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HomeMy WebLinkAbout1623 19TH ST.ENCROACHMENT PERMIT p4wBA..,�R CITY OF BAKERSFIELD d PUBLIC WORKS DEPARTMENT 1501 TRUXTUN AVE C® BAKERSFIELD CA 93301 IFO N� (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 . . . . . 12-30000011 nate 3/26/12 Property Andre es 1623 19TH ST Application type description PW - ENCROACHMENT PERMIT Owner Contractor HAMILTON MARK OWNER 3857 STOCKDALE HN BAAERSFIELO CA 93309 Perms[ . . . ENCROACHMENT PERMIT Additional desn . . Phone Access Cade . 1185024 Permit Fee . . . 'toy .00 Issue Data . . . . 3/26/12 Valuation . . . . 0 ---------------------------------------------------------------------"__."__ Special Notes and Comments March 26, 2012 12:00:16 PM mendenhal. Build w ought i n fence with ..i., in front of restaurant. Contact person: Mark Hamilton - 661-599-0407 Fee summary charged Paid Credited Dun Permit Fee Total nO .0o ;>O .Q .0o .00 .00 Grand Total .00 .00 .00 .00 Applicanra knowledges �?ight of the City Engineer, pursuant to the Bakersfield Municipal Code Chapter 12.20 to revoke a permit at any, ime. Signaturf of Applicant (Ow -n6 en 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) CO UTE A HAZARD TO PERSONS USING SAID PUBLIC PLACE; SAID APPLICATION IS THEREFO'yRp`E NT ) (D D) Said permit shall expire on date stated above. Siglature of Cityeer Additional Terms on the Back CITY OF BAKERSFIELD - PERMIT RIDER PUBLIC WORKS DEPARNIENT 1501 TRU%TUN AVENUE, BAKERSFIELD, CA 93301 (661)326-3724 INSPECTION 326-3049 To be attached to and made part of: APPLICANI LOCATION DATE /t� - !�� , 2 I�No.M� ❑ Transportation Permit. No. _ In response to your request of /0. �2 3 , 20 14— we hereby amend the above numbered permit as follows: Date of expiration extended to: 11r-� A1 10/ i) / Description of work changed to: ADS, 61 Li'- 4 LN Except as amended, all other terms and provisions of the original permit shall remain in effect. This rider must be attached to the original permit. APPROVED BY: Raul Rojas yy CITY ENGINEER BY f-- DEPUTY Rider Fee $ U L2 Other Fee $ Total $ White -Applicant Yellow -Public Works Pink -Construction PP 12101 From Janice Dehl FaxID:Clifford Bradford Page 2 M6. Data 3272012 03:05 PM Page:2 of 6 THEMA-2 OP 10: JD 4Lcorro CERTIFICATE OF LIA131LITY INSURANCE OAT 60 3/27312071WYY' !12 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 SETWEEN 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 I6 WAIVED, subject to the terms and ...dltions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s). PRODUCER 661-283- Clifford& Bradford Ins Agency 6100 1S1620th Street 661-283-8111 B IDENIFleld, CA 93301 Justin Garant COST NAMe Janice Diehl PBOHNEE EM.861-283-8100_ Iwa xe•661-283-B111__ Hotness: dish) cliffordandbradford.com --- OENeaKLIABILITY INBURW eI AFFORDIND GOVEHADE AICS INEURERA: Peerless Insurance Dompa�.__ 24198 INSURED The Mark Restaurant LLC INSUB UB 8: Golden Eagle Ins. Corp. 10836 The Mark Real Estate LLC 1779 Missouri Street INSURESeo p MISE J--,_ MEDEXP(AnysePmwN San Diego, CA 92109 A INSURERS: INSURER CBPI030801 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTLVITHSTANOING 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 P BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN. MAY HAVE BEEN REDUCED BY PAID CLAIMS. L jq il ttPE OF INSUPANCE PUBLIC WORKS DEPARTMENT POLTINICI ICA Mao"VY MMIDOMNV OMIi9 OENeaKLIABILITY EACH OCCURRENCE I 1,6Bg,O0 p MISE J--,_ MEDEXP(AnysePmwN 9 106,606 5 5,00 A X COMMERCIAL GENE.�LIABILITY CWjMS,MACE XI OCCUR CBPI030801 01/29112 01127113 FRSOXN.eAOVINGONY5 1,000;00 X NOA/HA GGSGNAI. AGGREGATE B.__2,000,00 GENLAGGBEOATEnMITAPPLIEe PER: PRODUCTS-COMPIOPACG ; 2,000,00 POLICY PRO LOC Ia AUTOMOBILE LMBILITY dvan"WiryffarET air U.