HomeMy WebLinkAbout2025 CHESTER AVEENCRO -ACHMENT PERMIT
CI-IFY OF BAKERSFIELD
pUBLiEC WORKS DEPARTMENT
L 501 TRUXTUN AVE
► ✓'ARY It �„ B�ERSFIELD CA 93301
`�LIF0 1 (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 . . . . . 10-30000 043 Date 10/20/10
Property Address . . 2025 CHESTER AVE
Application type description PW - ENCROACHMENT PERMIT
Owner
------------------------
WILLIAMS WALTER H & JOYCE TR
2025 CHESTER AV
BAKERSFIELD CA 93301
contractor
C>V^TNER
--- --- ------- ------- --- ------- - -- - -- -- - - - - - - - - - -----------------------------
Permit . . . . . . ENCROACHMENT PERMS =T
Additional desc .
Phone Access Code 1042365
Permit Fee . . . . 208.00
Issue Date . . . . 10/20/10 Valuation 0
Qty Unit Charge Per Extension
BASE FEE 208.00
-------------- -- ----- ----- ----- ---- --- - - - - -- --------------------------------
Special Notes and Comments
Place awning on building at Chester AVa.
Jerry Margrave
322 -7260
-------------- --------- --- ----------- - - - -- -- - -------------------------------
Fee summary Charged Paid Credited Due
Permit Fee Total 208.00 208.00 .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 revoke the
permit at any time.
- a
Signat a of Applican ner /Agent) Print Nofie
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
THEREFO ) (DENIED). Said permit shall expire on date stated above.
Signature of City Engineer
Additional Terms on the Back
TO:
FROM:
DATE:
SUBJECT:
"00� 40
D A K E R S F I E L E3
PUBLIC WORKS DEPARTMENT
MEMORANDUM
John Ussery, Engineer 11
Bob Wilson, Supervisor 11, Subdivisions
January 5, 2011
Encroachment Permit Application for: 2025 Chester Avenue
Name of Applicant: Walt & Joyce Williams
Description of Encroachment: Place awning on building at Chester Ave.
Please review the attached encroachment permit and return to me at your earliest convenience.
//0 -74011
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S A I� E R S F I E L L7
PUBLIC WORKS DEPARTMENT
MEMORANDUM
TO: Ralph Korn, Risk Manager
FROM: Bob Wilson, Supervisor II, Subdivisions
DATE: January 5, 2011
SUBJECT: Encroachment Permit Application for: 2025 Chester Avenue
Name of Applicant: Walt & Joyce Williams
Description of Encroachment: Place awning on building at Chester Ave.
Please review the insurance certificate with the attached encroachment permit and return to me
at your earliest convenience.
S: \PERMITS \ENCROACH \INSURANC\2025 Chester Ave.doc
6
O
B A I< E R S F I. E L lk�_�
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: zwetll /L/' /&,."s
. -20.2-s- e4e6y-.,- 'ex, e- . lakrA. Lea (,A 5�y-?6 / & / -.2-0 3 2
2. Nature or description of the encroachment for which this application is ade: (Exa ple Wo } or wrought iron
fence, concrete block wall, raised planter, etc...) Air. c ti , lc� a u ��' may,
3. Location of proposed encroachment: (Example: Side yard at back of sidewalk or front yard at back of sidewalk)
-JC, � a,d
4. Period of time for which the encroachment is to be maintained: a mite or Other.
ease Circle)
5. Is property part of a Homeowner's Association Yes
L/ 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 upon the
revocation thereof by the City engineer, 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 restored 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 evidenc-
ing the insurance required. The type(s) and amount(s) of insurance coverage is:
Applicant acknowled es the right of e City Engineer, pursuant to Bakersfield Municipal Code Chapter 12.20 to revoke the permit at
any time. z )
S:\EncroachrnentPermits\ApplicationforEncroachment
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STRUCTURAL ENGINEER, INC. SFIEET NO. _ �� " � OFZ
4800 EASTON DRIVE, SUITE 110 CALCULATED BY DATE'
BAKERSFIELD, CA 93309
(661) 635 -0121 FAX (661) 635 -0122 CHECKED BY DATE
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STRUCTURAL ENGINEER, INC.
