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AP1lLICATION FOR ENCROACHMENT PERMIT PERMIT NO.: EN-014l8
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 defmed.
1. Full name of applicant and complete address including phone number:
HALL AMBULANCE SERVICE
1001 21ST ST
93301 Phone No.661-322-874l
2. Nature or decription of the encroachment for which this application is made:
3-2" PVC CONDUITS TO BE RUN UNDER ALLEY SEP ARTING OUR
PROPERTY AND BUILDINGS. THESE ARE FOR PRESENT & FUTURE TELEPHO
DATA, AND OTHER LOW VOLTAGE COMM
3. Location of proposed encroachment is:
1001 21ST ST BAK
1001-2lST ST
4. Period of time for which the encroachment is to be maintained:
Applicant agrees that if this application is granted, applicant will idemnify, 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, 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 mantain 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 insuance evidencing sufficient coverage for bodily injury or property damage liability of both and required
endorsements evidencing the insurance required.
The type(s) and amount(s) of insurance coverage is:
Applicant acknowledges the right of the City Engineer, pursuant to Bakersfield Municipal Code Chapter 12.20 to revoke
the permit at any time.
Date:07/16/1999
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 THE
SAME IS TO BE LOCATED AND (2) WILL (NOT) CONSTITUTE A HAZARD TO PERSONS USING SAID PUBLIC PLACE; SAID
APPLICATION IS
THEREFORE (GRANTED) ~: Said permit shall expire
Date:07/16/l999
"
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.
I. Full name of applicant and complete address including phone number: H t4 LL- A tVJ~(A c...A N.C~ ..s~U(~r
/001 2..1s, S(k'"FC dA ~~Frc~ / CA, erg sor IW: ~&(,,1q:.::Z-C07'1(
/ /
2. Nature or description of the encroachment for which this application is made: ...'-S -.:~,,;~1!CH p Vc Ccr ~D (f./D'
10, Be {?I/N (jNc.~tf< AU-EY _C::::;~7"AJII!f!..Arl,A/a, (]U,t2 P~':::H.~?-'f /}-^-rD
EVI C-eJlrVG's. (r...ftl:sc=:: A ~e Fo~ Ptz.c:::se,....,-r /'3,../'{:; F<frv tee TC~-;&t'rC7N'~
. i'
D!9,t'1 t' r4,.,rj) 0 n:rce-I'I!.. La t.J VOtC-TAG.c- CC!r.r.7,.-n c/NlcA (7C1AJ~ #~.3 .
3. Location of the proposed encroachment: ~A (7$ ~ (rYe f1~ /I LL.-c't' (A/ft'/q~ IS f?.cr~to.,/
/(JO! 2-1 5.,5r-/t..~ t"l'Vl> M:l.1 2-fST -s~r, 77 ra:r Sa1/'7r:-/ C1,c' 2JST :ST-~~.:{!:'l
C--u~ a LJ f'r~ r
4. Period of time for which the encroachment is to be maintained:
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, quasi-judical.or judicial tribunals of any kind
whatsoever, arising out of. connected with. or caused by applicant's placement. erection, use (by applicant or any
other person or entity) or maintenance of said encroachment. The applicant further agrees to maintain the aforesaid
encroachment during the life of said encroachment or until such time that this permit is revoked.
Applicant further agrees that upon the expiration of the permit for which this application is made, if granted, or
upon the revocation thereof bv the City en\:ineer, apolicant 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:
Date: 7 "- / & ..
99
rsfield Municipal Code Chapter 12.20 to
Applicant acknowledges the right of the City Engineer. pursuant to
revoke the permit at any time.
SIgnature of Applicant (Owner or Representative)
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 THE SAME IS TO BE LOCATED AND (2) WILL (NOT)
CONSTITUTE A HAZARD TO PERSONS USING SAID PUBLIC PLACE; SAID APPLICATION
IS THEREFORE (GRANTED) (~IE~AID PERMIT SHALL EXPIRE
Date:
7-2(-(7
Signature Of~--
No.
