HomeMy WebLinkAbout1400 s stCOB 10/13/2010 10:28:48 AM PAGE 2/003 Fax Server
ENCROACHMENT PERMIT
C= OF BAKERSFIELD
1501 TRTJXTUN AVE
(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- 30000040 Date 9/29/10
Property Address . . . . . . 1400 S ST
Application type description PW - ENCROACHMENT PERMIT
Owner Contractor
------------------------ ------------------ - - - - -- THIS PERMIT ISSUED TO PG &E
SILL FAMILY PARTNERSHIP PACIFIC GAS & ELECTRIC 4
1401 19TH STREET # 400
BAKERSFIELD CA 93301 BAKERSFIELD CA 93301
(661)
----------------------------------------------------------------------------
Permit . . . ENCROACHMENT PERMIT
Additional desc . .
Phone Access Code . 1037092
Permit Fee . . . . 208.00
Issue Date . . . . 9/29/10 Valuation 0
Qty Unit Charge Per Extension
BASE FEE 208.00
-----------------'-----------------------------------------------------------
Special Notes and Comments
PROPOSED DEEP WELL ANODE FOR CATHODIC
PROTECTION OF NATURAL GAS PIPELINE - E.
SIDE OF S STREET, 270' N/O 14TH ST.
CONTACT PERSON: PHIL MILAN
559 - 263 - 5162/559- 908 -8148
----------------------------------------------------------------------------
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.
P il'l /L�iH
Signa0de of Applicant (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 G ) (DENIED). Said permit shall expire on date stated above.
Signature of City Engineer
Additional Terms on the Back
Received Time Oct.13. 2010 10:28AM No.4025
COB 10/13/2010 10:28:48 AM PAGE 3/003 Fax Server
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 or judicial tribunals of any kind whatsoever, arising out of, connected with, or caused by applicant, or in any way arising
from, the terms and provisions of this permit or the placement, use (by applicant or any other person or entity) or maintenance of said
encroachment, whether or not caused in part by a party indemnified hereunder, except for CITY's sole active negligence or willful
misconduct_ The applicant further agrees to maintain the aforesaid encroachment during the life of the 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 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 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 issuance evidencing sufficient coverage for
bodily injury or property damage liability of both and required endorsements evidencing the insurance required.
I have read and acknowledge the above.
Applicant's Initials
Received Time Oct.13. 2010 10:28AM No.4025
i acfflcr Gas and Hudson T. Martin One Market, Spear Tower
Fla I I Director Suite 2400
Efectic Company ERM & Insurance Department San Francisco, CA 94105
415.267.7239
415.267.7248
STATEMENT OF
SELF- INSURANCE PROGRAM
October 25, 2010
Issued to: City of Bakersfield
Public Works Dept.
1501 Triton Ave.
Bakersfield, CA 93301
Re: Insurance Requirements
This letter certifies PG &E is insured under a major risk management program with large self- insured
retentions. The program provides coverage for the insurance types and limits reflected in the
agreement which includes:
Commercial General Liability: $ 1,000,000 each occurrence/ $ 2.000,000 aggregate
Business Automobile Liability: $ 1,000,000 each occurrence /$ 2,000,000 aggregate
Further, PG &E has qualified as a self - insurer under the laws of the State of California with respect to
Workers' Compensation. Our identification number for this purpose is 2- 0012 -01 -099.
This letter shall remain in effect until the termination of the insurance agreement between PG &E and
the City of Bakersfield.
*Please note a certificate of insurance is not applicable when an entity is self- insured, such as PG &E, and
note there is no expiration date.
d
HUDSON T. MARTIN
SI Certification Letter
File: PGE- 246.01
Pay Me Gas and
Philip Milam
Senior Engineering Estimator
GTO Gas Engineering
September 23, 2010
City of Bakersfield,
Public Works Department
In Regards to: PSRS: 22161, PM: 30778890, L -142S, MP 10.36, DEEP WELL ANODE,
BAKERSFIELD
375 N. Wiget Ln., Rm. 250
Walnut Creek, CA 94598
Phone: 925-9744157
FAX: 925 - 974 -4102
Email ptm6 @pge.com
Please see attached Encroachment Permit application and attached drawings for your review.
Also, there is a check for $208 enclosed with permit application.
If you have any questions or concerns please feel free to contact me at any time.
Sincerely,
#hi Mil am
- �4vo
Ll -
ENCROACHMENT PERMIT M 3owoo(io
APPLICATION FORM
e� ' CITY OF BAKERSFIELD
PUBLIC WORKS DEPARTMENT
,"w�, 1501 TRUXTUN AVE
1`Il (ISM BAKERSFIELD CA 93301
(661) 326 -3724 Fax: (661) 852-2012
LOCATION OF ENCROACHMENT(Address required where available):
F F A S' ST"I # K .Z7o' y0--PTf/OF /S/T/f STic�EE! ?Sxe /EL, J _
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,ofIG // /c G.lS��t�d E�ECT•7 /c�'O., �s�r� ��G�� -r
COMPLETE ADDRESS: y87 , S'f/ W AyE PHONE:
FAX:
CELL: .SSq,�9O8 - 8/M8
PROJECT INFORMATION
DESCRIPTION OF ENCROACHMENT (Example: Wood or wrought iron fence, concrete block wall, raised
planter, etc.): "049-sO &UZO WELL AAME 64-W GAT7120le A %072-5 erl V Di"
N ,4T///�l G,15 64id ZlMf-
PERIOD OF TIME FOR ENCROACHMENT: INDEFINATE or OTHER: TU S,
/1a1/
(Please Circle)
CONTACT PERSON PHONE:
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
propegy 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, 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: \PERMITS \ENCROAC14\Encroachment Permit Req Form.DOC January 2009
ENCROACHMENT 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 . . . . . 10- 30000040 Date 9/29/10
Property Address . . . . . . 1400 S ST
Application type description PW - ENCROACHMENT PERMIT
Owner Contractor
--- ---- ----- --- --- - - - - -- ------------------ - - ----
SILL FAMILY PARTNERSHIP PACIFIC GAS & ELECTRIC
1401 19TH STREET # 400
BAKERSFIELD CA 93301 BAKERSFIELD CA 93301
(661)
----------------------------------------------------------------------------
Permit . . . . . . ENCROACHMENT PERMIT
Additional desc . .
