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HomeMy Public PortalAboutC-23-196 - ELITE SPECIAL EVENTS - 2023 WINTERFEST SPACity of Carson Community Services Department f | 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: Scott Griffee (Event Coordinator's Name) 18601 S. Main St., Carson, CA 90248 (Enter Event Coordinator’s address (i.e., city hall, corporate yard, or specific park address) Email: S9riffee@carsonca.gov (Enter event coordinator’s email address) Should you have any questions, please feel free to contact the staff member listed below . Truly, Scott Griffee (Name) Recreation Program Manager (Title) 532227.5 CFN 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) Service Provider Application Agreement Invoice for Future Event Date! a F N/A Business License (if applicable) Proof of Insurance/Certificate of Insurance OR Waiver Requested Waiver, Release, Hold Harmless, Agreement Not to Sue, Indemnification, and Photo Release BL FBR Current Copy of W-9 Form (if not on file already) * The date of the Event shall be listed on the Invoice for Future Event Date (IFED). If the Service Provider Application is approved, then the IFED will be processed as an invoice for services rendered for the Event. No payment will be made until the conclusion of the Event, at earliest. 532227.5 CFN AS OF 6-14-2023 D/z2e/Zz3 (Date) ELL Sfecial £uert (Compathy — _BL2 7S Las flla2das Lf fel! (Company Address) Lot L14,2. Zs £298 Padre (City, State ZIP) ~ Insurance Requirements Dear Elite Special Events (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, unless a waiver of insurance requirements is requested (by checking the box in the application below) and approved by the City’s Risk Manager in his or her sole discretion. Failure to submit such required forms or obtain waiver approval shall be cause for City of Carson to reject or terminate any service provider application agreement. The City of Carson reserves the right to modify these requirements based on the nature of the tisk, prior events, insurance coverage, or other special requirements. The City’s Risk Manager, in his or her discretion, may waive these requirements on a case-by-case basis, but the City cannot and will not add entertainers (i.e., persons, such as singers, dancers, or comedians, whose job is to entertain others) as additional insureds on the City’s insurance (regardless of whether or not a waiver is granted), and therefore City’s insurance will not cover any liability of entertainers in the event of a loss. Entertainers: By submitting this application, you: (i) acknowledge that the City’s insurance will not cover your or your business’ liability in the event of a loss; (ii) assume the risk of performing services without City’s insurance coverage, and without any insurance coverage in the event City grants you a waiver of the service provider insurance requirements below or you fail to comply with such requirements; and (iii) agree to release and hold harmless the City from any claims or liability related to same. MINIMUM SCOPE AND LIMIT OF INSURANCE 532227.5 CFN AS OF 6-14-2023 4 General Liability Insurance: Coverage shall be at least as broad as Insurance Services Form CG 00 O1 covering CGL on an “occurrence” basis, including property damage, bodily injury and personal & advertising injury with limits no less than $1,000,000 per occurrence and $2,000,000 aggregate. Additional Insured Status The City of Carson, and its elected and appointed officials, employees, volunteers and agents, are to be covered as additional insureds with respect to liability arising out of their work or operations performed at or on behalf of the City-sponsored event including materials, parts, or equipment furnished in connection with the event. 532227.5 CFN AS OF 6-14-2023 City of Carson Community Services Department Service Provider Application Agreement Check one (staff use): [ | Carson Event Cente Human Services Recreation [ | Transportation Event. WinterFest 2023 Event Location: Veterans Park... »,,.. 