4800 EASTON DRIVE, SUITE 110
BAKERSFIELD, CA 93309
(661) 635 -0121 FAX (661) 635 -0122
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Sep 24 03 09:42a Specialty Trim & Awning 661 322 6404 p.1
CASE
ICNGINEERINC
March 15, 1992
American Sun Control
925 McFarland /400 Boulevard
Alpharetta, GA 30201
A"n: Glorio Patsy
Dear Glorio:
Per your request we provide the following explanation of section property terms used in the
materiel which we suppiied you:
R: The distance from the "Y" axis to the centroid of the section in inches.
4: The distance from the "X" axis to the centroid of the section in inches,
Ix: The moment of inertia of the section about the centroidal axis which is parallel to the
"X" axis In (inches)'.
ly: The moment of inertia of the section about the centroidal axis which is parallel to the
"Y" axis in (inches)'.
Sx; The section modulus about the "X" axis in (inches) ". The letters "t ", "b ", "I" and "r"
following this term indicate "top ", "bottom " "left" and "right" respectively.
Sy: The section modulus about the "Y" axis in {inches)'. The letters "t ", "b ". "I" and
following this term indicato. "top ", "bottom ", "left" and "right" respectively.
rx: The radius of gyration about the "X" axis in inches.
ry: The radius of gyration about the "Y" axis in inches.
AlSo, would you please provide us a copy of the material which you are publishing so that
we can backcheck it?
Thank you for the opportunity to be of service to you in this matter.
Best regards,
Ja W. Case, PE
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October, 1994
VII-67
Specialty Trim & Awning, Inc.
631 California Ave.
Bakersfield, CA 93304
661 - 322 -7360
10/19/10
Specialty Trim & Awning, Inc. has my permission to apply for an
Encroachment Permit for the awning at 2025 Chester Ave., Bakersfield, CA
93301, which is property that I own.
alt Williams
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OP ID: SJ
CERTIFICATE OF LIABILITY INSURANCE
711124110
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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terns 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 949.365 -5100
Brakke- Schafnitz Ins. Brokers 949. 365 -5161
License #0428915
28202 Cabot Road, Suite 500
Laguna Niguel, CA 92677 -1251
Aacobs
NAMEA T Sue Jacobs
PHONE , 949- 365 -5149 AIC No); 949- 203 -8695
E -MA L
ADDRESS: Sue. aCobs@slg.us
PRODUCER WILLI -1
INSURERS AFFORDING COVERAGE
NAIC #
Sue
INSURED Walter & Joyce Williams
3053 Jacaranda Dr.
Bakersfield, CA 93301
INSURER A 1 Valley Forge Insurance Co
Sue Jacobs
INSURER B :
.a •nee %nn Annen eT DDnDATInkl All rinhtn ranerved.
INSURER C:
$ 1,000,00
INSURER D:
300,00
INSURER E:
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE a OCCUR
INSURER F:
/r00T1El/-ATC W lOOCD. REVISION NUMBER:
VV•CR/1VG�7 v..,� „ vr,rr,- v..,vr... __ -___ -
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,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
TYPE OF INSURANCE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
POLICY NUMBER
Bakersfield
POLICY
LIMITS
GENERAL LIABILITY
1501 Truxton Avenue
Bakersfield, CA 93301
Sue Jacobs
.a •nee %nn Annen eT DDnDATInkl All rinhtn ranerved.
EACH OCCURRENCE
$ 1,000,00
PREMISE$ Ea occurre nce I Is
300,00
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE a OCCUR
X
2090884619
11101/10
11101111
MED EXP (Any one person)
S 5,00
PERSONAL& ADV INJURY
$ 1,000,00
GENERAL AGGREGATE
$ 2,000,00
GENT AGGREGATE LIMIT APPLIES PER.
PRODUCTS - COMPIOP AGG
$ 2,000,00
$
POLICY PRO- LOC
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY (Per person)
$
ANY AUTO
BODILY INJURY (Per accident)
$
ALL OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
S
a
UMBRELLA U AB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAR
CLAIMS -MADE
DEDUCTIBLE
S
WC 67N
.-.RETENTION
WORKERS COMPENSATION
E.L. EACH ACCIDENT
$
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED9
(Mandatory In NH)
NIA
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
N yesdeecribeunder
DE8GIRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addt$onal Remarks Schodula, if more space Is required)
The City of Bakersfield, Its mayor, council, employees, agents and
volunteers are added as additional Insured's with respect to the
Installation of at awning at 2025 Chester Avenue, Bakersfield, CA.
