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HomeMy WebLinkAbout9820 Panama LaneENCROACHMENT PERMIT CITY OF BAKERSFIELD PUBLIC WORKS DEPARTMENT 1501 TRUXTUN AVE BAKERSFIELD CA 93301 (661) 326 -3724 TO THE CITY ENGINEER OF THE CITY OF BAKERSFIELD CALIFORNIA: Pursuant to the provisions of Chapter 12.20 of the Bakersfield Municipal Code, the undersigned applies for a permit to place, erect, use and maintain an encroachment on public property or right of way as therein defined. Application Number . . . . . 17- 30000040 Date 12/27/17 Property Address . . . . . . 9820 PANAMA LN Application type description PW - ENCROACHMENT PERMIT Owner Contractor Old River & Panama, LLC OWNER 9201 Camino Media, #120 BAKERSFIELD CA 93311 (661) 885 -9406 ---------------------------------------------------------------------------- Permit . . . . . . ENCROACHMENT PERMIT Additional desc . . Phone Access Code . 2124097 Permit Fee . . . . 420.00 Issue Date . . . . 12/27/17 Valuation . . . . 0 Expiration Date . . Qty Unit Charge Per Extension 1.00 420.0000 EA PW ENCROACHMENT 420.00 ---------------------------------------------------------------------------- Special Notes and Comments December 27, 2017 8:14:39 AM mmendenhal. Place a temporary 6' high chain link construction fence on the south side of Panama Lane approximately 12' back from edge of pavement between Old River Road and Mountain Vista Drive for approximately 6 months. (Fence has already been placed here) Contact person: Matt Wade 706 -8109 December 27, 2017 9:29:10 AM mmendenhal. Applicant acknowledges-the- rlqht -of the -City -Engineer,, pursuant- to- the Bakersfield Municipal Code Chapter 12.20 to ee summ r1� Cha ged Paid Credited --- -Due -- revoke tli��e[171I�it;�J1y time________ __ __ _ _ _ ___ ____ ______ Per "It Fee Total 420.00 420.00 .00 .00 /7 Gr Total 20. 42 .00 .00 ,/ xp0/ (,[ / )�177-4 Signat a of Applicant (O er /Agent) Print Name I HEREBY CERTIFY THAT I HAVE MADE AN INVESTIGATION OF THE FACTS STATED IN THE FOREGOING APPLICATION AND FIND THAT THE MAINTENANCE OF SAID ENCROACHMENT (1) WILL (NOT) SUBSTANTIALLY INTERFERE WITH THE USE OF THE PLACE WHERE THE SAME IS TO BE LOCATED AND (2) WILL (NOT) CONSTITUTE A HAZARD TO PERSONS USING SAID PUBLIC PLACE; SAID APPLICATION IS THEREFORE (GRANTED) (DENIED) _Said permit shall expire on date stated above. Signature of City Engineer Additional Terms on the Back ENCROACHMENT PERMIT APPLICATION FORM o CITY OF BAKERSFIELD PUBLIC WORKS DEPARTMENT J 1501 TRUXTUN AVE t'� BAKERSFIELD CA 93301 ALIFO (661) 326 -3724 Fax: (661) 852 -2012 LOCATION OF ENCROACHMENT(Address required where available): Southwest corner of Panama Lane and Old River Road If there is no address adjacent to work describe limits of work by distances from nearest existing street intersection. APPLICANT INFORMATION FULL NAME OF APPLICANT Old River & Panama, LLC COMPLETE ADDRESS: 9201 Camino Media. #120 PHONE: 661- 885 -9406 Bakersfield, California 93311_ FAX: PROJECT INFORMATION 661- 885 -9411 661-706-8109 DESCRIPTION OF ENCROACHMENT (Example: Wood or wrought iron fence, concrete block wall, raised planter, etc.): There is a temporary construction fence located on the south side of Panama Lane and is currently in the City's right of way. We are asking for permission to encroach on City's right of way so the temoorary fence does not have to be relocated. i t PERIOD OF TIME FOR ENCROACHMENT: INDEFINITE OTHER: Temporary (Please Circle) CONTACT PERSON Matthew Wade PHONE: 661 - 706 -8109 Applicant agrees that if this application is granted, applicant shall indemnify, defend and hold harmless the City, its officers agents and employees against any and all liability, claims, actions, causes of action or demands, whatsoever against them, or