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APPLICATION FOR ENCROACHMENT PERMIT
TO THE CITY ENGINEER OF THE CITY OF BAKERSFIELD, CALIFORNIA:
4, Period of time for which the encroachment is to be maintained:
'To . 1; ye-6~S
Applicant agrees that if this application is granted, applicant shaU indenmifv, defend and hold harmless City, its officers,
agents and employees against any and all liability , claIms, actions, causes at action or demands, whatsoever against them,
or any of them, before administrative, quasiiudicial, 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 pennit is revo,ked.
Applicant further agrees to obtain and keq:> all liability insurance req,uired by the City Engineer in full force and effect
for however long the encroaclunent remams. Applicant shall furrush the City Risk M~er with a Certificate of
Insurance evidencing sufficient coverage for bodily mjury or property damage liability or both and required endorsements
evidencing the insurance required, The type(s) and amount(s) of insurance coverage is:
. Appli~t acknowl.edges the right of the City Engineer, pursuant to Bakersfield Municipal Code Chapter 12.20 to revoke
the penmt atany tune. . ~ . . .
Date:___,!ijz-Z--j)Y ~A -L
, Signature~~er or Representative)
PERMIT
I HEREBY CERTIFY TIIAT I HAVE MADE AN INVESTIGATION OF THE FACTS STATED IN THE
FOREGOING APPLICATION AND FIND THAT THE MAINTENANCE OF SAID ENCROACHMENT (1)
WD..L (NOT) SUBSTANTIALLY INTERFERE WITH THE USE OF THE PUBLIC PLACE WHERE TIlE
SAME IS TO BE LOCATED AND (2) WD..L (NOt) CONSTITUTE A HAZARD TO PERSONS USING SAID
PUBLIC PLACE; SAID APPLICATION IS THEREFORE (GRANTED) (DENIED). SAID PERMIT SHALL
EXPIRE
Date:
~
Signature of City Engineer
No.
G:\C'olOOl'l>A 1\F.......IF..,.o..hm.llrp.....lApp."JH!
ENCROACHMENT PERMIT
CITY OF BAKERSFIELD
PUBLIC WORKS DEPARTMENT
1501 TRUXTUN AVE
BAKERSFIEW 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 . .
pin number . . , . . .
Property Address . . .
Application description
04-30000062 Date
.800218
1701 PACHECO RD
. . PW - ENCROACHMENT PERMIT
9/03/04
Owner
Contractor
STOKES BOBBIE KATHERYN REV LIV
2711 N HASKELL
DALLAS TX 75204
OWNER/BUILDER
BAKERSFIELD
CA 93301
Permit . . . . .
Additional desc .
Phone Access Code
Permit Fee . . .
Issue Date . . .
ENCROACHMENT PERMIT
267146
150.00
9/03/04
Valuation
o
Qty Unit Charge Per
1.00 150.0000 EA PW ENCROACHMENT
Extension
150.00
Special Notes and Comments
INSTALLATION OF 2" DIAMETER MONITORING
WELL (SP-3) TO THE SIDEWALK.
Fee swnmary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 150.00 150.00 .00 .00
Grand Total 150.00 150.00 .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, er~tion,
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
"
..
4
.
-
BAKERSFIELD
PUBLIC WORKS DEPARTMENT
MEMORANDUM
TO:
Raul M. Rojas, Public Works Director
FROM:
Marian P. Shaw, Civil Engineer IV, Subdivisions
DATE:
February 10, 2006
SUBJECT: Encroachment Permit Application for: 1701 Pacheco Road
Name of Applicant: Secor International
Description of Encroachment: 2" diameter monitoring well in sidewalk
Engineering and Traffic staff has reviewed the attached encroachment permit to allow the "
applicant to build their corner of the garage onto the adjacent slope easement.
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
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Bj\.KERSFIELD
PUBLIC WORKS DEPARTMENT
MEMORANDUM
TO: Ryan Starbuck, Civil Engineer III
FROM: Marian P. Shaw, Civil Engineer IV, Subdivisions
DATE: September 5,2004
SUBJECT: Encroachment Permit Application for 1701 Pacheco Road.
Secor International
2" diameter monitoring well in sidewalk.
Please review the attached encroachment permit and return to me at your earliest convenience.
.I JPy ft!7!O <t
S:\PERMITS\ENCROACH\TRAFFIC\1701 Pacheco Rd.doc
,.a
ENCROACHMENT PERMIT
CITY OF BAKERSFIELD
PUBLIC WORKS DEPARTMENT
1501 TRUXTUN A VB
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 . .
pin number . . . . , .
Property Address . . .
Application description
9/03/04
Owner
Contractor
::9i~:.~~-. . : -~~;.~ '.
