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HomeMy WebLinkAbout1534 19TH STENCROACHMENT PERMIT r' CITY OF BAKERSFIELD PUBLIC WORKS DEPARTMENT 1501 TRUXTUN AVE dRY Ii. 4, BAKERSFIELD CA 93301 9LIFOR�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- 30000031 Date 7/15/10 Property Address . . . . . . 1534 19TH ST Application type description PW - ENCROACHMENT PERMIT Owner Contractor GROSS MARTIN & GENIA FMLY SURV OWNER 953 4TH ST SANTA MONICA CA 90403 ---------- --: -: -- -- -- -- -------------- ------- ------------------------ - - - - -I Permit ENCROACHMENT PERMIT I Additional desc . Phone Access Code 1017573 Permit Fee . . . . 20.00 Issue Date . . . . 7/15/10 Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 20.00 ---------------------------------------------------------------------------- Special Notes and Comments Permit for tables, chairs and umbrellas on sidewalk in front of Doo -Wop Diner. Contact person: Gregory Pfeifer Jr. 661 - 327 -4360 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------- - - - - -- ---- - - - - -- ---- - - - - -- --- -- - - - -- ---- -- - - -- Permit Fee Total 20.00 20.00 .00 .00 Grand Total 20.00 20.00 .00 .00 Supercedes Permit No. - SMIM500 - i �fYlt r Applicant acknowledges the right of the City Engineer, pursuant to the Bakersfield Municipal Code Chapter 12.20 to revoke the permit at at ti J � ( .. !' PI C � r Signature of ant (Owne n Print N 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) E A HAZARD TO PERSONS USING SAID PUBLIC PLACE; SAID APPLICATION IS THEREFO (GRANT DENIED). Said permit shall expire on date stated above. Signature of City Engineer Additional Terms on the Back cBAK��s ENCROACHMENT PERMIT °�'�� � f CITY OF BAKERSFIELD PUBLIC WORKS DEPARTMENT '� 4 1501 TRUXTUN AVE .01 �� 33 1 9L jF Vu BAKERSFIELD CA 9 0 (661) 326 -3724 ) THE CITY ENGINEER OF THE CITY OF BAKERSFIELD CALIFORNIA: trsuant to the provisions of Chapter 12.20 of the Bakersfield Municipal Code, the undersigned applies for a permit to place, erect, use and lintain an encroachment on public property or right of way as therein defined. Application Number . . . . . 06- 30000032 Date 9/21/06 Property Address . 1534 19TH ST Application type description PW - ENCROACHMENT PERMIT Owner Contractor ------------------ - - - - -- ------------------------ SHERMAN GROSS OWNER PO BOX 43 BAKERSFIELD CA 93302 File 06 -32 --------------------------------------------------------------------------- Permit . . . . . . ENCROACHMENT PERMIT Additional desc . . Phone Access Code 606327 Permit Fee 150.00 Issue Date 9/21/06 Valuation . . . . 0 'Qty Unit�Charge Per 1.00 •:150.0000 EA PW ENCROACHMENT ------------------------ 7 ----------------- - -- --- Fee summary Charged Paid ----------- - - - - -- ---- - - - - -- ---- - - - - -- Permit Fee Total 150.00 150.00 Grand Total 150.00 150.00 Extension 150.00 Credited Due --- - - - - -- - - - - - -- .00 .00 .00 .00 pplicant acknowledges the right of the City Engineer, pursuant to the Bakersfield Municipal Code Chapter 12.20'to revoke the t at any time hh ec� a edCl " L ignature of Applicant (Owner /Agent) Print Name HEREBY CERTIFY THAT I HAVE MADE AN INVESTIGATION OF THE FACTS STATED IN THE FOREGOING PPLICATION AND FIND THAT THE MAINTENANCE OF SAID ENCROACHMENT (1) WILL (NOT) UBSTANTIALLY INTERFERE WITH THE USE OF THE PLACE WHERE THE SAME IS TO BE LOCATED AND (2) 1ILL (NOT) TE A HAZARD TO PERSONS USING SAID PUBLIC PLACE; SAID APPLICATION IS HEREFORERANTED), EN1ED). Said permit shall expire on date stated above. ignature of City Engineer Additional Terms on the Back 0P> -A,. 