Phone Access Code . 1037092
Permit Fee . . . . 208.00
Issue Date . . . . 9/29/10 Valuation . . . . 0
Qty Unit Charge Per Extension
BASE FEE 208.00
----------------------------------------------------------------------------
Special Notes and Comments
PROPOSED DEEP WELL ANODE FOR CATHODIC
PROTECTION OF NATURAL GAS PIPELINE - E.
SIDE OF S STREET, 270' N10 14TH ST.
CONTACT PERSON: PHIL MILAM
559 -263- 5162/559- 908 -8148
----------------------------------------------------------------------------
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.
Signature of Applicant (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
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 or judicial tribunals of any kind whatsoever, arising out of, connected with, or caused by applicant, or in any way arising
from, the terms and provisions of this permit or the placement, use (by applicant or any other person or entity) or maintenance of said
encroachment, whether or not caused in part by a party indemnified hereunder, except for CITY's sole active negligence or willful
misconduct. The applicant further agrees to maintain the aforesaid encroachment during the life of the 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 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 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 issuance evidencing sufficient coverage for
bodily injury or property damage liability of both and required endorsements evidencing the insurance required.
I have read and acknowledge the above.
Applicant's Initials
Pacific Gas and
e
Elecittic Company
Philip Milam 375 N. Wiget Ln., Rm. 250
Senior Engineering Estimator Walnut Creek, CA 94598
GTO Gas Engineering
Phone: 925-974-4157
FAX: 925-974-4102
Email: ptm6 @pge.com
October 26, 2010
City of Bakersfield,
Public Works Department
1501 Truxtun Ave.
Bakersfield, CA 93301
In Regards to:
Encroachment Permit, Application Number 10- 30000040
PG &E Reference:
PSRS 22161, PM 30778890, L -142S, MP 10.36, DEEP WELL ANODE,
BAKERSFIELD
Pertaining to Trish Enriquez's request to provide a signed hard copy of permit and proof
of liability insurance.
Please see enclosed signed permit along with PG &E's Statement of Self - Insurance
Program letter.
If you have any questions or concerns please feel free to contact me at any time.
Sincerely,
-��%2•
Phil p Milam
I
Pacific Gas and Hudson T. Martin One Market, Spear Tower
Director Suite 2400
¢
Electric Company ERM & Insurance Department San Francisco, CA 94105
a
415267.7239
415.267.7248
STATEMENT OF
SELF- INSURANCE PROGRAM
October 25, 2010
Issued to: City of Bakersfield
Public Works Dept.
1501 Triton Ave.
Bakersfield, CA 93301
Re: Insurance Requirements
This letter certifies PG &E is insured under a major risk management program with large self- insured
retentions. The program provides coverage for the insurance types and limits reflected in the
agreement which includes:
Commercial General Liability: $ 1,000,000 each occurrence/ $ 2.000,000 aggregate
Business Automobile Liability: $ 1,000,000 each occurrence /$ 2,000,000 aggregate
Further, PG &E has qualified as a self - insurer under the laws of the State of California with respect to
Workers' Compensation. Our identification number for this purpose is 2- 0012 -01 -099.
This letter shall remain in effect until the termination of the insurance agreement between PG &E and
the City of Bakersfield.
*Please note a certificate of insurance is not applicable when an entity is self - insured, such as PG &E, and
note there is no expiration date.
HUDSON T. MARTIN
SI Certification Letter
File: PGE- 246.01
40
00� MOM""=---Mft
D A K E R S F I E L ID
PUBLIC WORKS DEPARTMENT
MEMORANDUM
TO: Ralph Korn, Risk Manager
FROM: Bob Wilson, Supervisor II, Subdivisions
DATE: November 2, 2010
SUBJECT: Encroachment Permit Application for: 1400 S St
Name of Applicant: Pacific Gas & Electric
Description of Encroachment. Proposed deep well anode for cathodic
protection of natural gas pipeline — East
side of S Street, 270' North of 14th St.
Please review the insurance certificate with the attached encroachment permit and return to me
at your earliest convenience.
S: \PERMITS \ENCROACH \INSURANC \1400 S StAoc
9
B A K E Ir? S F I E L L3
PUBLIC WORKS DEPARTMENT
MEMORANDUM
TO: John Ussery, Engineer II
FROM: Bob Wilson, Supervisor II, Subdivisions
DATE: November 2, 2010
SUBJECT: Encroachment Permit Application for: 1400 S St.
Name of Applicant: Pacific Gas & Electric
Description of Encroachment. Proposed deep well anode for cathodic
protection of natural gas pipeline — East
side of S Street, 270' North of 14th St.
Please review the attached encroachment permit and return to me at your earliest convenience.
you 5- Zv1 a
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S: \PERMITS \ENCROACH \TRAFFIC \1400 S StAoc
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