CERTIFICATE HOLDER
" ^ "" ""^ ""'•
BAKERSI
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Bakersfield
ACCORDANCE WITH THE POLICY PROVISIONS.
Public Works Department
AUTHORIZED REPRESENTATNE
1501 Truxton Avenue
Bakersfield, CA 93301
Sue Jacobs
.a •nee %nn Annen eT DDnDATInkl All rinhtn ranerved.
W "l aaa -wva n_v _ vj—, yr
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD
ACORO® CERTIFICATE OF LIABILITY INSURANCE
1..�./
,DD
100 /25/25 D /20010 10
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
Wm K. Lyons Agency, Inc.
PO Box 319 - 2100 F St #200
License #0461335
Bakersfield CA 93302
CONTACT JaA7.C@ K. Lyons
OAS y
A /CNNo Ext: (661)327 -9731 FA /C No: (661) 327 -2344
E-MAIL
ADDRESS:
CUST MER ID #-90001577
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
Specialty Trim & Awning, Inc.
631 California Avenue.
Bakersfield, CA 93304
INSURER A :American Economy Ins. Co.
01CH75941830
INSURERB:General Ins. Co. of America
1/1/2011
INSURERC:
$ 1,000,000
INSURER D:
1 000
$ r r 000
INSURER E:
$ 10,000
INSURER F:
$ 1,000,000
COVERAGES CERTIFICATE NUMBER:2010 /2011 -Liab. -Auto 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,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
ADDL
N
SUBR
D
POLICY NUMBER
POLICY EFF
MM /DD/YYYY
POLICY EXP
MM /DD/YYYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE Fx_1 OCCUR
X
Bakersfield, CA 93301
01CH75941830
1/1/2010
1/1/2011
EACH OCCURRENCE
$ 1,000,000
D AMAGETORENTED
PREMISES Ea occurrence
1 000
$ r r 000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
X POLICY PRO-
JECT LOC
PRODUCTS - COMP /OP AGG
$ 2,000,000
$
B
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
4CCO1848360
1/1/2010
1/1/2011
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
X
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
Uninsured motorist combined
$ 1,000,000
Medical payments
$ 5,000
UMBRELLA LIAB
XCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
[JD�ED
U CTIBLE
RETENTION $
$
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR /PARTNER /EXECUTIVE
OFFICER /MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
WC STATU- OTH-
TORY LIMITS
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYE
--
$
E.L. DISEASE - POLICY LIMIT
1 $
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
RE: Encroachment Permit /Install Awnings at 2025 Chester Avenue, Bakersfield, CA 93301
Additional Insured: The City of Bakersfield, its mayor, council, employees, agents & volunteers per endorsement CG
7635 (02/07) attached.
*10 days notice of cancellation shall be given for non - payment of premium - 30 days other than non - payment.
CERTIFICATE HOLDER rANIrFI I ATIONI
(661)852-2011
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Bakersfield
ACCORDANCE WITH THE POLICY PROVISIONS.
Public Works Department
AUTHORIZED REPRESENTATIVE
Attn: Bob Wilson
1501 Truxtun Avenue
Bakersfield, CA 93301
ACORD 25 (2009/09) 1988 -2009 ACORD,,(' 6RPORATION. All rights reserved.
INS025 (200909) The ACORD name and logo are registered arks of ACORD
MZ111SUrance COMMERCIAL GENERAL LIABILITY
d' CG 76 35 02 07
POLICY , #01CH75941830
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
LIABILITY PLUS ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
The City of Bakersfield, its Mayor, Council, Employees, Agents
and Volunteers
c/o Public Works Department
1501 Truxtun Avenue
Bakersfield, CA 93301
Project: Encroachment Permit /Install Awnings at 2025 Chester Avenue, Bakersfield, CA 93301
ADDITIONAL INSURED — BY WRITTEN
CONTRACT, AGREEMENT OR PERMIT, OR
SCHEDULE
The following paragraph is added to WHO IS AN
INSURED (Section II):
4. Any person or organization shown in the Sched-
ule or for whom you are required by written con-
tract, agreement or permit to provide insurance
is an insured, subject to the following additional
provisions:
a. The contract, agreement or permit must be
in effect during the policy period shown in
the Declarations, and must have been exe-
cuted prior to the "bodily injury ", "property
damage ", or "personal and advertising
injury ".