1C E R S F I E Ts .1 PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Luda Fishman, Risk Manager FROM: Marian P. Shaw, Civil Engineer IV, Subdivisions DATE: September 29; 2006 SUBJECT: Encroachment Permit Application for: 153419th St. Name of Applicant: Sherman Gross Description of Encroachment. To allow outdoor seating at le & Eye $L Please review the insurance certificate with the attached encroachment permit and return to me at your earliest convenience. S:\PERMI-rS\ENCROACH\INSURANCLlnsurahce memo.doc F A. K E. R S F I_ E L D PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Raul M. Rojas, Public Works Director FROM: Marian P. Shaw, Civil Engineer IV, Subdivisions DATE: October 9, 2006 SUBJECT: Encroachment Permit Application for: 1534 19th St. Name of Applicant. Sherman Oross Description of Encroachment: Permit allows outdoor seating & wrought iron fence at 10 & Eye St. Engineering and Traffic staff has reviewed the attached encroachment permit to allow the applicant to. have outdoor seating and fence around the tables and chairs. The applicant has provided proof of appropriate insurance coverage to Risk Management, and has provided signatures of all immediate neighbors stating that .they have no objection to the proposed construction. Based on their review, staff recommends approval of the permit. O�-3� A K E R S. F I E I, D PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Ryan Starbuck, Civil Engineer III FROM: Marian P. Shaw, Civil Engineer IV, Subdivisions DATE: October 2, 2006 SUBJECT: Encroachment Permit Application for: 1534 19" St. Name of Applicant. Sherman Gross Description of Encroachment: To allow outdoor seating at 19�h & Eye, St. Please review the attached encroachment permit and return to me at your earliest convenience. SAPV3M1TS\ENCR0A0HVrRAFF1C\1 traffic memd.doc M j ham! M APPLICATION FOR ENCROACHDIENT PE&MIT TO THE CITY ENGINEER OF THE'= OF BAKERSFIELID, CALIFORNIA: Pursuant to the provisions of Chapter 12.20 of the Bakersfield Municipal Code, the undersigned ap lies for a permit to place, erect, use and maintain an encroachment on public property or right -of -way as therein ed. 1. Full name of anolicant and complete address inpl ding.phone number: d/' GtP �q fie OMa/ zt,/,/),�w/ IQ-.Z) 2. Nature or description of the encroachment for which this application is made: I'l t, I-' -f 661 C . IT, t . A rb�d Orehlse 3. Location of the proposed encroachment: �. ,�.%' `. �!-�� �/l P-1 S-' / •P/�/ ear 4. Period of time for which the encroachment is to be maintained: _ Applicant agrees that if this application is granted, applicant shall indemnify, defend and hold harmless 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, arisin 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•tiie expiration of the permit for which this application is made, if granted, or-upon the revocation thereof bvthe City engineer, applicant will at his own cost and expense remove the same from the pu Iic property 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, iaintenance or existence of said encroachment. Applicant further agrees to obtain and keep all liability insurance required by the City Engineef 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 is: Applicant acknowledges the right of the City Engineer, pursuant to- .B•4ersfield Municipal,,Cc 12.20 to revoke the permit at any time. Date: `"' �,gn