Loading...
HomeMy WebLinkAbout900 22ND STA E A I.: E R. S F I E L D PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Ralph Korn, Risk Manager FROM: Bob Wilson, Supervisor II, Subdivisions DATE: October 4, 2010 SUBJECT: Encroachment Permit Application for: 900 22 "d Street Name of Applicant: Garden Community Church Description of Encroachment: Chain link fence along the west side, % of north side and % of south side of 900 22"d Please review the insurance certificate with the attached encroachment permit and return to me at your earliest convenience. S:\PERMITS\ENCROACH\INSURANC\—Insurance memo.doc ENCROACHMENT PERMIT CITY OF BAKERSFIELD PUBLIC WORKS DEPARTMENT 1501 TRUXTUN AVE BAKERSFIELD CA 93301 (661) 326 -3724 'O THE CITY ENGINEER OF THE CITY OF BAKERSFIELD CALIFORNIA: 'ursuant to the provisions of Chapter 12.20 of the Bakersfield Municipal Code, the undersigned applies for a permit to place, erect, use and wintain an encroachment on public property or right of way as therein defined. Application Number . . . . . 10- 30000042 Date 10/01/10 Property Address . . . . . . 900 22ND ST Application type description PW - ENCROACHMENT PERMIT Owner Contractor GARDEN COMMUNITY CHURCH - OWNER 2010 O ST BAKERSFIELD CA 93301 ( 66) 309 -0928 ---------------------------------------------------------------------------- Permit . . . . . . ENCROACHMENT PERMIT Additional desc . . Phone Access Code . 1037944 Permit Fee . . . . 208.00 Issue Date . . . . 10/01/10 valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 208.00 ---------------------------------------------------------------------------- Special Notes and Comments Chain link fence along the west side, 1/2 of north side and 1/2 of south side of 900 22nd Street-. Contact person: Josh Graham 661 - 912 -4381 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due --- -- -- ---- - -- --- - --- - - -- -- ---- -- -- -- - -- - - - - - -- - --- - - ---- Permit Fee Total 208.00 208.00 .00 .00 Grand Total 208.00 208.00 .00 .00 right of the .,ity Engineer, pursuant to the Bakersfield Municipal Code Chapter 12.20 to revoke the ermit at anY tt d. ;ignature f— Appheant (Owner /Agent) Print Name HEREBY CERTIFY THAT I HAVE MADE AN INVESTIGATION OF THE FACTS STATED IN THE FOREGOING d"PLICATION 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) VII,L (NOT) CONSTITUTE A HAZARD TO PERSONS USING SAID PUBLIC PLACE; SAID APPLICATION IS 'HEREFORE (GRANTED) (DENIED). Said permit shall expire on date stated above. ignature of City Engineer Additional Terms on the Back AICCRDM CERTIFICATE OF 'RODYCER 800.843.6054 FAX 909.307.1245 The Cutler Group 201 Cajon Street Redlands, CA 92373 Suzanne Stone NSURED Garden Community Church 2010 "0" Street Bakersfield, CA 93301 rnvoDAr_Ge LIABILITY INSURANCE DATE(MMIDD/YYYY) 12/21/2009 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURERA: GuideOne Specialty T INSURERS: Gui deOne Mutual INSURER C: INSURER D: INSURER E: 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. VSR -TR DD' NE TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDD/YYYY POLICY EXPIRATION DATE MMIDD/YYYY LIMITS GENERAL LIABILITY 1230-822 01/11/2010 01/11/2011 EACH OCCURRENCE $ 1,000,000 DA E T RENTED PREMISES Ea occurrence $ 1, 000 000 X COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $ 10,000 CLAIMS MADE FRI OCCUR PERSONAL & ADV INJURY $ _ 1,000,000 A X GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ , 000 , 0_0_0__ ^3 PRO - X 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) $ I GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC ANY AUTO $ — $ AUTO ONLY: