HomeMy WebLinkAbout04-30000044
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 . . .
ATN (11 Digits) :
Application description
Owner
04-30000044 Date
.262344
9700 STOCKDALE HWY
339-181-25-00-2
PW - ENCROACHMENT PERMIT
4/12/04
Contractor
OWNER/BUILDER
KERN HEALTH SYSTEMS
9700 STOCKDALE HWY
BAKERSFIELD CA 93311
664-5010
BAKERSFIELD
CA 93301
--------------------------------------------
Permit . . . . .
Additional desc .
Phone Access Code
Permit Fee . . .
Issue Date - . .
ENCROACHMENT PERMIT
204289
150.00
4/12/04
Valuation
o
Extension
150.00
Qty Unit Charge Per
1.00 150.0000 EA PW ENCROACHMENT
--------------------------------------
--------------------------------------
Special Notes and Comments
CARPORT AND TRASH ENCLOSURE ENCROACHING
INTO KERN RIVER LEVEE EASEMENT
:'~
'Fee summary
Permit Fee Total
Grand Total
SEE ADDITIONAL LIABILITY INFORMATION
ON,. THE REVERSE SIDE.
Charged
Paid
Credited
Due
150.00
150.00
150.00
150.00
.00
.00
.00
.00
Applicant acknowle ges the right of the City Engineer, pursuant to the Bakersfield Municipal Code Chapter 12.20 to revoke the
permit at any ti
IX. ~ 4JAt~
, frint 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.
Signa,ureOfCi'Y& ./
Additional Terms on the Back
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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.
pve read and acknowledge the above.
Applicant's Initials
The City of Bakersfield and lor its designated contractor(s) may at any time
have access 1;:0 the 1{~~.,River Levee for repairs and Maintenance. Permittee
understandsC1that 'i:his-c~nd:oachment is on the Kern River Levee District easement
which may require periodic maintenance including the use of heavy equipment
City shall not be responsible for any damage whatsoever occuring within the
easement including damages to landscaping. structures. vehicles, machinery
or any other ~quipment which may be located w1thin the easement in the performance
by City in levee repairs or maintenance. City shall not be responsible for the
repair/replacement of items damaged or destroyed within the easement as a result
of emergency repair and maintenance. Permittee recognizes this encroachment may
cause City additional expense in its ability to perform maintenance and will be
held responsible for any reasonable additional expenses incurred by the City
p~rforming maintenance and repair operations caused by this encroachment.
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BAKERSFIELD
PUBLIC WORKS DEPARTMENT
MEMORANDUM
TO:
Raul M. Rojas, Public Works Director
FROM:
Marian P. Shaw, Civil Engineer IV, Subdivisions
DATE:
May 17,2004
SUBJECT:
Encroachment Permit Application for car port & trash enclosure within Kern River
Levee easement.
Kern Health Systems
9700 Stockdale Highway
Engineering, Traffic and Water Resources staff has reviewed the attached encroachment permit to allow
the installation of a car port and trash enclosure within the Kern River Levee easement. The site is located
at 9700 Stockdale Highway.
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.
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S:\PERMITS\ENCROACH\03-04 Permits\9700 Stockdale Hwy.doc
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BAKERSFIELD
MEMORANDUM
May 4, 2004
FROM:
Bob Wilson; Engineering-Subdivisions
~
Mark Lambert; Water Resources
TO:
SUBJECT: Kern River Levee District Encroachment Permit Application
No. 04-30000044 for 9700 Stockdale Hwy.
The encroachment permit application number 04-30000044 should also include the
following language:
The City and/or its designated contractor(s) may at any time have access to the Kern River
Levee for repairs and maintenance. Permittee understands that this encroachment is on
the Kern River Levee District easement, which may require periodic maintenance including
the use of heavy equipment. City shall not be responsible for any damages whatsoever
occurring within the easement including damages to landscaping, structures, vehicles,
machinery, or any other equipment which may be located within the easement in the
performance by City in levee repairs or maintenance. City shall not be responsible for the
repair/replacement of items damaged or destroyed within the easement as a result of
emergency repair and maintenance. Permittee recognizes this encroachment may cause
City additional expense in its ability to perform maintenance and will be held responsible for
any reasonable additional expenses incurred by City performing maintenance and repair
operations caused by this encroachment.
Cc: Alan D. Daniel, Deputy City Attorney
04/05/2004 10:17
3250255
COB
PAGE 04/07
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APPLICATION FOR ENCROACHMENT PERMIT
TO THE CITY ENGINEER OF THE em" OF BAKERSFIELDt 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 therein defined.
