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HomeMy WebLinkAbout1701 Westwind DrENCROACHMENT 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 . . . . . 18- 30000020 Date 9/27/18 Property Address . . . . . . 1701 WESTWIND DR Application type description PW - ENCROACHMENT PERMIT Owner ------------------------ ATA PROP LLC PO BOX 2822 BAKERSFIELD CA 93303 Contractor --------------- --- - - - - -- OWNER ---------------------------------------------------------------------------- Permit . . . . . . ENCROACHMENT PERMIT Additional desc . . Phone Access Code . 2253243 Permit Fee . . . . 420.00 Issue Date . . . . 9/27/18 Valuation . . . . 0 Qty Unit Charge Per Extension 1.00 420.0000 EA PW ENCROACHMENT 420.00 ---------------------------------------------------------------------------- Special Notes and Comments September 27, 2018 4:07 :25 PM mmendenhal. 3' high block wall on Truxtun Avenue side of building. See attached sketch. Already looked at and approved by Traffic Div. Contact person: Donna Lowe 404 - 5042/472 -9695 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------- - - - - -- ---- - - - - -- ---- - - - - -- ---- - - - - -- ---- - - - - -- Permit Fee Total 420.00 420.00 .00 .00 Applicanf-ftft6WIddges the right •df the CItrE'llgineer, puftuant to the Bakersfield Municipal Code Chapter 12.20 to revoke the permit,at any time. Signature of licant (Owner /Agent) Print ame 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) (QENIED) Said permit shall expire on date stated above. "'-- W- A 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 provision 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, including, but not limited to, repairing or replacing the encroachment at Applicant's cost even if CITY inadvertently damages or destroys the encroachment in the ordinary course of CITY's business, 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 must contact Dig -Alert at 811 at least 2 full working days prior to all excavating. 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. / ad and acknowledge the above. Applicant's Initials ACORD` ATAPROP -01 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 09/27/2018 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 have ADDITIONAL INSURED provisions or 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 License # OB48084 CONTACT Sofia Rios . NAME: Wraith, Scarlett & Randolph Insurance Services, Inc. PHONE FAX 509 Bush Street (A/c, No. ExQ: I (A/c. No): Woodland, CA 95695 kUAIL DRESS:_ sofiar@wsrins.com AD INSURED ATA Properties, LLC PO Box 2822 Bakersfield, CA 93303 R A: Travelers Casualty Insurance Company of America INSURER D INSURER E INSURER F T HIS 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. L.IMI FS SHOW N MAY HAVE BEEN REDUCED BY PAID CLAIMS. ISR ADD L SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE -1 .5P_ POLICY NUMBER D LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE is 1,000,000 CLAIMS -MACF X OCCUR 6807J6091101842 08/01/2018108/01 /2019 DAMAGE TO RENTED 300,000 _..! X PRFMIRFS !Fa nrn mnnrnl 5 L AGGREGATE LIMIT APPLIES PER: POLICY ❑ JE a F] LOC AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NOW WNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MI�MBER EXCLUDED? NIA (Mandatory In NH) If Yes. describe under 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it rnore space is re wired) The City of Bakersfield, its mayor, council, employees, agents and volunteers are named as Additional Insure d on General Liability (endorsement to follow by the carrier), as respects to work being performed at 1701 Westwind, Bakersfield CA 93301 /city sidewalk CERTIFICATE HOLDER City of Bakersfield Public Works Department 1501 Truxtun Avenue Bakersfield, CA 93301 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988 -2015 ACORD CORPORATION. The ACORD name and logo are registered marks of ACORD All rights reserved. C-- S P O (0,- ff 0 N OA cG a N C� 0 ,t0 V L� L 0\ t- M Q� Q C X p L F- ON r- In M f �f (, a 0 0 C7 0 N r O N d W N ti d m U N l0 f0 C C 0 U N C a M N U y U v cm O N (� Y y f0 m 00 0 N 7t O w 0 U bA as a o o (V o C9 � O o^' N a O N CL w ui n m U C! O m E m 'c 0 p V N S n d U y U _v 0 O Y y f0 � m � Q� a X F- al c� lw rn ¢' o w o o (V o C9 � O o^' N a O N CL w ui n m U C! O m E m 'c 0 p V N S n d U y U _v 0 O Y y f0 � m � ENCROACHMENT PERMIT '0160 �r APPLICATION FORM o CITY OF BAKERSFIELD PUBLIC WORKS DEPARTMENT 1501 TRUXTUN AVE C`�LIFO�� � BAKERSFIELD CA 93301 (661) 326 -3724 Fax: (661) 852 -2012 LOCATION OF ENCROACHMENT(Address required where available): If there is no address adjacent to work describe limits of work by distances from nearest existing street intersection. FULL NAME OF APPLICANT COMPLETE ADDRESS: APPLICANT INFORMATION F1 . NXWNA iF � CELL Z: 0/��(I�1-�D�� LPlo 9195 PROJECT INFORMATION DESCRIPTION OF ENCROACHMENT (Example: Wood or wrought iron fence, concrete block wall, raised planter, etc.): /Z�,C )6C ZtlI f PERIOD OF TIME FOR ENCROACHMENT: INDEFINITE or OTHER: /, (Please Circle) C &/- C� - CONTACT PERSON 1-1 k clb C�� -�" PHONE: 6&1-6L-7,?- 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 exWnse remove the same from the public prope , 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 The Commercial Liability policy must identify City and City's mayor, council, officers, agents, employees, and designated volunteers as Additional Insureds. Encroachment Permit Fee: $420.00 S :IPFRMrrS \ENCROACMF- nctoachment Permit Req Form.DOC Aug. 2017 .Oe� B _\� E R I r T? I, T PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Ed Murphy, Engineer III Nv" - FROM: Michelle Mendenhall, Engineering Tech DATE: October 4, 2018 SUBJECT: Encroachment Permit Application for: 1701 Westwind Drive Name of Applicant: ATA Properties, LLC Description of Encroachment: X high block wall on Truxtun Avenue Please review the attached encroachment permit and return to me at your earliest convenience. S: \PERMITS \ENCROACH \TRAFFIC \1701 WESTWIND.doc s '.O� 1-� :\ I--� T-1 1-1; S F I PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Jena Covey, Risk Manager:_�'V� ti FROM: Michelle Mendenhall. Engineering Technician DATE: October 4, 2018 SUBJECT: Encroachment Permit Application for: 1701 Westwind Drive Name of Applicant: ATA Properties, LLC Description of Encroachment: 3' high block wall on Truxtun Avenue Please review the insurance certificate with the attached encroachment permit and return to me at your earliest convenience. S: \PERMITS\ENCROACH \INSURANCE \1701 WESTWIND.doc