—.1, ---- 5_____T__ _ BODEYBDURYSASCHIMV S ANYAUm ALL OWNEDacXEOULEO AUTOS AUTOS pDOILYINInRV (PmeNMnn a ISH.AUTOE XOXaWNEa ALTaR ND -H., AMFGE -L_ssd.L--_,. q. S \' UIVEREWI LIAR X OCCUR EACH OCCURRENCE S 1,000,00 B @xisaS LIAR CON... G CU0E94641 01/27112 01/27113 ADOREOATE 4 1,000,00 OED X RETENTIONS 10000. COPIPrd s 1,000,00 WORHERBCOMPENSATION WC STAT0. OTR. ANDEMPLOYERB•IIUMIY YO ( CRYUM fL. EACH Accl .1 CEAu PROPACaGNGLCWOw CURVE NIA LOISEASE-FAEMPLOYE a (Massaxis, In NH1 IIy v, tlevmEavnYvr OESGIPRON OF OPERATION. T.— E,L.DISEASE-POLICY LIMIT S ION bP OPERATIONS! LOCATIONS / VEHICLE. @IYCFAEONDtOf,AONUonv1 RvmvN ECM1VCUIv, ITmy vepvcviv nqulnEl the Ci(l.v�Of Bakersfield It's mayor, council , officers,aSanta , employoea and volunteers ere included as eddigonal insured per adaeh.d. endorsement REFERENCE: ENCROACHMENT PERMIT HM PER CITYBAI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF BAKERSFIELD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE. POLICY PROVISIONS. PUBLIC WORKS DEPARTMENT ATTN: TRISH 1716 CHESTER AVENUE BAKERSFIELD, CA 93301 AUTHORIZED REPRESENTATIVE ®1988-2010 ACORD CORPORATION. All right° reserved. ACORD 26 (2010/05) The ACORD name and logo ere registered marks ofACORD From:Jaaioe Dahl FaADClWord Bradford Page 3of6 Date M7 01203:06 PM Pages of THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL LIABILITY GOLD ENDORSEMENT This endorsementmDdfles insurance provided underthe following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SECTION I—COVERAGES COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY 2. Exclusions Item2.g. 2) isrepiacedw0hthefollovang: 2:g. 2) A watercraft you do not own that is: a) less than 50 feet long; and b) Not being used to carry persons or property for a charge. Item 2.9:6) Is added: 6) An aircraft in which you have no ownership interest and that you have chartered with crew. The last paragraph of 2. Exclusions is replaced with thefolbwing: Exclusions c. through n. do not apply to damage by Ore, explosion, sprinkler leakage, or lightning to premises while rented to you, temporarily occupied by you with the permission of the owner, or managed by you under a: written agreement with the Owner. A separate limit of Insurance applies to this Coverage as described in Section III — Limits of insurance. SECTION I—COVERAGES COVERAGE C. MEDICAL PAYMENTS If Medical Payments Coverage is provided under this policy, the following is changed: 3. Units The medical expense limit provided bythis policy shall bathe greater of. a. $10,000; or b. The amount shown in the declarations. Coverage C. Medical Payments is primary and riot contributing with any other insurance, even if that other Insurance is also primary. The following is added: COVERAGE D. PRODUCT RECALL NOTIFICATION EXPENSES Insuring Agreement We will pay -product recall notification expenses" incurred by you for the withdrawal of your products; provided that: a. Such withdrawal is required because of a determination by you during the policy period, that the use or consumption of your products could result in "bodily injury' or "property damage"; and b. The"product recall notification expenses"are incurred and reported to us during the policy period. The most we will pay for "product recall rtotRcalion expenses' during the policy period is $100,000. SUPPLEMENTARY PAYMENTS —COVERAGES A AND B Item b. andel. are replaced with: b. The war of bail bands required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. d. All reasonable expenses incurred by the insured at Our request to assist. us in the investigation or defense of the claim or "sur including actual loss of earnings up to $600 a day because of time off from work. Incidas copyrighted metedal off nsurance services