1. Full name: of applicant and complete address including phone nwnber: K t:.,{ ^" f~M.',11 I~+ L CiJ4-Y L
2. Nature or description of the encroachment for which th.is application is made: 10 I:L/lo..v k 'frASt.t!..Nt...L~t;vl"-L-
+ (!.Jl.rflS>rJ-$ l~ 1(-e~1"l.(. ~\.-u~ Lf-V~<- ~.4~.e.~.f- .
,
Q700 -5hLk~k. ~I/'''''' ~~<:. ,4;/:;~
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3. Location of the proposed encroachment:
4. Period of time for which the encroachment is to be maintained: IN. tA.~ feN" f~tu
Applicant agrees that if this application is ~ted, applicant shall indemnify, defend and hold hannless City, its
officers, agents and employees against any and allliabihty. claims, actions, causes 0 f action or d~d5, whatsoever
against them. or any pfthem, 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 tlie aforesaid encroachment during the
life of said encr~achment, or until such time that this permit is revoked. . , , .',
Applicant: further agrees that upon the expiration of the perinit [or which this application is made, if granted, or 'Y!!Q!!
the revocation therroibv the City engineer~apptical1t \\IiIl at his own cost and C:XDense remo~the same from the ~.lic
pr.QIL~ or right of way where the same is located, and restore said public property or right of way to the conditi,on
as near, y as that in which it was before the placirtg. erection, inaintenance or existence of said encroachrOeot. .
Applicant further agrees to obtain anli keep all liability insurance required by the City Engineet in full force and effect
. for however' long tlie 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 arid required
endorsements evidencing the insurance required. The type(s) and arnount(s) of insurance' coverage is:
Applicant acknowledges the right of the City Engineer, pursuant to B
revoke tbe pennit at any time.' .
Date: 4-7-0 '7-
sfield Municipal Code Chapter 12.20 to
.t....
I HERIBY CERTIFY THAT I HAVE MADE AN INVESTIGATION OF THE FACTS STATED IN THE
FOREGOlNGAPI'L1CATION AND FIND THATUlE MAIN'TENANCE OF SAID ENCROACHMENT (1) WILL
eNOT) SUBST ANTIALL Y INTERFERE WITH THE USE OF THE PUBLIC PLACE WHERE THE SAME IS TO
DE LOCAtED AND (2) WILL (NOn CONSTITUTE A HAZARD TO PERSONS USING SAID PUBLIC PLACE;
SAID APPLICATION IS THEREFORE (GRA.~TED) (DENIED). SAID PERMIT SHALL EXPIRE
Date:
Signature of City Engineer
No.
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BAKERSFIELD
PUBLIC WORKS DEPARTMENT
MEMORANDUM
TO: Pat Flaherty, Risk Manager
FROM: Marian P. Shaw, Civil Engineer IV, Subdivisions
DATE: April 27, 2004
SUBJECT: Encroachment Permit Application for 9700 Stockdale Hwy.
Kern Health Systems
Carport & Trash Enclosure in Kern River Levee Easement.
Please review the insurance certificate with the attached encroachment permit and return to me
at your earliest convenience.
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S:\PERMITS\ENCROACH\INSURANC\9700 Stockdale Hwy.doc
... _ _ ~~/07!2004 10: 05
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COVERED
. PARTIES:
COVERAGE
PROVIDER:
COVERAGE
TERM:
SELF-INSURED.
RETENTION:
. MEMBER
. COVERAGE.
AND LIMITS:
5515545180
KFHC
PAGE 02
. . CSAC.. EXCESS INSURANCE AUTHORITY
CALIFORNIA PUBLIC ENTITY INSURANCE AUTHORITY
EXCESS LIABILITY PROGRAM
Effective July 1, 2003
Terms & Conditions
Participating Members within CSAC Excess Insurance Authority and California
Public Entity Insurance Authority Excess Liability Program
CSAC E:xcess Insurance Authority (ErA)
Reinsur~d by Insurance Company of the State ofPennsylvania*.
July 1,2003 to July 1, 2004
See Attached '.
CSAC EIA rool Laver: Difference between $5~000.OOO Pool Laver.. and
. ~~eduled Self-Insured ~eteDtion
. General Liability - $5,000,000 Per Occurrence
. . Automobile Liability. $5,000,000 Per Occurrence
. Public Officials Errors & Omission - $5.000,000 PerOccurrenl;e
. EmployJntmt Practices Liability - $5,000,000 Per Occwrence
. Completed Operations - $5,000,000 per Occurrence and Annual Aggregate
UNDERLYING OF*
. $1 O.OOO~OOO Reinsuranc.~ Laver IS of $5.000,000 Pooled Retention
.. Gener~l Liability - $1 O,OOO~OoO Per Dec.
