CONTRACT 6104 One Page Service Agreement CLOSEDAgreement No. 6104
CONTRACTOR: Airballing LA LLC
Aft Agreement
DATE MAILED: .0612912021
Below you will find a checklist relating to Insurance and other requirements that are required for doing business with the City of El
Segundo. Only those items checked -off are MANDATORY, however if your standard policies exceed the minimum requirements please
include. Commercial general liability insurance must meet or exceed the requirements of ISO-CGL Form No. CG 00 01 11 85 or
88. The amount of insurance set forth below will be a combined single limit per occurrence for bodily injury, personal injury, and property
damage for the policy coverage. Liability policies will be endorsed to name the City, its officials, and employees as "additional
insured's" under said insurance coverage and to state that such insurance will be deemed "primary" such that any other
insurance that may be carried by the City will be excess thereto. Such insurance must be on an "occurrence," not a "claims
made," basis and will not be cancelable or subject to reduction except upon thirty (30) days prior written notice to the City.
Please find additional Terms and Conditions on the reverse side of this Services Agreement. This is not a purchase order or an
authorization to begin work.
® Comprehensive General Liability, including coverage for premises, products and completed operations, independent contractors,
personal injury and contractual obligations with combined single limits of coverage of at least t 000 t'�00 per occurrence.
® Auto Liability, including owned, non -owned and hired vehicles with at least:
® $1,000,000 per occurrence.
❑ 100 000 -- 300,000 per occurrence.
❑ As required by State Statutes. A copy of your current policy must be submitted naming yourself and or your company.
® Workers' Compensation Insurance: as required by State Statutes. (Not needed if Self-employed with no employees and
CONTRACTOR signs statement to this effect.)
❑ Busin ss License: The CONTRACTOR shall agree to have a current City of El Segundo license on file at City Hall or purchase
said license (at no cost to the City).
❑ Permits: Plans must be approved and permit(s) issued (no fee) by the Community, Economic and Development Services
Department if appropriate. Call the Building Manager @ (310) 524-2345 if you have questions.
❑ Cooy of valid picture I.D. (Drivers license etc.)
PLEASE NOTE: ALL APPLICABLE INFORMATION LISTED ABOVE MUST BE OBTAINED AND ON FILE, PRIOR TO THE ISSUANCE OF A CITY
PURCHASE ORDER BEING SENT TO YOU (VIA FAX OR HARD COPY) BY THE RISK MANAGERIPURCHASING AGENT, THUS AUTHORIZING
COMMENCEMENT OF WORK FOR THE CITY.
Submitted by tcomplete all blank : COLOR COPY REQUIRED BACK TO THE CITY
Company Name:
By (Print name & title):
Airballing LA LLC
Cp mpany Street Address,
Vendor's Authorized ature required:
3215 W. Pico Blvd. #304
City, State,:Zip:
Date signed:
Los Angeles, CA 90019
Phone:
310-496-7734
I FAX: NSA
Vendor's Email address:
airbalringia@2mail.com
Mail original agreement and insurance to: City of El Segundo — City Clerk 350 Main Street, Room 5, El Segundo, CA 90245-3813
OriginatorlDepartmentContact pgym zMag t' ft, G.:tri+i A, Date initiated: Xz
Department Head Approval: I < Date Approved: 2 { -
Finance Approval: Insurance Approval Date Approved: 7/7/2021
cc: Business License; City Clerk; Purchasing Agent; Requesting Dept. name-
VED AS 10 FORM.
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Agreement No. 6104
City of El Segundo
Recreation and Parks Department
401 Sheldon Street
El Segundo CA 90245
EXHIBIT "A" — SCOPE OF SERVICES
AIRBALLING LA LLC agrees to provide services for El Segundo's Special Events.
• The Mega Nerf Gun Battle July 12th $700.00
The Bubble Soccer August 2nd $400.00
EXHIBIT "B"- COMPENSATION SCHEDULE
• City agrees to pay AIRBALLING LA LLC for such services, the sum of;
o One thousand one hundred dollars. ($1,100.00)
Airballing LA 6/29/21