Loading...
HomeMy WebLinkAbout7200 E BRUNDAGE LNENCROACHMENT 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 . . . . . 14- 30000065 Date 11/12/14 Property Address . . . . . . STOCKDALE RANCH, S/ STOCK DR Application type description PW - ENCROACHMENT PERMIT Owner Contractor -------- -- --- --- -- -- - - -- ------------------------ WM BOLTHOUSE FARMS INC 7200 E BRUNDAGE LANE BAKERSFIELD CA 93307 (661) 366 -7209 ---------------------------------------------------------------------------- Permit . . . . . . ENCROACHMENT PERMIT Additional desc . . Phone Access Code . 1552884 Permit Fee . . . . 208.00 Issue Date . . . . 11/12/14 Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 208.00 ---------------------------------------------------------------------------- Special Notes and Comments Will be placing a 10" irrigation line underground. Work is being done on Stockdale Ranch Drive south of Stockdale Hwy at beginning at station 75 +00.00 to 79 +18.85 per Approved Signed Plans page 3. See Attached Sheet. Contact: Donny Hopkins (661) 330 -2612 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ---- ---- --- - - - - -- ---- - - - - -- ---- - - - - -- ---- - - - --- ---- - - - - -- Permit Fee Total 208.00 208.00 .00 .00 ApplicanbaaknowLedges the rigtd.af the City.Emgineer, pursuant to the Bakersfield Municipal Code Chapter 12.20 to revoke. the p rmit at any time. mA Si nature o scant (Owner /Age )--- 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. re of City Engineer Additional Terms on the Back V/ !,NCROACHMENT PERMIT APPLICATION FORM CITY OF BAKERSFIELD PUBLIC: WORKS DEPARTMENT 1501 TRUXTUN AVE BAKERSFIELD CA 93301 (661) 326 -3724_ Fax: (661) 852 -2012 ATION OF ENCROACHMENT Address required where available ` Vten 6V i coo —71HESZ, S 'r6 ,QJ� If there is no address adjacent to work describe limits of work by distances from nearest existing street'interseetion. APPLICANT INFORMATION FULL NAME OF APPLIC COMPLETE ADDRESS: _ `72oc► ,—P. 1 ` °- ive, r PHONE: 6&1-- .'�Gk —7746t CELL: PRO.1 EC:T ,INFORMATION DESCRIPTION OF ENCROACHMENT (Example: Wood or wrought iron fence, concrete block wall, raised planter, etc.): 44 jY'fht7�rtr��, �r� cet��t�trs ._3t.rtx,�i'2I._.:iCr2'rrc� PERIOD OF TIME FOR ENCROACHMENT: 1NDEFINIT6 r WFHER: tt cr1ease Girre e CONTACT PERSON t Ie a 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 protpert y 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.'rhe 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 1\Il.1. 5p%V( 01 Lt,v -el 43 Ufr B J vh i + + (- e,(",, r 0 CJ Encroachment Permit Fee: $20$.00 S: \I'ElI M1 "I'S\t;NCROACH \Encroachment Permit Req Fonn.DOC January 2009 A�oRL?® CERTIFICATE OF LIABILITY INSURANCE DATE(MM / 10130/2 014 Y) 014 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 AOn Risk Services Central, Inc. Philadelphia PA Office One Liberty Place 1650 Market Street CONTACT NAME: PHOE (AICNNo. Exl): (866) 283 -7122 IC No.): (800) 363 -0105 E -MAIL ADDRESS: TC JGLSA T suite 1000 Philadelphia PA 19103 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA: Travelers Property Cas Co Of America 25674 Wm. BolthOUSe Farms, Inc. Bolthouse Farms INSURER B: American Guarantee & Liability Ins CO 26247 INSURER C: 7200 E. Brundage Lane Bakersfield CA 93307 USA INSURER D: GENERAL AGGREGATE INSURER E: PRODUCTS - COMP /OPAGG $2,000,000 INSURER F: A COVERAGES CERTIFICATE NUMBER: 570055719010 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. Limits shown are as requested LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MMI CYEXY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE X❑ OCCUR TC JGLSA T EACH OCCURRENCE $2,000,000 DAMAGE O ENTED PREMISES Ea occurrence $1,000,000 MED EXP (Any one person) $500,000 PERSONAL & ADV INJURY $2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: X POLICY ❑ PRO- ❑ LOC JECT OTHER: GENERAL AGGREGATE $3,000,000 PRODUCTS - COMP /OPAGG $2,000,000 A AUTOMOBILE LIABILITY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIREDAUTOS NON -OWNED AUTOS I TC2JCAP- 199T9868 -14 08/01/2014 08/01/2015 COMBINED SINGLE LIMIT Ea accident $3,000,000 BODILY INJURY ( Per person) BODILY INJURY (Per accident) PROPANY ERTY DAMAGE Per accident B X UMBRELLALIAB EXCESS LIAB X OCCUR CLAIMS -MADE AUC356295113 08/01/2014 08/01/2015 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 DED I RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/ PARTNER/ EXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A PER STATUTE I JOTH. iER E.L. EACH ACCIDENT E.L. DISEASE -EA EMPLOYEE E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The Cityy of Bakersfield, its mayor, council employees, agents and volunteers are added as additionally insured's with respect to Stockdale Ranch Drive North Side irrigation line underground with regards to the General Liability policy. `m w e tv 9 d v 0 2 0 0 m r 0 0 r O Z .4+ V w L' d U L_.ii 'SC z CERTIFICATE HOLDER CANCELLATION L2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Bakersfield AUTHORIZED REPRESENTATIVE Attn: Risk Management 1600 Truxton Avenue 9301 Bakersfied CA 93301 USA ?Q.,rd_Ycp ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000029468 LOC #: "ACO ADDITIONAL REMARKS SCHEDULE �-- --�' " Page _ of _ AGENCY Aon Risk Services Central, Inc. NAMED INSURED Wm. Bolthouse Farms, Inc. POLICY NUMBER See certificate Number: 570055719010 CARRIER see certificate Number: 570055719010 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Insurance Certificate issued for Wm. Bolthouse Farms, Inc. a subsidiary of Campbell soup Company (acquired March 31,2013). ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD r +� Public Works Department 1501 Truxlun Avenue Bakersfield, California 83301 (681)326.3724 ENCROACHMENT PERMIT REQUIREMENTS Application 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 S. 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 %Cncroacrm,r ,IPermitspnsureneeNoquiremems TO: FROM: DATE: SUBJECT .00e E Imo. E R S F I E L L PUBLIC WORKS DEPARTMENT MEMORANDUM John Ussery, Engineer III Bob Wilson, Supervisor II, Subdivisions November 12, 2014 Encroachment Permit Application for: Stockdale Ranch Drive Name of Applicant: WM Bolthouse Farms Inc Description of Encroachment: Will be placing a 10" irrigation line underground. Work is being done on Stockdale Ranch Dr. s/o Stockdale Hwy from station 75 +00.00 to 79 +18.85. Please review the attached encroachment permit and return to me at your earliest convenience. S:\ PERMITS \ENCROACH \TRAFFIC \Stockdale Ranch Dr.doc paw, lei 20l4 p. lam-, 40 B A Imo. E R `.`-^yi F I E E I7 PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Jena Covey, Risk Manager A� I FROM: Bob Wilson, Supervisor II, Subdivisions DATE: November 12, 2014 SUBJECT: Encroachment Permit Application for: Stockdale Ranch Dr Name of Applicant: WM Bolthouse Farms Inc Description of Encroachment: Will be placing a 10" irrigation line underground. Work is being done on Stockdale Ranch Dr. s/o Stockdale Hwy from station 75 +00.00 to 79 +18.85. Please review the insurance certificate with the attached encroachment permit and return to me at your earliest convenience. S:\ PERMITS \ENCROACH \INSURANCE \Stockdale Ranch Dr.doc