12/9/23 Name of Service Provider: Elite Special Events Business Form/Entity Type (if individual, sole proprietorship, corporation, or limited liability company, specify here): Business Form/Entity Type is general partnership, limited partnership, limited liability partnership, or other, specify here): f £ eae Ziey Business Entity State of Incorporation (if applicable): C lag) ~ Leaf, ye. ot 4 Type of Service: $ oa Blasts Contact Person: ZL Lee 2a en < Phone #: ( ) Emer. Contact: alt 22427 Lielcam 5 Phone #: ( ) Billing Address: L275 fas fIhn tas LS He] 01007.000 1/532227,8 Street Loss Cle £9 Lad Lat Da? Za- City State ZIP Proof of Insurance (check one)? Yes [_ ] No Ifno, you must request a waiver of insurance requirements. Do you wl a waiver of insurance requirements? (check yes if you checked no in the two boxes above) Yes Y . . Event is on Saturday, December 9, 2023 from 12 pm to 4:00 pm at Veterans Park Special Instructions / Notes: . P 22400 Moneta Ave., Carson CA, 90745. The same location as last year - on the hill next to the ball diamond. 532227.5 CFN AS OF 6-14-2023 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 $981 0.00 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] 532227.5 CFN AS OF 6-14-2023 Further Terms of Service Provider Application Agreement: The undersigned signatory of Service Provider (Service Provider being the above-referenced person or entity seeking to provide services at the above-referenced event, including all its officers, agents, employees and volunteers) hereby represents and warrants that he or she is duly authorized by Service Provider to execute and deliver this application on behalf of Service Provider, and that by so executing this application, and in consideration for the City’s review of this application, Service Provider is bound by these terms. Service Provider understands and agrees to comply with the City’s “Service Provider Rules & Regulations,” which are set forth below and incorporated herein by this reference. Service Provider agrees to indemnify and release City in connection with its proposed services in accordance with the “Waiver, Release, Hold Harmless, Agreement Not to Sue, and Indemnification” agreement submitted concurrently herewith, which is incorporated herein by reference. Service Provider agrees to maintain all required insurance coverages and comply with all associated insurance requirements as set forth on the above “Insurance Requirements” page, which is incorporated herein by reference. Service Provider agrees that all required policies shall contain, or be endorsed to contain, an agreement by Service Provider to waive all rights of subrogation and contribution against the City, its elected or appointed officers, officials, employees and agents, for all losses and liabilities paid under the terms of any policy which arise from the activities or operations of, or the services performed by, Service Provider, regardless of any prior, concurrent, or subsequent non-active negligence by the City. In the event there is more than one person or entity named in this Service Provider Application Agreement as the Service Provider, then all obligations, liabilities, covenants and conditions hereunder shall be joint and several. This Service Provider Application Agreement, unless and until accepted, approved, and executed by the City Manager or designee, is only an application for provision of services to City, and does not constitute an approval or authorization for Service Provider to perform or provide any service to City. Neither Service Provider nor any of its agents or employees shall be deemed agents or employees of the City, nor a member of a joint enterprise with the City. Neither Service Provider nor any of its agents or employees shall at any time or in any manner represent that Service Provider or any of its agents or employees are agents or employees of City, or that it is a member of a joint enterprise with City. Subject to the requirements of this Service Provider Application Agreement, neither the City nor any of its employees shall have any control over the manner, mode or means by which Service Provider, its agents or employees, perform the services set forth herein. In the event that part of this Agreement is declared invalid or unenforceable by a valid judgment or decree of a court of competent jurisdiction, such invalidity or unenforceability shall not affect any of 532227.5 CFN AS OF 6-14-2023 8 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 PRovipgr: Elite Special Events VA LE BC ZL Za/ ZF (Signature of Service Provider's Authorized Representative) (Date) (Printed Name of Service Provider's Authorized Representative) (Space below this line for City use only) B R APPLICATION APPROVAL: CITY QF CARS - %-8- 2023 Signa anager or Designee) (Date) 4 Vars~ 532227.5 CFN AS OF 6-14-2023 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. 