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HomeMy Public PortalAboutC-23-175 - PARTY PRONTO - 2023 FAMFEST SPACity of Carson Community Services Department imax’ 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: Howard Johnson (AJ) (Event Coordinator’s Name) 17400 Lysander Drive, Carson 90745 (Enter Event Coordinator’s address (i.e., city hall, corporate yard, or specific park address) Email: hlonnson@carsonca.gov (Enter event coordinator’s email address) Should you have any questions, please feel free to contact the staff member listed below . Truly, Howard Johnson (AJ) (Name) RCS | (Title) Qu 532227.5 CFN AS OF 3/14/2023 i) Before submitting your application packet make sure each of the below indicated items have been attached or completed. (POR COMMUNITY SERVICES OFFICE USE ONLY) X Service Provider Application Agreement x Invoice for Future Event Date’ Business License (if applicable) xX Proof of Insurance/Certificate of Insurance X Waiver, Release, Hold Harmless, Agreement Not to Sue, Indemnification, and Photo Release e Current Copy of W-9 Form (if not on file already) ’ The date of the Event shall be listed on the Invoice far 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. Owe 532227.5 CFN AS OF 3/14/2023 fa 8/12/23 (Date) Party Pronto (Company) 4131 E. Live Oak Ave. (Company Address) - Arcadia, CA 91006 (City, State ZIP) Insurance Requirements Dear Party Pronto (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 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 G1 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. a if 532227.5 CFN AS OF 3/14/2023 City of Carson Community Services Department Service Provider Application Agreement Check one (staff use): [| Carson Event C enter] _| Human Services Recreation [| Transportation FamFest cation: Stevenson Park 8/26/23 Event: Event Location: Event Date: Party Pronto Name of Service Provider: Business Form/Entity Type (if individual, sole proprietorship, corporation, or limited liability company, specify here): Inc. Business Form/Entity Type (if general partnership, limited partnership, limited liability partnership, or other, specify here): a S-Covperan pat Business Entity State of Incorporation (if applicable): Type of Service: ONT Fy <4 vi Pp ment venta ls Contact Person: Jen ber Roberks Phone #: (626) 321 -©@Z006 Emer. Contact: aiker Reberts Phone #:(GZb FU4S- 7907 ¢et] Billing Address: “141 E€. Live Oak Aue Number Street Ay CAALEA CA 4(O0 lb City State ZIP Proof of Insurance (check one)? [Vlyes [ INo If NO, please complete the attached insurance waiver form. Special Instructions/Notes: Party Pronto will provide jumper services for the entire duration of the event. Party Pronto will honor all items on quote Q23721. Itis advised that party pronto be completely set-up by 11am CMe a 532227.5 CFN AS OF 3/14/2023 aA and pickup items by 69m on same day. 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: Total Service Fee $3,822.00 _ 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] Che 4 ‘ 532227.5 CFN AS OF 3/14/2023 Yurther 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 msurance 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 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 PRovipER: Party Pronto Co weds Leyrtote 5 / / +/, Agad C Pignure op Servi ice Provider's Authorized Representative) (Date) Jenn: ‘ Fer Roberis {Printed Name of Service Provider’s Authorized Representative) (Space below this line for City use only) APPLICATION APPROVAL: CITY OF CA (sien: ature of City Mahager-et Designee) 7 é 7 “& Sh] 23 532227.5 CFN AS OF 3-14-2023 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. Qe 532227.5 CFN OF 3-14-2023 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 Jogo 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. $32227.5 CFN AS OF 3-14-2023 Waiver, Release, Hold Harmless, Agreement Not to Sue and Indemnification 10 Jenni fey Roberts , Cindividual”) [on behalf of Part, Preasnte, tac: (“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 FamFest (“Event”) on 8/26/23 (“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 trom 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 lo 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 casts (including without limitation costs and tees of litigation) of every nature (including, but not Hmited to, property damage, bodily injury, or death), whether imposed by law or otherwise, sustained or alleged to be sustained by any person or entity (whether they be members of the public visiting the Event, employees of the City, other Exhibitors at the Event, or otherwise), occurring at, arising from, or connected with Signatory’s preparation or performance of services at the Event, Signatory’s actions, inactions, or use of facilities at the Event, or any