Parcae I.., sith its pennisalon. GECG 602 (O7/it) Page 1 c44 NNta'rA0231ot INSUREDCOPY 0VPRm2 tcooeot PGDM000p none OOme]63 Paae 133 From: Janice DieEl Fa,10 Clirford Bradford Page 4 of Date:M7,201203:06 PM PageA of SECTION II —WHO IS AN INSURED Item 4, is replaced with: 4. Any subsidiaries, companies, corporations, firms, or organizations you acquire or form during I period over which you maintain a controlling Interest of greater than 50% of the stock or assets, wit a Named Insured it: a} you have the responsibility of placing insurance for such entity; and b) coverage for the entity is not otherwise more specifically provided; and C) the entity is incorporated or organized under the laws of the United States of America. However, coverage under this provision does not apply to "bodily injury' or 'property damage" that before you acquired or formed the entity, or 'personal injury" or "advedising injury" arising out of a committed before you acquired or formed the entity. Coverage under this provision Is afforded only until the end of the policy period, or the twelve 1 anniversary of the policy Inception date whichever is earlier. SECTION 111—LIMITS OF INSURANCE Paragraph 21s amended to Include: The General Aggregate. Limit of Insurance applies separately to each 'location* owned by you, rented I occupied by you with the permission of the owner. Paragraph 6. is replaced with the following: 6. Subject to 5. above, the Fire Damage Link is the most we will pay under Coverage Afor damages til 'Property damage' to premises while rented to you, temporarily occupied by you with permission of 11 or managed by you under a written agreement with the owner, arisingout of any one fire, exp sprinkler leakage Incident. The Fire Damage Limit provided by this policy Shall be the greater of: a. $500,000; or b. The amount shown in the Declarations. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS Item 2. a. is replaced with: 2. Duties In The EVem of Occurrence, Offense, Clain orSuft a. You must promptly notify us. Your duty to promptly notify us is effective whenany of your officers, partners, members, or legal representatives Is aware of the "occurrence", offense, claim, Knowledge of an'occurrence , offense, claim of "suit- by other employee(s) does not Imply you t such knowledge. To the extent possible, notice to us should include: 1) How, when and where the "occurrence, orcifensetook place; 2) The names and addresses of any injured persons and witnesses; and 3) The nature and location of any injury or damage arising out of the "occurrence"; offense, "suit'•. Item 4. b. 1) b) is reputed with: b. Excesslnfuranoa 1) bJ That Is Fire, Explosion or Sprinkler Leakage Insurance for premises whits rented temporarily occupied by you with permission of the owner, or managed by you under agreement with the owner; or Item 6. is amended to include: S. .Representations d. If you unintentionally fail to disclose any hazards existing at the inception date of your policy, w deny coverage under this Coverage Pad because of such failure. However; this provision does I our right to collect additional premium or exercise our right of cancellation or non -renewal. Includes copyrighted material of imumnea services OXicec Inc., with Its permission. GECG 602 (01111) Pa Otrd42pi2 1060901 NN1ereT2 3101 INSURED COPY t PODNOfAD J21870 _ OOAOPPN 00018r1 From:Janice Diehl FaxlD:Clifford Bradford Page 5 of Dats=7=1203:06 PM Pagers of Item 8. is replaced with: B. Transfer of Rights Of Recovery Against Others To Us 8. If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The Insured must do nothing after loss to Impair them. At our request, the insured will bring suit or transfer those rights to us and help us enforce them. M If required by a written 'insured contract, we waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of your ongoing operations or 'your work' done under that written "insured contract' for that person or organization and. included in the products-wmplated operations hazard". Item 10. and Item 11. are added: 10. Cancellation Coreiflon If we cancel this policy for any reason other than nonpayment of premium we will mall or deliver written. notice of cancellation to the first Named Insured at least 60 days prior to the effective date of cancellation. 