HomeMy Public PortalAboutC-23-176 - ERIC MONDRAGON - 2023 FAMFEST SPA;a e
1 t = City of Carson
tonununitySerteesDepartment ;1
Service Provider Application B��1~�
Dear Applicant.
On bchalfofthe City of Carson, 1 would like to thank. you for taking the time to explore business
opportunities with the Cit' by applying to provide services for an event at a City facility- As par,
ofour api)lication process, yvu must complete, siP-L and return the following fortis Snlrtnission
of these form, d{3e5 not guaranice that you will be provided the business opportunity you seek.
Your prompt assistance in sttontitting tlx: requested documentation to the Cit' staff nYniber
listed below will be appreciwed arxi will help expedite the application process. ?lease send yetµ
completed application and attachments directly to the following address:
City of Canon
Attn: Kenny Hams
. Lscnt Cw. dttat. is `>.r
18601 S. Main Street. Carson Ca. 90248
:FnrerF.cent Cootdmawr'sad ress (LC.. 6 - 121L corperatc;:ard, or speci& pat, address)
Entail: kharrisecarsonca.ocv
l:'.ntcrclout vxrd.rater,=ia: address)
Should you hHve any questions. please feel free to contact the staff n3en ber listed below.
Truly.
Konmy f-ans
(vanr)
RCS. II
(Title)
53.::7.1; FN
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Before submitting your application packet make sure each of the belotis
indicated items have been attached or completed.
(FOR COAiMU-LAITY SERVICES OI•TICE USE ONLY)
%< Service Provider Application Agreement
X Invoice for Future Event Date'
Business License (if applicable)
Proof of Insurance/Certificate of Insurance
X waiver, Release, Hold Hannless, Agreement Not to
Sue, Indemnification, and Photo Release
Current Copy of W-9 Form (if not on file already)
-,ie date if the Event shall be listed on the invoice fcr Future Even: Date (I FED). If the Service Proatder ApplicaUpr, is
approved. ;hen the IFFD will be. pro-xssed as an invoice for services rendered for the Evert. No pa9tnent wit be made
until the conciuslon of the Event. at easiest
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AS OF 3114rA23
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2 of 11 8r 10; 2023 11:49
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(Date)
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(Company)
V/, ,.9ND-e-CASS7-
(Company :Address)
(City, state ZIP)
Insurance Requirements
(Enter Provider's \arra:)
Please be advised pursuant to yotrr desire to work with the City of Carson. you are required to
submit the tbllowing:
✓ Compliant Certificates of Liability Insurance (to be maintained for the duration of services
against claims which may arise from or in comx ction with the services), evidencing the
coverege(s) as indicated 'below.
Certificates of insurance, as well as additional insured and waiver of subrogation
endorsements in favor of the Cir', must be submitted in their entirety before any services
are provided or the event takes place. Fafluty to submit such required forms shall be cause
for City of Carson to reject or terminate any wrice provider application agreement.
The City of Carson reserves lite right to tnadify these requirements based on the nature of the
risk. prior events, insurance coverage. or ot)ocr peciai requirenxmts.
\ MIMUNI SCOPE AND UNIT OF NSURA\CE
Gertarn; 7.iariiln h.orrn�rce: ['overage sinal/ be ar least cts brvad as burr;cmce Set t ices Fonn
CG 00 01 co ering CGL at nt "oecrrn emir" baste. inrlrtding propern• darngge. bodily ligan
mrd Personal a och•ermstig intim m limirs no less r1wn 51.000,000 per oreurrence and
S'.000, 00 aggregate.
.iridiriorta; irznrrrd.Sr�auc
(ire Cin• o; Carson, and its elecird avid appointed ofjiciafs, employees. ralmurers mrd ngetrrs, are
to 6" corerrd ac ardirtrnurl irurreds sridi respect to habihn• arisirrq out of tlxir work or
operations;xrTarrncd at or on beha..T of rlk Cin•-spmar ed ereta Includbrg awrerials, parts, or
equipnrenr nwis,'r a' in ramrertion wirlr rive r.•ent.