Secor International
3017 ~ilgore Rd Ste. 100
Rancnd Cotaova CA 95670
STOKES BOBBIE KATHERYN REV LIV
2711 N HASKELL
DALLAS TX 75204
OWNER/BUILDER
~.
----------------------------------------------------------------------------
Permit . . . . .
Additional desc .
Phone Access Code
Permit Fee . . .
Issue Date . . .
ENCROACHMENT PERMIT
267146
150.00
9/03/04
Valuation
o
Qty Unit Charge Per
1.00 150.0000 EA PW ENCROACHMENT
Extension
150.00
----------------------------------------------------------------------------
Special Notes and Comments
INSTALLATION OF 2" DIAMETER MONITORING
WELL (SP-3) TO THE SIDEWALK.
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 150.00 150.00 .00 .00
Grand Total 150.00 150.00 .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)
-4
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 wh~ch 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
RightFax
8/20/2004 3:14
PAGE 002/005
Fax Server
APPLICATION FOR ENCROACHMENT PERMIT
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 pennit to
place, erect, use and maintain an encroachment on public property or right-of-way as therem defined.
1. Full name of applicant and complete address inclUdi~g phone number: 5 E(',of( Tniroff}Ot/D/Jo~ ItJC,
2i217 {,lgor,. Rd: SOfie /00; fonr~f) Co,dOI/L); cA CZbc;70 (ct/6) 1?01-0'!PO
2 Nature or description of the encroadunent for which this application is made: L,~-ft2/h1J/)n of a 2 ;)IC"~7C"
l:1J.ap IrOfJflg h/~// f5P-3) Jf} 7h~ ~~L/a/f(5rL. oftoci~ 1r100fl) ..11/ra~ ~/I,,/~// /..f ~G,- lel'laJe
oXYJeQ Injr/'/I/O/l mto 71e 5IJi~f.lf-tc.e II) s-J1hll/!c1ebIDJ'7jJ'od-,7/0/J. TnJ7/o1//M7047/a?/..$
3. Location of the proposed encroachment: -to Tctl::- rrfr~J(, Ijir,) :to/lowed by /~l), oxYr4 /~7ICJ/J
~ f'Aren1..5 -the/~o/'r:/J
4, Period of time for which the encroachment is to be maintained: (3 1D, 1; ye..6r....'5
-,.-
, J\
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 or action or demands, whatsoever against them,
or any of them, before administrative, quasi-Judicial, or judicial tribunals of any kind whatsoever, arising out of,
colUlected 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 pennit is revo~ed,
Applicant further agrees that upon the expiration of the permit for which this application is made, if granted, or .!!Jm!!
the revocation thereofbv the CIty e~ineer, ~plicant will at his own cost and exoense r~ove the same from the public
orooert:y or right of way where the same is ocatecl, and restore said public property or nght of way to the condition as
nearly as that in which it was before the placing, erection, maintenance or existence of said encroaclunent.
Applicant further agrees to obtain and k~ all liability insurance required by the City Engineer in full force and effect
for however long the encroachment remams. Applicant shall furrush the City Risk Manager with a Certificate of
Insurance evidencing sufficient coverage for bodily mjury or property damage liability or both and required endorsements
evidencing the insurance required, The type(s) and amount(s) of insurance coverage is:
as alftichc-4
, Applicant acknowledges the right of the City Engineer, pursuant to Bakersfield Municipal Code Chapter 12.20 to revoke
the pennit at any time. ~ ~
Date:_,_~y J.o 'I-- _777, "
. . , S'gna fiion~can. or or 'Presentative)
PERMIT
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 PUBLIC PLACE WHERE TItt
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
Date:
Signature of City Engineer
~
------=--
No.
('.:\GROUI'DA'J\F,,",,"~~,wpd
PACHECO ROAD
LEGEND:
..- SHALLOW ZONE MONITORING WELL
-+- VAPOR EXTRACTION WELL
!-CONCR~-- + AIR SPARGE WELL
{- PROPOSED AIR SPARGE WELL
I . SOIL BORING
--.. {CURRENT USTS MW-2 & PRODUCT PIPING MONITORING WELLS
I
I . I, -+- ------ CANOPY
GP-4 \.... .......
(-....... "
I , .:::- ....... ....... ---- PROPERlY BOUNDARY
I \.... !;2 "I
-....... '
I .............. I'O~~_J I ----- CURRENT SVE PIPING
I '- 'fj' ~tt9 ~
7-ELEVEN I j~-}""",,,,,,,,,:~~
F' ACILlTY
NO. 16329 - -MW-s---ht~:tI
I EW-~ · ~ ~ t ~f'~~
I SP_I~W-l I tl1
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COMPOUND I .- ,
PLANTER MW-3
o
,
30
60
,
FEET
APPROXIMATE SCALE
REFERENCE: THIS FIGURE IS BASED ON A .srrE PLAN"
PROVIDED BY SHAW E & I, INC., DAlEO
JULY 2002, AND IS INTENDED FOR
ILLUSTRATION ONLY,
DRAWN
DWR
JSA
6/16/04 DWR
FIGURE 4
7-ELEVEN, INC.
