19-001 Blue Eternity Trio NO.
FY2019-20
CITY OF
SHORT FORM ENTERTAINMENT AGREEMENT
CITY OF CUPERTINO
Parks and Recreation Department
CUPERTINO 10185 N. Stelling Road
Cupertino, CA 95014
408-777-3120
--USE OF THIS FORM IS ONLY VALID FOR AGREEMENTS UP TO$3,500.00--
Contractor Name: BLUE ETERNITY TRIO
Contractor Authorized Representative:JEFF OSTER
By the signature of its Authorized Representative below, Contractor hereby agrees to the following:
A. SCOPE OF SERVICES.Contractor shall provide or furnish the following specified
services and/or materials:
CONTRACTOR WILL PROVIDE A MUSIC PERFORMANCE IN ADDITION TO THE FOLLOWING:
1. PROVIDE SOUND ENGINEER, MUSICAL INSTRUMENTS, AMPS, D-BOXES, XLR CORDS FOR
INSTRUMENTS,AND ANY OTHER NECESSARY EQUIPMENT "ON THE STAGE."
2.ARRIVE A MINIMUM OF ONE AND HALF(1.5)HRS BEFORE PERFORMANCE START TIME.
3.PERFORM CONSISTENTLY FOR 2 HOURS,WITH AN INTERMISSION UP TO 15 MINUTES.
4. ACTIVELY MANAGE SOUND MIXING AND MONITORS.
5,MAINTAIN A VOLUME LEVEL NOT TO EXCEED 70 DECIBELS AT THE NEAREST RESIDENCE.
THE CITY RESERVES THE RIGHT TO LOWER VOLUME.
6.PROVIDE OWN MEALS AND WATER DURING THE EVENT.
7.WILL NOT BRING ALCOHOL OR ILLEGAL DRUGS TO THE EVENT.
THE CITY WILL PROVIDE THE FOLLOWING:
1.STAGE UP TO 12X16 FT(STAGE IS UNCOVERED,THOUGH WE AIM TO SET-UP IN SHADE).
2.ELECTRICAL POWER FROM PORTABLE GENERATOR(S).
3.UP TO FIVE (5) WIRED MICROPHONES(SHURE SM58)AND MIC STANDS.
4. (IF NOT WILLINGLY PROVIDED BY CONTRACTOR)MAIN SPEAKERS TO THE CROWD--SIX
(6) QSC SPEAKERS AND UP TO THREE(3) STAGE MONITORS.INCLUDES XLR CORDS.
5. (IF NOT WILINGLY PROVIDED BY CONTRACTOR) 16-CHANNEL DIGITAL SOUNDBOARD
(ALLEN&HEATH QU16) AND 16-CHANNEL AUDIO SNAKE(NOTE:REQUIRES XLR PLUG-INS).
Location and Time of Contractor Services:
Location: LINDA VISTA PARK LINDA VISTA DR. CUPERTINO, CA
Time: OFFICIAL EVENT TIME IS SATURDAY,AUGUST 17m, 2019 FROM 8-10PM
CONTRACTOR agrees to arrive at least one and half(1.5)prior to performance start.
B. TERM. The services and/or materials furnished under this Agreement shall be provided from
8/17/2019 to 8/17/2019.
C. COMPENSATION. For the full performance of this Agreement, the City of Cupertino shall
pay Contractor a total of$600 in a lump sum to be paid following receipt of Contractor's invoice.
D. EXHIBITS. The following attached exhibits hereby are made part of this Agreement:
Iff Exhibit"C"-Affidavit of no Employees
❑ Exhibit"D"-Contractor's Mandated Reporter Declaration if Contractor provides services to children
GENERAL TERMS AND CONDITIONS
1. Indemnification. To the fullest extent allowed by law and except for losses caused by the sole
negligence or willful misconduct of City personnel, Contractor agrees to indemnify,defend,and
hold harmless the City, its City Council, boards and commissions, officers, officials, employees,
agents, servants, volunteers and Contractors (collectively, "Indemnitees"), through legal counsel
acceptable to City, from and against any liability for damages, claims, actions, causes of action,
demands, charges, losses, costs and expenses (including attorney fees, legal costs and expenses
related t6 litigation, arbitrations, administrative and regulatory proceedings), of every nature,
arising out of or in any way related to Contractor's or Contractor's agents performance of the
Scope of Services. This includes but is not limited to liability resulting in personal injury, death,
property damage,or economic losses. Contractor must pay any costs City may incur in enforcing
this provision and must accept a tender of defense upon receiving notice from City. Contractor's
payments may be deducted or offset to cover any money the City lost due to a claim or
counterclaim arising out of this agreement.
2. General Liability Insurance: The undersigned shall maintain general liability insurance in an
amount not less than one million dollars ($1,000,000) per occurrence for bodily injury, personal
injury, and property damage. Undersigned's general liability policies shall be endorsed to
provide that City and its officers, officials, employees, and agents shall be additional insureds
under such policies.