532227.5 CFN AS OF 6-14-2023 10 9. VOLUME/LIGHT CONTROL: The City reserves the right to regulate the volume or intensity of any and all noise or light generating mechanisms (including, but not limited to, loudspeakers, radios, television sets, musical instruments, entertainers, or blinking or flashing lights) in the reasonable judgment of the City. 10. FLAMMABLE MATERIALS — All decorations, props and electrical equipment must be fireproof or of fire retardant materials, must meet City requirements and are subject to removal. Candles and other open flame devices will not be permitted except as authorized on this agreement; subject to Fire Department regulations. 11. COPYRIGHT INFORMATION: Provider is responsible for licensing fees as required by law. Provider may be subject to legal action for the use, display or sale of any item using any copyrighted and/or trademarked name or logo which has not been specifically authorized under license from the trademark holder. 12. PERMITS AND LICENSE: Provider shall procure at its own cost and expense all the required licenses and permits applicable to Provider’s use or activity . 13. OBLIGATION FOR CLEANLINESS: Provider agrees that the facility and any other surrounding City property (including parking lots) used by the Provider must be left in a clean and orderly condition (equal to or better than the condition existing prior to the event). If additional maintenance is required, other than the normal cleaning process, the Provider will be charged additional fees based on the cost of such maintenance. 14. DISPUTES: All points not covered by the Service Provider Rules & Regulations are subject to the decision of the appropriate City representative. 15. FLOOR MANAGEMENT: The City will appoint a Floor Manager who is authorized to enforce these rules and regulations. 16. SPACE ASSIGNMENT: Event space is assigned to providers at the sole discretion of the City. Concerns regarding competitive or specific types of providers should be communicated to the City at the time of application. 17. RULE CHANGES: The City reserves the right to make reasonable changes to the foregoing rules, event hours and move-in/move-out arrangements at any time without notice to Provider, unless the change affects a permit already issued to Provider. 532227.5 CFN AS OF 6-14-2023 Waiver, Release, Hold Harmless, Agreement Not to Sue and Indemnification 1] L , (“individual”) [on behalf of Elite Special Events (“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 WinterFest 2023 (“Event”) On December 9, 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. If Signatory in an entertainer (i.¢., a person, such as a singer, dancer, or comedian, whose job is to entertain others), then regardless Signatory’s business in the event of a loss; (ii) assumes the risk of performing services without City’s insurance coverage, and without any insurance coverage in the event City grants a waiver of the service provider application agreement insurance requirements or Signatory fails to comply with such requirements; (iii) waives, releases and discharges the City and each City party from any claim related to same; and (iv) agrees to hold City and each City Party harmless from any claim or liability related to same. In giving the foregoing releases and waivers, Signatory expressly waives any and all rights conferred upon it by the provisions of California Civil Code Section 1542, which Signatory understands reads as follows: “A general release does not extend to claims that the 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 materially 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 Tepresentations, 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 terms. SIGNED: TL orcanizaTion: Elite Special Events NAMB: Lan fle fans DATE: 01007.0001/781805.1 AS OF 6-14-2023 Elite Special Events, Inc 11278 Los Alamitos Blvd #101 Los Alamitos, Ca 90720 (562) 799-7737 7/31/2023 Invoice #139 e Event: Carson Snow Day e Address: Veterans Park - 22400 Moneta Ave, Carson e Contact: Dani Cook 310-952-1782/ Scott Griffee — 310-847-3572 e Event Date: December 9 e Hours: 12-4pm e Setup: 9am — start blowing at 11:00am Description Amount Total 20 Tons of snow with 4 sledding hills. 