FACIUTY NO. 16329
1701 PACHECO BOULEVARD
BAKERSFIELD, CAUFORNIA
PROPOSED WELL LOCATIONS
M:\7_E1even\1632917.11_16329 PROPOSEO.dwg
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SECOR
APPA
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JOB NO.
77EL.16329.04.0104
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BAKERSFIELD
PUBLIC WORKS DEPARTMENT
1501 TRUXTUN AVENUE
BAKERSFIELD. CALIFORNIA 93301
(661) 326-3724
RAULM. ROJAS. DIRECTOR' CITY ENGINEER
September 5, 2004
Secor International
3017 Kilgore Road
Rancho Cordova, CA 95670
Atten: Scott Graham
RE: Encroachment Permit 04-30000062
DearMr. Graham:
Enclosed is the encroachment for your signature. Please sign and return at your earliest convenience so
that we may complete your application. Also for your information this encroachment permit allows the
monitoring well to be in the city right of way. Your contractor who will be installing the monitoring well
will be required to obtain an Open Street Permit. The Open Street Permit can be obtained in the City of
Bakersfield Development Services Building. The permit fee will be waived, but a $176 refundable deposit
and proper insurance from your contractor will be required. Your contractor can contact the City of
Bakersfield Risk Management Department for Open Street Permit insurance requirements at (661) 326-
3738.
Should you have any questions please feel free to contact me at (661) 326-3566.
Very truly yours,
RAUL M. ROJAS
Public Works Director
by:
ROBERT WILSON
Engineer Technician I
cc: encroachment file
S:\PERMITS\ENCROACH\Letters\1701 Pacheco Rd.doc
.
SECOR
SECOR INTERNATIONAL INCORPORATED
3017 Kilgore Road, Suite 100 www.secor.com
Rancho Cordova. CA 95670
916-861-0400 TEL /916-861-0430 FAX
let t e r 0 f
transmittal
attention: Bob Wilson
date: August 24, 2004
company:
City of Bakersfield
address:
1505 Truxton Avenue
Bakersfield, California 93301
project:
7 -Eleven #16329
1701 Pacheco Road
Bakersfield, CA
job no.:
77EL.16329.04.0313
re:
Encroachment Permit Application
enclosed:
( )
( )
( )
( )
(X)
Proposal
Contract
Report
Letter
Other: Encroachment Permit App.
( )
( )
( )
(X)
( )
( )
( )
As Requested
Review
Your Information
Approval
Signature
Return
Other:
comments: Please review the attached encroachment permit application for one
groundwater monitoring well located in the sidewalk along South H Street (see the
attached Site Plan). I have also included our Certificate of Liability Insurance and a
Check (#597499) for $150.00 made out to the City of Bakersfield. Please contact me at
(916) 861-0400 ext.245 or sQraham@secor.com if you have any questions or any
additional information is needed.
ck~~
slgnator: Scott Graham
title: Associate Geologist
cc:
File /7-Eleven, Inc.
16329 Encroachment trnsmtl.doc
SECOR INTERNA T10NAL INCORPORA TED
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~.
~~'\
CITY OF BAKERSFIELD INSURANCE REOUIREMENTS FOR
STREETS AND ENCROACHMENT PERMITS
STREETS PERMITS
For street permits issued to contractors for work on major arterials and collectors (select GEO
City web to determine street type) the following insurance is required:
(See sample certificate-attachment 1)
. Minimum of$I,OOO,OOO comprehensive generaIliability insurance with an additional
insured endorsement fonn in favor of the City, it's mayor, council, officers, agents,
employees and volunteers (see example in attachment 2).
. Minimum of $1 ,000,000 automobile liability insurance covering all vehicles working on
the project. The certificate of insurance must name the City, its mayor, council, officers,
agents, employees and volunteers as additional insured.
. Workers' compensation insurance with statutory coverage or limits not less than
$1,000,000 and employer's liability insurance with limits not less than $1,000,000.
Waiver of subrogation in favor of the City of Bakersfield is also required (see example in
attachment 3).
or street permits issued for work on residential streets (select GEO City web to determine street
e) the following insurance is required:
. Minimum of $1 ,000,000 comprehensive general liability insurance.
. Minimum of $1 ,000,000 automobile liability insurance covering all vehicles working on
the project.
. Workers' compensation insurance with statutory coverage or limits not less than
$1,000,000 and employer's liability insurance with limits not less than $1,000,000.
