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Home My WebLink About04-30000070 . '1 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 )he Bakersfield Municipal Code, the undersigned applies for a permit to place, erect, use and maintain an encroachment on public proP-.ertYor right of way as therein defined. . Application Number , , pin number , . . , , , Property Address . . . Application description 04-30000070 Date 12/21/04 282730 2530 DRAKE ST PW - ENCROACHMENT PERMIT Owner Contractor GRACE LUTHERAN CHURCH 2530 DRAKE ST. OWNER/BUILDER BAKERSFIELD CA 93301 (805) 324-4315 Permit , . , . . Additional desc . Phone Access Code Permit Fee . . . Issue Date , . . ENCROACHMENT PERMIT 310581 .00 12/21/04 Valuation o Qty Unit Charge Per 1.00 .0000 EA PW ENCROACHMENT Extension .00 Special Notes and Comments V-GUTTER IN THE ALLEY Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total .00 .00 ,00 .00 Grand Total .00 ,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 (Ownerl 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, - G- ~ Signature of City Engineer Additional Terms on the Back ,t,.,. v' 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 ackrwwledge the above. _Applicant's Initials T- ..{i, ~~ ~ . BAKERSFIE L D ~~0/-. Y:\ 'l- "\ , C\\ 1 - PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Raul M. Rojas, Public Works Director FROM: Marian P. Shaw, Civil Engineer IV, Subdivisions DATE: February 14, 2005 SUBJECT: Encroachment Permit Application for 2530 Drake St.. Grace Lutheran Church V-gutter in alley. Engineering and Traffic staff has reviewed the attached encroachment permit to allow the installation of description of encroachment. The site is located at address of encroachment. The applicant has provided proof of appropriate insurance coverage to Risk Management, and has provided signatures of all immediate neighbors stating that they have no objection to the proposed construction. Based on their review, staff recommends approval of the permit. S:\PERMITS\ENCROACH\_Approval memo.doc 0'1- 70 iJ ,,,.:J. ~ . - BAKERSFIELD PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Ryan Starbuck, Civil Engineer III FROM: Marian P. Shaw, Civil Engineer IV, Subdivisions DATE: February 10, 2005 SUBJECT: Encroachment Permit Application for 2530 Drake St. Grace Lutheran Church V-gutter in alley. Please review the attached encroachment permit and return to me at your earliest convenience. 'l;/I/O ,- ~ 1~l1r S:\PERMITS\ENCROACH\ TRAFFIC\_ Traffic memo. doc ,~ <i" ~ . - Bj\.KERSFIELD PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Pat Flaherty, Risk Manager FROM: Marian P. Shaw, Civil Engineer IV, Subdivisions DATE: February 1, 2005 SUBJECT: Encroachment Permit Application for 2530 Drake St. Grace Lutheran Church V-gutter in alley Please review the insurance certificate with the,att c ed encroachment permit and return to me at your earliest convenience. S:\PERMITS\ENCROACH\lNSURANC\_'nsurance memo. doc f'R i ~'~""ff 'F ~-'1!.Ill ~~.&.iiJtt:Q . kt tf. 8" !J ~.S.~ &f Oij $ .f'> APPLICATION FOR ENCROACHMENT PER.\UT TO THE CITY ENGINEER OF THE CITY OF BAKERSFIELD, CALIFO&~L-\: PursWlIlt to the provisions of Chapter 12.20 of the Bakersfield Municipal Code.. the undersigned applies for a permit to place, ere~t, use and maintain an encroachment on public property or right-of-way as therein defined, " I 1. Full name of aoolicantand comolete address including phone number: .Gr~ce it.fAtherltn CAlAV'~h' ~j-30 [}f'~ke pA 3;;. f- ~31? ~ ~ tre et 8 a !\rlrr{[et.d . cA , ~~ I .1 2. Nature or description of the encroachment for which this application is made: st~ItJ 4t'''' a.LLey'c..rt)ss :Jut/er / . .- . _. ' I - l. .... . . . ,I . CAfAf'Cf! fJaf/'~;"J tb1' -Fa.c.injatt~y". 