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Home My WebLink About2830 EYE STBA E ENCROACHMENT PERMIT CITY OF BAKERSFIELD o PUBLIC WORKS DEPARTMENT aate�,, 1501 TRUXTUN AVE BAKERSFIELD CA 93301 LIFO (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 . . . . . 12-30000025 Date 6/21/12 Property Address 2830 EYE ST Application type description PW - ENCROACHMENT PERMIT Owner Contractor ------------------------ ------------------------ SAN JOAQUIN COMMUNITY HOSPITAL OWNER 2615 EYE ST EAEERSFIELN CA 93301 ----------------------------------------------"___-------------------------- PermitENCROACHMENT PERMIT Additional deec . . Phone Acce9e Code . 1213172 Permit Fee . . . . 208.00 Issue Date . . . . 6/21/12 valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 208.00 ---------------------------------------------------------------------------- Special Note. and Comments Construct 42 inch high wroght iron fence 9 It behind back of curb approx 188 ft along 29th St with 4 gates. Robert Easterday 869-6775 ------------------------------------------------------------------------ Pee summary Charged Paid Credited nue --- ------ ---------- ------------------------------------- Permit Fee Total 208.00 208.00 .00 .00 Grand Total 208.00 208.00 .00 .00 Applicant ackngwla ges the right of the City Engineer, pursuant to the Bakersfield Municipal Codo Chapter 12. tc thep�fmit anytime. - Gtfe�—' an f 5 '� SAnatUI-4 of AppliOvvedgeN)Print Name I'N1EREBY CERTIFY,Tk1A'f 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) ITUTE A HAZARD TO PERSONS USING SAID PUBLIC PLACE; SAID APPLICATION It THEREFORE .. GRA ) (DENIED) Said permit shall expire on date stated above. �t Signature of City Engineer Additional Terms on the Back FwBA„r S ENCROACHMENT PERMIT s f” APPLICATION FORM u o CITY OF BAKERSFIELD � PUBLIC WORKS DEPARTMENT 1501 TRUXTUN AVE GlF0 N BAKERSFIELD CA 93301 (661)326-3724 Fax:(661)852-2012 LOCATION OF ENCROACHMENT(Address required where available): Z,•$ (Z) 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 COMPLETE ADDRESS: \7Q PHONE: L l.\ • 4 4q • to l`�� FAX: iJ.o\` $lac\• �1`Z.� CELL: (,k.\, 41AIA • 050,D PROJECT INFORMATION DESCRIPTION OF ENCROACHMENT (Example: Wood or ``wrought iron fence, concrete block wall, raised W planter. etc.): 2AA0e h AS\ t)/l gbh ,��T. — C/ % //7/f A"e-Lai PERIOD OF TIME FOR ENCROACHMENT: INDEFINATE r lr �ec�tn\�Cc. n(� A\ A\ e� (Please Circle) CONTACT PERSON 11O9ZN'C CAe-ri'CYt� 411A PHONE: \e\e\ • �Ioc\ • b—I �I,rj 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, orjudicial 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 theaforesaid 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 own the revocation thereof by the City Fneineer, applicant will at his own cost and expense remove the same from the Public property or right of way where the same is located, and restore said public property or right of wav 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 Encroachment Permit Fee: $208.00 S:TERMITS\ENCROACH\Encroachment Permit Req Form.DOC January 2009 CERTIFICATE OF COVERAGE wAdventist Health PARTICIPANT: Sen Joaquin Community Hospital 2615 Chester Avenue Bakersfield, CA 93301 IN THE EVENT OF TERMINATION OF THE PROGRAMS DESIGNATED BELOW, IT IS THE INTENT OF ADVENTIST HEALTH SYSTEMANEST RISK MANAGEMENT TO MAIL THIRTY (30) DAYS PRIOR NOTICE THEREOF TO CERTIFICATE HOLDER: City of Bakerefield Attn: Risk Management 1501 Truxtun Avenue Bakersfield, CA 93301 ANSA VEST RISK MANAGEMENT CERTIFIES THAT THE FOLLOWING PROGRAMS ARE IN FORCE: TYPE OF COVERAGE COMPANY& TRUSTITRUST NO.ITRUSTEE PERIOD OF PERIOD OF COVEROCCURRENCE AMOUNT OF COVERAGE AGGREGATE' AHSANEST TRUST 01-07-2012 HOSPITAL PROFESSIONAL LIABILITY NO. 14389200 a. $1,000,000 $3,000,000 COMPREHENSIVE GENERAL. LIABILITY WELLS FARGO 01-01-2013 TRUST THE COVERAGE PROGRAM LISTED ABOVE HAS BEEN ISSUED TO THE ADVENTIST