HomeMy Public PortalAboutC-23-190 - DAVID BERNAL - 2023 COUNTRY WESTERN SPAo, "N'
joake
0tv ofCarson
COMRIU.nitv Services, Depar-Irnent
Service Provider Application eiet tel
Dear Applicant,
On behall'ot-the Citv ol'Carson, I would like to thank --voa for taking the time to explore business
oppor tuni ties with the City by applying toprowide services 16r an e%,,ent at a ('fly facility. As part
ofour apphcrtmn process, you must complete, sign, and ret -urn the following f« ries. Submission
ofthe.ge forms d(342s not guarantee that you viiII Vie provided the business opportunitv you seek.
Your prorript assistance in submitting the requested (locamentation to the Oty staff member listed
below will be appreciated and will help expo-dite the apitcation prm:ess. Please send your
complewd application aud attachruents directly to ffic. fetflowing addrc.'ss.-
Ot-v of CIMOrk
Attn: Hvyo-,
-Amami's, Name)
DormrquiN, P,,Irk- 213,30 S Santa Fe Avo Car�,,,,on, CA 90810
,t ,-stir 1"'YoW O.e-("ity hl'iM, comoras. phark
nroyeseocarsonca.gov
f,f-ratm e-vew email addro.,-,I
Should you have any que,;Iions, please feel free t:. r.Iontact thw,,taffmcmiyer fisted tx:kov ,
Truly.
Nick Reyes
4 Narn'.:j
Recreation Center Supervisor I
-5 -1 L.1:'. LI N
2
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'
Business License (if applicable)
Proof of Insurance/Certificate of Insurance
Waiver, Release, Hold Harmless, Agreement Not to
Sue, Indemnification, and Photo Release
Current Copy of W-9 Form (if not on file already)
1 The date of the Event shall be listed on the Invoice for Future Event Date (IFED). If the Service Provider Application is
approved, then the IFED will be processed as an invoice for services rendered for the Event. No payment will be made
until the conclusion of the Event, at earliest.
532227.5 CFN AS OF 3/14/2023
(Datc,",
JDB Entertainment
(Cornpany)
12762 Oxnard St
f Company Addres's)
North Hollywood, CA 91606
(CRY, State ZIP)
Insurance Requirements
Dear
Provider's Narric I
Please Imo; advised parsuant to rmr desire to work w9h dw City of Carson, you are required to
subW Me Whwin&
Clonwilimo ClUkAws of Liability Insuraiwe ou be ummained for the duration ot, Services
against ciaims which may arkfrom or in comenon with the services), evidencing the
covcr-a'-Yc�s,; as indic"ited befow
Cert cafe of insurance, as well as additional insaired and waiver of subrogation
eodor%enient� in favor of the City, must he submitted in their entirety before any services -
are provided or the event takes place, unless as waiver of insurance requirements is
requested (by checking the box in the applicabon b0ow) and approved by the City's Risk
Nlanager in his or her sole discretion. Failure to, sobinit such required forms or A, fain
waiver approval shall be cause for Chy of Carson to reject or terminate any service
provider application agrvernent.
The City of Car:,,on reserves the right ia rm-,xfify Tese based on the witUre of' the
risk, prior events, ir.surance coverage, of other—specia"', Fhe (.'ity's Risk Manager,
Sit his or her discretion, may ugibe hese requiremen""," -on ,-. case-by-c.;,isc basis, but the Cily
cannot andwill futt acki entemidners the., persons, such as Ninn erN, dancms, or tmnrethans, whow
Q is W enWddn (Awrs) as mIddional insurads om dit, Cwy (regardicss of whether
or not a ,vaiVCF W gTantedh anti therel-orc Crvy`w in:�mwnuc wdl not cover any liatility of
criterfainers in the cvviii of a loss,
Entertainers: fly subnokiing this applicatkin. you: (i,) acknowledge that the City's
insurance will not cover your or your busin"s' babithy 4:, the event of a loss; (ii) assume
the risk of performing iervices Athout (Ity"s insurance coverage, and without any
insurance coverage in the event City g rants you a a air x r 4 the service provider insurance
requirements b0ow or you fail to comply with such requirements; and (iii) agree to release
and hold harmless the City from any clahns or liahifity related to same.
h
,*4I-NF,,'vRTM SCOFIF,: AND 1,04 1 l'0FINSUPAN(T:
53VTT5 CFF AS(05-Z5-2923
4
General Liability Insurance: Coverage shall be at least as broad as Insurance Services Form CG
00 01 covering CGL on an "occurrence " basis, including property damage, bodily injury and
personal & advertising injury with limits no less than $1,000,000 per occurrence and
$2, 000, 000 aggregate.
Additional Insured Status
The City of Carson, and its elected and appointed officials, employees, volunteers and agents, are
to be covered as additional insureds with respect to liability arising out of their work or operations
performed at or on behalf of the City -sponsored event including materials, parts, or equipment
furnished in connection with the event.
532227.5 CFN AS OF 5-2S-2023
COV of ( 'arscfn
Commur"i1v Scn.,1cc,,, I leparimcm
Service Provider Application Agreement
Check one (staff ivirl.
r-1
El Cavorl F"writ C'enterD 11mm-in services Z Recreation L 'Fransportati-MI
Fv,m,Country Western Fair Fwn, Location. Dominguez Park I:Vcl-.,i Date: 9/16/23
Natvic of'Scmce Provider, - JDB Enteirtainrnelnit
Business Form." , LntRyType ('0'"idividwal, solk� proprietorship, corpi',ralion, or limited liability
conipany, spiicll�here)-
LLC
BuslniFornuljltlt'� T,)neral partilci-ship, hin W hiroled hab lity partnership,
vie 1 1-
e
l
orother—spccdhere):
CAI
T'ypv,,)t-S,,.i,,: Entertainment Co-. Just Dave Band
. . ....... ..... ...... . . ..... .... .. ..... I I
Per'14M: Dave Bernal VhOne 0: 818 1987-6966
Sara Steele94 9
truer.Contakct:
Billing, ddrew- 1276121
OMC?