any of them, before administrative, quasi-judicial, or judicial tribunals of any kind whatsoever, arising out of, connected with, or caused by applicant's placement, erection, use (by applicant or any other person or entity) or maintenance of said encroachment. The applicant further agrees to maintain the aforesaid encroachment during the life of said encroachment or until such time that this permit is revoked. Applicant further agrees that upon the expiration of the permit for which this application is made, if granted or upon the revocation thereof by the City Engineer, applicant will at his own cost and expense remove the same from the public 12rol2= or right of way where the same is located, and restore said public property or right of way to the condition as nearly as that in which it was before the placing, erection, maintenance or existence of said encroachment. Applicant further agrees to obtain and keep all liability insurance required by the City Engineer in full force and effect for however long the encroachment remains. Applicant shall furnish the City Risk Manager with a Certificate of insurance evidencing sufficient coverage for bodily injury or property damage liability or both and required endorsements evidencing the insurance required. The type(s) and amount(s) of insurance coverage required are: Residences: Homeowners General Liability coverage in an amount of at least $300,000.00 Commercial: Commercial Liability coverage in an amount of at least $1,000,000.00 The Commercial Liability policy must identify City and City's mayor, council, officers, agents, employees, and designated volunteers as Additional Insureds. Encroachment Permit Fee: $420.00 S :IPFRMITS\ENCROACH\Encroachment Permit Req FOrm.DOC Aug. 2016 i d J .rte. �a jl ii M� LO 9 W H H f� Y ' Z J Z Q U W W N F- u. ap v H � � U a) LL c O V i r i ]yam R ° r a 'A- Alm. . eL Lf- CN +•+ • • s_lJ�.�rwiF y�•Z.+�w.+w�f "t l _ • •.�./•yti' y •_r J•.' w Alm ^I -It - C7� .•t' s. 'sr 3i .. __.�° -tee r�- _ .. .. �aK -4- � 9685 Panama Ln - Google Maps Go. gle Maps 9685 Panama Ln Ow- -7!" j Bakersfield, California Google, Inc. Street View - Jul 2015 ?9820 Panama Lai Page I of 1 Image capture: Jul 2015 0 2017 Google https: / /www.google.comlmaps / @3 5. 2961895, - 119 .1107265,3a,60y,309.66h,82.54t /data =... 12/27/2017 MCINTOSH AssocIATES� LAND SURVEYING - CIVIL ENGINEERING 2001 WHEELAN COURT BAKERSFIELD, CA 93309 661- 834 -4814 - FAX 661 - 834 -0972 e -mail — mcengr4mcintoshassoc.com 10: COB PUBLIC WORKS ATTN: MICHELLE MEDENHALL LETTER OF TRANSMITTAL Date: 12 -15 -17 Job No: ]3-077 TRACT 6536 ENCROACHMENT PERMIT WE ARE SENDING YOU: ® Enclosed Via: MESSENGER the following items: ® APPLICATION FOR ENCROACHMENT PERMIT SWC OF PANAMA AND OLD RIVER ROAD COPIES DATE NO. DESCRIPTION 1 12 -15 -17 ENCROACHMENT PERMIT APPLICATION I AERIAL PHOTO OF PERMIT AREA 1 12 -14 -17 CHECK #001171 $420.00 FOR APPLICATION FEES INSURANCE CERTIFICATE ON FILE WITH CITY OF BAKERSFIELD THESE ARE TRANSMITTED as checked below: PLEASE CONTACT BLAINE NEPTUNE WITH QUESTIONS OR COMMENTS:834 -4814 EXT 109 bneptune c ,mcintoshassoc.com COPY TO: Roger McIntosh Matt Wade SIGNED: Blaine Neptune P: \PROJECTS\] 3077.00- T6536\LTRS \Out\EnchPmt temp Const WL Panama -Old River APP COB.docx City of Bakersfield Public Works Dept. 1501 Chester Ave. Bakersfield, CA 93301 I hereby authorize McIntosh & Associates to act as our agent in the processing of all necessary applications and permits for Tract 6536. The proposed project is located in the northeast quarter of Section 30. T S., R. 27E M.D.M. in the County of Kern, State of California. Old River & Panama, LLC MR ��c> Title Print Name Date A ® DATE (MM DD VYVY) CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Ryan