. .. Automobile Liability - $10,000,000 Per Dec.
. Public Officials Errors & Omission - $10,000,000 Per Occurrence
. . Employment Practices Liability - $10,000,000 Per Occurrence
. . Completed Operations - $10,000,000 Per Occurrence/$iO)ooo,OOO Aggregate
* Applies only to Members partiCipating in the program at limits excess of $5,000,000
** Various limits apply within the pool- see attached member list for details.
i' - . qM0712004 10: 06
MAJOR
EXCLUSIONS:
.. (including but not
l~ited to): .
6616645180
KFHC
PAGE 03
. Airpons/Aircraft
. Failure to Supply
. Nu~lea.r Material/Nuclear Incident
. Pollution
. Dam Failure
. Asbes~os
. punitive Damages
. Fiduciary Liability
. Mold I Fungus
. Subsidence
. Inverse Condemnation/Eminent Domain
. War'
. . Fixed Route Transit (unless endorsed)
. Securities and Financial Exclusions
. ERISA
.. 'Under the Personal Injury Definition, unlawful discrimination intentionally
committed by, at the direction of, or with consent of covered party is .
excluded,.
. Managed Care E & 0, As respects to Kern Health Systems
Please refer to the proposal for more detail.
rl
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5515545180
KFHC
PAGE 04
'15Wl; OA TE (MM/tlD/YY1
07(08/03
._~ ...., . ,,' _._~ "-._.u.,......_... .
COMPAHY
BINDEl! NO_
OR1VE~ ALUANT'INSURANc;E'SERVICES
P_O. Box 6450. .
. Newport Beach, CA 92658-6450 .
(949) 756-0271
CSAC Excess Insurance Authority
~1'f"ECTIVE
DATE TIM!;
42034611 RA
I;ltPlRATl9N .
llA,tt "tiME
CO~ . SUB.cOOE.
INSUREP . .
CSAC EIAAND CPEIA MEMBER ENTITIES
C/O CSAG EXCESS INSURANCE AUTHORITY
3017 GOLD CANAl DRIVE, #300
RANCHO CORDOVA,. CA 95670
07/01/03 12:01 AM 10/01/0312:00 AM
Tt'llll BINDER 15 IllSUED TO eXTE,NP COVERAQe IN THE. ABOVE N,o,MECI COMPANY
peR EXPiRING POliCY NO:
DESCRIPT1QN OF OPIiRATlONSIVEHlCLJOIilll"R,Ol'ERlY (InClu~I~S L"","lon)
EXCESS LIABILITY PROGRAM .
MEMBER ENTITIES AND SELF.INSURED RETENTIONS
PER THE ATTACHED BINDER ADDENDUM
.LIAIIIUTY
c6MMI'~1AL GENER.lL ~1A/lILlTY
ClAIMIil 0 OCCUR
. MACE
.OWNER'S & COI'rt~CTOR.'S PROT,
PERSONAl. ~!'JN. INJURY.
EACH OCCURRENCE:
FIRE OAMAGE (Any Ol'l~ fifll) .
MErl. EXPENse (My Dn. pa=n)
RET~O OAfS, FOR CLAIMS MADE:
AlrTOMOiJILe UAIlI~llY
ANY AUTO
ALL OWNED AUrOS
SCHEDUlE:P AUTOS
HIRED AUTOS
NO~N~O AUTOS
IJAAAGE UAB1UTI
COM6I~ I;l SINGLE LIMIT
eODll Y INJURY (Par pe1'8O~)
BODII. Y INJURY (Per llocide~\)
PROP 1'( DAMAGE
IIIIWII;:",," PI\VMENTS
p~R80NAL I~JURY PR.OT,
UNINSURED MOTOR11il'r
l)l;.DV~;le~
AI.L VEH1C~ES
SCHEDULED Ve,HIc:LES
ACTUAl. H VALUE
STATED AMOUNT
Ol't1ER
AGGREGATE
Set! Altached .