3. Location of the proposed encroachment: I, 'Pel' Pta:n en t. I . 4, Period of time for which the encroachment is to be maintained: . . Applicant agrees that if this application is granted, a'p'pIicant shall indemnify, defend and hold hannless City, its officers, agents and employees against any and allliablhty, claims, actions, causes of action or demands, whatsoever against them, or any pfthem, before administrative, quasi-Judicial, or judicial tribunals of any kind whatsoever, ari5in~ 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 encr?achrnent or ':l1ltil such time that this permit is revoked. ' . ,.,', Applicant' ~rther agr~es that ~pon, th~ expiratio~ of the. p~t r~r ~hich this ap~lication i~ rnad~, if granted, or '!!12Qn the revocatIon thereofby the CIty ensnneer. aophcant wITl at his own cost and expense remove the same from the Qub,lic propert~ or right of way where the saIne is located, and restore sa,id public property or ri~t of way to the condition as near y 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 Engineet in full force and effect , for however' long the encroachment remains. ApplIcant shall furnish the City Risk Manager with a Certificate of Insurance cvider:tcing sufficient coverage for bodily inj~ or property damage liability or both and required endorsements evidencing the insurance required. The type(s) and amount(s) of insurance' coverage is: .," , R. Appllcant acknowledges the right of the City Engineer. pursuantto-B~ersfieJd MUflicipal,Cgde...Ch.wJe~2,20 to revoke the permit at any time. , Date: )2-I-oi,f" ,~.~~ . , '--Slgnaturerif App t t Owner or epresentatlve) PER'\1IT . I HEREBY CERTIFY THAT I HAVE MADE A:-l INVESTIGATION OF THE FACTS STATED IN THE FOREGOL'iGAPPLICATION AND FIND ffi.\TTEE MAINTENA..'iCE OF SAID ENCROACHMEN'T (1) WILL (NOT) Sli'BSTA.~TIALL Y INTERFERE WITH THE USE OF THE PUBLIC PLACE WHERE THE SA;\IE IS TO BE LOCATED AND {2} WILL (:'lOT) C01'\STITIJTE A HAZARD TO PERSONS uSING SAID PUBLIC PLACE; SAID APPLICATION IS THEREFORE (GR.J._'lTED) (DE~IED). SAID PERMIT SHALL EXPIRE Date: ~fC"Y Engmeer-- No, :i ~ f;; "1 2 - 1"1' -'0 4; -:::2. 7 PM Rlgh~Fax Har~~ord:# 3 ".' ACORD.. CERTIFICATE OF LIABILITY INSURANCE J DATE (MMlDDlYYYY) 12/17/2004 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION WM K LYONS AGENCY INC ; ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE POBOX 319 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR BAKERSFIELD, CA 933020319 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (888) 661-3938 ; XW134 882 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:THE TRAVELERS INDEMNITY COMPANY OF CONNECTICUT GRACE LUTHERAN CHURCH 2530 DRAKE STREET . INSURER B: BAKERSFIELD, CA 93301 INSURI'R c: , INSURER 0: - INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED ,BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POliCY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMI'NT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WrrH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR ADD'( POLICY EFFECTIVE pg~gl~r;rI;~J)~~ 'TR INSRC TYPE OF INSURANCE POLICY NUMBER DATE IMMlDDlYVl LIMITS A X GENERAL L1ABlITY 680-253P5491-04 02l15!2004 02115/2005 EACH CCCURRE,CE $1 000.000 r-- ~ COMMERGiAL GE"ERAL LIABILITY DAMAGE TO RENTED :;;300,000 Pi=:~.~(';';;=~ Ia..:"" o~"""rot'r"\ r-- =:J CLAIMS MADE I]] OCCl,R ~ MED ::XP IArw on9 oe'so01 $5000 PERSONAe ~ ADV INJURY $1,000.000 ,,~ ="^' '''G" ~~..,.= $2000,000 G"N'LAGGRE':iATE Llt./IT APPLIES "ER, PRODUCTS - COM"/OP AGG $2,000,000 t"Xl POLICY nPRC' n. JECT LOC I 02115/2005 A AIJTOMOBI LE UA BIUTY 680-253P5491-04 02/15/2004 COMB,NED SINGLE LIMIT - (Ea acciden1) $1,000,000 - A"V AU-:-O - A_L OWN::D A'" TOS BODILY iNJURy $ (Per pef'5or,) X SCHEDULED AU,CS H RED A'),OS BODIL YNJURY -'-'- (Per 8cc!::1ertl $ X NO N-OW~::D AUTOS .' PROFERTY DAMAGE $ IF'9f acr.l:1erl) GARAGE LIABIUTY AU,O ONL Y EA ACCIDEN, $ ~ A"V AU-eo CTHE R T'iAN EA ACC $ AU-DO\;LY AGG $ EXCESS,UMBRELLA LIABiLITY EA>:H CCCURRE"CE $ :J O,:Cl: R DCLAIMS MADE ACGR,EGA'E $ $ R DCDUC-'E~= $ c - -.