equipment, machinery or items displayed or used by the Signatory at or for the Event, except for such claim, liability, loss, damage, expense, or cost which was caused by the sole negligence or willful misconduct of the City. In giving the foregoing releases and waivers, Signatory expressly waives any and all rights conferred upon it by the provisions of California Civil Code Section 1542, which Signatory understands reads as follows: “A general release does not extend to claims that the credifor or releasing party does not know or suspect to exist in his or her favor at the time of execuling the release and that. i{ known by him or ber, would have materially affected his or her settlement with the debtor or released party.” Uhis 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. Lf 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 terms. SIGNED: Geer (< P AUts NAME: JEr Eni fer Re beats ORGANIZATION: Kaaty Pron i, lv DATE: ¥ Jig! [2023 01007.0001/78 1805.1 AS OF 3-1442023 Please note: The City of Carsen’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. ftaman entertainer that will perform at the City of Carson FamFest event Qe 2. {am confirming that | and my business do ox have commercial general liability insurance as required by the City of Carson but am still interested to provide services at the FamFest event. 3. |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. 4. | 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. 5. The City of Carson may approve this request or may reject it at its discretion. Signed: Cc we ler Gin C4 Ff Date: 8/14/20 AB ) ® ACORD ae CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 01/09/2023 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 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, , . . CONTACT Liberty United Insurance Services, Inc Nee Sam Muradyan FAX . . PHONE 8187618888 | _ 8882656889 704 S Victory Blvd, Suite 204 {ArG. No. Ext: (ANC. Ne: Burbank. CA 91502 MA os. Sam@libertyunitedinsurance.com ¥ License #: OF89841 INSURER(S} AFFORDING COVERAGE NAIC # insuRERA: Admiral Insurance Company INSURED iwsuRERB: Markel Insurance company Party Pronto, Inc. INSURER C : 4131 E Live Oak Ave INSURER D : Arcadia, CA 91006 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: _00002047-228273 REVISION NUMBER: 211 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 Insp | wp POLICY NUMBER (MM/DDIVYYY) | (MMIDDIYYYY) LIMITS A |X| COMMERCIAL GENERAL LIABILITY Y | Y | CA000025838-07 01/07/2023 | 01/07/2024 | EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED | CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY | $ 1,000,000 EN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X | Pouicy oRS Loc PRODUCTS - COMP/OP AGG | $ 2,000,000 OTHER: 3 AUTOMOBILE LIABILITY & OMBINED SINGLE LIMIT | g ANY AUTO BODILY INJURY (Per person) | $ OWNED SCHEDULED ; SNE ONLY SCHED BODILY INJURY (Per accident)| $ HIRED NON-OWNED PROPERTY DAMAGE 3 AUTOS ONLY AUTOS ONLY | (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE 3 EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- BN EMRLOVERG CAbILiY VIN MWC017507203 10/02/2022 | 10/02/2023 | X | SFxrure |__| ee ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? [| NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE) $ 1,000,000 if yes, describe under 000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT | $ 1,000, DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder Is An Additional Insured CERTIFICATE HOLDER CANCELLATION The City of Carson, its officals, employees and volunteers 701 E. Carson Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Carson, CA 90745 ean proved AUTHORIZED REPRESENTATIVE 05/04/23 —_——~. la (SMS) ACORD 285 (2016/03) The ACORD name and Iogo are registered marks of ACORD © 1988-2015 ACORD CORPORATION. All rights reserved. Printed by SMS on 01/09/2023 at 02:03PM — ® ACCORD Lal CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIVYYY) 07/31/2023 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 have ADDITIONAL INSURED provisions or be endorsed. lf 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 hoider in lieu of such endorsement(s). PRODUCER CONTACT the No. Ext): (G, No): ARTHUR J GALLAGHER RISK MGMT ADDRESS: PO BOX 2807 INSURER(S) AFFORDING COVERAGE NAIC # CLINTON 1A 52733-2807 | insureRa: NATIONWIDE MUTUAL INSURANCE COMPANY 23787 INSURED INSURER B: PARTY PRONTO INC INSURER C: DBA PARTY PRONTO JUMP AND RIDE INSURER D: 4131 E LIVE OAK AVE INSURER E : ARCADIA CA 91006-5828 | insurERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 1S 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 POLICY EFF | POLICY EXP LTR TYPE OF INSURANCE INSO | WwvD POLICY NUMBER (MNUDDIVYYY) | (MMIDDIVYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s ir ] DAMAGE TO RENTED | CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $ ee MED EXP (Any one person} $ to PERSONAL & ADVINJURY | $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ | GEN oan Te | |poucy! | ORO. [ _| Loc PRODUCTS - COMP/OP AGG | $ OTHER: 5 AUTOMOBILE LIABILITY oweadent EMIT $4,000,000 x ANY AUTO BODILY INJURY (Per person) | $ -o 7 - A Se oNLY | SCHEDULED x ACP BA 7825101865 07/28/2023 | 07/28/2024 | BODILY INJURY (Per accident), $ 3<| HIRED | NON-OWNED PROPERTY DAMAGE § AUTOS ONLY j; AUTOS ONLY {Per accident) $ UMBRELLALIAB OccUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ i t DED |__| RETENTIONS $ WORKERS COMPENSATION PER [TOTR- AND EMPLOYERS’ LIABILITY YIN STATUTE | ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? [| NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESGRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT | $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION CARSON Insurance Approved DJ 08/03/23 CITY OF CARSON, IT'S OFFICIALS, EMPLOYEES, AND VOLU 701 E CARSON ST CA 90745-2224 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 Desiree Guerrero ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SCHEDULE Name(s) Of Person(s) Or Organization(s}: CITY OF CARSON, IT'S OFFICIALS, EMPLOYEES, AND VOLUNTEERS. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shawn in the Schedule, but only to the extent that subrogation is waived prior fo the "accident" or the "loss" under a contract with that person or organization. CA 04 441013 © Insurance Services Office, Inc., 2011 Page 1 of 1 ACP BA 78-2-5101865 MACH 23150 INSURED COPY CA0444101300 0200 43 0000833 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsementidentifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. SCHEDULE Name Of Person(s) Or Organization(s): CITY OF CARSON, IT'S OFFICIALS, EMPLOYEES, AND VOL 701 E CARSON ST CARSON, CA 90745 information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section Hl — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section | -— Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 1013 © Insurance Services Office, Inc., 2011 Page 1 of 1 ACP BA 78-2-5101865 MACH 23150 INSURED COPY CA2048101300 0100 43 0000834 Form W-9 (Rev. October 2018) Department of the Treasury Internal Revenue Service Request for Taxpayer identification Number and Certification > Go te www.irs.gov/FormlW9 for instructions and the latest information. 1 Name (as shown on your income tax return). Name is required on this fine; do not leave this line blank. Give Form to the requester. Do not send to the IRS. 2 Business name/disregarded entity narne, if different from above Party Pronto, Inc. following seven boxes. (7 tndividual/sole proprietor or C] C Corporation single-member LLC Print or type. C] Other (see instructions) > S Corporation C 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 LUC 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 frorn 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 whase name is entered on fine 1. Check only one of the | 4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3): CT] Partnership C] Trust/estate Exempt payee code (if any) code (if any) {Applies (a accounts maintained outside the U.S.) 5 Address (number, street, and apt. ar suite no.) See instructions. 4131 E. Live Oak Avenue See Specific instructions on page 3. Requester’s name and address (optional) 6 City, state, and ZIP code Arcadia, CA 91006 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, fora 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, 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 | 915) -1418)/5)4;/3;2]8 Part ll Certification Under penaities of perjury, | certify that: 1. The number shown on this form is my correct taxpayer identification number (or | arn waiting for a number to be issued to me); and 2. 1am 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 resuit 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 3.1ama 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 crass out item 8 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 nat apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payrnents other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part Il, later. Sign Signatu & , of ong Sign] serawe I Stoz General Instrdctions 7 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 nurnber (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) Cat. No. 10231X pwr 01/02/2023 ® Form 1099-DIV (dividends, including those from stocks or mutual funds) * Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) ® Farm 1099-B (stock or mutual fund sales and certain other transactions by brokers) ¢ Form 1099-S (proceeds 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) * 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. Form W-9 (Rev. 10-2018)