ui —re-cr p��u� w3zeror- • e res`entative ' PER'�iIT I HEREBY CERTIFY THAT I HAVE MADE AN INVESTIGATION OF THE PACTS STATED IN THE FOREGOING APPLICATION AND FLND TILAT THE MAPS ITENANCE OF SAID ENCROACIH'i IEN T (1) WILL (NOT) SUBSMUNTIALL'Y INTERFERE WITH THE USE OF THE PUBLIC PLACE MERE THE SAME IS TO DE LOCATED AND (Z) WILL (NOT) CONSTITUTE A HAZARD TO PERSONS USING SAID PUBLIC PLACE; SAID APPLICATION IS THEREFORE (GRANTED) (DENIED). SAID PERMIT SHALL EXPIRE Date: No. ignature of -ity Engineer CITY OF B AIKERSFIELD DEPART'MEN'T OF PUBLIC WORKS 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. !V Y ' (Owners Name) (Street for pdVosed encroachment) 53� / el- of (Address of purposed encroachment) SIGNED: 1) Name: Address 2) Warne: .!address 3) fume: Address 4) Name: Phone: Address: 5) Name: Address: ��- -- Date: Date: O/6/06 o "2n� v Date: Date: 6) Name: Date: Address: ai I - TM PiODUCER Michaud's Low Cost Insurance 6300 White Lane Suite E Bakersfield, CA 93309 (661)396 -9900 INSURED Capistrano's 1534 19th Street - ... ■..r ■■r■ ■ ■ ■■�vvt��■�v�.. 08/07/06 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE i HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR INSURERS AFFORDING COVERAGE I NAIC # INSURERA: OREGON MUTUAL INSURANCE COMPAN Bakersfield, CA 93301- I INSURER D:__.._.. INSURER E: COVERAGES ! INSURER F: THE POLICIES OF INSURANCE LISTED 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 CLAIMS._ ISR: ADD'L' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION 713A IN$RD ,__• _.. _^ _ DATE IMMIDD/YY DATE MM /DD/YY LIMITS ! GENERAL LIABILITY EACH OCCURRENCE $1,000,000 d❑ COMMERCIAL GENERAL LIABILITY 856219010 08/21106 08/21/07 PREMISES SES Ea occurence $100,000 ® ❑❑ CLAIMS MADE d❑ OCCUR i MED EXP Any one person) $10,000 El _ _ _ PERSONAL & ADV INJURY $1,000,000 �❑ _.4 __..._._ - -. i GENERALAGGRE _ GATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:; PRODUCTS - COMP /OP AGG $2,000,000 ❑ POLICY ❑ PROJECT ❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ ANY AUTO I (Ea accident) ❑ ALL OWNED AUTOS -- I ❑ BODILY INJURY L-i SCHEDULED AUTOS ❑H Per person) HIRED AUTOS _ BODILY INJURY ❑ NON OWNED AUTOS (Per accident) ❑❑ "' ' PROPERTY DAMAGE i .. _ _ -_ _ _ _ (Per accident) _ GARAGE LIABILITY I _ — - AUTO ONLY - EA ACCIDENT T— — ❑ ❑ ANY AUTO OTHER THAN EA ACC ❑ AUTO ONLY- AGG _... - - - ----- _.... - ._..- .. - - -- - —° - __— -- - -- -- EXCESS LIABILITY EACH OCCURRENCE 1 I ❑ I ❑ OCCUR ❑ CLAIMS MADE AGGREGATE — I ❑ DEDUCTIBLE ❑ RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE.- POLICY LiiJIT ,ESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS estaurant Property $100,000 CERTIFICATE HOLDER CANCELLATION_ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRI TICS TO THE CERTIFICATE HOLDER NAMED TO LEFT, BUT FAIL RE TO DO O SHALL IMPOSE NO OBLIGATION OR LIABILITY OF A Y KIND UPON THE INSURE ITS AGENTS OR REPRESENTATIVES. ACORD 25 (2001108) - - - 0 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 endrosement(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, extend or alter the coverage afforded by the polcies listed thereon. ACORD 25 (2001108) e2S" f0 e4 hca vmA n W 4fvi 4( -T en" 1,53 V-1 P2 7t G�G �Df�f l l �tJ .2.� r�r'LI�J LD.� r x,'�,a hue le tip r/ld. ;71 �� 07 f O-0 C a)O = O O .0 cn C Qo •C cn W cis .= ' 00 a) Q o C � .M NCn- �� =Eo O O v- `+- a) Q O 4- LOL �C a) Q) � — E 3 Q L O U �Nc QEc a) U) U �1 O = 2 a) O a)�ava) cnL�Ya)U . . .«r >, co O_ U O Q O O O N 'j a' a) c E c a) n- Q'_� a.. 