For any street pennit issued to homeowners, the following insurance is required:
. Homeowners personal liability insurance of not less that $300,000. (See attachment-4)
Additional insurance and or endorsements may be required if City determines that the work
may expose City to unusual risks. All commercial insurers must have an AM Best's rating of
not less than AS on the general liability and the auto liability policy. (Go to
www.ambest.com to determine insurance company rating).
ENCHROACHMENT PERMITS
For encroachment permits issued to business owners, the following insurance is required:
. Minimwn of $1,000,000 comprehensive general liability insurance with an additional
endorsement fonnin favor of the City, its mayor, council, officers, agents, employees and
volunteers.
For encroachment permits issued to homeowners the following insurance is required:
. Homeowner's personal liability insurance of not less than $300,000.
Additional insurance and or endorsements may be required if City determines that the work
may expose City to unusual risks. All commercial insurers must have an AM Best's rating of
not less than AS on the general liability and the auto liability policy. (Go to
www.ambest.com to determine insurance company rating).
ACO~D...
A riA{!, H ~1 E.-NT -1.
CERTIFICA.TE OF. LIABILITY INSURANGE, ~~~
(661) 322. THIS CERTIFICATE IS ISSUED AS A MAneR OF INFORMATION
Insurance Agency. Inc. - Bakersfield ONLY AND CONFERS NO RIGHTS UPON THE CERnFICA TE
HOLDER. THIS CERnFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
. -I
- INSURERS AFFORDING COVERAGE
IRVGUIN-G1
TULO
ROOUCER
icen.. II 0707
.0. Box
akersfleld, CA 93389-9548
DfSURED'S HAIlE
INSURED'S ADDRESS
INSURER A:.
INSURER B:
INSURER c:
INSURER D:
INSURER E:
ISURED
:OVERAb~
THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POlICY PERIOD INDICATED. N01WlTHSTANDING
ANY REQUIREMENT, TERM OR CONDmON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUClES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDlnONS OF SUCH
POUCIES. AGGREGATE UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID ClAIMS. ,
~ 1YPE OF INSURANCE POUCYN"BER POLICY EFFECllVE POLICY EXPIltA110N UIIITS
~ERAL UA8lIJ'1Y EACH OCCURRENCE I 6 000.004
, X COMMERCIAL GENERAL LlABIU1Y 8167030 10/112002 10/112003 FIRE o..MAGE (Any _Ilre) I 5O.00c
I ClAIMS MADE [i] OCCUR 10DAYNOnCEFORNON~A~ llIENT OF PREll IUM. MED EXP (Any_~1 I 6.00c
~ ~ 6 OOO.OOCl
PERSONAl. & ADV INJURY I
GENERAL AGGREGATE I 5 OOO.OOCI
"iiLAGGREnUMlT nPER: PRODUCTS. COMPIOP AGG I 5 OOO.OOCl
X POLICY !:~ LOC
..!!!fOIIOBlLE UA8lIJ'1Y COMBINED SINGLE UMrr s 5.000,OOC
, .x /!IN'( AUTO 8167040 10/112002 10/112003 IE.~ I
- ALL OWNED AUTOS BOOIL Y INJURY
(Par pet'IOt\) S
SCHEDULED AUTOS
- I
.x. HIRED AUTOS BODILY INJURY
S
.x. ~EDAUTOS IPar~
- PROPERlY DAMAGE S I
(Par M:Cidenl)
=TE UA8lIJ'1Y AUTO ONLY. EA ACCIDENT S
/!IN'( AUTO OTHER THAN EAACC S
AUTO ONLY: AGG S
EXCESS UABIU1Y EACH OCCURRENCE S
o OCCUR 0 CLAIMS ~ AGGREGATE S
S
R ~oucnBLE S
RETENTION I S
WORKeRS COMPeNSA11ON AND I 1M:: STATU-, I X IO~
I DlPLOYERS" LIA8lUTY 59345-02 1/112002 1/112003 E.L. EACH ACCIDENT I 1 000 000
e,L. DISEASE. EA EMPLOYEE I 1 000 000
E,L. DISEASE. POLICY LNIT S 1 000 000
OTHER
: !Total Value
: I. Ilotal Value ~
-..
UCRIP1ION OF 0I'eM11ONSA.OCA11ONSM!HICLU/EXCWSIONS ADDED BY I!NDORSEIIEN17IPI!ClAL PRO\/IlIION\I
11. City of Bakersfield, Its mayor, council, officers, agents, employee & volunteers are named as additional Insureds
:ERTIFlCATE HOlDER
X ADOI11CINAL INSURED: INIUIlER &.ETTER:
CANCELLATION
SHOULD Nf't oF 'lItE A8OVI! DElICRI8ED POUCll!S BE CANCELI.ED BEFORE 1M!! ElCPlRA~
DATl1M!REOF. 'lItE ISSUING INSUMR WILL ENDEAVOR TO IIAIL~ DAYS WIlITlEN
N011C1E 10 1HI! CER11I'ICATI HOLDER NAIlED 10 THE U!FT. BUT FAILURE 10 DO sa ItIAU.