Crosby AX PHONE Crosby and Crosby Insurance Service A'C No. Ext : Off: 6613275531 (A/C, No): 6613273153 I I 1 "H" Street ADDRESS: ryan icrosbyandcrosby.com Bakersfield INSURED CA 93304 URBAN l -AND ADVISORS. LLC: Old River S Panama, LLCfl"ract 6536 9201 Camino Media. Suite 120 13AKERSFIELD CA 93311 INSURER(S) AFFORDING COVERAGE INSURER A: TRAVELERS CAS INS CO OF AMER INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, FXCI I ISIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NAIC # 19046 INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY h" (MM /DD/YVYY) U (MM;DD,YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR 680816OX63A 10/01/2017 10/01/2018 EACH OCCURRENCE $ 2,000,000 PREMISES (Ea occurrence) S 300.000 MED EXP (Any one person) $ 25,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ PRO- ❑ JECT LOC OTHER: GENERAL AGGREGATE $ 4,000,000 PRODUCTS - COMP /OPAGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON OWNED HIRED AUTOS AUTOS (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Per accident) $ A X UMBRELLALIAB EXCESS LIAB X OCCUR CLAIMS -MADE 680816OX63A 03/01/2017 03/01/2013 EACH OCCURRENCE $ 5,000.000 AGGREGATE $ DED RETENTION$ $ ORKERS COMPENSATION ND EMPLOYERS' LIABILITY Y / N NY PROPRIETOR /PARTNER/EXECUTIVE a FFICER'MEMBER EXCLUDED? Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A STATUTE I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) re: "Tract 6536" The City of Bakersfield, its mayor, council, officers, agents, employees and volunteers are named as Additional Insureds as respects to all operations of the Name Insured. Coverage includes blanket waiver of subrogation. RTIFICATE HOLDER City of Bakersfield 1501 TrUxtun Avenue Bakersfield, CA 93302 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014 01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER:680816OX63A COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Narne Of Additional Insured Person(s) Or Organization(s): Locations Of Covered Operations The City of Bakersfield, its Mayor, Council, Officers, Tract 6536, Bakersfield, CA Agents, Employees and designated Volunteers. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 ❑ POLICY NUMBER: 680816OX63A COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: The City of Bakersfield, its Mayor, Council, Officers, Agents, Employees and Designated Volunteers I Information required to complete this Schedule, if not shown above will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard ". This waiver applies only to the person or organization shown in the Schedule above. O M co M CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ TO: FROM: DATE: SUBJECT: L> _\, h E R F I E L D PUBLIC WORKS DEPARTMENT MEMORANDUM Jena Covey, Risk Manager Michelle Mendenhall, Engineering Technician I December 27, 2017 Encroachment Permit Application for 9820 Panama Lane Name of Applicant: Old River & Panama, LLC Description of Encroachment: Temporary 6' chain link construction fence located 92' back from edge of pavement Please review the insurance certificate with the attached encroachment permit and return to me at your earliest convenience. S: \PERMITS \ENCROACH \INSURANCE \9820 PANAMA LN T6536.doc L _A� I_: R S F I E i- Z> PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Ed Murphy, Engineer III FROM: Michelle Mendenhall, Engineering Tech I DATE: December 27, 2017 SUBJECT: Encroachment Permit Application for: 9820 Panama Lane Name of Applicant: Old River & Panama, LLC Description of Encroachment: Temporary 6' chain link construction fence located 92' back from edge of pavement Please review the attached encroachment permit and return to me at your earliest convenience. S: \PERMITS \ENCROACH \TRAFFIC \9820 PANAMA LN T6536.doc