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Na) oQ-0 QU U) co va)'0 ) E� a) QSO Zu n 2-0 OL �E 61- U � a) r- cn 0- � c4� 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: Nature or description of the encroachment for which this application is made: (Example: Wood or wrought iron fence, concrete block wall, raised planter, etc...) 3. Location of proposed encroachment: (Example: Side yard at back of sidewalk or front yard at back of sidewalk) 4. Period of time for which the encroachment is to be maintained: Indefinite or Other. (Please Circle) 5. Is property part of a Homeowner's Association Yes 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 acknowledges the right of the City Engineer, pursuant to Bakersfield Municipal Code Chapter 12.20 to revoke the permit at any time. S:\ EncroachmentPermits\ApplicationforEncroachment B A K E R S F I 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: Nature or description of the encroachment for which this application is made: (Example: Wood or wrought iron fence, concrete block wall, raised planter, etc...) 3. Location of proposed encroachment: (Example: Side yard at back of sidewalk or front yard at back of sidewalk) 4. Period of time for which the encroachment is to be maintained: Indefinite or Other. (Please Circle) 5. Is property part of a Homeowner's Association Yes 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 acknowledges the right of the City Engineer, pursuant to Bakersfield Municipal Code Chapter 12.20 to revoke the permit at any time. S:\ EncroachmentPermits\ApplicationforEncroachment B A K E R S F I E L D 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. (Street for proposed encroachment) (Owners name) Of Phone: (Address of proposed encroachment) SIGNED: 1.) Name: Date: Address: 2.) Name: Date: Address: 3.) Name: Date: Address: 4.) Name: Date: Address: 5.) Name: Date: Address: 6.) Name: Date: Address: Application Public Works Department 1501 Truxtun Avenue Bakersfield, California 93301 (661) 326 -3724 ENCROACHMENT PERMIT REQUIREMENTS 2. Permit Fee of $208.00 3. Drawing; Minimum 8 1/2 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.). S:\ LncroachrnentPermitsilnsuranceRequirements B As. I` r= P. S F I 'S L p Public Works Department 1501 Truxtun Avenue Bakersfield, California 93301 (661) 326 -3724 ENCROACHMENT PERMIT REQUIREMENTS 2. Permit Fee of $208.00 3. Drawing; Minimum 8 1/2 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.). S:\ LncroachrnentPermitsilnsuranceRequirements 7 /12/2010 3:21 PM PROM: Cal-Valley Cal.- Val.l.ey Tnsurance TO: 661 -8,12 -2011 PAGE: 002 OF 004 '`NCO CERTIFICATE OF LIABILITY INSURANCE DATE /12 /DDIYY0 �- 7i12iz01D PRODUCER (559)225 -1300 FAX: (559)225 -8966 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION CAI, VALLEY INSURANCE SERVICES INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE License #0733383 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, 5070 N. 6th St. #155 Fresno CA 93710 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Allied Mutual Insurance Co. 0003s Greg Pfeifer, DBA: DOO Wop Diner INSURER B: 1534 19th St. INSURER Bakersfield, CA 93301 I INSURER E: rnvFRAnFR THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE 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 BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OFSUCH POLICIES. AGGREGATE LIMITS SHOWN MAYHAVE BEEN REDUCED BYPAID CLAIMS. INSR LTR DD'L NSRDI TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 