3. Compliance with Laws. Contractor shall comply with all laws applicable to this Agreement
including, without limitation, laws regarding workers' compensation, antidiscrimination, and
conflict of interest. If Contractor has no employees an affidavit to that effect shall be attached to
this agreement. If the scope of work involves providing services to children, the City of
Cupertino, Consultant Declaration shall be attached
4. Assignment. Contractor may not assign, transfer, or subcontract this Agreement or any portions
thereof, without prior written consent of City.
5. Termination. City may terminate this agreement at any time. In the event of cancellation within
24 hours of the time Contractor is to begin providing services City shall pay contractor one half
of the total agreement amount unless cancellation occurs after Contractor's personnel have
arrived at the location where services are to be performed in which case the total contract amount
shall be paid.
6. Interest of Contractor. It is understood and agreed that this Agreement is not a contract of
employment and, at all times, Contractor shall be deemed to be an independent contractor and
Contractor is not authorized to bind the City to any contracts or other obligations in executing
this Agreement. Contractor certifies that no one who has or will have any financial interest under
this Agreement is an officer or employee of City. City shall have no right of control as to the
manner Contractor performs the services to be performed. Nevertheless,City may, at any time,
observe the manner in which such services are being performed by the contractor. Contractor
shall comply with all applicable Federal, State, and local laws and ordinances including,but not
limited to,unemployment insurance benefits,FICA laws,and the City business license ordinance.
7. Changes.No changes or variations of any kind are authorized without the written consent of the
City.
CONTRACT COORDINATOR and representative for CITY shall be:David Chen.
IN WITNESS WHEREOF,the parties have executed this Agreement effective the date last signed
below.
CONTRACTOR CITY OF CUPERTINO
Blue Eternity Trio A Munici I orporation
...
By(sign) BY
Name Name David Chen
Title etaw � Title_Community, Coordinator
Date /�y/�9 Date /
Tax I.D.No.:
APPROVALS EXPENDITURE DISTRIBUTION
PARKS AND RECREATION DATE ACCOUNT NUMBER AMOUNT
SUPERVISOR 100-62-640-700-702 $600.00
adVVr
C ATTORNEY:APPROVED AS TO FORM DATE
CITY CLERK: ATTEST DATE
March 28,2019
EVANSTON INSURANCE COMPANY
CERTIFICATE NO.: -
CERTIFICATE OF INSURANCE
SPECIAL EVENT LIABILITY PROGRAM
PRODUCER PUBLIC ENTITY(ADDITIONAL INSURED)
Alliant Insurance Services,Inc.in conjunction with Amended certificate replaces certificate issued to you on
Apex Insurance Services May 21,2019
P.O.Box 6450
Newport Beach,CA 92658
License No: OC 36861
NAMED INSURED(EVENT HOLDER): EVENT INFORMATION:
City of Cupertino,Its City Council,Boards and Commissions. TYPE: 2019 Summer Events
Officers,Officials,Employees,Agents,Volunteers and DATE(S): See attached listing
Consultants LOCATION: See attached listing
10300 Torree Ave *Liquor Liability Yes❑ No
Cupertino,CA 95798 **Liquor Liability after 12 am ends before 2 am ❑
This is to certify that the insurance policy listed below has been issued to the above insured named(event holder)for the policy
period indicated. The insurance described herein is subject to all the terms,exclusions and conditions of such policy(ies)unless
amended as described in Special Conditions.
INSURANCE CARRIER:Evanston Insurance Company
MASTER POLICY NUMBER: SEP41028
MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2019 EXPIRATION:JANUARY 1,2020
COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE
General Aggregate Limit $2,000,000
Products&Completed Operations 1,000,000 SPECIAL CONDITIONS:
Personal&Advertising Injury 1,000,000 The following endorsements attached to
Each Occurrence Limit 1,000,000 the Master Policy do not apply to this
Damage To Premises Rented To You(Any One Premises) 100,000 Certificate Of Insurance:
Medical Payments(Any One Person) 5,000 MEGL643
Liquor Liability (If purchased) 1,000,000
Optional Limits Purchased
❑ $1,000,0001$3,000,000
❑ $2,000,00052,000,000
Damage To Property(If purchased)
The limits of insurance apply separately to each event insured by this policy as if a separate policy of insurance has been issued for that event.
OTHER ADDITIONAL INSUREDS
CANCELLATION: Should the above described policy be cancelled before the expiration date thereof,notice will be delivered in accordance with the policy
provisions.