5322:73 [FN
AS OF 9126/=3
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3 of 11 8110.+'3023 11:44
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City of Carsoll
Comn2tutit}• Sen•ices Delulrllnr-•l
Service Pro -Oder Application Agreement
Check one (srafJruse):
DCa. :l Lyent centerD Iluman Services ✓❑ Recreation C Trenslx+raten:
E%. n;.�amies- 2023 Frau Location: Stevens on Park Event Date: 812612023
Sanr of Se -rice Provides: I]W3 Musk INC.
Business FornrEntity Type (if individual sole proprietorship, corporation or limited liability
conipany. specify Isere):
INC
Business Form Entity Type (if general partnership, lirnited partnership, linrilctl liability partncrshgl,
or other. specify here):
Business F,ntity State of Incorporation (ifapplicable):
rypeofSe~ice: Live Band and Vocal Performance
Contact Person: Eric Mondragon 'Phone =:(626)482-3298
EneT. Contact: Phone
Billin2.address: 1860 Via Bandera
Whittier Ca. 90601
Proof ofInsurance (check one)? Dyes Vo
T:`\O.19case complete the artaehed insurance waiver fonn.
Special Inslructions'\otes:
10%Y -i YWI lric+xiiW:m?is SM.—%V Wa:—::•::r1^..]Fz1--:0:1 3v3 VtA h:!sh!•�T, yt-.mal Y,•J,•••rtmn M•••_
sL:eC4!P G''iDCC.1')Cc S.TN,rBJJ for [Cad M. a•-] <Bt_ o P 03Sn k'NarC stage Not and:tcn ^ctr f V sol:'!C':c SD'rc3 td U5K :Re : ,•." •ece"e
pyment for Pamfest 2023 cn =+e Cay cf the aver: 8+2rZ23. Payment will be n cne:K made to W.ior name above
53::2" 9 :Fu u OF 3/t4/=
4 of i 1 S.' 10.202? ! 1.-49
Please fix any spee:al concerns m the sect:cn below. Please note. that the City of Carson .s not respcnsbfe
!or any Hotel.?rarsportation. or Per Clem ezpens_. M inese cosi fall under the respons!bsliy of the Pertormer.
!f Service Provider wishes to request any special acconunodation needed to facilitate provision of tate
services. please identify it here or contact the staff member referenced on Page 1 of this application:
76' A -C/,
Total Service Fee $6000.00
NOTE. i f ser ice provider is unable to provide the sen icL-s as proposed or requested or the City
of Carson cancels :ir. service for anyremm the associated fees will not be paid.
1`renrafruler of page nnemaiorralh- le,, blmrn%
532327.5: %
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Further Terms of Service Prodder Application Agreement:
The utdersiened signatory of Service Provider (Service Provider being the above-referemed person
or entity seeking to provide serices at the above -referenced event. including all its officers, agents.
envloyees and volunteers) hereby, represents and warrants that he or she is duly autlxrrizcd 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 rent
Service Provider understands and agrees to comply with the City's "Service Provider Rules SC
.Regulations." which are set forth below and incorporated herein by this reference.
Service Provider agrees to indemnify and release City in connection with its pr%xrscd services in
accordance with the -Waiver. Release. hold Harrnles., Agreement, Not to Sue, Indemnification. and
Photo Release" stilmnined concurrently herewith.
Service Provider agrees to maintain all required insurance coverages and comply with all associated
insurance requirements as set for --h 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 agrcentent by Service Provider to «hive all rights of stiltrogation and
contribution against the Cir•, its elected or appointed officers, of2iciais, employees and agents. for all
losses and liabilities paid under tie terms of any policy which arise from the activities or operations
oL• or the services performed by, Service Provider. regardless of any prior. connrurrent, or srilmsequent
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 Prodder, then all obligations, liabilities. covenants and corxfitions
hereunder shall be joint and several.
This Service Provider .application :Agreement, unless and until accel ted. approved and executed by
the City .%danager or designee, is only an application for provision of services to City. and does not
constitute an approval or authoriza•inn for Service Prodder to perform or provide any service to City.
Neither Service Provider nor any of its a^_ents or en*jrioyceS shall be deemed agents or employees of
the City, nor a rntcnin-r of a joint emerprise with the City. Neither Service Provider nor any of its
agents or employees shall at arty tinx: or in any nxtmter 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 Aenentent. neither the Cir'
nor any of its employees shall have any control m cr the ntan ner, mode or means by which Service
Provider, its a_etts or employees. perfomt the services set forth herein.
