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HomeMy WebLinkAbout03-30000028 """ '?... 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 . . pin number . . . . . . Property Address . . . Application description Owner OJ-30000028 Date 7/08/03 2567 2615 EYE ST PW - ENCROACHMENT PERMIT Contractor OWNER/BUILDER SAN JOAQUIN COMMUNITY HOSPITAL POBOX 2615 BAKERSFIELD CA 93303 (661) 326-4140 BAKERSFIELD CA 93301 ---------------------------------------------------------------------------- Permit . . . . . Additional desc . Phone Access Code Permit Fee . . . Issue Date . . . ENCROACHMENT PERMIT 104869 .00 7/08/03 valuation o Extension .00 Qty unit Charge Per 1.00 .0000 EA PW ENCROACHMENT ------------------------------------ ---------------------------------------- Special Notes and Comments PERMENANT ENCROACHMENT ACROSS 27TH ST FOR DATA, PHONE, AND POWER LINES TO REPLACE OLD LINES NO FEE PERMIT AS PER B WILSON 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 ermit t any . me. ~~~~~ 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 shalI 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 alI 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 " i 1 ~~ J I ~'1Jo/& ~ 4 . - BAKERSFIELD PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Raul M. Rojas, Public Works Director FROM: Marian P. Shaw, Civil Engineer IV, Subdivisions DATE: July 29, 2003 SUBJECT: Encroachment Permit Application for data, phone and electrical lines across 2th Street. San Joaquin Community Hospital 2615 Eye Street. Engineering and Traffic staff has reviewed the attached encroachment permit to allow the installation of data, phone and electrical lines across 27th Street. The site is located at 2615 Eye Street. 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\03-04 Permits\2615 Eye St.doc GS/;j8 ~ 1 'i': 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 permit to place, erect, use and maintain an encroachment on public property or right-of-way as therein defined. 1. 2. Nature or description of the encroachment for which this application is made: rt ' V~~ h~~ . ('t"k\4. (c.. ~D ~~\....,...a o\~ \~) 3. Location of the proposed encroachment: \ ~ '-~ 'L. (~~ ~\::. 4. Period oftime for which the encroachment is to be maintained: ~V"~\: Applicant agrees that if this application is granted, applicant shall indemnify, defend and hold hannless 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-judical,or judiciaJ'tribunals of any kind whatsoever, arising out of, connected with, or caused by applicant's placement, erection, use (by applit!ant 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 bv the City eneineer. 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 Insurance evidencing sufficent 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 is: Cft~~":~ CJ.~ ~__~ \~""h\.\~ oct ~ \)QOO)t)OO..OO Applicant acknowledges the right of the City Engineer, pursuant to Bakersfield Municipal Code Chapter 12.20 to revoke the permit at any time. Dat~: 'I. ~ . 03 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 OFTHE PUBLIC 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 Date: Signature of City Engineer No. _ ~_' . r. . .' CITY OJ::, BAKERSFIELD DEPARTMENT OF PUBLIC WORKS TO WHOM IT MAY CONCERN: We the undersigned I have no objection to the construction of a fence beside the sidewalk within the public right of way. '2.. 