HEALTH PARTICIPANT INDICATED ABOVE FOR THE PERIOD OF COVERAGE STATED, 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 COVERAGE AFFORDED BY THE PROGRAM DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH COVERAGE DOCUMENTS. AGGREGATE LIMITS ARE SHARED By ALL ADVENTIST HEALTH PARTICIPANTS AND MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1 DISCLAIMER Thie Ce�oate of Corerege egea nolwneNNlee conlredbetxaen the AHSANeet HPL/GL1TmateM Na mmfloeta harder, nortloeaN e%amalivay w nege0vay amend axtard m e0ariha coverega a%ortlatl MNe wvare9e tloamanle eclatl hereon. DESCRIPTION OF OPERATIONS/LOCATIONS: All occurrences subject to theterms and conditions of the above Trust as respects the liability of San Joaquin Community Hospital directly resulting from its use of space at the Parc at Riverwalk for Its mobile immunization. clinic. Effective: January 01, 2012 THIS CERTIFICATE IS NOT VALID UNLESS SIGNED BY AN. AUTHORIZED REPRESENTATIVE OF ADVENTIST HEALTH SYSTEMANEST RISK MANAGEMENT. April 30, 2012 DATE AUTHORIZED REPRESENTATIVE ADVENTIST HEALTH SYSTEMNJEST Risk Menegement 21 DD Douglas Boulevard, PO Box 619002, Roseville, CA 95081-9082. Phone 916.71314620, Fax 81&]81.200{ Endorsement No. 2012-WO203 mAdventist Health This endorsement modfies such coverage as is afforded by the provisions of the treat relating to the following coverage part(s): COMPREHENSIVE GENERAL LIABILITY. This endorsamenteffective January 01, 2012 (12:01 A.M., Standard time) forms apart of Trust Document No. 14969200. issued by Adventist Health System/West Risk Management. It is agreed that City of Bakersfield, Its mayor, council, officers, agents, employees and volunteers are added as AddlOonal Participants of this Trust but only to the extent that Additional Participant is held liablefor the acts, errors or omissions of San Joaquin Community Hospital directly resulfing from its use of space at the Park at Riverwalk for its mobile immunization clinic. This Endorsement does not extend coverage for the acts, errors or omissions of City of Bakersfield its mayor, council, officers, agents, employees and volunteers. As respectsthe acts, eFrom and omissions of San Joaquin Community Hospital this coverage shall be primary to and not contributing with any other insurance maintained by the City of Bakersfield. All other terms, conditions and exclusions remain unchanged. In the event of termination of this program of coverage It Is the Intent of Adventist. Health SystemlWest Risk Management to mail thirty (30) days prior notice thereof to: City of Sakersfield 1501 Tmxtun Bakersfield, CA 93301 AUTHORIZED REPRESENTATIVE ADVENTIST HEALTH SYSTEMAREST msk Msnenemeot 2109 Douglas BOVIeveN, P Box 619002, Roseville, CA 955949002. Phone 91&'!914620, Fax 910-751-2904 • B A h E R_ S F I E L D PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Jena Covey, Risk Manager "V-) FROM: Bob Wilson, Supervisor II, Subdivisions DATE: June 21, 2012 SUBJECT: Encroachment Permit Application for: 2830 Eye St Name of Applicant: San Joaquin Community Hospital Description of Encroachment: Construct 42" high wrought iron fence 9' behind back of curb approx. 188' along 29" St with 4 gates. Please review the insurance certificate with the attached encroachment permit and return to me at your earliest convenience. S:\PERMITS\ENCROACH\INSURANCE\ 830 Eye Stria P. a Ii E R S F I E L D PUBLIC WORKS DEPARTMENT MEMORANDUM TO: John Ussery, Engineer II FROM: Bob Wilson, Supervisor II, Subdivisions DATE: June 21, 2012 SUBJECT: Encroachment Permit Application for: 2830 Eye St. Name of Applicant: San Joaquin Community Hospital Description of Encroachment: Construct 42" high wrought iron fence 9' behind back of curb approx. 188' along 291h St with 4 gates. Please review the attached encroachment permit and return to me at your earliest convenience. SAPERMITSENCROACHNTRAFFIC12830 Eye SLdoc