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HomeMy WebLinkAbout11200 LAKE MING RDENCROACHMENT 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, erec4 use and maintain an encroachment on public property or right of way as therein defined. Application Number . . . . . 11- 30000001 Date 1/28/11 Property Address 11200 LAKE MING RD Application type description PW - ENCROACHMENT PERMIT Oscar contractor ------------------ - - - - -- ------------------------ CAVV ROOD PROP PROJECP 1 LLC GOLD 3TAR 9846 LORENE LN STE E 13061 STOCKDLAE HWY SAN ANTONIO It 98216 SUITE G -212 EAAERSFIELD CA 93314 (661) 281 -6107 -------------------------- ------------------------------------------------- Permit . . . ENCROACHMENT PERMIT Additional desc . . Phone Access Code . 1070234 Permit Fee . . . . 208.00 Issue Date . . . . 1/28/11 Valuation . . . . 0 Qty Unit Charge Per Exteneiwv EASE PEE 208.00 ---------------------------------------------------------------------------- Special Notes and Comments Constructing appruc 700 if of 40" high block wall along Lake Ming Rd. TR 6850 Eugene Winter 331 -2758 __ __---- - - - - -- Pee summary Charged Paid Credited nue ----------- - - - - -- ---- - - - - -- ---- - ----- ---- - - - - -- ---- - --- -- Permit Fee Total 208.00 208.00 .00 .00 Grand Total 208.00 208.00 .00 00 Applicant acknowledges right of the City Engineer, pursuant to the Bakersfield Municipal Code Chapter 12.20 to revoke the per(([A/mjit at any time. 1 , �1n...w. A.d t- ei'rexne Q.I�rt' 1'(J Signao6 of Applicant (Owner /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 �2 B A K E R S F I E L U Public Works Department 1501 Truxtun Avenue Bakersfield, California 93301 (661) 326 -3724 APPLICATION FOR ENCROACHMENT PERMIT - Permit Fee $208.00 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 define d.. 1, Full name of applicant and complete address including phone number:. iSfN --D. 7TA2rZ. 6*i, iM-tJf%T1Dfi lot, j3Efn1 ti ikG,1.q .s"rf, t37211 't` LC;'P_. �162L� 1: C_6 173�-1j ®= !:(ol-2i3l-tu lo7 E- 2. Nature or description of the encroachment for which this application is made: (Example: Wood or wrought iron fence, concrete block wall, raised planter, etc... 1 ) 3. Location of proposed encroachment: (Example: Side yard of back of sidewalk or front yard at back of sidewalk) (� 2,r) 0 L-A ce 'A( n vl IZD" - '7rM lk, e'_W 4. Period of time for which the encroachment is to be maintained: I efim a or Other. lease Circe) 5. Is property part of a Homeowner's Association as No 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 or right of way to the conoltlon as nearly as that in which it was before the placing, erection, maintenance 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 evidenc- ing the insurance required. The type(s) and amount(s) of insurance coverage is: Applicant acknowledges the right of the City Engineer, pursuant to Bakersfield Municipal Code Chapter 12.20 to revoke the permit at anytime. SEncmachmentPemits W pplicationforEncmachment ACORD CERTIFICATE OF LIABILITY INSURANCE oi28 /2011 PRODUCER 661.616.4700 FAX 661..616.4500 TWIW Insurance Services, LLC - 8DE52073 5001 California Avenue Ste 150 Bakersfield, CA 93309 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAICR INSURED Gold Star Construction, Inc. 13061 Rosedale Hwy G 212 Bakersfield, CA 93314 INSURERA. American Safety Ins INSURER B'. Praetorian Ins CO INSURER O: INSURER D: MEURER E: COVERAGES 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID GI-AIMS. INS. AU GR TYPE OF INSURANCE POLICY NUMBER POIICYEFFECTNE POLICYEXPWATION 07/07/2011 LIMBS GENERAL LIABILITY ESLO199861003 07/07/2010 EACH OCCURRENCE $ 1,000,00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,00( CLAIMS MADE OOCDUR MEDEXFIAny OPepe,50n) $ Exclude A PERSONAL& ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00[ SELL AGGREGATE LIMIT APPLIES PER PRODUCTS- COMP /OPAGG $ 2,000,00 --] IS CT POLICY PRO LOG AUTOMOBILE LIABILITY ANYAUTO PICCA0001485 07/25/2009 07/25/2010 CDMBINEOSWGLEUMn IE98ttiUCM) $ 1,000,00C BODILY INJURY (Per pa�awl $ B ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON. OWNED AUTOS X X r PAM.") I I $ X. Physical Damage % PROPERTY (Per awdent) DAMAGE $ GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO I $ AUTO ONLY AGG EXCESSNMBRELLA LNBWTY EACHOCCURRENCE $ OCCVR 0PIGS MADE AGGREGATE $ g DEDUCTIBLE $ RETEN90N $ WORKERS COMPENSATION AND WC STATLL OTW EMPLOYERS' LIABILITY ANY PROPPIETOR /PARTNEN/EAMECUTIVE OFFICERAIEMBER EXCWOEDP v S.