. Su AttIc:hed
CSAC EIA EXCESS LIABILITY I MEMORANDUM OF
COVERAGE,
ll~I,F-INSURED RETENTION
Site Attached
i' 01lil;R THAI>\ UMBRELLA I'ORM
WORKEf\'S COMl'I!NSA1l0H
MID
EM"l-OYE~'!llWlILITY
. SPE,CIAL CQNlltnoNSJO;KI!R COVElWjllO.S
SUBJECT TO TERMS. CONDITIONS AND EXCLUSIONS OF THE CSAC EIA EXCESS LIABILITY PROGRAM MEMORANDUM OF
COVERAGE..' . .
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5515545180
KFHC
PAGE 05
..,
CONDITIONS
This Company binds the kind(s) of insurance stipulated on the reverse side. Th~lnsurance
Is subject to the terms; conditions and limitations of the policy(ies) in current use by the
company. .
This binder may be cancelled by the Insured by surrender of this binder or by written notice
to the Company stiilting when .cancellation will be effective. This binder may be cancelled by
the Company by notice to the Insured In accordance with the policyconditions~ This binder is
. cancelled when repla~d by a policy. If this binder Is not replaced by a policy, the Company.
is entitled to charge ~ premium for the binder according to the Rules and Rates in use by the
Company. .
APP.LICABLE IN NEVADA
Any perSon who refuses to accept a bInder which provides. coverage 'of less than
$1,000,000.00 when proof is required: (A) Shall be fined not more than.$500.00,alid (B) is
liable to the party presenting the binder as proof of insurance for actual da.mages sustained
therefrom. . . .
~
, ~jI/ 07/2004 10: 05
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5515545180
.,
County Member
Alpine County
Amador County
. Butte County .
Calaveras County
Colusa County
Del Norte County
Fresno County
Humboldt County
Imperial County
Inyo County
Kings County
. Lake County
.. Lassen County
Madera County
. Marin County
MaripOSf;l County .
Mendocino county
MerCed County
Madoc County
. Mono County
Napa County
Nevada County
Plumas County
San Benito County
San Luis Obispo County
Santa BaroaraCounty ..
Shasta County .
Sierra County .
Siskiyou County
Solano County
Sonoma County
Stanislaus County
Sutter County
Tehama County
Trinity County
Tulare Cou.nty
Tuolumne County
Yuba County
KFHC
MEMBERSHIP LIST
1lelf-lnsured Retention
$100,000
$100,000
$100,000
$100,000
$100,000
$100,000
$750,000
$150,000
$200,000
$100,000
$500,000
$100,000
$100,000
$100,000
$250,000
$100,000
$200.000
$100,000
$100,000
.. $100,000
$300,000
$100,000
$100,000
$100,000
$250,000
$500,000
$250,000
$100,000
$100,000
$100,000
$750,000
$250,000
$100,000
$100,000
$100,000
$250,000
$100:000
$100,000
PAGE 05
Limit Qf Liabilitli
$15,000,000
$15,000,000
$15,000,000
$15,000,000
$15.000,000
$15.000,000
$15;000,000
$15,000,000
$15,000,000
$15,000,000
$15,000,000
$15,000,000
$15,000.000
$15,000.000
$ 1,000,000.
$15,000,000
$15.000,000
$15,000,000
$15,000,000
$15,000,000
$15,000,000
$15,000,000
$15,000,000
$15,000,000
$15,000,000
$15,000,000
$15,000,000.
. $15,000,000
$15,000,000
$15.000,000
$15,000,000
$15,000,000
$15,000,000
$15,000.000
$15,000,000
$ 1,000,000
$15,000,000
$15.000,000
~,
~ 0..4/07/2004 10: 05
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5515545180
KFHC
CPEIA Member
Self-Insured Retention
Capital Area Df;}velopmenf Authority
CADA . .
$ 50,000
central Sierra Child Support Agency
City of Concord
City of Lompoc
$100,000
$250,000
$100,000
$150,000
$100,000
City of Napa.
CitY of Rancho. Cordova
. City of Santa Clara. Sport and Open Space Authority
$ 50,000
Council of San Benito County Gove,nments $ 25,000 (Non~Fixed Route Transit)
. . . . $ 100,000 (Fixed Route Transit)
County of Sacramento/City of Citrus Heights
Transportation Department .
$100,000
County of Sacramento I
Elk Grove Police Services Cqntract
$100,000
Del Norte In HomeSuppnr1ive SE!rvlces Public Authority
$100,000
$500,000
$250,000
$100,000
$100,000
$50,000
$100,000
East Bay Regional ParK District
. Golden State Risk Management Authority
Imperial County In-Home SupportivE! Services PUblic Authority
. Irvine Ranch Water District
Kern Health Systems .