11. tibermaaatlon If we adopt a change in our forms or rules which wouldbroaden your coverage without an extra charge, the broader coverage will apply to this policy. This extension Is effective upon the approval of such broader coverage in yourstate. SECTION Y— DEFINITIONS The following definitions are added or changed: 9. "Insured contracr a. Is changed to: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fro, explosion or sprinkler leakage to premises while rented to you, or temporarily occupied by you with permission of the owner, or managed by you under a written agreement with the owner is not an.Nnsured contract". 23 and 24 are added: 23.-Locailon' means premises Involving the some or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. 24. 'Product recall notification expenses' means the reasonable additional expenses (including, but not limited to, cost of correspondence, newspaper and magazine advertising, radio or television announcements and transportation cost), necessarily incurred In arranging for the return of products, but excluding costs of the replacement products and the cash value of the damaged products. T following Provlslons are also added to this Coverage Par: A. ADDITIONAL INSUREDS— By CONTRACT, AGREEMENT OR PERMIT 1. Paragraph 2. under SECTION 11— WHO IS AN INSURED is amended to include as an insured any person or organization when you and such person or organization have agreed in writing in a contract, agreement or permit that such person or organizatiodbe added as an additional insured on your policy to provide insurance such as is afforded under this Coverage Part. Such person or organization is not entitled to any noticas that we are required to send to the Nomad Insured and is an additional insured only with respect to liability arising out of: a. Your ongoing operations performed for that person or organization; or b. Premises or facilities owned or used by you. With respect to provision 1.e.. above, a person's or organization's status as an Insured under this endorsement ends when your operations for that person or organization are completed. With respect to provision 1.b. above, a person's or organization's status as an insured under this andorsemend ends when their contract or iggfeement with you forsuch premises or facilities ends. Ied.d. copyrigNoil malaHal of Irrsumnee Sorvkeo Oise. Ines, WM IIs p ege.sien. GECG 602 (01111) Page 3 of 4 01,gg m2 e2 3101 INSURED COPY toaawt NNfalb PGOM080p J21810 GCAOPPN OOefS188 Paf1e. 136 From:Janice Dehl FaxID:Clieord Bradford Page 6 orb Date:3292012 03:06 PM Page:6 of 6 2. This endorsement provision A. floes matapply; a. Unless the written contract or agreement has been executed, or permit has been issued, pn� "bodily injury", "properly damage" or "personal and advertising injury"; b. To "bodily injury' or *property damage' occurring after: (1) All work, including materials, pans or equipment furnished in connection with such wor project (other than service, maintenance or repairs) to be performed by or on paha additional Insured(s) at the site 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 I use by any person or organization other than another