2 adult and 2 kiddie 260 $5.200 Use natural slope from hill at Park ’ 8 tons of snow for kids play area 20X20 area. 260 $2,080 Life size snowman in kids play area l $150 54 bales of straw — our company will setup and take away 20 $1080 And dispose of straw after show. 7 (6) Staff to attend sledding course, groom course 150 $900 and snow play area 10 professional foam sleds 10 $100 ™] Setup/teardown/delivery $300 Total $9,810.00 e Payment of half due at signing to reserve package/ Balance paid before setup at show e 6 trained attendants included in above price. Additional 5 volunteers needed to attend snow area needed by city. 1 security guard for crowd control also provided by city. e Insurance certificate of 1 Million additionally naming your organization will be issued after deposit is received. Name: __City of Carson Cancellation Policy: All events are "rain or shine" unless otherwise stipulated. The PURCHASER is responsible to provide an alternate indoor location in the event of inclement weather. The client agrees to pay the full amount contracted once the PROVIDER has arrived at the event location, even if PROVIDER cannot perform due to inclement weather. PURCHASER will not have to pay balance if they cancel atleast 1 day prior to event. Purchaser will receive full refund if they cancel atleast one week prior to event. Hold Harmless: PURCHASER agrees to indemnify and hold harmless Elite Special Events, Inc, its shareholders, officers, directors, employees and representatives, customers and invitees against all actions, claims, demands, costs, damages, and expenses of any kind (including legal fees) which may be brought or made against Provider by reason of Providers activities. Purchaser acknowledges that using amusement devices or inflatable attractions comes with inherent risks. If you choose to rent above attraction you do so at your own risk. Checks Payable to: Elite Special Events We agree to the above terms and conditions: Rentor Signature Date Elite Special Events, Inc 11278 Los Alamitos Blvd #101 Los Alamitos, Ca 90720 (562) 799-7737 7/19/2022 Invoice #138 e Event: Carson Snow Day e Address: Carson Community Center — 801 E Carson St, Carson e Contact: Bobby Grove 310-952-1760 Scott Griffee 310-847-3572 e Event Date: December 10 e Hours: 12-4 e Setup: 8am — start blowing at 11:00am Description Amount Total 20 Tons of snow with 4 sledding hills. 2 adult and 2 kiddie 250 $5,000 (2) extreme wood ramps in Parking lot 150 $300 8 tons of snow for kids play area that includes life-size 250 $2.000 snowman to take pictures with. 20X20 area. , Life size snowman 1 $150 54 bales of straw — our company will setup and take away 20 $1080 And dispose of straw after show. (6) Staff to attend sledding course, groom course 125 $750 and snow play area 10 professional foam sleds 10 $100 Setup/teardown/delivery $300 Total $9,680.00 e Payment of half due at signing to reserve package/ Balance paid before setup at show e 6 trained attendants included in above price. Additional 5 volunteers needed to attend snow area needed by city. 1 security guard for crowd control also provided by city. e Insurance certificate of 1 Million additionally naming your organization will be issued after deposit is received. Name:__City of Carson Cancellation Policy: All events are "rain or shine" unless otherwise stipulated. The PURCHASER is responsible to provide an alternate indoor location in the event of inclement weather. The client agrees to pay the full amount contracted once the PROVIDER has arrived at the event location, even if PROVIDER cannot perform due to inclement weather. PURCHASER will not have to pay balance if they cancel atleast 1 day prior to event. Purchaser