IIIPOlIE NO 08UGATlON OR LIABlUlY OF Nf't KIND UPON THE INSURER, ITS AGENTS OR
REPRElENTA1NES.
AtmtOIlIZED REl'lU:SENTA11VE
City of Bakerd.ld
1501 Truxtun Ave
Bakersfield. CA 93301-
\COR~ 25-5 (7/97)
-
F\ -\t c; (.~t ('v\t 'f'.t
2
CITY OF BAKERSFIELD
:ert;'ficate issued to CITY OF BAKERSFIELD
Ins . Ir Co :Ins Brokers
,0/25/2001
10/26/200
'olicy Number:
lAMED INSURED:
"HIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
-011
COfato1ERClAl CENERAL LIABILI1Y
.J, ADDITIONAL INSURED-
~ OWNERS, LESSEES OR CONTRACTORS (FORM B)
-his endorsement modifies insurance provided under the foll~ng:
C(MotEROAL GENERAL LIABILITY COVERAGE PART
SOIEDULE
4ame of Person or Organization:
"1J(
CITY OF BAKERSFIELD, ITS MAYOR. COUNOL
AGENTS, EMPLOYEES AND VOLUNTEERS.
1505 TRUXTON AVENUE
BAKERSFIELD, CA 93301
RE: ALL CALIFORNIA OPERATIONS; PROJECT LOCATION:
BAKERSFIELD, CA
(If no entry appears above, information required to complete this endorsement will be shown in the
)eclarations as applicable to this endorsement.)
~O 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 "your work" for that insured by or for
you.
The limits of Liability for the additional insured are those specified in the written contract or
agreement. or in this policy, whichever is less. These limits are inclusive of and are not in addition
to the limits of insurance shown in the declarations.
CANCELLATION CLAUSE: It is further understood and agreed that the attached certificate holder will be
given thirty (30) days written notice before any reduction of coverage or cancellation of this insurancl
is effecti ve.
CC 20 10 11 85
Copyright, Insurance Services Office. Inc., 1984
At1tj~\n~i :s
STATE
COMPENSATION
INSURANCE
FUND
P.o. BOX 420807, SAN FRANCISCO, CA 94142{)807
CERTIFICATE OF WORKERS' CO~PENSAn()N .INSURANCE
.. '~-,~.-'. '" :"
SEPTEnBER 20, 2001
,,':i,' -;'POUCYNUMBER:
:, CERTIFICATE EXPIRES:
r
CITY OF BAKERSFIELD
1505 TRUXTON AVE
BAKERSFIELD CA 93301
983
9-1-02
- 01
;....:,...-'l... .
.-.) ~
~: .l.....:--:-:. . ..~,.
:;<:'~__.-/~ - '.~ -J.
JOB: ALl'; (:'ALIFORNIA OPERATIONS
L
This is to certify that we have issued a valid Workers' Compensation Insurance policy in a form approved by the California
Insurance Commissioner to the employer named be,1ow for the policy period indicated. . .
This policy is not subject to cancellation by the Fund except upon 19I days' advance written notice to the employer.
. XX
We will also give you ~N days' advance notice should this policy be cancelled prior to its normal expiration.
XX
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the
policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with
respect to which this certificate of Insurance may be Issued or may pertain;.. the insurance afforded by the policies
described herein is subject to all the terms, exclusions and conditions of suc~ poliCies.
;;
~~-.
~~~~~.
AUTHORIZEO REPRESENTATIVE
'I(~
PRESIDENT
E~PLOYER'S LIABILITY LInIT INCLUDING DEFENSE COSTS: .1~000,OOO PER OCCURRENCE.
M2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE
AND FORMS A PART OF THIS POLICY.
_J
'. ,
.:'.. :~.
RECEIVED
SEP 25 2001
.. " RISK MGMt
EMPLOYER
r
DlSURED' S RAIlE
· ADDBESS
. '..
:-:..
~
'E
.=I~.I.I.'J6.I~~..:".""'a.II."_:l:'lI..~:'~I.'.:~.J'.:'C":(.I.I~I.
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;<,;_...~, - RightFax
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.
9/7/2004 11:43
PAGE 002/006
Fax Server
ENCROACHMENT PEItMIT
CITY OF BAKERSFIELD
PUBLIC WORKS DEPARTMENT
1501 TRUXTUN A VB
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 fol' a permit to place, crect. use and
maintain an encroachment on public property or right of way as therein defined,
Application Numbec
pin number . , , . . .
Property Address . , .