b. The person or organization added as an in-
sured by this endorsement is an insured only
to the extent you are held liable due to:
(1) The ownership, maintenance or use of
that part of premises you own, rent,
lease or occupy, subject to the following
additional provisions:
(a) This `insurance does not apply to
any "occurrence" which takes place
after you cease to be a tenant in
any premises leased to or rented to
you;
(b) This insurance does not apply to
any structural alterations, new con-
struction or demolition operations
performed by or on behalf of the
person or organization added as an
insured;
(2) Your ongoing operations for that in-
sured, whether the work is performed
by you or for you;
(3) The maintenance, operation or use by
you of equipment leased to you by such
person or organization, subject to the
following additional provisions:
(a) This insurance does not apply to
any "occurrence" which takes place
after the equipment lease expires;
Includes Copyrighted Material of Insurance Services Office, Inc., with its permission.
Copyright, Insurance Services, 2001
CG 76 35 02 07 Saleco and the Saleco logo arc registered trademarks of Safeco Corporation
Page 1 of 4 EP
(b) This insurance does not apply to
"bodily injury" or "property dam-
age" arising out of the sole negli-
gence of such person or
organization;
(4) Permits issued by any state or political
subdivision with respect to operations
performed by you or on your behalf,
subject to the following additional pro-
vision:
This insurance does not apply to "bodily
injury ", "property damage ", or
"personal and advertising injury" arising
out of operations performed for the state
or municipality.
c. The insurance with respect to any architect,
engineer, or surveyor added as an insured
by this endorsement does not apply to
"bodily injury ", "property damage ", or "per-
sonal, and advertising injury" arising out of
the rendering of or the failure to render any
professional services by or for you, includ-
ing:
(1) The preparing, approving, or failing to
prepare or approve maps, drawings,
opinions, reports, surveys, change or-
ders, designs or specifications; and
(2) Supervisory, inspection or engineering
services.
d. This insurance does not apply to "bodily
injury" or "property damage" included within
the "products- completed operations haz-
ard".
A person's or organization's status as an insured un-
der this endorsement ends when your operations for
that insured are completed.
No coverage will be provided if, in the absence of this
endorsement, no liability would be imposed by law on
you. Coverage shall be limited to the extent -of your
negligence or fault according to the applicable princi-
ples of comparative fault. .
NON -OWNED WATERCRAFT AND NON -OWNED
AIRCRAFT LIABILITY
Exclusion g. of COVERAGE A (Section 1) is replaced
by the following:
This exclusion applies even if the claims
against any insured allege negligence or
other wrongdoing in the supervision, hiring,
employment, training or monitoring of others
by that insured, if the "occurrence" which
caused the "bodily injury" or "property
damage" involved the ownership, mainte-
nance, use or entrustment to others of any
aircraft, "auto" or watercraft that is owned
or operated by or rented or loaned to any in-
sured.
This exclusion does not apply to:
(1) A watercraft while ashore on premises
you own or rent;
(2) A watercraft you do not own that is:
(a) Less than 52 feet long; and
(b) Not being used to carry persons or
property for a charge;
(3) Parking an "auto" on, or on the ways
next to, premises you own or rent, pro-
vided the "auto" is not owned by or
rented or loaned to you or the insured;
(4) Liability assumed under any "insured
contract" for the ownership, mainte-
nance or use of aircraft or watercraft; or
(5) "Bodily injury" or "property damage"
arising out of:
(a) the operation of machinery or
equipment that is attached to, or
part of, a land vehicle that would
qualify under the definition of
"mobile equipment" if it were not
subject to a compulsory or financial
responsibility law or other motor ve-
hicle insurance law in the state
where it is licensed or principally
garaged; or
(b) the operation of any of the machin-
ery or equipment listed in Paragraph
f.(2) or f.(3) of the definition of
"mobile equipment ".
(6) An aircraft you do not own provided it is
not operated by any insured.