will receive full refund if they cancel atleast one week prior to event. Hold Harmless: PURCHASER agrees to indemnify and hold harmless Elite Special Events, Inc, its shareholders, officers, directors, employees and representatives, customers and invitees against all actions, claims, demands, costs, damages, and expenses of any kind (including legal fees) which may be brought or made against Provider by reason of Providers activities. Purchaser acknowledges that using amusement devices or inflatable attractions comes with inherent risks. If you choose to rent above attraction you do so at your own risk. Checks Payable to: Elite Special Events We agree to the above terms and conditions: Os. 7b 3/ 20722. 4X Rentor Signature Date & 7 Elite Special Events, Inc ar aS 11278 Los Alamitos Blvd #101 E L iv ora , Los Alamitos, Ca 90720 Sapiens (562) 799-7737 11/1/2021 To whom it may concern: Elite Special Events is a soul source provider of Snow Day Events. We are one of the only companies in California that blows the snow, provides bailes of straw, build the sledding course with life size snowmen and snow targets. We also provide all the equipment such as sleds, barricades and staff. For anymore questions on our one-stop shop Snow Days please call me Ted Holcomb Elite Special Events President ——™ « ACORD Ma =< CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 07/13/2023 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. . ‘ Py Liberty United Insurance Services, Inc 704 S Victory Blvd, Suite 204 imac Sam Muradyan 8187618888 (Arc, No): 8882656889 PHONE (A/C, No, Ext): Burbank, CA 91502 ADDRESS: __Sam@libertyunitedinsurance.com License #: 0F89841 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Certain Underwriters at Lloyd's of London INSURED INSURER B : Elite Special Events, Inc INSURER C : 11278 Los Alamitos Boulevard #101 INSURER D : Los Alamitos, CA 90720 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 00001977-435267 REVISION NUMBER: 384 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 POLICY EFF | POLICY EXP LTR TYPE OF INSURANCE INSD | WVD POLICY NUMBER (MM/DD/YYYY) | (MM/DD/YYYY) LIMITS A | X | COMMERCIAL GENERAL LIABILITY Y ZISMB1499 02 05/07/2023 | 05/07/2024 | EACH OCCURRENCE $ 1,000,000 | [| DAMAGE TO RENTED X | CLAIMS-MADE OCCUR PREMISES (Ea occurrence) _| $ 300,000 MED EXP (Any one person) $ PERSONAL & ADV INJURY | $ 1,000,000 EN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X|pouicy| | SBS [J t06 PRODUCTS - COMP/OP AGG | $ 2,000,000 OTHER: $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) $ ANY AUTO BODILY INJURY (Per person) | $ OWNED SCHEDULED ; AUTOS ONLY AUTOS BODILY INJURY (Per accident) | $ HIRED NON-OWNED PROPERTY DAMAGE $ |__| AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB occuR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED | | RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS’ LIABILITY VN STATUTE | ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? [| N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE] $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT | $ A | Accident/Medical ZISMB1499 02 05/07/2023 | 05/07/2024 $10,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Carson, its elected and appointed officials, employees, volunteers and agents are additional insureds CERTIFICATE HOLDER CANCELLATION Insurance Approved City of Carson DJ 18601 S. Main Street, 07/31/23 Gardena, CA 90248 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 ( (SMS ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD © 1988-2015 ACORD CORPORATION. All rights reserved. Printed by SMS on 07/13/2023 at 12:46PM —s ®& DATE (MM/DDIYYYY ACORD CERTIFICATE OF LIABILITY INSURANCE 07/19/2023 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 KONTACT Jim McAnany Nielsen McAnany Insurance Services, Inc. | (AIG. No, Ext); (805) 379-8805 (AIG, No); (805) 204-4501 4165 E, Thousand Oaks Blvd ADDRESS: Suite 325 INSURER(S) AFFORDING COVERAGE NAIC # Westlake Village CA 91362 INSURERA: California Auto Insurance 38342 INSURED INSURER B : ELITE SPECIAL EVENTS, INC. INSURER C: 404 N Sparks St INSURER D : INSURER E: Burbank CA 91506-1963 INSURER F : COVERAGES CERTIFICATE NUMBER: ©1L2292908998 