- , $ $ :=l....T::.NII'_N WORKERS COMPENSATION AND 1 I i~~~LtM8s I I u=~ EMPLO't ERS' L!ABILlTY Is ANY:")R0?RIETORt?D.::-'TNERI:::XE::UTIV= E L ::ACH NXIDENT I OFFJCE::\:MEM3E~ EXC~UDED" I EL DISEASE - EA EMPLovEE $ 11 ves, d9s::ite und.<}r E L ::iSEASE. POL'CY _IMIT $ SPECIAL P=:OV1SI0~::': :elow OTHER DESCRIPTION OF OPERATlONS I LOCATIONS I VEHICLES! EXCLUSIONS ADDED 3Y ENDORSEMENT I SFECIAL PROVISIONS CERTiFICATE HOLDER is NAMED ADDITIONAL INSURED - DESiGNATED PERSON/ORGANIZATiON CERTIFICATE HOLDER' CANCELLATION CITY OF BAKERSFiELD MARY ELLEN GONZALES 1501 Ti=\UXTON ,.':I,VENUE BAKERSFI ELO, CA. 93301 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DA,E iHEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~_ DAYS WRITTEN NOTiCE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHAll IMPOSE NO OBLIGA710N OR LIABILITY OF-ANY KIND.UPON THE INSURER, ITS AGENTS OR REFMESENTATIVES AUTHORIZED REPRESENTAnVE . ACORD 25 (2001/08) Y"I~ @ ACORD CORPORATION 1988 '" : -'", '6,'- '". .Jt_ c;i POLICY NUMBER: I-680-253P5491-TCT-04 COMMERCIAL GENERAL LIABILITY ISSUE DATE: 12-02-04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 1. Designation of Premises (Part leased to You): 2530 DRAKE STREET BAKERSFIELD CA 93301 2. Name of Person or Organization (Additional Insured): CITY OF BAKERSFIELD / 1501 TRUXTUN AVENUE BAKERSFIELD CA 93301 3: Additional Premium: INCLUDED (If no entry appears above, the information required to complete. this endorsement ~i11 be shown in the Declara- tions as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to: 1. Any .occurrence" which takes place after you cease to be a tenant in that premises. 2. Structural alterations, new construction or demoli- tion operations performed by or on behalf of the person or organization shown in the Schedule. CG 20 11 01 96 Copyright, Insurance Services Office, Inc., 1994 Page 1 of 1 i'}o'C_ ,,' , ~.I -'& .', ~f WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY . THIS FORMS A PART OF INFORMATION PAGE ENDORSEMENT PAGE 01 A POLICY NO, 90-XA-2889-5 COVERAGE IS PROVIDED BY 1613-F784 'N.....'~ STATE FARM FIRE AND CASUAL TV COMPANY 900 OLD RIVER ROAD, BAKERSFIELD CA 93311-6000 NAMED INSURED AND MAILING ADDRESS GRACE LUTHERAN CHURCH OF BAKERSFIELD 2530 DRAKE ST BAKERSFIELD CA 93301-2718 THE EFFECTIVE DATE IS THE EXPIRATION DATE IS 05/01/2004 05/01/2005 FORM WC040306 IS ADDED TO THE POLICY ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. /'"": PREPARED DEC 162004 WC 99 00 02 04-84 TN 2004 ."i;, .. .-.:. ~;;. ~, , .. ..;0 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed, 4-84) , WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be otherwise due on such remuneration. 5 % of the California workers' compensation premium Schedule Person or OrQanization CITY OF BAKERSFIELD ITS MAYOR, COUNCIL, OFFICERS, AGENTS AND , EMPLOYEES 1501 TRUXTON AVENUE BAKERSFIELD CA 93301 Job Description PERMIT LICENSOR This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) WC 04 03 06 (Ed. 4-84) Policy No, 90 - XA- 2 8 89- 5 Endorsement No. WC04 0 306 Insurance Company STATE FARM FIRE AND CASUALTY COMPANY !/l ! I \[ laktf@------ Countersigned BY! '(. __ ~ I ;' I i Printed in U.S.A. V Endorsement Effective 05/01/04 Insured GRACE LUTHERAN CHURCH OF BAKERSFIELD From: To: Date: Subject: Robert Wilson Permit Techs 12/21/200410:05:59 AM 2530 Drake St The Grace Lutheran Church will be submitting an encroachment permit for a v-gutter in the alley. This will be a no fee perm it. ~