AGG EXCESS /UMBRELLA LIABILITY 1230 -823 01/11/2010 01/11/2011 EACH OCCURRENCE $ 1,000,00_0 _ AGGREGATE $ 1,000,000 IOCCUR E:1 CLAIMS MADE $ B -- _ -- � DEDUCTIBLE $ X RETENTION $ 2,500 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) if yes, describe under SPECIAL PROVISIONS below TORY E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE ^_ $ E.L. DISEASE - POLICY LIMIT $ I OTHER 7ESGKIP I IUN Ur Ul tKAI IUNb I LUGA I IUNS r VCr11ULCJ I CAULUJIUNJ /AUUCU DT CIVUVf[J CIYI CIV 1 I or—Im" rnvvw e: All buildings at 900 22n St. Bakersfield, Ca 93301; 1/4 acre each at 2201, 2205 "0" St nd 2214 "N" St, Bakersfield 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 WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR San Joaquin Bank P.O. Box,1907 Bakersfield, CA 93303 RD 25 (2009/01) AUTHORIZED REPRESENTATIVE Jason Raymond /SUZANE ©1988 -2009 ACORD CORPORATION. All The ACORD name and logo are registered marks of ACORD reserved. 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. ,CORD 25 (2009/01) additional Coverages and Factors 12/21/2009 Line of Business Coverages for General Liability Coverage Limits Ded /Ded Type Rate Premium Factor Sexual Misconduct 250,000/500,000 General Aggregate 3,000,000 Personal & Advertising 1,000,000 Injury Each Occurrence 1,000,000 Fire Damage 1,000,000 Medical Expense 10,000 Products /Completed Ops 3,000,000 Aggregate Employment Practices 500,000 0 Liability E A Imo. E R. S F I E L L3 PUBLIC WORKS DEPARTMENT MEMORANDUM TO: John Ussery, Engineer II FROM: Bob Wilson, Supervisor II, Subdivisions DATE: October 4, 2010 SUBJECT: Encroachment Permit Application for: 9 0 22nd Street y� 2UJC sef�e�� Name of Applicant: eiaa -b4 Description of Encroachment: Chain link fence along the west side, % of north side and % of south side of 900 22 "a Please review the attached encroachment permit and return to me at your earliest convenience. ocnr /l1 20 /0 A CNrfi_L poizTi m; or FeucF 15 1WIpE 7ZtC 5'lG�ff? G//L/C ,4T' rwc - a -cot�oT coPjc-2 or -F416 hq,QP SAPERMITS \ENCR0ACH \TRAFFIC \1 traffic memo.doc ENCROACHMENT PERMIT CITY OF PUBLIC WORKS • • • y� 1 1501 TRUXTUN AVE ♦ �� BAKERSFIELD (661) 326-3724 O THE CITY ENGINEER OF THE CITY OF BAKERSFIELD CALIFORNIA: ur'suant to the provisions of Chapter 12.20 of the Bakersfield Municipal Code, the undersigned applies for a permit to place, erect, use and taintain an encroachment on public property or right of way as therein defined. Application Number . . . . . 10- 30000042 Date 10/01/10 Property Address . . . . . . 900 22ND ST Application type description PW - ENCROACHMENT PERMIT Owner Contractor GARDEN COMMUNITY CHURCH OWNER 2010 O ST BAKERSFIELD CA 93301 ( 66) 309 -0928 ----•----------------------------------------------------------------------- Permit . . . . . . ENCROACHMENT PERMIT Additional desc . . Phone Access Code . 1037944 Permit Fee . . . . 208.00 Issue Date . . . . 10/01/10 Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 208.00 Special Notes and Comments Chain link fence along the west side, 1/2 of north side and 1/2 of south side of 900 22nd Street. Contact person: Josh Graham 661 - 912 -4381 .