— See, SPECenn IAL PROVISIONS Below EL EACH ACCIDENT $ EL DISEASE - EA EMPLOYER $ SAL DISEASE v POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/ LOCATION. I VEHMLEB/ EXCLUSIONS ADOEO BY ENDORSEMENT / SPECIAL PROVISIONS Gb: Installation of block wall on Lake Ming Rd in conjunction with TTM6850. ONLY WHEN REQUIRED VA SIGNED. WRITTEN CONTRACT IS: The City of Bakersfield, its Mayor, Council., Officers, Agents, Employees & Volunteers named as additional insured as respects the operations of the amed insured on their behalf. Endorsement kES98 015 05 08 0 day notice of cancellation will be sent for non payment of premium. CERTIFICATE D SHOULD My OF THE ABOVE DESCRIBED POLICIES BE CAMOELLEO BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL City of Bakersfield 30 DAYCWRRTENNOTICE TOTHE CERDFlCATE HOLDER NAMEOTO THE Col. Public Works Department BUT FA,LURETO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 1501 Truxtun Ave OF MY KIND UPON THERISURER, ITS AGENTS OR REPRESENTATIVES. Bakersfield, CA 93301 AUTHORRED REPRESENIATVE Shaun Kell SHERID �Y'"• —T11 ACORD 25 (2001/08) © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), . authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, eMend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108) Vfj THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.. ES 98 015 05 08 ADDITIONAL INSURED ENDORSEMENT — OWNERS, LESSEES OR CONTRACTORS (MODIFIED FORM 6) This Endorsement shall not serve to increase our limits of insurance, as described in SECTION III - LIMITS OF INSURANCE. Name of Person or Organization: Project owners or general contractors, if other than a named insured, as well as their directors, officers and employees where required to be named as an Additional insured in a written contract with the Named Insured entered into prior to the loss or occurrence. Effective Date: The later of the effective date of this policy or the date on which "your work" first started on the applicable project for which this Endorsement applies, but in no event later than the policy expiration date or applicable earlier termination date of this policy. In consideration of the payment of premiums, it is hereby agreed that the following changes are incorporated into the policy: WHO IS AN INSURED (SECTION ll) is amended to include as an insured the person or organization shown above, but only with respect to defense and liability arising out of "your work." This endorsement applies only to ongoing operations performed by the Named Insured for the Additional insured on or after the effective date of this Endorsement. Coverage under this Endorsement applies only as respects a legally enforceable written contract with the Named Insured and only for defense and liability arising . out of or relating to the Named Insured's sole negligence and only for "bodily injury" or "property damage" caused by an "occurrence" under Coverage A not otherwise excluded in the policy to which this Endorsement applies. If this policy includes a self- insured retention or deductible endorsement, such endorsement shall apply and affect our obligations pursuant to the policy. It is further understood and agreed that irrespective of the number of entities named as insureds under this policy in no event shall the Company's limits of liability exceed the limits of liability designated in the Declarations. All other terms, conditions . and exclusions under the policy are applicable to this Endorsement and remain unchanged. ES 98 015 05 08 Copyright© 2008 American Safety Indemnity Company Page 1 of 1 wv,w.amsafely.com THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ES 98 10 10 04 PRIMARY INSURANCE This Endorsement shall not serve to increase our limits of insurance, as described in SECTION III - LIMITS OF INSURANCE. Name of Person or Organization: Project owners or general contractors, if other than a named insured, as well as their directors, officers and employees requiring primary wording and additional insured status inawritten contract with the Named Insured entered into prior to the loss or occurrence. Effective Date: The later of the effective date of this policy or the date on which "your work" first started on the applicable project for which this Endorsement applies, but in no event later than the policy expiration date or applicable earlier termination date of this policy. In consideration of the payment of premiums, it is hereby agreed that the following changes are incorporated into the policy: It is agreed that such insurance as is afforded to the person or organization named above as Additional Insured under the applicable Additional Insured Endorsement attaching to this policy shall be considered primary to such person or organization if other valid and collectible insurance is available to such person or organization for a loss or occurrence we cover for such person or organization, but only as respects liability arising out of "your work" performed by the Named Insured for the person or organization named above. This Endorsement applies only to: 1. Ongoing operations performed by the Named Insured on or after the effective date of this Endorsement; 2. Liability arising out of or relating to the Named Insured's sole negligence; and 3. "Bodily injury" or "property damage" caused by an "occurrence" under Coverage A not otherwise excluded in the policy to which this Endorsement applies. All other terms, conditions and exclusions under the policy are applicable. to this Endorsement and remain unchanged. ES 98 10 10 04 Copyright© 2004 American Safety Indemnity Company Page 1 of 1 www.amsafety.com