7t~ st.~"\: (Street for puposed encroachment) By: So-.n-rO~\')\r\ ComW\\)h~ (Owners Name) "bE.?~~ of \ S Z-4:,,- "l1c.'h S\v-~\. (Address of purposed encroachment) SIGNED: 1) Name: Address: 2) Name: Address: 3) Name: Address: 4) Name: Address: 5) Name: Address: 6) Name: Address: r' Phone:~ ' ~2..~ .'+\40 ~~\~ ~ -t~ ~-\-~ ~~ ~~ ~"lc~ \O\~ ,~ oWV\4..~ ~ ~ h~t>\-tM - Date: Date: Date: ..,.~ '03 Date: Date: Date: j ~ , -". ~ . - BAKERSFIELD PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Ryan Starbuck, Civil Engineer III FROM: Marian P. Shaw, Civil Engineer IV, Subdivisions DATE: July 22,2003 SUBJECT: Encroachment Permit Application for 2615 Eye Street. San Joaquin Community Hospital Data, phone, & electrical lines across 21h Street east of Eye Street. Please review the attached encroachment permit and return to me at your earliest convenience. V'o~ J 1\il1t-~ V\+r,..,,, 2..- vv t.. y ~,,-t:"I~t 4- 'V\ "27iiL ~+V.c..(.-t ccb a.-fI r/~.(.~, JZ.t- 7/l-{;/oJ S:\PERMITS\ENCROACH\TRAFFIC\2615 Eye St.doc ~ ,. '~ ~ . - Bj~KERSFIELD PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Pat Flaherty, Risk Manager FROM: Marian P. Shaw, Civil Engineer IV, Subdivisions DATE: July 22,2003 SUBJECT: Encroachment Permit Application for 2615 Eye Street. San Joaquin Community Hospital Data, phone, & electrical lines across 21h Street east of Eye Street. Please review the insurance certificate with the attached encroachment permit and return to me at your earliest convenience. ~)/ S:\PERMITS\ENCROACH\2615 Eye St.doc j.~ ' --. .,l." I i . or_ ,:~l1";r;g-!)j (4 :07P8 ~ i' ~ ;'l)in":Ai)VEr~T1 SfHf::AlTH.R I SK ~4ANAGEIENT DEPT \~-'-"'- .' : :T:;:~2t: :p',O?/03' . ;:-,699 "'a,...,,~,\,:j"V;(lll'Y.fi (,'Ji ~,.....a~" v \;. ~ .....1t.Jlil.;;"l... q. 1.... 1'" . t .10" "'~ .,.[~..;. h.. Endorsement No.. 2003"'iflJ158 .. -------- fi:te Attaching Clause need be completed only when thisendbrsimicnt is s(Jbsequent to preparation of the trust coverage part) " {j;r."H'~/;Ifitl'-iY....~tlIm:.fj' !1 This i.T:dllrs':l;I'~II( l\1C1iifes such coverage as is afforded by the provisions of the trust relating to the following ctJYerag~ P::!r1(s): f-l COMPI1ElfILNSIV.E GENERAL LIABILITY COVERAGE :"j 11':'_l:IHltm,ml'lflfJf'ilt'li'U'!i'.r::t!i;;'lIl':W~~. ........ -~~~"'~'i& '~i ,i:; C:'l:iO(;.cu;r:t, e:(ec!:~e June 1, 2Q03 (12:01 A.M., Standard time) forms a part of TrLlst DOGWfle[,{ ;-. ;. 5C;~:;'(>Y.';::.i.;'H! U/ P.dvemist H;::81~rl SystemNJest Risk Management. !1 ii> c",we;:,d U'tal n",e City of Bakersfir::ld, ils mayor, council. agents, employees and VOllH11:')er.'i a~8 adcied ;JS ac1dit:t)o1a! p';iti<u;.;!,l~_ ot tr,!~; Trust but only 10 the extent that additional participant is held liable for the H~::ts, en;A;; or (:rniss:')n~> of Sti:i .. nqLir; CO;"'fTlunity ~iospHal. This Endorsement does not extend coverage for the act'), (~lrDrs Dr ()rn;s~ions d City 0' i3,,':.'::;f'I';(, ii,: mayor, council. a!]ents, employees and volunteers. All other terms, conditions find f~\,;'.:!_':~il}ns (e;rain urli:i~..i '1r-~:';'1.1 City of Bakersfield 1505 Truxton Avenue Bakersfield, CA 93301 /), / /), / ~,j!!