In the event that part o_ this A$recnxent is declared invalid or unenforceable by a valid judgment or
decree of a court of competent jurisdiction, such invalidity or unenforceabitiry small not affect any of
53225 S M AS OF 361 .=3
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the remaining portions of this Agreement which am 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 ProVid- s
application to provide the alx�ve-referenced services is on the express condition that Service Provider
represents aml warrants that it is and will be in compliance with all applicable restriction+ on tete use
of intellectual prolx v,". inclajin cop}Tight laws. in connection with tlx: services proposed to lie
provided. Service Provider shall indemnify, defend, and hold harmless the City against any penalties.
claim, or liabilities arising rope or in connection with Service Provider's noncompliance with same.
The undersimcd. on bohalf of Service Provider. agrees that Service Pnn•idor seeks and is willing w,
movide the above -referenced service(s) on the date ami tine of the above -referenced event.
This Service Provider Application Agreement has been executed on the dates written helnw
APPLICAI'1O.N SURNITSSiO\ ;.wet sigrattre re(lldred: no electronic signatures):
SERNICEPROVIDER: DW3 Musk INC
i, a -m ofSG�•�c! tid✓�Am.`�n-wd Asunm;sCre) l
r Nrc7ce.» OfS_n•im zkvc AvthesiZet q:M=. C)
ispx-b Ww 011 tine .ir City use ottyi
APPLICATION APPROVAL:
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Service Provider Rules & Regulations
1. SERVICE PROVIDER APPLICATION: upon acceptance, approval. and execution of a
service provider application by the City of Carom (" City"). these Hiles and provisions shall
becorne biniina and a part ofthe Service Provider Application Agreement betty Pell the applicant
(being the entity providing a service to City as specified in the service provider application).
inclndinv it, officers. employees, agents and volunteers ("Provider-). on :he one lush, and the
City. on the outer hand. Any additions and anendments thereto that may be established or put
into effect by the City. and Tim%idcd in writing to the Provider, shall also become binding and a
part of the Service Provider .application Ageenent.
'_. PAYMENT. CANCELLMON: If the Provider is unable to perform or cannot provide ilia
services as requesta or the City cancels the service for any reason- the associated fees for
service will not be paid.
3.
CA.
CELLATiON: No refunds will be given lidless the subject event is cancelled by ilia
City's Comaninir,.• Semices Department. Applications may be denied or events cancelled in
Favor of City progran>:.
4. PROPERTY LOSS OR DAMAGES: The City is not responsible for any damage to. loss or
theft ofthe Provider's property, or that ofPn,vider's agcuts. employees or invitees.
5. CHARACTER OF ENTERTAINMENT: The Provider shall obsrrve, obey anal comply with
all applicable local. state ani tederal lasts, and all applicable policies. rules, regulations and
terms and conditions governing are ofCity facilities. The Provider will forfeit all rents or other
tees paid if eiected from premises for %'iolations of same. Ejection shall mot 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 ilia public in the best possible mariner.
The Provider shall at all times cooperate to this end.
The policies. rules. regulations and condition, governing use of City facilities are subject to
change :without notice to Provider unless the change affects a perinit already issued to Provider.
Provider shall foe solely responsible for the orderly conduct of all persons using the premiss by
its invita)ion, either expressed or implied, daring all tures covered by the Service Provider
Application Agreetuent. The City reserves the right to eject or cause to lx ejected from the
1>re:niscs any person or persons due to unlawful conduct.
6. RESPONSIBILITY: The Provider shall provide all material. equipment, and personnel
necessary for provision cfthe service described in this agreennent.
Nf0VF-]N;A1OVF-OUT: Move -in to the event area will be set for each venue. finless
otherwise stated, Provider will lie required to keep its area fully set up and manned until the
event is officially over. Please note that these tunes are subject to change.
S. SAFETY: Standing on chair, tables or other rental equipment is prohibited. Titis equipment is
not engineered to support your weight. l lie City of Carson its employees. agents, or pincers will
plat be resT)onsible fnr injuries or falls caused by the unproper nue of furniture. Please assist in
our efforts to pnn idc it SAFE NVORKING ENVIRON.LENT.