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PRQOUCER "THIS CERTI! CATE IS IS~_...O AS A MATTER OF INFORMATION
. ONLY AND... )NFERS NO RIGHTS UPON THE CERTIFICATE
Cind.y Elbert. Ins. services ,HOLDER. Tfi S CERTIFICATE DOeS NOT AMEND. EXTeND OR
3610 N 44th. st:. SteM #ASO ALTERTHE"OVERAGEAFFORDEDBVTHEPOLlCIESBELOW.
phoeniJC A~ 85018 COMPANIES AFFORDING COVERAGE
cindy Elbs:r:t
Phone No. 6 02 - 9 5 6 - 3 6 86 Fex ~n 60:3 - 9 56 - 2 0 03
INSURED
Hall Ambulance Service, ~na,
Harvey Hall &.
Hall commercial vehicle
Se:rvice Center
1.001. :alat street
~akersfield CA 93301
COMPANY
A Rt>>yal :tna-=ni ty company
COMPANY
6
COMPANY
C
;qg~~~!;~{@:g::;;;;~:.:~#~i:r3::i~ii:~(!j;jit:;>P?!i~:?i;~~:~~~!g:~i~B~f;~~::i~r.:;::;:!i1:}j!i!&:~r);:ii~::!~);ii;::i;:;::;:::./:'~:;:!{;i~~~:;:!!:!:~!:\::\:if;:::~l~?t.::jijj~:!:r~;~Wt:w~.fmU~!~i!~:Hm~:!jg[;iii~~:ilgH:~{:;;;~;~;;g;i:~:;::;;~:~:;?~~]ri~:;-::;tfi::::~:;:;;
THIS IS TO CERTIFY THAT THe POLICIES OF INSURANCE LISTeO BI<LOW HAVE aeellllSSUED TO THE INSUREtl N'WED A80VE FOR THE POI.lCY PERIOO
INDICATED. NOlWlTHSTANDING ANY REQI,JIREMElIlT, TERM OR cONOmON of ANY Co~T OR OTHER OO~MENl' WITH RG.SPECT TO WHICH THIS
CERTIFICATE. MAY BE ISSUED OR MAY p~TA1N, THE INSURANce AFFORDED BV THE POLICIEs DeSCRIBED H6f!,EIN IS SUBJECT TO Al-L THE T~Ma,
EXCLUSIONS AND CONDITIONS 01' SUCH POLICIES. LIMITS SHOWN MAY HAve BeEN REDUCED BY PAID CLAIMS.
P I,' U .. POLICY NUMB"'R \POl.ICY EFFECTiVe ~OLICY exPIRATION
TY 10 OF ..S RA,.CE &;. DATE (MMlCOIYV) 1 DATE (MM/ODrrr)
COMPANY
D
LIMITS
CO
LTR
RLX004852
i
! 07/01/99
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GENERALAOGR~GATE $3,000,000
07/01/00 PRODUCTs-COM~OPAGG $3,000,000
PERSONAL" ADV INJURY $1,000,000
EACH OCCURRENCE $1,000,000 I
FIRE OAMAGE IJ'.ny one nre) s 300,000
MED E.XP (Anyone Ptl1'5Dn, $10,000
07/01/00 COMBINED SINGLE LIMIT $1,000,000
i10DIL Y INJURY $
(Pot perllon)
BODILY INJURY $
(Per acddtlnl)
PRoPER'N DAMAGE S
GENEPAL LIAillLI1Y
I--
A X CoMMERCIAL GENERAL LLABILI1Y RST 3 0 (; & 4 7
ES ,..._J OLAIMS MADE [iJ OCCUR
r-- OWNER'S & CONTRACTOR'S PROT
~ Pll.OF L!AB
I 07/01/99
~TOMOBILE L1ABILIl"V
A ....!. ANY AUTO
ALl- OWNED AUTOS
-~
ScHEDULED AUTOS
I--
~ HIRcD AUTOS
...!. NON.oWNEO AUTOS
RST 306647
GAFlAGE LIABILITY
-
ANY AUTO
-
-
L
I
.-
EXCESS LIABILITY
A Ii UMBRELLA FORM
rx1 OTHER THAN uMBRcLLA FORM
WORKERS COMPENSATION AND
EMPLOyeRS' LIABILITY
I
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r
07/01/99\'
l'
!