~fil~________._,.___~~ AuthorizedA~f;p i":! sentat'Je .-VNEnnST hi: I-\l HI ."~~'STr:M/Wf:ST RisK Managerrent. 2100 Douglas Boulevard, PO Box 619002 HOilcvil!e. Cf\. 9Sf,()1-90G2. f:li,un~ Fil6-i'8146?O, F2^ ~;'16-7Bl-2g04 T,.'~T:, . -.- -..--""~ -",-"-,'.-. ,- ~~->-c." 1 ';; -,~~;, :~ .",;l. .~ 'Of' .'.. . " ,;"",:--1\ \ reo .' u tf-D 9 -,D .1 (.1 :117 PIC .. . ,. . - " - F;- om-'AOVEtHl ST !-HLTH RISK MANAGEl.ENT DEPT . . .T-227' 'P.03/03 F~699 CERTIFICATE OF COVERAGE liI'iIW1,,\,dvent i8~ ;;.f,...h }.. .,; ~,~AA,'l..n IN THE EVENT OF TERMINATION OF THE PROGRAMS DESIGNATED BELOW, IT IS THE INTENT OF ADVENTIS1H'EA~J'ffSVSTEr...1lWEST RISK MANAGEMENT TO MAIL THIRTY (30) DAYS PRIO'~ NOTICE THEREOF TO: ENTllY: ...... " Scm Joaquin CIYI1!llunity Hospital qr\ 1:: c':. ",', r;'- t ('\':" t..O :.1 I..Y": ,-"re...; R' f" (.,.. ~ ~ '''()3 ~'l' 1'- ~~~"':>"'I <:' 1''''1'': fJ, :.;-,;,' -.10.... ..f~40."\~.;....~ \_ ,\',11 J.. ......_. '._ v City of Bakersfield 1505 Truxton Avenue Bakersfield, CA 93301 J ~;.:};:~~~~J.'/~;}~~b,~.~~;~~.,~;~EME!,~]...:~E~TU:IES THAT THE FOLLOWING PROGRAMS ARE IN .~()~fE: '.. n " .', '" """-U " AfI,uLJNT {Ir' ',,(:\:l,:f;,r.GE II I' 'i\T:, '::, ,;OVER.A,GJ; __...___-..__._.M_______.-:i 1',1111 ("IP~(EN'cE'l' t" GG"\::""A,F' !l, 1....'\..- , I'h.-v.. - H ;f...-------..--.........-....-.-.-...-------.- ~J .-.. . l! :1 CCf::"i:<-~ :E,-;;::,,'f: "EW;:~/\:.lI,;B!UT :, if ___,__.___._ ______.____ ~~"";O ___ "~~O_!I ~ ! ~ I,.. ...h_______ _.._____......_...0.______ ..,__-+____ I,,! ,! I ---', :i ' I, ,'.". " Ii H lL...::..:.::.:=.:::;:.=:::;.:.::=-:':, ".::,:,::, :':"".-;::':':; ',::';' ~ :.-:.:::=-:=-"';':=-::.::,:,,:-:::;'::-==- p -::,;=-~,,:,",;-=-=;:"'....:::;.;:..:::=:::.:.......:,::.;::::!: COMPANY & PI::RIOO OF -- TRUSTfTRUST COV~RAGE NO.fTRUSTEE OC y AHSJWEST TRUST 01-01-2003 NO. 560~0 10 , \l THE NORTHERN TRUST 01-01-2004 I .' -- .'. THiS~;E:in!CAlt~'~ 'SSUt::J UNDER 1\ GROUP PROGRAM WHICH HAS A SINGLE ^GG,~EGATE liMIT Of' :>~VEi":AGE.:~;:;.'~jl.;'::):;.:SS OF THE NUMBER OF (1) PARTICIPANTS UNDER THIS PROGFU\M (2) PEHSOi'lS OR ':}~(;N!lZi\-f :"iNS V\i!'iC'.\SSEFn CLA1V-S FOR COVERED EVENTS, THE TOTAL LIABILITY OF THE A80Vr::mUST Of-< i:,;~'( b::CE~::: i6Ui.;;'T: rOF: ALL DI'JAAGES BECAUSE OF COVERED CLAIMS WHICH OCCUR DURli\l3 EACH ',:tiU.;:.L (IL<;Y) V(:;l(: THI'~. PRJGHAM is IN FORCE, COMMENCING FROM ITS EFFECT~VE DATE. SHALL f.1CT '>~;.T[D 'i'\-;:: iiMI"; cr Lii,!3IUTY STATED AS THE APPLICABLE AGGREGATE LIMIT ON TI-US CERTiFiCATE. ~]E;SCf'IPT!C:,1 OF (.'1, ;~;:;jrfl()r!S{LOGATI()NS: ':,i: ''-'p';!i'lLOfj;, ;; "ojec.J '::' 'i:e tenT,S and conc:itions of the above Trust as respects the liability of San .Joaquin Canl'11unity . 'i!J::-)pi~:;:.~:_ ~~i';'I;CIj'i'O:: ,Jun':! ;;003 :-:lIS CEFnli::Ci\TE ::~; ;'-;01 VALID UNLESS SIGNED BY AN AUTHORIZED REPRESENTATfllE OF AHS/WEST RISI<: ;1.fi/\f\ll"'\(;Erv1E~ ~"J'r w~ Cl~, (-p:' ~..-,..- -----..--. - RIZED REPHl-SENTATIV~ . .illril: Ci. ':003 DATE: .' c,;)\!ENTIST W:ALTI-I SY:Hl~M/\-VEST Risk Management, 2100 Douglas Boulevard, PO Box 619002 RoseviUe. CA9S661.9002 n'~r:n!) ';i1f;n:'l,.',G:~;), F<,y, (j1l}-7B1.28Ci4 . " -- ,---',... .,~ , . '. _ '(.-,tf....