North Hollywood CA 91606
r-111
1'rcx.)f ofinstiTance (chyvk one)'? OYC's [!�JN(-,
It'no, "'ould y( -'-m R'.c to purchase special -vent insurance through the, City (cheCk one)',' IlYc's No
110, you alati. i requc"a a walvero F in."Iffarice
DO YOU rCqVCS1 .! W-AiVCr OfillsUrMICe requirclilents"? / chre'A
abo vc) Y es 1-71 N
Special Instructions Just Dave Band will peirlorm a 45 minute set
for the City of Carson Country Western F -air. Band will provide
U N AS Of
6
their own instruments and will perform from 1
-------------- --. --,-
....... ... .
ff Service Provider wishe's to request nny special accommodation necded to fac)IM-ite Provision ofthe
Ser", Ices, p Iea.:e idenfit-V �t here or contact the staff member TCFCrCflCCd On I ofariaapp I icati011:
. . .......... .
Total Service Fee $1,500
NOTF If providcr is km able to provkh- the S41;11'vi�,:�:--. I,,,-, propwed fir requested or the C.ity
o(Car'son umlce+'� the ;;Crvice f0l, ;-uly rea-Son, the als-f:Idated ft -es will not tv paid.
Iremainder olf'Pagye,-, iwtwfio tie j fl"i';i''�' blank"I
S,1222?.S LIN AS OF.5-2S-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 5-25-2023
8
be mnlnmg ymions of this ApIcentent which are hereby, declared its sever -able and Aiall be
interpreted to carry out the imcm, of the parties JICTCundor,
Servicu Provider ackno,,kiedige-, [fiat the Cify (A (AmoWs cess sideration of Saar -Vice Provider"s
application to provide the aNwe-refcraced services i ; om the cNpress oandition that SeTvico Provider
rupments antt W.IFF-anb,; that it is atui Wl R in mriqliance with adl apj,,ilicable, restric[ions on the ime
of inicilectual propl,rty, including copyrighl lam, in conncction with the services proposed io be
provided. Service Provider shall indCnInify, defend, and ImId haunkss dw Chy agahtst any penalbes,
Claims, or fi<,Ibijitics arising thim or in oinrecut" n %,ith Serbee F'romki"s rionconiphance, with. samc,
Thc, undersignaL on behall 'of ServRe Pnwider, agrees that Sem ice Providcr ,;eek.,, and is willing to
provide the above -referenced serme(s) mi the date .n)d timc. ofth,,*- Avve-ref erenced event-
ThA Sem we Provkfer Applicmion Agreement ha.,., been uxeciaed on the dates -,%,,ritten belo%v,
APPLICATRIN SUBNIIISSION (wel signam, required: nci ciectrc.fnic signatures):
SERVICT PROV9DERI. Dave Bernal
(Nimt,d iIwjw, of Semi :c Pro,,W-7r's wyzml
APPLICATION APPROVAL:
(7 ry N, of f. I im
8/23/2023
MMS ON AS Of 5017ACU-3
E
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 S-25-2023
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 5-25-2023
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is 1I.
SON1,11
NNANII, David Bernal
%S0F i IS OZ,;
N% aiver, Relvase, flold flarmsess, Agrcf�mcuf. Nol to Slwv and Indvionification I -r
ORliANI , i,()N,JDB Entertainment LLC
OM ,,:8/23/2023
C* 11 IS OZ3
Please note: Ihe City of Carson's own insurance will cover the City's liability but will not cover an
Entertainer's liability. All service providers (including entertainers) are still required to carry
insurance.. We must require this because it is a condition of the City's Fxcess insurance policy,
Acknowledgement:
arn an enter-tainer that will nerform at the City of Carson
Country Western Fair
event,
art-� confffrnfrig that I and my business do nor hove con-m-nercial Penereal liability insurance as
required by the, City of Carsont. but, .in,, still inti rp&ted to P, ovide servwlfAs at the
rII
I,ountry Western Fair
event.
3. 1 acknowledge and agrf. ethat in the event of 11 loss the City of C-,,oscm or its in-Surance carrier will
not provide coverage to mr, or to my bus4iess..
4. t fuftherack.nowledgc., and agree that in ths, t!wnr Of a JOSS r-f-SUitWi,.4 frVin my Or my business'
wrong,tul of negkeent acts, the City of Caro a, :- %surer w"If seek to recover its finanoai loss
from me or my business. I will, ccroperato in evivnway mth uhe s,3id recovery efforts.
5, rhe City of Carson rnay approve this roques, w, Ta l` rewcll F,
at its discretion.
Signed:
Date: 8/23/2023
ENTERTAINMENT
|N\//—\|CE
David Bernal
JOBEntertainment LLC
Tax ID: 47-1728571
127O2Oxnard Street
North Hollywood, CA
91606
"CALIFORNIA COUNTRY AT ITS FINEST"
Date: 8/23/2023
Attn: Nick Reyes
Client: Qty of Carson
Event: 2023Country Western Fair
File: CORP23
Invoice Number: CORP091623
!
Sept 10.20231:30pn+215pm:Just Dave
Band, 5-pieoaband. Band brings all
musical equipment
City provides all sound equipment,monitors, and stage
i
Vendor Meals
/TBA
I PA sound package
N/A
DJ Equipment - DJ set
N/A
! � �Subtotal ! $1500�
Deposit N/A i
Due day of the event Total
Authorized Client Signature:
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