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 POLICY EFF | POLICY EXP LTR TYPE OF INSURANCE INSD | WvD POLICY NUMBER (MMI/DDIYYYY) | (MM/DDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $ = MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY [| ae [| Loc PRODUCTS - COMP/OPAGG | $ OTHER: $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident $ 1,000,000 ANY AUTO BODILY INJURY (Per person) | $ OWNED SCHEDULED A OWNED ely pied BA040000023533 08/31/2022 | 08/31/2023 | BODILY INJURY (Per accident) | $ ><] HIRED ><| NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED | | RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS ' LIABILITY ¥7N starure |__| ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? [_] N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE | $ If yes, describe under DESCRIPTION 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 and its elected and appointed officials, employees, volunteers and agets are additional insured per attached MCA85100817-CA. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Insurance Approved THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Carson DJ ACCORDANCE WITH THE POLICY PROVISIONS. 701 E Carson Street 07/31/23 AUTHORIZED REPRESENTATIVE Carson CA 90745 J McAnany l © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Z4MERCURY INSURANCE Business Auto Broadening Endorsement Newly Acquired or Formed Entity (Broad Form Named Insured) — Adds, as an insured, any newly acquired or formed entity provided the insured owns at least 50% of that entity and it is formed during the policy period. The maximum period is 180 days. Primary and Non-Contributory if Required by Contract - We will not seek contribution from any other insurance available under specific conditions. Employees as Insureds — An employee becomes an insured while using a covered auto that the insured does not own, hire or borrow. Automatic Additional Insured — Any person or organization that the insured is required to include as an additional insured based on a contract or agreement that is executed prior to the injury or damage. Employee Hired Auto — An employee is an insured when operating an auto that is hired or rented in the employee’s name while on company business. Supplementary Payments — Bail bonds coverage is increased to $3,000. Reasonable expenses and loss of earnings, up to $500 per day, incurred by the insured are covered. Fellow Employee Coverage — The exclusion has been removed. Additional Transportation Expense — We will pay up to $50 per day, maximum is $1,000, for temporary transportation expense resulting from the total theft of a covered auto. Hired Auto Physical Damage Coverage — If you have Hired Auto Liability coverage, and you carry physical damage coverage for any of your autos, we will extend coverage for Hired Auto Physical Damage to a limit of $50,000, subject to a $500 deductible. Accidental Airbag Deployment — We removed the exclusion, providing coverage for airbag deployment that is accidental. Loan/Lease Gap — Coverage for the unpaid amount due on the lease or loan has been added if there is a total loss of an auto insured under this policy. Glass Repair — Deductible Waiver — We will waive the deductible if glass is repaired rather than replaced. Two or More Deductibles — If two or more policies or coverage forms from the company apply to the same accident, only one deductible will be applied. Amended Duties in the Event of Accident, Claim, Suit or Loss — The insured must notify us of an accident as soon as possible. Waiver of Subrogation — We waive our right of recovery against others if the insured has executed a written agreement prior to the accident or loss. Unintentional Error, Omission, or Failure to Disclose Hazards — The policy will not be deemed invalid if the insured unintentionally omits, errs or fails to disclose a hazard. Employee Hired Auto - If the employee hires or rents a vehicle with permission of the insured, Hired Auto Physical Damage applies. Hired Auto — Coverage Territory — Coverage applies anywhere in the world if an auto is leased, hired, rented or borrowed without a driver for a period of 30 days or less, and the insured’s responsibility to pay