023 | am confirming that | and my business do not have commercial general liabilit y insurance as required by the City of Carson but am still interested to provide services at the 2 n d A nnual Famf est 2023 ave rt . | 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. y business’ | furt her acknowledge and agree that in the event of a J oss resulting from my o r m wro ngf ul o r negligent a c t s , the City of Carson or its insure r w ill seek to recover its financi al loss from me or my business. | will cooperate in every way with t he said recovery effor ts. The City of Carson may approve this request or may reject it at its discretion. Signed: AKL Date: rans U Form W-9 (Rev. November 2017) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification > Go to www.irs.gov/FormW9 for instructions and the latest information. Give Form to the requester. Do not send to the IRS. Luis Gomez 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. 2 Business name/disregarded entity name, if different from above Fullrange Productions following seven boxes. IM Individual/sole proprietor or O C Corporation single-member LLC Print or type. [_] Other (see instructions) > Oo S Corporation CT 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 is disregarded from the owner should check the appropriate box for the tax classification of its owner. 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the | 4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3): O Partnership O Trust/estate Exempt payee code (if any) code (if any) (Applies to accounts maintained outside the U.S.) » R E N T S a y A e U N See Specific Instructions on page 3. Requester's name and address (optional) 6 City, state, and ZIP code Santa Fe Springs CA 90670 7 List account number(s) here (optional) 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 |, later. For other - - entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. 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 for guidelines on whose number to enter. | Social security number or | Employer identification number & 1 -|4/446 45/3 Part Il Certification Under penalties of perjury, | certify that: 1. The number shown on this form is my correct taxpayer identification number (or | am waiting for a number to be issued to me); and 2. | am not subject to backup withholding because: (a) | am exempt from backup withholding, or (b) | have not been notified by the Internal Revenue Service (IRS) that | am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that | am no longer subject to backup withholding; and 3. lama U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that | am exempt from FATCA reporting is correct. 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 all interest and dividends on your tax return. 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 other than interest and dividends, yous are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part Il, later. Q Sign ; } Here soroureet A General Insthuctioks U Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 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 information return with the IRS must obtain your correct taxpayer 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 (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. ¢ Form 1099-INT (interest earned or paid) pate» 1/10/22 ¢ Form 1099-DIV (dividends, including those from stocks or mutual funds) e Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) e Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) e Form 1099-S (proceeds from real estate transactions) e Form 1099-K (merchant card and third party network transactions) ¢ Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) ¢ Form 1099-C (canceled debt) ¢ Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231X Form W-9 (Rev. 11-2017) 2 i) ACORD We CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 08/15/2023 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: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 SONTACT Insurance Canopy Program Support Insurance Canopy PHONE ex 844-520-6993 FAX oy, 801-763-1374 PO Box 34833 EMAL <5. _ info@insurancecanopy.com North Chesterfield VA 23234 INSURER(S) AFFORDING COVERAGE L_Nac# wsureRA: Creat American E&S Insurance Company 