AUTHORIZED REPRESENTATIVE:
DATE ISSUED:
DATES
July 6, 9, 10, 12, 13, 14, 16, 17, 18, 20, 23, 24, 25, 26, 27, 28, 30, 31, 2019
August 1, 3,4, 6, 7, 8, 11, 17, 18, 25, 30, 31, 2019
September 6, 7, 2019
LOCATIONS
Creekside Park, 10455 Miller Ave,
Main Street Park, 19469 Stevens Creek Blvd, Monta Vista Park,
22601 Voss Ave, Jollyman Park,
1000 S. Stelling Road, Portal Park,
10225 N. Portal Ave, Three Oaks Park,
7535 Shadowhill Ln, Wilson Park,
10200 Parkside Ln, Linda Vista Park,
11097 Linda Vista Dr., City Center Amphitheater,
20350 Stevens Creek Blvd., Civic Center Plaza,
100350 Torre Ave., Library Field, 10400 Torre Ave., Cupertino, CA 95014
EXHIBIT C
AFFIDAVIT OF NO EMPLOYEES
State of California
Counhj of Santa Clara
City of Cupertino
.I, the undersigned, declare as follows:
I am an independent contractor and the owner of C.156
I wish to enter into a services contract with the City of Cupertino. I am fully aware of the
provisions of section 3700 of the California Labor Code,which requires every employer to
provide Workers' Compensation coverage for employees in accordance with the provisions
of that Code. I am also aware that I must provide proof of workers' compensation insurance
to the City of Cupertino for any and all employees I may have, pursuant to Section 12 of the
City of Cupertino's contract.
I hereby certify that I do not have any employees nor will I have any employees working for
me or my business during the term of any service contract with the City of Cupertino.I am
not required to have Workers' Compensation insurance.
I declare under penalty of perjury under the laws of the State of California that the foregoing
is true and correct. AA/
Executed on this day of2019, at , California.
444
PRINT N E
SIG A E
Form
Request for Taxpayer Give Form to the
(Rev.December2011) Identification Number and Certification requester.Do not
Department of the Treasury send to the IRS.
Intemal Revenue Service
Name(as shown on your Income tax return)
N Business name/dis7mb
tity e,If different from above
ro
a3
a Check appropriate box for federal tax classification:
0 p(1 Individual/sole proprietor ❑ C Corporation ❑s Corporation ❑ Partnership ❑Trust/estate
t?x o
❑ Umtted liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership)► Exempt payee
r
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ar_
� ❑ Other(see Instructions)►
Address(number,street,and apt.or suite no.) Requester's name and address(optionai)
Taxpayer Identification Number(TIN)
Enter your TIN in the appropriate box.The TiN provided must match the name given on the"Name"line Soclal security numbor
to avoid backup withholding.For individuals,this is your social security number(SSN).However,for a
resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other
entities,it Is your employer identification number(EIN).If you do not have a number,see Now to get a
77N on page 3.
Note.If the account is in more than one name,see the chart on page 4 for guidelines on whose Employer Identitilcation number
number to enter. F11 -1 1 1 1 ITP
97.Me Certification
Under penalties of perjury,I certify that:
1. The number shown on this form is my correct taxpayer identification number(or 1 am waiting for a number to be issued to me),and
2. 1 am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Intemal Revenue
Service(IRS)that I am subject to backup withholding as a result of a fallure to report all Interest or dividends,or(c)the IRS has notified me that I am
no longer subject to backup withholding,and
3. 1 am a U.S.citizen or other U.S.person(defined below).
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 int est and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage
interest paid,acquisition or abandon t of secured property,cancellation of debt,contributions to an individual retirement arrangement([RA),and
generally,payments other than inter s and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the
instructions on page 4.
Sign Signature of
Here U.S.person► Date►
General Instruction Note.If a requester gives you a for other than Form W-9 to request
your TIN,you must use the requester's fort if it is substantially similar
Section references are to the Internal Revenue Code unless otherwise to this Form W-9.
noted. Definition of a U.S.person.For federal tax purposes,you are
Purpose of Form considered a U.S.person if you are:
A person who is required to file an information return with the IRS must •An individual who is a U.S.citizen or U.S.resident alien,
obtain your correct taxpayer identification number(TIN)to report,for e A partnership,corporation,company,or association created or
example,income paid to you,real estate transactions,mortgage interest organized in the United States or under the laws of the United States,
you paid,acquisition or abandonment of secured property,cancellation .An estate(other than a foreign estate),or
of debt,or contributions you made to an IRA. .A domestic trust(as defined in Regulations section 301.7701-7).
Use Form W-9 only if you are a U.S.person(including a resident Special rules for partnerships.Partnerships that conduct a trade or
alien),to provide your correct TIN to the person requesting it(the
requester)and,when applicable,to: business In the United States are generally required to pay a withholding
tax on any foreign partners'share of income from such business.
1.Certify that the TIN you are giving is correct(or you are waiting for a Further,in certain cases where a Form W-9 has not been received,a
number to be issued), partnership is required to presume that a partner is a foreign person,
2.Certify that you are not subject to backup withholding,or and pay the withholding tax.Therefore,if you are a U.S.person that is a
3.Claim exemption from backup withholding if you are a U.S.exempt partner in a partnership conducting a trade or business in the United
payee.If applicable,you are also certifying that as a U.S.person,your States,provide Form W-9 to the partnership to establish your U.S.
allocable share of any partnership income from a U.S.trade or business status and avoid withholding on your share of partnership income.
Is not subject to the withholding tax on foreign partners'share of
effectively connected income.
Cat.No.10231X Form W-9(Rev.12-201 t)