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HomeMy WebLinkAbout4241 CHESTER LNENCROACHMENT PERMIT CITY OF BAKERSFIELD PUBLIC WORKS DEPARTMENT 1501 TRUXTUN AVEr °,. BAKERSFIELD CA 93301 VE (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- 30000027 Date 6/25/10 Property Address . . . . . 4241 CHESTER LN Application type description PW - ENCROACHMENT PERMIT Owner ------------------------ RESIDENCE INN III LLC 3141 HOOD ST STE 700 DALLAS TX 75219 Contractor --------------- --- - - -- -- OWNER ---------------------------------------------------------------------------- Permit . . . . . . ENCROACHMENT PERMIT Additional desc . . Phone Access Code . 1013069 Permit Fee . . . . 208.00 Issue Date . . . . 6/25/10 valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 208.00 ---------------------------------------------------------------------------- Special Notes and Comments 6 ft wrought iron fence along Chester Ln. & Easton Dr. ---------------------------------------------------------------------------- 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. i�wLa A 0�u(� Signature of Applic t (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 THEREFO GRANT D� (DENIED). Said permit shall expire on date stated above. Signature of City Engineer Additional Terms on the Back 1. .rr • B A rC E R S V Z 'E -L ID Public V orks Department 15( : 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 Pull name of applicant and complete address including phone number: 2. Nature or description of the encroachment for wh fence, concrete block wall, raised planter, etc...) _ n is le: aG&s 800 or wrought iron 3. Location of proposed encroachment: (Example: Side yard at back of sidewalk or front yard at back of sidewalk) n &-+ 4. Period of time for which the encroachment is to be maintained: Q;efl��Wlelrc or Other. ale) Appli cant 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 properly 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 JQAJes XVA 900 /V ROVd Wd 9T:TZ :C 0TOZ /D /T 900 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. (8-txcet for proposed encroachment ) (Owners Name) ��G(+ M0/ Q'V (Address of proposed encroachment) SIGNED: 1.) Name: Address: 2.) Name: Address: 3.) Name: Address: 4.) Name: Address: 5.) Name: Address: 6.) Name: Address. Date: Date: Date: Date: Date. Date: CUMMW ' &J �"904L CA '), ('�-nm9U owv�v+s, aanaaS XVA 900 /9 HOVd Nd 9T :TZ:£ OTOZ /D /T 900 TO: FROM: DATE: SUBJECT: .4000, B A Imo. E R. S F I E L D PUBLIC WORKS DEPARTMENT MEMORANDUM Ryan Starbuck, Civil Engineer III Bob Wilson, Supervisor II, Subdivisions July 7, 2010 Encroachment Permit Application for: 4241 Chester Lane Name of Applicant: Residence Inn III LLC Description of Encroachment: 6' wrought iron fence along Chester Avenue and Easton Drive. Please review the attached encroachment permit and return to me at your earliest convenience. 71,zlW,o q) e! tr,E P C-?AST L of r'eti6,C- (k) 17V t4e,�s A)l5r PPCNl V c>°r✓ P c��rl -- � ' 1441F%) -AOV u L,tq- c,6(uV e-,m� 4-IcUE P(ff614M i 7ttrs � iu�f�. S: \PERMITS \ENCROACH \TRAFFIC \4241 Chester Ln.doc D A K E R 5 F I E E D PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Ralph Korn, Risk Manager FROM: Bob Wilson, Supervisor II, Subdivisions DATE: July 7, 2010 SUBJECT: Encroachment Permit Application for: 4241 Chester Lane Name of Applicant: Residence Inn III LLC Description of Encroachment: 6' wrought iron fence along Chester Lane and Easton Drive Please review the insurance certificate with the attached encroachment permit and return to me at your earliest convenience. S: \PERMITS \ENCROACH \INSURANC \4241 Chester Ln.doc ACOR"0 DATE(MMIDD/YYYY) L� CERTIFICATE OF LIABILITY INSURANCE 6252010 PRODUCER Beecher Carlson Insurance Services THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 2002 Summit Boulevard, Suite 900 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Atlanta, GA 30319 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 678 - 539 -4800 www.beechercarlson.com 678- 539 -4890 INSURERS AFFORDING COVERAGE NAIC # INSURED Marriott International, Inc. & Subsidiaries INSURER A: National Union Fire Ins Co of Pittsburgh, PA 19445 Attn: Risk Management Dept. 52/924.36 (Insurance) INSURER B: New Hampshire Insurance Co. 23841 301- 380 -5685 INSURER c: The Insurance Company of the State of PA 19429 10400 Fernwood Road INSURER D: Ace Property & Casualty Insurance Co. 20699 Bethesda MD 20817 INSURER E: Lexington Insurance Company 19437 rnVPPAr:rc 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS E GENERAL LIABILITY GL 093 -96 -40 10/1/2009 10/1/2010 EACH OCCURRENCE $ 2,500,000 COMMERCIAL GENERAL LIABILITY DAMAGE PREMISES S ( RENTED Ea occurrence ) $ 2,500,000 CLAIMS MADE Fv_] OCCUR MED EXP (Any one person) -- $ PERSONAL & ADV INJURY $ 2,500,000 Liquor Liability $500,000 SIR GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 3,000,000 POLICY 7 PRO �/ LOC A AUTOMOBILE LIABILITY ANY AUTO CA 093 -63 -21 AOS CA 093 -63 -22 VA 10/1/2009 10/1/2010 COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ B HIRED AUTOS NON -OWNED AUTOS CA 093 -63 -23 MA PROPERTY DAMAGE (Per accident) $ GKLL - See Attached GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG D EXCESS / UMBRELLA LIABILITY XOO G24874084 10/1/2009 10/1/2010 EACH OCCURRENCE $ 25,000,000 V OCCUR EI CLAIMS MADE AGGREGATE $ 100,000,000 Per Loc A $ 25,000,000 $ DEDUCTIBLE $ RETENTION $ B B C WORKERS COMPENSATION AND EMPLOYERS LIABILITY ' Y/N OFFICERIMEM ER EXCLUDED? ECUTIVE (Mandatory in NH) WC4288966 TX WC4288967 CO UT WI WY WC4288964 MA 10/1/2009 10/1/2010 `/ WC STATU- OTH - E.L. EACH ACCIDENT $ 3.000.000 E.L. DISEASE - EA EMPLOYEE $ 3,000,000 E.L. DISEASE - POLICY LIMIT $ 3,000,000 If yes, describe under SPECIAL PROVISIONS below OTHER Workers Compensation 10/112009 10/1/2010 See Attachment for Additional I j- Policies DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS BAKERSFIELD RESIDENCE INN 4241 CHESTER LN. Not Entered BAKERSFIELD CA 93309 ID:57423 RE: Encroachment Permit The City of Bakersfield, its mayor, council, employees, agents and volunteers are added as additional insured's with respect to the wrought iron fence at 4241 Chester Lane, Bakersfield, CA 93309. rcoTi Cl/`ATC Lini n=o rAMt%=I I ATInKI ACORD 25 (2009/01) ©1988 -2009 ACORD CORPORATION. All rights reserved. CERT NO.: 7668287 CLIENT CODE: 38 (ATL) Kathy Black 6/25/2010 8:52:19 AM Page 1 of 3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Bakersfield DATE THEREOF, THE ISSUING INSURER WILL 0(V,08 pp MAIL 60 DAYS WRITTEN Attn: Public Works Dept. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 9)rEXIKD4*=)00M)6)(0= 1501 Truxtun Avenue 1K](�c>auDti�cdtxD( X4( IONi) �E (XICp(iQE7R)4xSCACGF}IIX9C�(6K Bakersfield CA 93301 It»( AUTHORIZED REPRESENTATIVE A (ATL) Robert W. Hessel �j� /,•�Ti1+1 /Y /� // ACORD 25 (2009/01) ©1988 -2009 ACORD CORPORATION. All rights reserved. CERT NO.: 7668287 CLIENT CODE: 38 (ATL) Kathy Black 6/25/2010 8:52:19 AM Page 1 of 3 6/25/2010 Attachment to Marriott International, Inc. Certificate of Insurance DESIGNATION OF ADDITIONAL INSUREDS It is agreed that, with respect to the insurance afforded by any policy listed