'L A• /, �r-A GENERAL LIABILITY Thomas Powell /DOB -o-+ . EACH OCCURRENCE $ 1 000 000 X .. _ C'UMMERCIAL GENERAL LIABILILY PREMISES jE, urr nee) g. 300L000_ A X CLAIMSMADt' X OCCUR CP7804499723 5�10�2010 5�10�2011 __. MLI.JFXI (AiyoneparsonJ -- $ 10,000 PERSONA- 6 ADV INJURY $ 1,000,000 _ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMITAPPLIESPER: PRODUCrs. COMP /OPAGG $ 2,000,000 X POLICY C PRO- JFF LOC AUTOMOBILE - -- LIABILITY COMBINED SINGLE LIMIT ANY A01'0 (Ea accident) $ BODILY INJURY ALL OWrJED AUTOS 3CIIEDLIt [D AUTOS (Per person) $ BODILY INJURY $ HIRED AUTOS NON-i �%NED AUTOS (Per accident) PROPERTY DAMAGE 'F (Per accident) GARAGE LIABILITY - AUTO ONLY - EA ACCIDENT _ OTI IER THAN EA ACC 'F ANY AUTO AU 10 ONLY. AGG EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE OCCUR CLAIM`:, MADE AGVREC AIE `C DEDUC.TIOLF $ $ RETENTION $ WORKERS COMPENSATION v1r;' S "rATU- I OTH- S 17R AND EMPLOYERS' LIABILITY YIN E.L. EACH ACCIDENT $ ANY PROFRIETOR'IPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ E.L. DISEASE - EA EMPLOYEE (Mandatory In NH) $ If yes, descnue under --- ---- -- - - --- __.__..... ----- -- --- ------ :3PECIAL PROVISIONS bclnw E.L. DISEASE -POLICY L.IMII" $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS City of Bakersfield is added as Additional Insured r FRTIFICATR Wrll nl:P rAKIrC1 I ATInK1 A(:UKL) Zb (ZUU91U1) © 1988 -2009 ACORD CORPORATION. All rights reserved. INS025 ( ?nocim) The ACORD name and logo are registered marks of ACORD PAGE 2!4 * RCVD AT 7/12/2010 3:21:06 PM [Pacific Daylight Time] * SVR:NEWYORKI2 * DNIS:2011 * CSID:Cal- Valley * DURATION (mm- ss):01.42 SHOULD ANY OF THE ABO VE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City Of Bakersfield DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 1501 Truxton Ave. Bakersfield, CA 93301 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $O SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 'L A• /, �r-A Thomas Powell /DOB -o-+ . A(:UKL) Zb (ZUU91U1) © 1988 -2009 ACORD CORPORATION. All rights reserved. INS025 ( ?nocim) The ACORD name and logo are registered marks of ACORD PAGE 2!4 * RCVD AT 7/12/2010 3:21:06 PM [Pacific Daylight Time] * SVR:NEWYORKI2 * DNIS:2011 * CSID:Cal- Valley * DURATION (mm- ss):01.42 7/1.2 /2010 3:21 PM FROM: Cal- Vall.ey Cal-Valley Insurance TO: 661- £352 -2011 PAGE: 003 OF 004 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. AGORD 25 (2009101) INS025 (200901) PAGE 3(4 * RCVD AT 7/12/2010 3:21:06 PM [PaCiflC Daylight Time] * SVR:NEWYORKI2 * DNIS:2011 * CSID:Cal- Valley " DURATION (mm- ss):01.42 7/12/207.0 3:27. PM FROM: Cal.- Valley Cal. - Valley Tnsurance TO: 6u"1 -852 -2011. PAGE! 004 OF 004 Additional Named Insureds Other Named Insureds Pco Wop Liner Doing Business As D "o Wop rin " -r Doing Business As OFAPPINF (02/2007) COPYRIGHT 2007, AMS SERVICES INC PAGE 4141 RCVD AT 7112/2010 3:21:06 PM [PaCIfIC Daylight Time] • SVR:NEWYORKl2 - DNIS:2011 ' CSID:Cal- Valley " DURATION (mm- ss):01 -42 7/12/2010 3:21 PM FROM: Cal- Valley Cal- Valley Insurance TO: 661 - 852 -2011 PAGE: 001 OF 004 Cal - Valley Insurance fx c o n f i d e n t i a l To: Greg - Doo Wop Diner Fax Number: 661- 852 -2011 From: Diane O'Brien Fax Number.• Business Phone: Home Phone: Pages: 4 DatelTlme: 7/12/2010 3:21:13 PM Subject.- City of Bakersfield - Certificate PAGE 114 * RCVD AT 7112/2010 3:21:06 PM [Pacific Daylight Time] * SVR:NEWYORKI2 * DNI8:2011 * CSID:Cal- Valley * DURATION (mm- ss):0142