CONTRACT 5199 CLOSEDN,
CONTRACTOR: Bobby Johnson for Jam Band
Agreement No. 5199
Services Agreement
DATE MAILED: 9121116
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•CCL Form No, CC 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 ntust 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.
® Comorehensive fenera�, including coverage for premises, products and completed operations, independent contractors,
personal injury and contractual obligations with combined single limits of coverage of at least S1,000.000 per occurrence.
® Auto Liability, including owned, non -owned and hired vehicles with at least.
❑ S1.000.000 per occurrence.
❑ 1O�u,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.
V "porkers" Comoensation Insurance: as required by State Statutes. (Not needed if Self- employed with no employees and
CONTRACTOR signs statement to this effect.)
❑ Business 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.
❑ ff ogv of valid oicture 0, (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 MANAGER/PURCHASING AGENT, THUS AUTHORIZING
COMMENCEMENT OF WORK FOR THE CITY.
Submit',,, d by comptete all blanks":
Company Name: By (iN"pt na, �ee� r�tl
Bobby Johnson for Jam Band
Company Street Address: °Vendor's Auui .� "�lo rare required:
1001 Wst Lambert Rd #287 _
City. State, Zip: Date.ai'gned: �
La Habra, CA 90631 „m m
Phone: FAX:
Vendor's Email address. _�...� __••___�,..w.,M_ �.,u .m�.m _.. 7. �...__ ._ __�..�.��.�..- .��...��.�.�w.w.k
g •g g Ai, City g ty Ct 3 Main Street, Room 5, El Segundo, CA 902745•. 13
On inatorlDepartment Contact: Date srritiated: �� .
Mail original agreement and insurance to: Ci of El Se gun C
Department Head Approval: __.._ Date Approved: Z,�-
rovc,4
Finance Approval:
Date A �� � _ �...�mm.���,.. ,�.,. ,�,.,�� p4�
cc: Business License; City Clerk; Purchasing Agent; Requesting Dept, name
Bobby Johnson- Jam Band - Word
F l O FORM:
CA ATTORN
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Agreement No. 5199
Bobby Johnson- Jam Band - Word 9121P16
City of El Segundo
401 Sheldon Street
El Segundo CA 90245
EXHIBIT "A" — SCOPE OF SERVICES
Halloween Frolic Celebration:
Agreement No. 5199
0 Location: in St. El Segundo
a Date: Monday, October 31,2016
a Hours: 4:00pm-7:00pm
0 City of El Segundo agrees to provide sound and stage.
e Any changes to dates and times will require approval from Recreation & Parks Department.
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Bobby Johnson- Jam Band - Word 9121116