TENANTS' PROPERTY DAMAGE LIABILITY
When a Damage To Premises Rented To You Limit is
shown in the Declarations, Exclusion j. of Coverage
A, Section I is replaced by the following:
g. "Bodily injury" or "property damage" arising
out of the ownership, maintenance, use or ). Damage To Property
entrustment to others of any aircraft, "auto" "Property damage" to:
or watercraft owned or operated by or rented
or loaned to any insured. Use includes oper- (1) Property you own, rent, or occupy, including
ation and "loading or unloading ". any costs or expenses incurred by you, or
Page 2 of 4
any other person, organization or entity, for WHO IS AN INSURED — MANAGERS
repair, replacement, enhancement, restora-
tion or maintenance of such property for any The following is added to Paragraph 2.a. of WHO IS
reason, including prevention of injury to a AN INSURED (Section ll):
person or damage to another's property;
(2) Premises you sell, give away or abandon, if Paragraph (1) does not apply to executive officers, or
the "property damage" arises out of any part to managers at the supervisory level or above.
.of those premises;
(3) Property loaned to you;
(4) Personal property in the care, custody or
control of the insured;
(5) That particular part of real property on which
you or any contractors or subcontractors
working directly or indirectly on your behalf
are performing operations, if the "property
damage" arises out of those operations, or
(6) That particular part of any property that must
be restored, repaired or replaced because
"your work" was incorrectly performed on it.
Paragraphs.(1), (3) and (4) of this exclusion do
not apply to "property damage" (other than
damage by fire) to premises, including the con-
tents of such premises, rented to you. A separate
limit of insurance applies to Damage To Prem-
ises Rented To You as described in Section 111
— Limits Of Insurance.
Paragraph (2) of this exclusion does not apply if
the premises are "your work" and were never
occupied, rented or held for rental by you.
Paragraphs (3), (4), (5) and (6) of this exclusion
do not apply to liability assumed under a side-
track agreement.
Paragraph (6) of this exclusion does not apply to
"property damage" included in the "products -
completed operations hazard ".
Paragraph 6. of LIMITS OF INSURANCE (Section III)
is replaced by the following:
6. Subject to 5. above, the Damage To Premises
Rented To You Lirnit is the most we will pay un-
der Coverage A for damages because of
"property damage" to any one premises, while
rented to you, or in the case of damage by fire,
while rented to you or temporarily occupied by
you with permission of the owner.
The Damage To Premises Rented To You limit is the
higher of the Each Occurrence Limit shown in the
Declarations or the amount shown in the Declarations
as Damage To Premises Rented To You Limit.
SUPPLEMENTARY PAYMENTS — COVERAGES A
AND B — BAIL BONDS — TIME OFF FROM
WORK
Paragraph 1.b. of SUPPLEMENTARY PAYMENTS —
COVERAGES A AND B is replaced by the following:
b. Up to $3,000 for cost of bail bonds 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.
Paragraph 1.d. of SUPPLEMENTARY PAYMENTS —
COVERAGES A AND B is replaced by the following:
d. All reasonable expenses incurred by the in-
sured at our request to assist us in the in-
vestigation or defense of the claim or "suit ",
including actual loss of earnings up to $500
a day because of time off from work.
EMPLOYEES AS INSUREDS — HEALTH CARE
SERVICES
Provision 2.a.(1)(d) of WHO IS AN INSURED (Section
II) is deleted, unless excluded by separate endorse-
ment.
EXTENDED COVERAGE FOR NEWLY ACQUIRED
ORGANIZATIONS
Provision 3.a. of WHO IS AN INSURED (Section II) is
replaced by the following:
a. Coverage under this provision is afforded
only until the end of the policy period.
EXTENDED "PROPERTY DAMAGE"
Exclusion a. of COVERAGE A (Section 1) is replaced
by the following:
a. "Bodily injury" or "property damage" expected
or intended from the standpoint of the insured.
This exclusion does not apply to "bodily injury"
or "property damage" resulting from the use of
reasonable force to protect persons or property.
CG 76 35 02 07
Page 3 of 4
EP
EXTENDED DEFINITION OF BODILY INJURY
Paragraph 3. of DEFINITIONS (Section V) is replaced
by the following:
3. "Bodily injury" means bodily injury, sickness or
disease sustained by a person, including mental
anguish or death resulting from any of these at
any time.
TRANSFER OF RIGHTS OF RECOVERY
The following is added to Paragraph 8. Transfer Of
Rights Of Recovery Against Others To Us of COM-
MERCIAL GENERAL LIABILITY CONDITIONS (Sec-
tion IV):
We waive any rights 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 a contract with
that person' or organization and included in the
"products- cornpleted operations hazard This waiver
applies only to a person or organization for whom you
are required by written contract, agreement or permit
to waive these rights of recovery.