26832 INSURED INSURER B : Luis Gomez, DBA Fullrange Productions INSURER C: 9760 Jersey Ave 171 INSURER D : | Santa Fe Springs CA 90670 INSURER E: INSURER EF : 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. INSR ADDL'SUBR LTR POLICY EFF | POLICY EXP | TYPE OF INSURANCE INSR | WVD POLICY NUMBER MM/DDIYYYY) | (MM/DDIYYYY) Limits GENERAL LIABILITY | | EACH OCCURRENCE is 1,000,000 xO] DAMAGE TO RENTED r 300,000 COMMERCIAL GENERAL LIABILITY cs = PREMISES (Ea § ' CLAIMs-MADE | * | occuR _MED EXP (Anyone person) _S 5,000 A PLE786898-CDJA104284 02/01/2023 02/01/2024’ personal &ADVINIURY _S 1,000,000 |__| GENERAL AGGREGATE s 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S$ 2,000,000 X | poucy, | ARS Loc "ANIMAL BAILEE s COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY eMBINED § $ ANY AUTO | BODILY INJURY (Per person) . $ AL OWNED _ | SCHEDULED | BODILY INJURY (Per accident) $ NON-OWNEO PROPERTY DAMAGE 1 HIREDAUTOS | AUTOS | (Per accident) | _ 1 | j s UMBRELLALIAB) |X | occur EACH OCCURRENCE [s 1,000,000 EXCESS LIAB = | 1,000,000 x GEAME MADE XSE676889-OX1121111 02/01/2023 | 02/01/2024 AGGREGATE 2 veo |__| RETENTIONS | is WORKERS COMPENSATION | WC STATU- iOTH- AND EMPLOYERS LIABILITY YIN | TORY LIMITS |__| ER ANY PROPRIETOR/PARTNER/EXECUTIVE r E.L. EACH ACCIDENT $ OFFICE/MEMBER EXCLUDED? L] [NIA | | (Mandatory In NH) | E.L. DISEASE - EAEMPLOYEE $ Aer Oh Oe OPERATIONS bale | E.L. DISEASE - POLICY LIMIT | $ | | DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Certificate holder had been added as additional insured regarding the above mentioned policy per attached Additional Insured - Designated Person or Organization (CG 20 26 Ed. 04 13) CERTIFICATE HOLDER CANCELLATION Carson 701 E. Carson St Carson, CA 9074 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 ACORD 25 (2014/01) INS025 (201401) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Fullrange Productions INVOICE INVO718 Fullrange Productions Business Number LAC Vendor ID: DATE 18335501 / LSBE: 092140 Aug 26, 2023 9760 Jersey Ave, Unit 171 SUE Santa Fe Springs Ca 90670 On Receipt (562) 922-0374 fullrangepro@gmail.com BALANCE DUE USD $4,800.00 BILL TO City of Carson O +13102271380 Kharris@carsonca.gov DESCRIPTION RATE QTY DISCOUNT AMOUNT RCF Festival Package $1,800.00 1 -$500.00 $1,300.00 4 RCF TTS18 Subwoofer 8 RCF HFL26 Line Array Loud Speakers with 2 ground-stack bumpers 5 K12.2 Powered monitors 2 HDL6 front fills reinforcements 24 Piece Mic/Input Package with stands Shure ULXD $100.00 4 -$200.00 $200.00 Handheld sm58 50% Allen & Heath SQ7 $400.00 1 -$200.00 $200.00 40 Channel Digital Mixer 50% Digital Stage Box GX4816 and 150ft Cat5 Performance Backline Package $1,300.00 1 $1,300.00 Drums: DW 5Piece Limited Series DW9000 Hardware: Hihat stand, snare stand, 3 x booms, dual mt. Bass: Aguilar 700 & 410 Bass Cabinet Guitar: Fender HotRod Deville & Twin Reverb Keys: Nord Stage3, Yamaha Motif 3 x double brace keyboard stands Tech Labor $1,300.00 1 $1,300.00 Audiom Enginner, A2 Sound tech, Stage Tech RECREATION AND HUMAN SERVICES DIVISION Make MATERIALS AND SUPPLIES REQUISITION Better! Vendor Name: Fullrange Productions Today’s Date: 8/16/23 Address: 9760 Jersey Ave, Unit 171 Park/Area: CS/Recreation Sante Fe Springs, CA 90670 Staff Name: Kelsie Mitchell Phone: (562) 922-0374 Deliver order to: [_] Warehouse L] City Hall L) Will Call XX] SEE Unit Extended # Qty Unit Detailed Description of Item Price Amount 1 Lot Fullrange Productions will provide all audio equipment and sound techs | $4,800.00 $4,800.00 2 at the 2023 Famfest 3 4 5 Please process payment for one check payment to: 6 Fullrange Productions 7 8 9 Staff Contact: Kelsie Mitchell 310-714-7977 10 Special Events Coordinator Date order should be delivered: | 8/24/23 Tax: $0.00 Discount Terms: N/A Shipping | $0.00 Quoted by: Fullrange Productions Other: $0.00 Justification/Event: _ 2023 Famfest Total: $4,800.00 Approval Dit i 19 Account Object Event f No. | Number Code Ref Amount Program Manager: I. 244-90-950-709 6004 23176 $4,800.00 2. Superintendent: 3. 4. Requisition Input 2 Section: 7. 8. Page & Item: 9. 10. Req No: Notes: 1. Don’t forget to attach flyers, W9 (if new company), invoice, insurance, etc. P.O No: 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.