Kern In-Home Supportive S~lVi6es Public Authority,
. Marin County Transit District
$ 25,000 (Non.i=lxed Route Transit)
$100,000 (Fixed Route Transit)
. Marin tn-Home Supportive Services Public
Authority
$100,000
Merced In-Home Supportive Services Public
Authority . .
$100,000
CPEIA Mem.ber
Self-Insured Retention
PAGE 07
limit of Liabilitv .
$ 5;000,000
$15,000,000
$10,000,000.
. $15,000,000
$15,000,000 ·
$ 5,000,000.
$15,000,000
$ 5,000,000
$15.000,000 .
$ 2,000,000
$15,000(000
$15.000,000 .
$15,000,000
$15,000,000
.$15,000,000
$15,000,000
$15,000,000
$ . 5.000;000
$15,000,000
$15,000,000 .
Limit ofLiabilitv.
. _ 1I~4/07/2004 10: 06
5515545180
KFHC
PAGE 08
..
Oakland Base Reuse Authority . $ 50,000 $15,00.0,000
Orange County.ln Home Supportive $ 50,000 $ 5,0.00,000
.. Public Services Publio AlithoritY
Riverside In Home Supportive Services Public Authority $100,000 $15,000,000
San Bernardino In Home Supportive Services Public $100,000 $15,000;000
Authority
San Bernardino. Specified Departments $100,000 $ 1,000,00.0
Shasta In Home Supportive Services publio Authority $100,000 $15,000,000
Sutter In Home Supportive Services Public Authority $100,000 $15,000,000
Tulare In HQr:ne Supportive Services Public Authority $100,000 $15,000.,000..
.. Withregard$ to City of Concord, $5,000,000 excess of the $5,000,000 pooled llmit is covered by
Clarendon American In$urance Company
_ 04/07/2004 10:05
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5515545180
KFHC
PAGE 01
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. URN HEAL'rK SYST~S, OSA
fil
Kern Family
Health Care
(K~t'n County IIc<t.1.th Authod ty,
A .public ^g~ncy)
FAX COVER LETTER
A ~{'\ ~. 7, 200~
'RoJ P-M~e..
NAi'1E : ._
COMPANY: {q (l ~Se.V\ 01 v ~ .
32..~- '3,DO
32.4-.... 'jQOO
TO:
f"AX .NtJMaER:
FllOM;
Njl.,ME:
JOE OCAMPO - Controller
p~ONE: (661) 664-5021
Fax (661) 664-5180
. E~il adiress; joeo@khs-net.com
(t.l:ieludi.:1g CCl'lt~= Sheet)
.ORIGINAL IN MAIL:
1 YES ~y. J ~
PAGES ~
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COMMENTS:
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fr~ Ge-. c'(}(\ \Me ~ ~(,\vt ~e$.~'QyvS.
r ~~f<-s f
~his messa~~ is intend~d only for the use of the ~vidual or encicyto w~ch
.~C is ~d~a$sed. and may concai~ info~tion that is pr~vileged, corif~~~~ial
anci e.-cetUpt:. f:::om disc!.O$U:=~ wtder llppli.cal:lle law. If che ~eade:: of chi:;; .
message is nOt the ir.ten~~d ~ecipient. or the ~mployee or &ge~t ::es9onsible
fo~ delivering the message to the inter-cae r~ci~i~n~. you a~e ner~Y noc~fi~d
tha.I:. any clis.semi:iat:,ion~ dist:=,ihudco., or caprin; of this ccmmu.=.iC:ll.eion is .
st.rictly p=hibit~d. If you have rt!c~iv~c ~1l ::ocmnunic:ac:.:.cn in e::~:)='. plell.se
noeify .us iltll:lled:..a.cely.by ;:~!eph.one &l1d =etu== t~e Clr:.q:tn.a.l utessaqe to us a.t:
the above add:~5S by a.s. mail.
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BAKERSFIELD
PUBLIC WORKS DEPARTMENT
MEMORANDUM
TO: Ryan Starbuck, Civil Engineer III
FROM: Marian P. Shaw, Civil Engineer IV, Subdivisions
DATE: April 27, 2004
SUBJECT: Encroachment Permit Application for 9700 Stockdale Hwy.
Kern Health Systems
Carport & Trash Enclosure in Kern River Levee Easement.
Please review the attached encroachment permit and return to me at your earliest convenience.
4/ 1-1 I off
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S:\PERMITS\ENCROACH\TRAFFIC\9700 Stockdale Hwy.doc