Application description
. . . 04-30000062 Date
.800218
1701 PACHECO RD
PW - ENCROACHMEN1' PERMIT
9/03/04
Owner
Contractor
STOKES BOBBIE ~~THERYN REV LIV
2711. N HASKELL
DALLAS TX 75204
OWNER/BUILDER Secor International
3017 Kilgore Rd Ste. 100
Rancno toraova CA 95670
Permit . . . . .
Additional desc ,
Phone Access Code
Permit Fee
Issue Date
ENCROACHMENT PERMIT
267146
150.00
9/03/04
valuation
o
Qty unit Charge Per
1..00 150.0000 EA PW ENCROACHMENT
Extension
150.00
Special Notes and Comments
INSTALLATION OF 2" DIAMETER MONITORING
WIlLI. (SP-3) TO THE SIDEWALK.
l"'ec summary charged lo'aid credit:ed Due
----------------- ---------- --------~- ---------- ----------
Permit Fee Total 150.00 150.00 ,00 .00
Grand Total lSO.OO lSO.OO .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.
* rh~~L~
Signature of Applicant (Owner/Agent)
-* Ecoll crc'J10t"1
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
. 'ACORD.. CERTIFICATE OF LIABILITY INSURANCE OP 10 MO I DATE (MMlDDIYYYYj
SECOR 1 08/23/04
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Kibble & Prentice ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Commercial Insurance, Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 3467 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Bellevue WA 98009-3467
Phone: 425-454-2445 Fax: 425-646-9616 INSURERS AFFORDING COVERAGE NAlC#
INSUREO INSURER A Zurich American Insurance Co.
INSURER B: Steadfast Insurance Co
SECOR International
Incorporated INSURER C: Zurich American Insurance CO.
PO Box 230 I
Redmond WA 98073-0230 i INSURER D:
INSURER E
COVERAGES
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.
I'NSR ~DD'l POLICY EFFECTIVE POLICY EXPIRATION
LTR NSRD TYPE OF INSURANCE POLICY NUMBER DATE (MMlDDIYY) DATE (MMlDDlYYj LIMITS
~ERAL LIABILITY EACH OCCURRENCE $1,000,000
A X : X COMMERCIAL GENERAL LC0\81L1TY GL0522247702 11/02/03 11/02/04 PReMISES (Ea occurencel $ 250,000
~tJ ClAlMS MADE 0 OCCUR I MED EXP (Any one person) $ 5,000
X Owner/Cont Proto PERSONAL & PoDV INJURY $ 1,000,000
Per proj Agg. I $ 2,000,000
X I GENERAL AGGREGATE
GEN'L AGGREGATE LIMIT APPLIES PER I PRODUCTS - COMPIOP AGG $ 2,000,000
h !Xl PRO, nLOC Emp Ben. 1,000,000
I POLICY X JECT
AUTOMOBILE LIABILITY I I COMBINED S!NGLE LIMIT
f-- I BAP522248502 $ 1,000,000
A ~ />NY AUTO 11/02/03 11/02/04 (Ea accident)
ALL OWNED AUTOS I TAP387008102 (TX) BODILY INJURY
- -I (Per person) $
SCHEDULED AUTOS
-
X HIRED AUTOS BODILY INJURY
~ (Per accident) $
NON-OWNED AUTOS I
PROPERTY DAMAGE $
I (Per accident)
H'~'= I AUTO QNL Y - EAACCIDENT $
I />NY AUTO OTHER T~AN EAACC $
, AUTO ONLY AGG $
EXCESSIUMBRELLA LIABIUTY EACH OCCURRENCE $ 3,000,000
B U OCCUR D ClAlMS MADE SE0522249002 11/02/03 11/02/04 AGGREGATE $ 3,000,000
$
~ DEDUCTIBLE $
,X RETENTION $10,000 $
WORKERS COMPENSATION AND I, vv~,,= 'I IUE;;-
X TORY LIMITS
C EMPLOYERS' LIABILITY I WC9006846-00 11/02/03 11/02/04 $ 1,000,000
ANY PROPRIETORIPARTNERlEXECUTrvE EL EACH ACCIDENT
OFFICERlMEMBER EXCLU~ED? i WC9009231-00 EL DISEASE, EA EMPLOYEE $ 1,000,000
If yes, describe under $ 1. 000 000
SPECIAL PROVlS'ONS below E L DISEASE, POLICY LIMIT
OTHER I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Where required by contract, bid or work order, the City of Bakersfield its
Mayor, council, agents, employees and volunteers is an Additional Insured
as respects General Liability and/or Auto Liability with respects to
operations of the named insured on their behalf per CG2012 7/98
RE: 7-11 Site
CERTIFICATE HOLDER
CANCELLATION
CITYB20
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30
DAYS WRITTEN
City of Bakersfield
1505 Truxtun Ave
Bakersfield CA 93301
NOTICE TD THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBUGATlON OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
@ACORDCORPORATION 19BB
ACORD 25 (2001/OB)
~ '
09/07/2004 13:57
9168610430
SECOR
POUCY NUMBER: GL0!I222477~
COMMERCIAL GENERAL UABILnY
CO 20 33 1001
THIS ENCORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS -AUTOMATIC STATUS WHEN
REQUIRED IN CONSTRUCTION AGREEMENT WITH yOU
This endorsement modlfles insurance provided under the following;
Additional Insured: aty of Bakersfield its Mayor, council, agents, employees and volunteers
Re: AU California operations: Project location - Bakersfield CA
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Section II _ Who Is An Insured is amended to include as an insured any peffiOn or organization for whom
you are perfonning operations when you and such person or organization have agreed In wri~nQ In a
contract or agreement that such person or organization be added as an additional insured on your policy,
Such person or organization is an additional insured only with respect to liability arising out or your ongoing
operations performed for that insured. A person's or organization's status as an insured under this
endorwment ends when your operations for that insured are completed.