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9. VOLUME LIGHT CO\'TROL: The City reserves the nigh; to regulate the voline or intensity
of any and all noise or liaht getwrating niechanism s (including. but not limited to, loudspeakers,
radios, television sets. musical instrurnenis, glue tamers. or blinking or flashing lights) in the
reasonable judgment of rhe Cit}
10. FLAAt4fABLE MATERIALS All decorations, props and electrical equipment must he
fireproofor of fire retardant :,cuerials. must meet City requirements and are subject to removal.
Candles and other open llama devices will not be permitted except as authorized on this
agreetnert: subject to Fire Department regulation:,
11. COPYRIGHT 1NFORNLITION: Provider is responsible for licensing fees as required by
law. Pro\ ider ntay be subject to legal action for the use, display or sale of any item using any
copyrighted and or tradeTnarked bailie or logo which has not been specifically authorized tinder
license from the trademark holder.
1'_. PERMITS AND LICENSE: Provider shall procure at its oust cost anti expense all the
required iicenscs and permits applicable to Provider's use or activity .
13. OBLIGATION FOR CLEA\LL\ESS- Provider agrees ilia', The facility and am other
surrounding City property (ircludin_ parking lots) used ITy the Provider must be left in a clean
and orderly condition fegtiti to or better than the condition existing prior to the event). If
additional maintenance is required, other than the normal clearing process, the Provider will he
charged additional fecsbased oto the cost ofsu:ch maintenance.
14. D1SPU FES: All points not covered by the .Sertice Prorider Rides & Regulations are subject
to the decision of tine appropriate City representative
lz. Fi.00R \f-4NAGENIENf: The City :will appoint a Floor Manager wito is atuhoriicd to
enforce these rules and rt:eulations.
16. SPACE ASSIGN.NIENT: Event space is assigned to providers at the sole discretion of the
City. Concenis regarding competitive or specific types of providers should be communicated Io
the City at the time of application.
17. RL LE C•liA\GES: The City re�erves the right to nuke reasonable changes to the foregoing
rules. event hours and move -in move -out arrangements at any iiinc without notice to Provider,
unless the chance affects a permit already issued to Provider.
euzrs crt As a 3402 na
9 of 11 8% 10/2023 11:49
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R giver, liekase, Hold Harmless. Agreement.Nol to Jae and indemnification 10
(- n&-idtal') roc behalf e
o;•:. W. esu (-Exhibitor—, std ori a bona Side, agent of Exhibitor duly autlrt•.ccd :o exceute this
N'ahvr. Retease. Hold fianffina. Aareemetiliai to Sue and IndentniSeatWt agtttmtnt i^Agrttnl at") on behalf of Exhibito:j
(indisidnat and F%hibitor txrcinal.r: Wlketi)Yly reftmd:oas•-Sigaator•:'and tbt:,=-Signa-oq-^ S.^.tiudni Exh2bita'5 ofhcrn.
01163 K, rt:;rlsym a -n, ani w1writerc). seek acceptance ix- the Ciry of CArsun of an applkarion to pto:•ide sr%ices itat
rrrr•ca ; _
(-F"-:- j Cr; 3_saa: _ P'Da2e'
Sipa,-or• undt—mands that accidence. dltas e& and im)urtes a t arae out of the E.rnt ktoumg :he risks, and in
oons'd„ncon o: the acc<Ixatce ofat 4pph=1:v= to proiide a x'n-M at the P:rA .rt rte Dir Si -h- hrteby n'ai•. rs rcka,rs
and discharges ttr. City o: Carson, is ckc%d and appointed o2Fe_.s. offs. Is, v pkye — agent, and sulaman (colkt:tlwl,.