contractor or subcontractor eirl performing operations for a principal as a part of the same project: c. To the rendering of of failure to reider any professional services including, but not limtec professional architectural, engineering or surveying services such as: (1) The preparing, approving, or falling to prepare or approve, maps, shop drawings, r reports, surveys, field orders, Change orders or drawingsand specifications; and (2) Supervisory, Inspection, architectural or engineering activities; d. To "bodily injury", "property damage" or'pr monal andadvertising injury' arising out of any r or omission that results from the additional Insured's sole negligence or wrongdoing; a. To any person or organization Included as an insured underprovislon a ofthis endorsement; f. To any person or organization specifically designated an additional Insured for ongoing operi a separate AUDIT IONAL INSURED — OWNERS, LESSEES OR CONTRACTORS endc issued by us and made a part of this policy. B. ADDITIONAL INSURED—VENDORS Paragraph 2. under SECTION II — WHO IS AN INSURED is amended to include as an insured arty p organization (referred to below as "vendor") with whom you agreed, in a written contract or agrer provide insurance such as is afforded under this policy, but onlywith respect to 'bodily injury' or' damage" arising out of "your products" which are distributed or sold in the regular course of the business, subject to the following additional exclusions: 1. The insurance afforded the vendor class not apply to: a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by n the assumption of liability in a contract or agreement. This exclusion does not apply to Iii damages that the vendor would have in the absence of the contract or agreement; b. Anyexpress warranty unauthorized by you; C. Any physical or chemical charge In the product made intentionally by the vendor; d. Repackaging, unless unpacked solely for the purpose of Inspection, demonstration, I& substitution of pads under instructions from the manufacturer, and then repackaged In the container; e. Any failure to make such Inspections, adjustments, tests or servicing as the vendor has al make or normally undertakes to make in the Course of business, In connection with the distrit sale of the products; E Demonstration, installation, servicing or repair operations, except such operations perforate vendor's premises In connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or us, Container, part or Ingredient of any other thing or substance by or for the vendor; or h. To "bodily injury' or "property damage arising out of any ad, error or omission that results'. additional insured's sole negligence or wrongdoing. 2. This Insurance does not apply to any insured person or organization, from whom you have acquit products, or any Ingredient, part or container, entering into, accompanying or Containing such box Includes copyrighted material of Insurance Semces Mas Inc., with Its permission. GECG 662 (61111) 01192012 1030801 141,1191902 3101 INSURED COPY PGDMOfiOD J21M GCAOPPN J s .2 13 A h' E R S F 1 E L D 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 defined. 1. Full name of applicant and complete address including phone number: /✓fA(LK- WA Mt -no .� 1623 Iq`5-; 3ks Fr -n CA 713301 kot 549-0407 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...) w1z,0V(1rr 129n1 Fri -NCE Win+ 3. Location of proposed encroachment: (Example: Side yard at back of sidewalk or front yard at back of sidewalk) Nr— or - 4. Period of time for which the encroachment is to be maintained' or Other. 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 N or rigor of way where me same Is located, and restored said public property or right of way to me condition as. 