B. With respect to the insurance afforded to these additional Insureds, the following additional exclU$lons
apply:
2. Exclusions
This insurance does not apply to:
a, "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering
of, or the failure to render, any professional architectural, engineering or surveying services,
including:
(1) The preparing, approving, or failing to prepare or approve, maps, shop drawing5, opinions,
reports, surveys, field orders, change orders or drawings and specifications: and
(2) Supervisory, inspection, architeCtUral or engineering activities.
b. "Bodily Injury" or "property damage" occurring after:
(1) All work, including materials, pariS or equipment fumlshed in connection with suoh work, on
the project (other than service, maintenanoe or repairs) to be performed by or on behalf of the
additional insured(s} at the site of the covered operations has been completed: or
(2) That portion of "your work" out of which the iniury or damage arises has been put to Its
intended use by any person or organization other than another contractor or subcontractor
engaged in performing operations for a principal as a part of the same project.
CG 20 3310 01
Copyright, Insurance SeI"iCCS Office, !nQ. 1996
Page 1 of 1
PAGE 02/02
09/07/2004 12:03 9158510430 SECOR
RightFax 9/7/2004 11: 43 PAGE 001/006 Fax o6z-v6r'
PAGE 01/02
FAX TRANSMITTAL
PUBLIC WORKS DEPARTMENT
CITY OF BAKERSFlELD
ig}l rRUXToN AVENUE
BAKERSFIELD, CALIFORNIA 93301
Fu No. (66t) 852-2011
DATE: q - G2 . 01
aa.~ lfl'EASI: ROUlE AS SOON AS POSSIBU: TO:
N ; ~trttCt3AM,^^
. COMPANY/ORGANIZATION: ~L1C-
FAXNO. SENDlNGMESSAGE TO: f! IkJ) 8/'p/ -' ()f &::>
@ , FROM:
NAME: F3l~ _~u:J
OmCEpgONENO.:(661) 2~' ~ ~f't:,..J Inbl-SS2-Z!JJJ
NUMBER OF PAGES (INCLUDING TInS SHEET): . ()s; L
SPECIAL INSTRUCTIONS:
...
09/07/2004 07:40 FAX 661 281 7127
TICOR TITLE
City of Bakersfield
Public Works Department
1501 Truxtun Avenue
Bakersfield, CA 93301
Attn: Bob Wilson
RE: LLA 04-1158
Please be advised that Tieor Title Company of California will record the Certificate of
Compliance and the concurrent Deed on the above LLA upon instructed to do so by the
City_
Thank: you.
~~
Scott Murray /
Assistant Vice-President
Ticor Title Company of California
201 New Stine Rd. #300
Bakersfield, California 93309
141 001
09/07/2004 13:57
9168610430
SECOR
PAGE 01/02
.
SECOR
SECOR INTERNATIONAL INCORPORATED
3017 I<lIg," Road, Suite 100
~neho Cordove, CA 1151170
91$-8$1.0&00 ~"L 1916-861-0430 ~'"
\N\I\IW.secor. com
f
a
x
from:
~0/-8SZ-2Q/1
J30h hI'/Jo/J
Cf1.J of &kIk6~1cJ~ ~)Ltc h6t'~
q /7/0lf
5~ft ~r(/fi.a/1J
"Z-:::
fax no:
attention:
company:
datettime:
no. of pages (including cover):
message:
J:J~rc.- J (. Th~ r;orr/'q~c! ;n5L1r41'Y4'_ ~//114
Disclaimer: The information transmitted herein is intended only for the person or entity to which it is addressed and may
contain confidential and/or privileged material. If you are not the intended recipient of this message. you are hereby
notified that any use, review, retransmission, (Ilssemination. distribution. reproduction or any action taken in reliance
upon this message is prohibited. If you received this communication in error. please notify the sender Immediately and
delete the original meSS;;lge and all attachments from your electronic flies.
"",
..
.
