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Home My WebLink About1400 BAKER STENCROACHMENT 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 , . . 15-30000020 Date 5/25/15 Property Address 1400 BAKER ST Application type description PW - ENCROACHMENT PERMIT Owner Contractor ________________________ COUNTY OF BEAR UNITED WAY OF KERN COUNTY UNKNOWN 5405 STOCKUBLE HWY SUITE 20C BAKERSFIELD CA 93309 (661) 5344020 --------------------------------------------------------------------------- Permit ENCROACHMENT PERMIT Additional desc . . Phone Access Code , 1646934 P.—it Fee . . . . 205.00 Issue Date , . 5/26/15 Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 205.00 Special Notes and Comments Will be painting a 2'x B.' hopscotch on the Oregon Street side of the Baker Street Library, a,,roe. ♦/- 1001. from the corner Baker St. Sill Egland (661) 634-1820 ---------------------------------------------------------------------------- Fee summar' Charged Paid Credited Due ------------------------------------------------------- Permit Fee Total 208,00 200.00 .00 .00 Grand Total 208.00 208.00 .00 .00 Applicant acknowledges the right of the City Engineer,. pursuant to the Bakersfield Municipal Code Chapter 12.20 to revokethe per it ata y time. Signature oflAppkant (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 pBA„x R ENCROACHMENT PERMIT + APPLICATION FORM u CITY OF BAKERSFIELD r PUBLIC WORKS DEPARTMENT W ® 1501 TRUXTUN AVE FO BAKERSFIELD CA 93301 , l (661) 3263724 Fax: (661) 852-2012 $,/A ? w O n Thi. LOCATION OF ENCROACHMENT(Addrese required where available): fe �i_lP.ti S1i�Z fTt' rr t i rary Vtoo $aft r- 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 Vv�t%r tdylaq�fc *ilr COMPLETE ADDRESS: 1; 5tv&rin P_ } I iJ WONE: fool - g Z 4 - (8%D FAX: l0(O�Z- yl/PrS �?i32G CELL: PROJECT INFORMATION DESCRIPTION OF ENCROACHMENT (Example: Wood or wrought iron fence, .concrettte block wall, raised planter,. etc.): I ok t rv(- tP �D Jy ScQk .f... -�jy AmriT� )x Ma.GP v 'i_ I Y. d I PERIOD OF TIME FOR ENCROACHMENT: INDEFINIT )or OTHER: �' �. p (Please Circle) CONTACTPERSON Tail c-Ad,2n/1 PHONE: (X0—5{3�J—($2p 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 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 rp operl or right of way where the same i • 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 Ceueml Liability coverage in an amount of at least $300,000.00 Commercial: Commercial Liability coverage in an amount of at least $1.000,00000 Encroachment Permit Fee! $208.00 S:APERMIIStENCROACH\Encroachment Permit Req Fo.,DOC January 2009 P.1 CERTIFICATE OF LIABILITY INSURANCE n 05126/2015 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 INSURERCSI, AUTHOMM REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the cedifiwte ho Wer Is an ADDITIONAL INSURED, d1e FOlicy(iss) must be endorsed. If SUBROGATION IS WAIVED, subject ts, the tens and condition W the policy, certain policies may require an endora nnant. A statement on this cartiflcate rices not cotHer lights to the cLvtificate holder In lieu W such endorsemenys4 PROW CER JANET HOPKINS INS AGCYrndxE StateEame. 15281BTHST 'I BAKERSFIELD, CA 93301 NRYT_ .661-321-.KIFAX .G61 -32B-6393 E.R. INSURERSIAETORaINGCWEFA6B NNca INSVRERA;Etala Faml GenNsl trlsmance Company 25151 IxsseEo UNITED WAY OF KERN COUNTY 5405 STOCKDALE HWY STE 200 BAKERSFIELD,. CA 93309 SUNERB; INsuRERc: _ It5_V FERE; ONFURERF COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY. RECUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CEntFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND GOND17ONS OF SUCH POLICIES. LITAITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM6. L1R TPEOFINEVRAXCE 988a FOU.1 NUMBER '. MrClOY YVVFY A j( CO IEROAL GENER/1�L DAW LJN ! RCL\IMSJMCE L_f OCGUR Y' - EACMn `F`RNENCE S 20pU.0V0. H?EMISEL xtvre,vo S ^'Eo EXP mn FRAFA B.ODO (RURB12014�Ba11812Bis —I FRSIXUL UAOV INJURY OErRAOGREG.\TE L!MITAPPLESFE- - GNEAALAGOA6.AT S Q.Vp8,00V _ PROFFJ.-COMPMPAGG S A,MO,CW PoUCY' IP�T OLOL pT Eq; AUTONCANLELIANURY SINGLE LIMIT S HOMILY INJURY III mwn) 6 ANY AUTO ALLOVRiEO SCHEpULED ! AUTO6 NUpTµOp6E0 HIRf9AUi06 AUTOS j BODILY INJURY oma ..H) S PppQyry PFyA6E S S �UTABRELXA LNB pCLUR I EPLN OCCURRENCE S AGGflFRxTE ESCEES LIP@ LNM1S_M_POE PETENLIpN4 S WORKERS CS.RNNN AT1IX1 PTVR E$ ANOEMPLOYER-.WaLnY yIN AA ipNlN ELFACH AC018ENT S E.LOI6EASE-EA EMROWES IXTNEoR w{J MyeneaOroryWlnN NIA ELDISFASS-FOUCYLLWI ICE@CPIpiIONNJ OPERPTIONS E&w TION pF W EMmel Rener^ebcLuvub. mey ee eMc^aE Hmon wce le ngJnvl UFFITI OLDER LISTED ASADDITIONALNSUR CITY FICATERSFIERLISTEAYOADDITIONAL.INSURED. CITY OF BAKERSFIELD. ITS MAYOR, COUNCIL, OFFICERS, AGENTS, EMPLOYEES, AND VOLUNTEERS. CITY OF BAKERSFIELD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PUBLIC WORKS. DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED M 1501 TRUXTUN AVE ACCORDANCE WITH THE POLICY PROVISIONS. BAKERSFIELD, CA 933Dt rxOR¢Ep REPRES@NTATIY$'I ®196&2 14ACORD CORPORA,ON. ARI rights reserved. ACORD 25 (2014101 / The ACORD name and 1090 are reg$d Fast of A HUN. tOD148B 132849 S D24042014 S A K E R 5 F I F T. D PUBLIC WORKS DEPARTMENT MEMORANDUM TO: John Ussery, Engineer III FROM: Bob Wilson, Supervisor II, Subdivisions DATE: May 28, 2015 SUBJECT: Encroachment Permit Application for: 1400 Baker Street Name of Applicant: United Way of Kern County Description of Encroachment: Will be painting a 2'x 8' hopscotch in the sidewalk on Oregon Street side of Baker Street Library. Please review the attached encroachment permit and return to me at your earliest convenience. s�ar�ir e• r4,- v S:\PERMIT$\ENCROACH\TRAFFIC\1400 Baker Std.c E R S F I E L D PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Jena Covey, Risk Manager 4 v FROM: Bob Wilson, Supervisor II, Subdivisions DATE: May 28, 2015 SUBJECT: Encroachment Permit Application for: 1400 Baker Street Name of Applicant: United Way of Kern County Description of Encroachment: Will be painting a 2'x 8' hopscotch in the sidewalk on Oregon Street side of Baker Street Library. Please review the insurance certificate with the attached encroachment permit and return to me at your earliest convenience. S:\PERMITS\ENCROACHUNSURANCE\1400 Bake\ Std..