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 coveragefor 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: G F_NF,�."R- L/A•3i[l7y A.y'%'> F/�:� 1 S✓2 �.N L/y � />ru r.ar o.J� Applicant acknowledges the right of the City Engineer, pursuant to Bakerafeld Municipal Code Chapter 12.20 to revoke the permit at any time. S: EncmachmentPermltsWppllcalionforEncroachment B A K E R 5 F I E L D Public Works Department 1501 Truxtun Avenue Bakersfield, California 93301 (661) 326-3724 TO WHOM IT MAY CONCERN: Wethe undersigned, have no objection to the construction of a Fence beside the side/elk within the public right-of-way. (Street roposed (OWners No. sT Phone 6 II s 99-0,40'7 (Address of proposed encroachmsm) / SIGNED: 1.) Name: Date: Address: 2.) Name: Date: Address: 3.) Name Address: % 4.) Name: Address: 5.) Name: / Address: Date: 6.) Name: Date: Address; Public Works Departrnent 1501 Truxtun Avenue Bakersfield, California 93301 (661)326-3724 ENCROACHMENT PERMIT REQUIREMENTS 1. Application 2. Permit Fee of $208.00 3. Drawing; Minimum 8 112 x 11 showing encroachment on lot in relation to the existing curb, gutter and sidewalk, along with distances from curb, gutter and sidewalk to the encroachment. Drawing to include curb, gutter and sidewalk and any additional information that may assist the City in making a determination as to your request. 4. Type and Amount of Insurance Coverage for fence installation or construction for A. Residences Homeowners General Liability coverage in an amount of at least $300,000.00 B. Commercial Commercial General Liability coverage in an amount of at least $1,000,000.00 2. Additional Insured Verbiage (For Commercial) A. The City of Bakersfield, its mayor, council, employees, agents and volunteers are added as additional insured's with respect to (i.e. the installation of a chain link fence at 1501 Truxtun Ave.). 5?EncmachmentRetmitsllnsumnceRequirements From:Janim Dori Fa%ID.CIIRord Bradford Page 1 ofe Date =7=12 0306 PM Page:1 of 6 FAX OB Clifford & Bradford Insurance Clifford &Bradford 1515 20th Street, Bakersfield, CA 93301 CA License #0673141 Yili"W'r'r,"M 4iff4fC41 661-283-8100 or Fax 661-283-8111 00-327-3833 From: Janice Diehl To: ATTN: TRISH Pages: 6 Fax: (661) 852-2012 Date: 3272012 03:05:59 PM Phone: ( ) - The Mark Restaurant LLC Message: Trish: Please see attached certificate of insurance issued on behalf of our insured, The Mark Restaurant, LLC and the Mark Real Estate LLC for the Encroachment Permit. We have also attached Endorsement Form no: GECG 602 which includes automatic additional insureds on page 3 of 4, which I marked for you. Please let us know if you have any questions. Thank you, The information contained in this electronic transmission is intended only for the personal and confidential use of designated addressee indicated, and is intended to be privileged and/or confidential. If the reader ofthis transmission is not the intended recipient or addressee,you are hereby notified that you have received this transmission in error, and that any review, dissemination, distribution or copying. of this electronic transmission or any of the information contained herein, in any manner whatsoever, is strictly prohibited. If you received this transmission in mor, please notify the sender immediately. Thank you Y,/A 1-: E R S F I E L, D PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Jena Covey, Risk Manager FROM: Bob Wilson, Supervisor II, Subdivisions DATE: March 29, 2012 SUBJECT: Encroachment Permit Application for: 1623 190 Street Name of Applicant: Mark Hamilton Description of Encroachment: Build wrought iron fence with awning in front of restaurant. Please review the insurance certificate with the attached encroachment permit and return to me at your earliest convenience. 