and indlidually,'Cit• fatty"j. and ho= C:d a®fait any and all c'.a2ms ar lmbihct, to Six ncry or any otter pets:.m i•I
entity. including but nee limited to elanns or liabilities for bodily it>Jwy. illness. death, orp:cps.,; dannip. trisitg out of e:
Connected it say- way nith Signtilm"s pY:CpgtiC6 it. presetoe aL or pea• orcauce of ier"'IMS at Ca An :he E,Cm t:ea though
that liahilily -may attar a; of rieeligerce or arekcsnres on :ht part of Cit•, aryl SiPator• apreti to win't its:ipLts x :rake 3n:•
such claims'ltrough any action or procerdiza apans :he C im'oraay Cin•?am. However. Signator• under sna'_; :hr, ii s, � =raph
.s t v: iuteuded to release r^.y testy ::vm xi", w or omisim of--ercm rntipencr:'
5IF2lory Lerch.• g:utis cl:y tLC not to pboiogrepb or ,itko-record 5 ignatm• dtuiag Orin connection with the Event and ua nse
Signatory's Photographed or .id:o•reeo:ded !1kene,s. std any ,:nage. s•:Ib�ucnc. m repndarnm of the .v= or ap:nnn ice of
Sigtu:a;taken 6,i 5ortocotnxcnoa,.iLl:hc=_s-rt(••Ltketeis7.lora)prupve.tndrxhegpubhstitsatxlOrmlof'arofCtry
and its evtt:k aid creation o. p%ducdon of tet. -,cels it =., fonz l r itch pi.Wsc.:vith nc clan: olemnlemrni a=y ]atrr fee
cr :ocalq- o?aay kind frcm Cit}. Stu;atory' herein• amves sty rght to `ue x:tliccraal �op:m e: S:gurtor's Ltkcans.
J:Lcta: ey fin:hr.::rgr ens to irdenrnin.:kfn:d ani held harmless C'iz, and each Cinv ?ar.; Soni and asain5 any and all claims.
lilbihtir : kne•. rlunagec expresser, and mss (including a•ithou:limiceti,t cess and fees of utiutiori ofetertan,.•-e (ialt:dinn.
but W Imdsd to. property dautage. tkxhly injtny. or dea:hl. a-hetLet imper<d by ,): or erhem*iae. sa zained or alleged to be
sustained by nay peno•.i car r•tity (wnetLn they ire members of:he public )isitina the F,er.L employees of She City. oter Exhibitor
at The :•rete. a otharesrl. omumng a:, ariatg It=. or =uectcd Wath S1=,ta1', rnrpa:u1im or nfamaix of smices at the
Event. Sigtator's actio:,. macums. a relic el' fna!ibes at the Erra . or any err•ipmmt, machinery rt itrnl, displayed of Used by
the Signator,: at or ?or the L)enL cxeept far such :
altuut:bi
Please note: The City of Carscn'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. I am an entertainer that vall perform at the City of Carson
Famfest 2023
event.
2. 1 am confirming that I and my business do not have commercial general iiabiliiy insurance as
required by the City of Carson but am still interested to provide services at the
Famfest 2023
event.
3. 1 acknowledge and agree that in the event of a less the City of Carson or its insurance career will
not provide coverage to me or to my business.
6. 1 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. I 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:
Date:
/ Z
I 1 of 11 8110.12023 11:49
Request for Taxpayer
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W-9 Identification Number and Certification
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Enter Your TIN in the oppropriolx boa, Tho `TIN ManrYrd nuJ -wor, ;h.e n.. r gtven on ane t to avoid
baekup'Min MoGing. For inGvfCuals. this Is gar."yy your scoal security numtw F. SM. MC-Ngf er, for a
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General Instructions
Section rvfererces we to the Intern:d R—inji, Cudu wi--s otri—!<
noted.
Future developments. For the lateat ylfomtayon about deva:oprnints
,a'Wed to poem W-9 and its Iminrchrim vrat r. InryNatai enacted
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I of6 8110;2023 11:51 AN
Ifs
Live performances for aii occasions
1860 Via Bandera
Whittier, Ca. 90601
Phone 626-369-4081 Fax 626-369-4081
TO: KENY HARRIS
18601 S. Main St.
Carson. Ca 90248
SHIP TO:
[Name] Stevenson Park
[Company Name]
[Street Address] 701 E. Carson Street
[City, ST ZIP Code] Carson, Ca 90745
[Phone]
INVOICE
INVOICE #1
DATE: AUGUST 26TH, 2023
SALESPERSON P.O. NUMBER REQUISITIONER SHIPPED VIA F.O.B. POINT TERMS
8/26/23
QUANTITY
DESCRIPTION
UNIT PRICE
TOTAL
DW3 to perform (1 set) 3:00pm-4:00pm @ Stevenson
Park Saturday August 26th, 2023
Total
$6,000.00
SUBTOTAL
SALES TAX
SHIPPING & HANDLING
TOTAL DUE
$6,000.00
Make all checks payable to Eric Mondragon
If you have any questions concerning this invoice, contact Eric Mondragon 626-482-3298