AGGREGATE LIMITS OF INSURANCE — PER
LOCATION
For all sums which the insured becomes legally obli-
gated to pay as damages caused by "occurrences"
under COVERAGE A (Section 1), and for all medical
expenses caused by accidents under COVERAGE C
(Section 1), which can be attributed only to operations
at a single "location ":
Paragraphs 2.a. and 2.11b. of Limits of Insurance (Sec-
tion III) apply separately to each of your "locations"
owned by or rented to you.
"Location" means premises involving the same or
connecting -lots, or premises whose connection is
interrupted only by a street, roadway, waterway, or
rigWof. -way of a railroad.
INCREASED MEDICAL EXPENSE LIMIT
The Medical Expense Limit is amended to $10,000.
KNOWLEDGE OF OCCURRENCE
The following is added to Paragraph 2. Duties In The
Event Of Occurrence, Offense, Claim Or Suit of
COMMERCIAL GENERAL LIABILITY CONDITIONS
(Section IV):
Knowledge of an "occurrence", claim or "suit" by
your agent, servant or employee shall not in itself
constitute knowledge of the named insured unless an
officer of the named insured has received such notice
from the agent, servant or employee.
UNINTENTIONAL FAILURE TO DISCLOSE ALL
HAZARDS
The following is added to Paragraph 6. Representa-
tions of COMMERCIAL GENERAL LIABILITY CONDI-
TIONS (Section IV):
If you unintentionally fail to disclose any hazards ex-
isting at the inception date of your policy, we will noi
deny coverage under this Coverage Form because of
such failure. However, this provision does not affec
our right to collect additional premium or exercise our
right of cancellation or non - renewal.
LIBERALIZATION CLAUSE
The following paragraph is added to COMMERCIAL
GENERAL LIABILITY CONDITIONS (Section IV):
10. If a revision to this Coverage Part, which would
provide more coverage with no additional pre•
mium, becomes effective during the policy period
in the state shown in the Declarations, your pol-
icy will automatically provide this additional cov
erage on the effective date of the revision.
Page 4 of 4
4v CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY)
L� 10/25/2010
PRODUCER (661) 327 -9731 FAX: (661) 327 -2344 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Wm K. Lyons Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
PO Box 319 - 2100 F St #200 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
License #0461335
Bakersfield CA 93302 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Everest National Ins. Co.
Specialty Trim & Awning, Inc. INSURER B:
Jerry A. Margrave Dba : INSURER C:
631 California Avenue INSURER D:
Bakersfield CA 93304 INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTAN DING
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 CLAIMS.
INSR
L R
ADDT
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MM /DD/Y
POLICY EXPIRATION
DATE MM /DD/YYY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE F—I OCCUR
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OP AGG
$
POLICY PRO LOC
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS / UMBRELLA LIABILITY
EACH OCCURRENCE
$
AGGREGATE
$
OCCUR F—I CLAIMS MADE
$
DEDUCTIBLE
$
RETENTION $
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR /PARTNER /EXECUTIVE ❑
OFFICER /MEMBER EXCLUDED?
X WC STATU- OTH-
E.L. EACH ACCIDENT
$ 1 000 000
, —
E.L. DISEASE - EA EMPLOYE
$ 3.1000 000
(Mandatory inNH)
If yes, describe under
7600001668101
4/1/2010
4/1/2011
E.L. DISEASE - POLICY LIMIT
—
$ 1,000,000
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
RE: Encroachment Permit /Install Awnings at 2025 Chester Avenue, Bakersfield, CA 93301
*10 days notice of cancellation shall be given for non - payment of premium.
Ut=K I IFIGATE HOLDER CANCELLATION
(661)852-2011 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Bakersfield DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 * DAYS WRITTEN
Public Works Department NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
1501 Truxtun Avenue
Bakersfield, CA 93301 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES. -
AUTHORIZED �;l S TATIVE^
C
ACORD 25 (2009101) 988 - ACORD PORATION. All rights reserved.
INS025 (200901) The ACORD name and logo are registere arks of ACORD
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
This Certificate of Insurance 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,
extend or alter the coverage afforded by the policies listed thereon.
1 NS025 (200901)