8:\PERMITS\ENCROACH\INSURANCE\1623 191h St doc • PUBLIC WORKS DEPARTMENT MEMORANDUM TO: John Ussery, Engineer II FROM: Bob Wilson, Supervisor II, Subdivisions DATE: March 29, 2012 SUBJECT: Encroachment Permit Application for: 1623 19TH Street Name of Applicant: Mark Hamilton Description of Encroachment: Build wrought iron fence with awning in front of restaurant. Please review the attached encroachment permit and return to me at your earliest convenience. 410/ 2 2 6le, � r-qw $: WERMITSENCROAMTRAFFIC11623 19th SLdoc CITY OF BAKERSFIELD - PERMIT RIDER PUBLIC WORKS DEPARTMENT 1501 TRUXTUN AVENUE, BAKERSFIELD, CA 93301 (661) 326 -3724 INSPECTION 326 -3049 DATE Z — , 20 L� To be attached to and made part of: ❑ Street Permit No. ft* n jet *-j,;Z - ❑ Transportation Permit No. APPLICANT %hC / /!a/� l�G,!Y 1� PHONE L/V(D /1067- 77SG /VO #'" LOCATION In response to your request of / N—.20 we hereby amend the above numbered permit as follows: Date of expiration extended to: / Description of work changed to: O h�'� A PD.-nY 3,1) vh'1 Dl- 1�P. -70 Except as amended, all other terms and provisions of the original permit shall remain in effect. This rider must be attached to the original permit. APPROVED BY: Nick Fidler } CITY ENGINEER BY: DEPUTY Rider Fee $ Other Fee $ Total $ 4:;:'756U White - Applicant Yellow - Public Works Pink - Construction PP 12/01 1698 Wall St - Google Maps Go gle Maps 1698 Wall St OIL ! r�O Bakersfield, California Google, Inc. Street View - Aug 2016 L Sl ht T DC V" m 164319th TOOL j k . t � �.r1', �oogle Page 1 of 1 i� Image capture: Aug 2016 © 2017 Google https: / /www.google.com /maps / @3 5. 3757716 ,- 119.0209687,3a,75y,34.69h,8 l .97t /data =! ... 11/27/2017 � 7�" - ` i ��� � � •i .� � �.! �.- �� � , � � � •.- � �� !•I` �r rwr `� K � r, K E R S F I E L Z PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Jena Covey, Risk Manager Vim — v FROM: Michelle Mendenhall, Engineering Technician I DATE: November 20, 2017 SUBJECT: Encroachment Permit Application for: 1623 19'h Street Name of Applicant: Mark Real Estate LLC Description of Encroachment: Place backflow preventer in alley at back of building, approximately 30' from corner. Leave 48" for ADA clearance Please review the insurance certificate with the attached encroachment permit and return to me at your earliest convenience. S: \PERMITS \ENCROACH \INSURANCE \1623 19th St(2).doc .00e B _A� K E R F I E L. L PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Ed Murphy, Engineer III Mendenhall, En ineerin FROM: Michelle Engineering Tech DATE: November 20, 2017 SUBJECT: Encroachment Permit Application for: 1623 19th Street !Name of Applicant. Mark Real Estate LLC Description of Encroachment: Place backflow preventer in alley at back of building, approximately 30' from corner. Leave 48" for ADA clearance. Please review the attached encroachment permit and return to me at your earliest convenience. --r f1 le- _ � (� shows CMG! 4t"- r r✓ ,o- S�clearr�ce- �}�1e�e � (e�w- l ��sra. % , i s .tip► �.t� �. EC Lj C e u i-U,� VACS G!JD T- I) . S: \PERMITS \ENCROACH \TRAFFIC \1623 19th St(2).doc LOCATION OF ENCROACHMENT(Address required where available): If there is no address adj4d6nt to work describe limits of work by distances from nearest existing street intersection. APPLICANT INFORMATION FULL NAME OF APPLICANT 44AJT COMPLETE ADDRESS: /� 3 l PHONE: ,EAJCF;Q 59j FL D L 'A-L 17<0 gLu A FAX: CELL: --77 9 PROJECT INFORMATION DESCRIPTION OF ENCROACHMENT (Example: Wood or wrought iron fence, concrete block wall, raised planter, etc.): PERIOD OF TIME FOR ENCROACHMENT: INDEFINITE or OTHER: (Please Circle) CONTACT PERSON PHONE: 1,41 90 5 — Z2J9 