HomeMy Public PortalAboutC-23-200 - CPVA (ALMA DE ORO) - 2023 MARIACHI FIESTA SPAmks
City of Carson
Community Services Department Life 1 ;
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: Dani Cook
(Event Coordinator’s Name)
801 E. Carson Street, Carson, CA 90745
(Enter Event Coordinator’s address (i.e., city hall, corporate yard, or specific park address)
Email: dcook@carsonca.gov
(Enter event coordinator’s email address)
Should you have any questions, please feel free to contact the staff member listed below .
Truly,
Dani Cook
(Name)
Human Srvs. Program Mgr
(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!
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
BR
RD
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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 6-14-2023
08.24.2023
(Date)
CPVA/ Alma de Oro
(Company)
1000 E. 220th St
(Company Address)
Carson, Ca 90745
(City, State ZIP)
Insurance Requirements
CPVA/ Alma de Oro Dear ;
(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:
Y Compliant Certificates of Liability Insurance (to be maintained for the duration of services
against claims which may arise from or in connection with the services), evidencing the
coverage(s) as indicated below.
Certificates of insurance, as well as additional insured and waiver of subrogation
endorsements in favor of the City, must be submitted in their entirety before any services
are provided or the event takes place, 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
risk, 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 O01 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 Center| YW Human Services [ | Recreation [ | Transportation
iaci Fi Carsn Event Cent Event: Mariaci Fiesta Event Location: arsnevenswen * Event Date: cianinemones
CPVA/ Alma de Oro Name of Service Provider:
Business Form/Entity Type (if individual, sole proprietorship, corporation, or limited liability
company, specify here):
Corporation: Non- Profit Organization 501-C
Business Form/Entity Type (if general partnership, limited partnership, limited liability partnership,
or other, specify here):
N [a
Business Entity State of Incorporation (if applicable): NY hi
Entertainment
Carmen Salas Phone #: (210) 918-3565
Type of Service:
Contact Person:
Emer. Contact: N ( Pr Phone #: ( ) N ( fr
Billing Address: 1000 e. 220th st
01007.0001/532227.8 Street
Carson, Ca 90745
City State ZIP
Proof of Insurance (check one)? [_] Yes x] No
If no, you must request a waiver of insurance requirements.
Do you “Ay. a waiver of insurance requirements? (check yes if you checked no in the two boxes
Yes L] No above)
. _ Alma de Oro will perform with Mariachi Las Catrinas Special Instructions / Notes:
during the City of Carson Mariachi Fiesta on September 22, 2023.
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:
Changing area for dancers.
250.00 Total Service Fee
NOTE: If service provider is unable to provide the services as proposed or requested or the City
of Carson cancels the service for any reason, the associated fees will not be paid.
[remainder of page intentionally left blank]
532227.5 CFN AS OF 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
the remaining portions of this Agreement which are hereby declared as severable and shall be
interpreted to carry out the intent of the parties hereunder.
Service Provider acknowledges that the City of Carson’s consideration of Service Provider’s
application to provide the above-referenced services is on the express condition that Service Provider
represents and warrants that it is and will be in compliance with all applicable restrictions on the use
of intellectual property, including copyright laws, in connection with the services proposed to be
provided. Service Provider shall indemnify, defend, and hold harmless the City against any penalties,
claims, or liabilities arising from or in connection with Service Provider’s noncompliance with same.
The undersigned, on behalf of Service Provider, agrees that Service Provider seeks and is willing to
provide the above-referenced service(s) on the date and time of the above-referenced event.
This Service Provider Application Agreement has been executed on the dates written below.
APPLICATION SUBMISSION (wet signature required; no electronic signatures):
SERVICE PROVIDER: C PVA/ Al Ma d € O ro
slo4)az
(Date) Service Provider's Authorized Representative)
Carmen Salas
(Printed Name of Service Provider’s Authorized Representative)
(Space below this line for City use only)
APPLICATION APPROVAL:
CITY OF CARSON
Lr. Me FSi
Y (Signathre’c of City Manager or Designee) (Date)
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 ll
I, Carmen Salas , (“individual”) [on behalf of
CPVAI Alma de Oro (“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
Mariachi Fiesta 2023 (“Event”) on September 22, 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.e., a person, such as a singer, dancer, or comedian, whose job is to entertain others), then regardless
of whether any waiver of insurance requirements is granted, Signatory: (i) acknowledges and agrees that Signatory will not be
added to City’s insurance as an additional insured, and therefore City’s insurance will not cover any liability of Signatory or
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 representations,
statements or inducements, apart from this written form, have been made with regard to the subject matter of this form. If any
portion of this form is declared invalid by a court of competent jurisdiction, the remainder shall continue in full force and effect.
By signing below, Signatory acknowledges and represents that it has read and understands the above, and that it voluntarily agrees
to its terms.
By signing below, Signatory acknowledges and represents that it has read and understands the above, and that is voluntarily
agrees to its S.
SIGNED: orGANIzATION: CPVA/ ALma de Oro
NAME: Carmen Salas DATE: 8/24/23
01007.0001/781805.1
AS OF 6-14-2023
Please note: The 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 Excess insurance policy.
Acknowledgement:
1. | am an entertainer that will perform at the City of Carson
event.
| am confirming that | and my business do not have commercial general liability insurance as
required by the City of Carson but am still interested to provide services at the
| 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.
| 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.
The City of Carson may approve this request or may reject it at its discretion.
Form W-9
(Rev. October 2018)
Department of the Treasury
Internal Revenue Service
ALAS KARE
2 Business name/disregarded entity name, if different from above
Request for Taxpayer
Identification Number and Certification
> Go to www.irs.gov/FormW49 for instructions and the latest information.
1 Name (as Vp on your incomeax return). Name is required on this line; do not leave f line blank. VOLUN TEER
Give Form to the
requester. Do not
send to the IRS.
SEOCIRTION
following seven boxes.
CO Individual/sole proprietor or O C Corporation
single-member LLC
Print
or
type.
[_] Other (see instructions) >
oO 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 LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is
another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the | 4 Exemptions (codes apply only to
certain entities, not individuals; see
instructions on page 3):
O Partnership oO Trust/estate
Exempt payee code (if any)
code (if any)
(Applies to accounts maintained outside the U.S.) 5 Address (number, street, and "2 12. suite noe Das.
loco E. Requester's name and address (optional)
See
Specific
Instructions
on
page
3.
6 City, state, and ZIP code CAkson “oe GoT4sS 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 | Social security number |
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other - -
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
or 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.
| Employer identification number |
217| -Z)1/7// 08 |2 Part Il Certification
Under penalties of perjury, | certify that:
1. The number shown on this form is my correct taxpayer identification number (or | am waiting for a number to be issued to me); and
2. 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 result of a failure to report all interest or dividends, or (c) the IRS has notified me that | am
no longer subject to backup withholding; and
3. lama U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that | am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part Il, later.
Sign Signature of
Here U.S. person >
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FormW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
e Form 1099-INT (interest earned or paid)
Cat. No. 10231X
ome 8/24 | 23
e Form 1099-DIV (dividends, including those from stocks or mutual
funds)
e Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
e Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
e Form 1099-S (proceeds from real estate transactions)
e Form 1099-K (merchant card and third party network transactions)
® Form 1098 (home mortgage interest), 1098-E (student loan interest),
1098-T (tuition)
e 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)
QUANTITY DESCRIPTION
Folklorico and Modern
Performance for 30min
Event: Mariachi Fest
Carson Event Center on September 22,
2023
TOTAL
$250.00
Total $250.00