SECOR
3017 Kilgore Road, Suite 100 www.secor.com
Rancho Cordova, CA 95670
916-861-0400 TEL /916-861-0430 FAX
SECOR INTERNATIONAL INCORPORATED
letter of
transmittal
attention: Bob Wilson
date: September 22, 2004
company:
City of Bakersfield
address:
1505 Truxton Avenue
Bakersfield, California 93301
project:
7 -Eleven #16329
1701 Pacheco Road
Bakersfield, CA
job no.:
77EL.16329.04.0313
re:
Encroachment Permit Application
enclosed:
( )
( )
( )
( )
(X)
Proposal
Contract
Report
Letter
Other: Encroachment Permit App.
( )
( )
( )
(X)
( )
( )
( )
As Requested
Review
Your Information
Approval
Signature
Return
Other:
comments: Please review the attached encroachment permit application for one
groundwater monitoring well located in south bound traffic lane of South H Street (see
the attached Site Plans). You should have all of our insurance documents in conjunction
with the earlier encroachment permit for the well box in the sidewalk at the same location
(Permit Application #04-20022973, Pin number 679309). I have also included the page
from our Workplan that describes the proposed work and a traffic control plan for closure
of one lane. The work is expected to take approximately 6 hours. Please let me know
the fees that will be required and I will send you a check for the requested amount.
Please contact me at (916) 861-0400 ext.245 or sqraham@secor.com if you have any
questions or any additional information is needed.
~dh~-
signator: Scott Graham
title: Associate Geologist
cc:
File /7-Eleven, Inc.
16329 Encroachment trnsmtl 2,doc
SECOR INTERNA TIONAL INCORPORA TED
..
~'
.
SECOR
Corrective Action Plan Modification
7-Eleven Store #16329
June 23, 2004
Page 4
be contained in a steam-clean trailer and temporarily stored on site in DOT approved 55-gallon
drums.
All soil samples collected will be sealed with Tetlone sheets and plastic caps, then labeled and
placed on ice in an insulated container for delivery to Kiff Analytical located in Davis, California. Soil
samples will be analyzed for benzene, toluene. ethylbenzene and xylenes (BTEX), TPHg, and MtBE
using Environmental Protection Agency (EPA) Method 6260B.
Well Installation
Each remedial well will be constructed using 2-inch diameter polyvinyl chloride (PVC) blank casing
and O.020-inch-slot well screen. The remedial well screens in SP-2 and SP-3 will be installed from
45 feet bgs to 55 feet bgs (Table 7). A sand filter pack will be placed within the annulus of the well
from the bottom of the boring to approximately two feet above the top of the well screen, The
annulus of the well will be sealed with two feet of bentonite on top of the sand, and a portland
cemenVbentonite grout to the surface. An~nch-diameter, traffic-rated, watertight street box will be
installed to protect the well from surface traffic~
J2-
WASTE HANDLING AND STORAGE
During drilling operations, all augers, sampling tools, and down hole equipment will be steam
cleaned prior to use. All rinsate water, purge water and soil cuttings generated during the drilling
operations will be stored in 55-gallon drums at the site pending laboratory analysis for proper
disposal.
HEALTH AND SAFETY
SECOR will modify our existing site-specific Health and Safety Plan for the proposed scope of work
as required by the Occupational Health and Safety Administration (OSHA) Standard "Hazardous
Waste Operations and Emergency Response" guidelines (29 CFR 1910.120), The document will be
reviewed and signed by SECOR personnel and subcontractors performing work at the site.
PERMITTING AND UTILITY CLEARANCE
SECOR will obtain the necessary permits required by KCEHS for installing groundwater monitoring
wells. Prior to conducting subsurface work at the site, Underground Service Alert (USA) will be
contacted to delineate subsurface piping near the site with surface markings. In addition, a private
utility locator service will be contracted to located subsurface utilities that may be present at the
proposed monitoring well locations to ensure they are not intercepted during drilling activities.
REPORTING
SECOR will prepare a report summarizing the fieldwork completed and data collected InCluding:
. Details of field procedures and operations
. Boring logs
. Results of the soil analysis
. Updated map showing the location of each well.
SECOR will report the findings of the oxygen injection in the Quarterly Monitoring and Remedial
Progress Report.
_i-
,.
Traffic Manual
TRAFFIC CONTROLS
1-1996
(Rev. 1)
5-127
Typical Application 5-22
Right Lane Closure Far Side of Intersection
A
i RIGHT LANE
..... MUST
r TURN RIGHT
f-r
A
L
-,
('lj
C
o
E.'
ot
"""--":,
~ I cc
\.- A -+1
(reuondo)
A
~i
A
.....1
Note:
See Table 5-4
for 'A',
(Optional)
(Optional)
RIll
RIGHT LANE
MUST
TURN RIGHT
<3
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o.
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