on this certificate, the provisions of the policy designating who is insured thereunder have been amended to include any person or organization, the "Additional Insured ", for whom the Named Insured agrees in writing to procure liability insurance, provided: a) The coverage and limits of liability afforded to such "Additional Insured" apply only to the extent required by the agreement, but in no event for coverage not afforded by the policy, not for limits of liability greater than the insurer's liability stated in the policy declarations; b) The inclusion of more than one insured shall not increase the limits of the insurer's liability; and c) The designation hereunder of the "Additional Insured" as an insured shall be null and void during the term of any separate liability insurance policy not listed herein and procured by the Named Insured for such "Additional Insured ". CERT NO.: 7668287 CLIENT CODE: 38 (ATL) Kathy Black 6/25/2010 8:52:19 AM Page 2 of 3 6/25/2010 ATTACHMENT TO MARRIOTT INTERNATIONAL, INC. CERTIFICATE OF INSURANCE Additional Policies — Effective 10 -1 -2009 to 10 -1 -2010 TYPE /STATES COVERED CARRIER POLICY NO. COVERAGES WORKERS COMPENSATION SELF - INSURED SPECIFIC National Union Fire XWC 089 -90 -40 W.C. Statutory each EE for Disease EXCESS POLICY Insurance Company W.C. Statutory each Accident AL, AR, AZ, CA, CT, DC, of Pittsburgh, PA Employers Liability: DE, FL, GA, HI, IA, IL, IN, $2,500,000 - Each Accident KY, LA, MD, MI, MO, NH, $2,500,000 - Each Employee /Disease NJ, NM, NV, NY, OH, OK, $2,500,000 - Aggregate /Disease OR, PA, RI, SC, TN, WA, $ 500,000 - Self Insured Retention WV AK,ID, KS, ME, MN, MO, New Hampshire WC 428 -89 -65 Statutory Workers' Compensation MS, MT, NE, VA Insurance Company Employers' Liability: $3,000,000 - Each Accident $3,000,000 - Each Employee /Disease $3,000,000 - Aggregate/Disease NORTH CAROLINA National Union Fire XWC 089 -90 -41 Statutory — Workers' Compensation Self Insured — Insurance of Employers Liability: Specific /Agg Excess Pittsburgh, PA $ 2,500,000 - Each Accident Policy — Workers' $ 2,500,000 - Each Employee /Disease Compensation and $ 2,500,000 - Aggregate /Disease Employer's Liability $10,000,000 - Aggregate Excess $ 5,000,000 - Aggregate Retention $ 500,000 - Self Insured Retention GENERAL LIABILITY TEXAS Illinois National GL 093 -96 -39 (a) Associate Injury Benefit Plan per Non Subscriber Insurance Company Plan Benefits (b) Employers' Liability: $2,000,000 - Each Accident $2,000,000 - Each Employee /Disease $2,000,000 - Aggregate /Disease $1,000,000 - Retention USVI American 005 - 1001124 $3,000,000 Each Occurrence International $3,000,000 Damage to Rented Insurance Co. of Premises Puerto Rico $3,000,000 Personal & Adv Injury $5,000,000 General Aggregate $3,000,000 Products AUTO LIABILITY All Other States Excluding National Union Fire CA 093 -63 -24 Garagekeepers Legal Liability Only MA Ins. Co. of Pittsburgh, $3,000,000 Limit PA GKLL MA New Hampshire CA 093 -63 -23 Garagekeepers Legal Liability Insurance Co. $3,000,000 Limit USVI American 201 - 1001544 Automobile Liability: $2,000,000 Limit & International Ins. Co. Garagekeepers Legal Liability: of Puerto Rico $3,000,000 Limit CERT NO.: 7668287 CLIENT CODE: 38 (ATL) Kathy Black 6/25/2010 8:52:19 AM Page 3 of 3 C-3 nro ul m O CID o. 'Go Go o ol C3 ! kl. m 001- 001 .0 91* 911 Go pp \L7 ro—o Lgo I o o 0000 Go Go iL Go , F ho i L III dl C4 ;gz Easton Drive -------- -- - --- —000-80mm --- --- ----- ----- I I U-1 I 1 19 V 65 Go Ffl C-3 nro ul m O CID o. 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