for damages is determined in a suit brought in the US, its territories and possessions, Puerto Rico, Canada or in a settlement that we agree to. Bodily Injury Redefined to Include Resultant Mental Anguish — Bodily Injury includes mental anguish. CA, AZ, TX, OK, GA 10-16 MCA85100817-CA STATE HOME OFFICE SAN FRANCTSCO ANNUAL RATING ENDORSEMENT COMPENSATION pia Leas iT IS AGREED THAT THE CLASSIFICATIONS AND RATES PER $100 OF REMUNERATION APPEARING FUN D IN THE CONTINUOUS POLICY ISSUED TO THIS EMPLOYER ARE AMENDED AS SHOWN BELOW. HERE ARE YOUR NEW RATES FOR THE PERIOD INDICATED. iF YOUR NAME OR ADDRESS SHOULD BE CORRECTED OR IF INSURANCE IS NOT NEEDED FOR NEXT YEAR, PLEASE TELL US. IMPORTANT His 1S MOT A BILL CONTINUOUS POLICY 9304403-22 SEND NO MONEY UNLESS STATEMENT I5 ENCLOSED . THE RATING PE D AN AT 12: M PACIEIC STANDARD TIME NAT 12048 RATING PERIOD 8-26-22 TO 8-26-23 ELITE SPECIAL EVENTS, INC DEPOSIT PREMIUM $0.00 11278 LOS ALAMITOS BLVD #101 MINIMUM PREMIUM $1,400.00 LOS ALAMITOS, CALIF 90720 PREMIUM ADJUSTMENT PERIOD QUARTERLY R SC NAME OF EMPLOYER- ELITE SPECIAL EVENTS, INC (A CORP) (A CORPORATION) CODE NO. PRINCIPAL WORK AND RATES EFFECTIVE FROM 08-26-22 TO 08-26-23 INTERIM PREMIUM BASE BILLING BASIS RATE RATE* 9095-1 EVENT MARKET, FESTIVAL OR TRADE SHOW 18000 8.42 9.10 OPERATION--ALL EMPLOYEES--N.0.C. kkAKAKKKXBUREAU NOTE INFORMATION****4xx% Insurance Approved DJ FEIN 260747948 07/31/23 TOTAL ESTIMATED ANNUAL PREMIUM $1,638 COUNTERSTGNED AND ISSUED AT SAN FRANCISCO UGUST 29, 2022 POLICY L PAGE 1 OF 3 SCiF FORM 10963A (REV.7-2014) OVER PLEASE STATE COMPENSATION INSURANCE FUND HOME OFFICE SAN FRANCISCO ANNUAL RATING ENDORSEMENT IT IS AGREED THAT THE CLASSIFICATIONS AND RATES PER $100 OF REMUNERATION APPEARING IN THE CONTINUOUS POLICY ISSUED TO THIS EMPLOYER ARE AMENDED AS SHOWN BELOW. HERE ARE YOUR NEW RATES FOR THE PERIOD INDICATED. IF YOUR NAME OR ADDRESS SHOULD BE CORRECTED OR IF INSURANCE IS NOT NEEDED FOR NEXT YEAR, PLEASE TELL US. SEND NO MONEY UNLESS STATEMENT IS ENCLOSED IMPORTANT CONTINUOUS POLICY 9304403-22 THIS IS NOT A BILL THE RATING PERIGD BEGI AND AT 12: HM MChIC SHARELER Tie Se RATING PERIOD 8-26-22 TO 8-26-23 * INTERIM BILLING RATES WILL BE USED ON PAYROLL REPORTS. THEY TAKE INTO ACCOUNT RATING PLAN CREDITS (OR DEBITS) WHICH WILL APPLY AT FINAL BILLING AND AN ESTIMATE OF YOUR PREMIUM DISCOUNT AS DETAILED BELOW. RATING PLAN CREDITS (DEBITS) EFFECTIVE FROM 08-26-22 TO 08-26-23 RATING PLAN MODIFIER 1.08100 ESTIMATED PREMIUM DISCOUNT MODIFIER 1.00000 COMPOSITE FACTOR APPLIED TO BASE RATES TO DERIVE INTERIM BILLING RATES 1.08100 KKK KK KKK KEE EERE ERR RRR EEE ERE ERE KKK AAA EAA EKER RRR REE AA AAR EERE * * * PREMIUM DISCOUNT SCHEDULE EFFECTIVE FROM 08-26-22 TO 08-26-23 * * ESTIMATED MODIFIED PREMIUM IS DISCOUNTED ACCORDING TO THE FOLLOWING SCHEDULE: * * FIRST ABOVE * * $5,000 $5,000 * * 0.08% Lhe * * * KKK KKK KEKE EKER EERE ERE EERE EERE ERREEKAKRRE ERE EREEEERERAKE ERE REREREEEEREE THE ESTIMATED PREMIUM DISCOUNT IS BASED ON AN ESTIMATE OF YOUR PAYROLL. ACTUAL PREMIUM DI SCOUNT APPLIED AT FINAL BILLING WILL BE BASED ON THE ACTUAL PAYROLL REPORTED ON YOUR POLICY AND SUBJECT TO AUDIT. COUNTERS TI GNED AND ISSUED AT SAN FRANCISCO UGUST 29, 2022 POLICY L PAGE 2 OF 3 963A (REV.7-2014} OVER PLEASE ae COMPENSATION i{NSURANCE a IF YOU HAVE ANY QUESTIONS, HOME OFFICE SAN FRANCISCO ANNUAL RATING ENDORSEMENT IT IS AGREED THAT THE CLASSIFICATIONS AND RATES PER $100 OF REMUNERATION APPEARING IN THE CONTINUOUS POLICY ISSUED TO THIS EMPLOYER ARE AMENDED AS SHOWN BELOW. CONTINUOUS POLICY 9304403-22 PLEASE CONTACT YOUR LOCAL STATE FUND OFFICE BELOW: CSC - POLICY AT MONTEREY PARK 900 CORPORATE CENTER DRIVE MONTEREY PARK (877) 405-4545 CA 91754 Nothing herein contained When countersigned by a duly authorized officer or representative of the State Compensation Insurance Fund, these dectarations shall be vatid and form part shall be held to vary, alter, waive or extend any af the terms, conditions agreements or limitations of the Policy other than as herein stated. vit RUA ff AUTHORIZED REPRESENTATIVE of the Policy. Lie Meer PRESIDENT AND CEO COUNTERSIGNED AND ISSUED AT SAN FRANCISCO AUGUST 29, 2022 POLICY L PAGE 3 OF 3 SCIF FORM 10963A (REV.7-2014}