---------------••----------------------------------------------------------- Fee summary Charged Paid Credited Due --- -------- -- - - -- ---- - ----- ---- - - - --- -- -- - -- --- ---- - - - --- Permit Fee Total 208.00 208.00 .00 .00 Grand Total 208.00 208.00 .00 .00 �pplicalii a kn edgy t- right of the iry Enneer, pursuant to the Bakersfield Municipal Code Chapter 12.20 to revoke the } ermit at "an, ti ri: "_� •, _ ._. _ signature Applieant (Owner /Agent) Print Name HEREBY CERTIFY THAT I HAVE MADE AN INVESTIGATION OF THE FACTS STATED IN THE FOREGOING �PPL,ICATION 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) VILL (NOT) CONSTITUTE A HAZARD TO PERSONS USING SAID PUBLIC PLACE; SAID APPLICATION IS TIEREFORE (GRANTED) (DENIED). Said permit shall expire on date stated above. signature of City Engineer Additional Terms on the Back /v c Ti ► 0`90 c "i P, C-4! ............. co 9 B A K E R S F I E L D PUBLIC WORKS DEPARTMENT 1600 TRUXTUN AVENUE BAKERSFIELD, CA 93301 (661) 326 -3724 RAUL M. ROJAS, DIRECTOR • CITY ENGINEER November 3, 2010 Garden Community Church 2010 "O" Street Bakersfield, CA 93301 RE: Encroachment Permit Application Dear Sirs: We have reviewed your application for an Encroachment Permit for a fence within the road right of way around the Garden Community Church at 2010 "O" Street. A portion of the fence at the corner of 22nd Street and "O" Street intersection is within the line of site of vehicles on "O" Street to see approaching vehicles from 22nd Street as illustrated on the attached map. That portion of the existing fence as shown in red will need to be relocated to the "new fence line" designated in green before we can approve your Encroachment Permit application. To assist you the attached map also includes distances along and from the centerline of 22nd Street to the "new fence line ". Upon the completion of the fence relocation please contact our office and we will proceed with your approval. The line of site requirement is a health and safety issue. Vehicles approaching the intersection must be able to see any approaching vehicle. Should you have any questions, please contact Bob Wilson at (661) 326 -3566. Very truly yours, RAUL M. ROJAS Public Works Director by: MARIAN P. SHAW Civil Engineer IV cc: encroachment permit file — Randy Johnson Reading file Randy Fidler — Code Enforcement SAPERMITS \ENCROACH \Denial Letterst2010 0 Street.doc Ii i i i i i i i i i i - - - - - -- n0" S I ---- 1 --- -_ o Ii i i 'l ACORQ CERTIFICATE OF LIABILITY INSURANCE MIDDIYYYY) ATE (M DATE DD' NSR TYPE OF INSURANCE POLICY NUMBER P ODt CER 800.843.6054 FAX 909.307.1245 T. POLICY EXPIRATION DATE MMIDDIYYYY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The ' Cutler Group AUTHORIZED REPRESENTATIVE > ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1230-822 01/11/2010 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 201 Cajon Street $ 1,000,000 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Redlands, CA 92373 X COMMERCIAL GENERAL LIABILITY Suzanne Stone PREMISES Ea RENTED INSURERS AFFORDING COVERAGE NAIC # INSURED Garden Community Church INSURERA: GuideOne Specialty CLAIMS MADE T OCCUR 2010 "0" Street INSURERB: GuideOne Mutual PERSONAL & ADV INJURY Bakersfield, CA 93301 A INSURER C: INSURER D: INSURER E: rnvoonr_oc 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 LTR DD' NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDDNM POLICY EXPIRATION DATE MMIDDIYYYY LIMITS REPRESENTATIVES. AUTHORIZED REPRESENTATIVE > GENERAL LIABILITY 1230-822 01/11/2010 01/11/2011 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea RENTED $ 1,000,000 MED EXP (Any one person) $ 10,000 CLAIMS MADE T OCCUR PERSONAL & ADV INJURY $ 11000,000 A X GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 3,000,000 PO - R X POLICY JE C 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 1230 -823 01/11/2010 01/11/2011 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 OCCUR F-1 CLAIMS MADE $ B $ DEDUCTIBLE $ X RETENTION $ 2,500 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) TI TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE •POLICY LIMIT $ If yes, describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Re: All buildings at 900 22n St. Bakersfield, Ca 93301; 1/4 acre each at 2201, 2205 "0" St and 2214 "N" St, Bakersfield ACORD 25 (2009/01) W IV00.LVVV ML VIVJ VVRr VIVirV�. nu ynw cacvcu. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR San Joaquin Bank REPRESENTATIVES. AUTHORIZED REPRESENTATIVE > P.O. Box,1907 Ba ersfield, CA 93303 Jason Ra mond /SUZANE f �� ACORD 25 (2009/01) W IV00.LVVV ML VIVJ VVRr VIVirV�. nu ynw cacvcu. The ACORD name and logo are registered marks of ACORD ,j N 25 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. Additional Coverages and Factors 12/21/2009 Line of Business Coverages for General Liability Coverage Limits Ded /Ded Type Rate Premium Factor Sexual Misconduct 250,000/500,000 General Aggregate 3,000,000 Personal & Advertising 1,000,000 Injury Each Occurrence 1,000,000 Fire Damage 1,000,000 Medical Expense 10,000 Products /Completed Ops .3,000,000 Aggregate Employment Practices 500,000 0 Liability 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- 30000042 Date 10/01/10 Property Address . . . . 900 22ND ST Application type description PW - ENCROACHMENT PERMIT Owner Contractor -- ------------ -- -- -- - - -- - -- GARDEN COMMUNITY CHURCH OWT 2010 O ST BAKERSFIELD CA 93301 ( 66) 309 -0928 --------- ---- ----------------- Permit . . . . . . --- - - - --- ENCROACHMENT PERMIT' Additional desc . . Phone Access Code 1037944 Permit Fee 208.00 Issue Date 10/01/10 Qty Unit Charge Per BASE FEE --------------------------------------------- Special Notes and Comments Chain link fence along the west side, 1/2 of north side and 1/2 of south side of 900 22nd Street. Contact person: Josh Graham 661 - 912 -438 --------------------------------------------- Fee summary Charged Paid - --- ------ - - - - --- ---- - --- -- --- - - - - -- Permit Fee Total 208.00 208.00 Grand Total 208.00 208.00 /s the 3-(4 -il L-611 'p-r"t" *� g-,c .00 .00 .00 .00 , pursuant to the Bakersfield Municipal Code Chapter 12.20 to revoke the 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 /� 5�wx�)qy, 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: L,Z)S� K Nature or description of the encroachment for wni tnis app icatJo�n I maae: ttxampie: vvoou or wrouym uun fence, concrete block wall, raised planter, etc...) �K' . 1 �. - �1oe 3. Location of proposed encroachment: (Example: Side yard at back of sidewalk or front yard at back of sidewalk) .,A I ()r-A 6x�4- s ice, f % o- ri 5 r d2 .A % car s, -b; 4 e- car- YC�C 4. Period of time for which the encroachment is to be maintain d�Indefilnite or Other. 1--7777Tre'ase Circle) 5. Is property part of a Homeowner's Association Yes _Z�-No ,id 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: L,Z)S� K Nature or description of the encroachment for wni tnis app icatJo�n I maae: ttxampie: vvoou or wrouym uun fence, concrete block wall, raised planter, etc...) �K' . 1 �. - �1oe 3. Location of proposed encroachment: (Example: Side yard at back of sidewalk or front yard at back of sidewalk) .,A I ()r-A 6x�4- s ice, f % o- ri 5 r d2 .A % car s, -b; 4 e- car- YC�C 4. Period of time for which the encroachment is to be maintain d�Indefilnite or Other. 1--7777Tre'ase Circle) 5. Is property part of a Homeowner's Association Yes _Z�-No ,id 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 vl �-- G- i s e r- �.v C •--�— _ _ _________ _.—. . I C) Idl �I 9no� �T (J I� I I� I lc CH r r�.1 �iN r, �z n!C- — -� 3 J, 1