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 propegy 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 :\PERMITS\ENCROACH\Encroachment Permit Req Fonn.DOC Aug. 2017 a Q) caj Cb ° N= Q) Z) C6 p 4 I �� ° � ,�AcCRv� +�✓1 ���L - - – ^ — — — — -- Ex/sting or Proposed Sdewalk ,Oi � y Curb and Gutter 80, QiQ IN keyi F�J^ CJnntr' Street Centerline 0 "I n s aIR� r O � Q) � I I � I BAKE RS FIELD Public Works Department 1501 Truxtun Avenue Bakersfield, California 93301 (661) 326 -3724 TO WHOM IT MAY CONCERN: We the undersigned, have no objection to the construction of a fence beside the sidewalk within the public right -of -way. 67 ATh E- Al G.E' y &At k— 01= v.0 �/ r By: I7'1 Al?r gAm t street for proposed encroac ent) 7 (Owners Name) ' , -2 3 ( cr 1 r` :5 1 Phone- (Address of proposed encroachment) SIGNED: 1.) Name: JlJanmA n/ /I�N�/r`✓gRD - t ,,�D,,•� rv�q n- Date: /4 Address: )(a 7-7b l `7 2.) Name: Address: 3.) Name: Address: 4.) Name: Address: 5.) Name: Address: 6.) Name: Address: • See Signatures needed for approval page Date: Date: Date: Date: Date: S MINIMUM SIGNATURES NEEDED FOR APPROVAL OF APPLICA T/ON, IF APPLICANT IS UNABLE TO OBTAIN A REQUIRED SIGNATURE PLEASE SUBMIT A LETTER STATING REASON FOR OMISSION. 1a k �I� o I� ly I� �I \l %------- - - - - -- street Centerline- -- -- — — — — — — — — — — — — — — - — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — \ \ / 10 — — — — — — — — — — — — — it '/D BLOC LOT --- - - - - -- -------------------------------- - — — — _ _ _ _ - x ;stinior Proposed Sidewolk — — — — — — — – Curb and Gutter Street Centerline I I --- - - - - -- -------------------------------- - — — — _ _ _ _ - x ;stinior Proposed Sidewolk — — — — — — — – Curb and Gutter Street Centerline PACIFIC PARTNERS INSURANCE AGENCY 25283 Cabot Rd.. Suite 224. Laguna Hills. CA 92653 License #OC46086 Telephone 949 -580 -1969 Fax 949 - 580 -1963 7!10/2017 INSURANCE COMPANY: POLICY NUMBER: POLICY PERIOD: ANNUAL PREMIUM: INSPECTION FEE•. BROKER FFE: l'Oi':\L AN'Nt :\1. PREMIUM: Down Payment: INSVR:ANCE PROPOSAL -2017 For The Mark Restaurant American Auto Insurance Co. TBD 712W2017- 7;27/2018 $9.816 $230 $300 $10,346.00 $3,474.80 1623 -1629 19 °i Street. Bakersfield. CA 93301 1. PROPERTY Limits: Business Personal Propert% $515.000 Building lT.LB $1.084.000 Business Income Monthly limit & Extra Expense $600.000 Coverage: Special Fornt, Replacement Cost. Plus D Endorsement Deductible: $1.000 (Thefl Included) IL LIABILITY $2.000.000 Limits: General Aggregate Products/Contpleted Operations Aggregate $2.000.000 Personal & Advertising Injury $1.000,000 Per Occurrence $1.000.000 Fire Legal Liability $300,000 Medical Expense Lintit $5.000 Assault Battery Occurrence /Aggregate (defense inside) $ Included Liquor Liability Occurrence /Aggregate $1.000.000/$2.000.0011 Non-Owned Auto 11 -lired $1,000.000 Basis: Gross Receipts of 1000.000 'ir; 480.000 - Alcohol & 1.420.000 Food EXC'LI SIONS: Absolute Pollution: Asbestos: Lead Contamination: Nuclear: Punitive Damages: Professional: Voluntary Labor: Gunployntent Fermination: Employment Related Practices: Fungi or Bacteria: War or Terrorism: Awning /canopy: CONDITIONS: Premium is "Minimtun & Deposit'. 30% of premium and 100% of lees are fully earned at inception. No Flat Cancellations Allo\wd: Subject to Favorable Inspection: Premium is Subject to Audit: Proposed terms and conditions may dif icr from those requested. "This is a premium quotation, not a binder or a polio, and (toes not includr a// the conditions, terms and e-velusions. " B\ Signing below. I agree that I have read and understand fully the coverage. terms and conditions in this proposal and am requesting coverage be bound as quoted. \pplirrnt's Printed Name tI ir, ) L- \pplicanl Signature I or I Date