07/01/00
AUTO oNL.,. . Ell. ACCIDENT 5
OT~ER THAN AUTO ONLY: :!i;~~1%;!r~Hlf;jt~iQ~~~j~~;~:;~~~.~~;%~t;~
EACH ACCIOENT $
AGGREaATE $
EACH OCCURRENce $ 1, 00 13 , 000
AGaReOATE S J., 000,000
s
Ef m~~:*~(iib;:?::i:;:;~/t@'~)i!i,
TWi'i STATU, 1
IT
EL EACi'I ACCIDENT $
EL DISEAse. POLICY LIMIT $
EL DiSEASE. s... EMPLOYEE S
'!'He PROPRIETOR!
PAflTNe~eCUTJVE
OFl'ICERS ARE:
OTHeR
A Elec~ric Data
proaessing Equip
RINCL
EXCL
RST 306647
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07 iOl/99I.
07/01/00
Value
S2000
$746,688
Dec1uct:i'ble
l
DESCRIPTION QF OPERATIONSlLOCA'l'ION8Nlii'lICLESlSPECIAL ITEMS
~~l.mt~t9~t;;1.1.~~'$~~::::~i~;~:;:F!:?/!ii\ji!r:!i;.!~?!;rm%:;ji}!)~;;::::f):;'::~i:rb'i!::~';;;C2[:f.::;:t:!0N:::::::,::?r.Wf:S~~,~R~~~m%:iW5r;g\%!:MWt!J:i:@~:iiiii!i~W;ig:H~gg~{f,:j!&;;:1~&g;~p~~M:;;mW;gWUi;N
SHOULD AN'I'IOF THE ABOVE OESC"IBEC PQLICU:S BE CANCELLEO BefORE THE
EXPIRATION ~ATE THEREOF. THE ISSUING COMPANY wiLL eNDI;AVOR '1'0 MAIL
~ DAV. WRITTEN HOTICETO THE CERTIFlc;a.TE HOLDER NAMED TO THE ~EFT,
l
BUT FAILUR~ TO MAIL SUCH NOTICE SHALL IMPOsE NO OBLIGATION OR liABILITY
OF ANY KIIIl~UPON THe COMPANY. ITS AGENTS OR, REPReSENTATIVES.
. ,r.UTHORIZEOREfRESENTATIVIO ~~
Cindy :\lli"lIrt ,. " . "" , ". ", . ... " . , ." ,,'"
_~~=;;;;;:;;;~'X~~'l;!;i:!irii"",,;r~,&;";:,c,,,,,~:=!t\tj(:i5l\\~W&I'>'~'~~!'!\l~
,
CJ:'1'YO:rB
Ci~y of Sngineer
of the Ci~y of ~aker$fie1~.
c/o
Hall Ambulance Servicel ~nc.
CA
PIU ~ bl-- 3;;S--/l / I
ht.\ "., \I{I d
li::"t~ c~ iJ l)
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4
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BAKERSFIEL
PUBLIC WORKS DEPARTMENT
MEMORANDUM
o
RECEIVED
JUL 2 0 1999
RISK rvli3iVIT.
'"
.
-
TO:
Scott Manzer, Risk Manager
FROM:
John Ussery, Engineering Tech. 1, Subdivisions
DATE:
July 20, 1999
SUBJECT:
Encroachment Permit Application for Hall Ambulance Service
1001 2r Street
Three - 2" PVC conduits to be run under alley for future communications needs
f-
Please review the insurance certificate with the attached encroachment permit and return to me at your
earliest convenience.
0'1
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7(2,01 q?
S:\PERMITS\ENCROACH\INSURANC\IOO 1 21 sl. wpd
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BAKERSFIEL
PUBLIC WORKS DEPARTMENT
MEMORANDUM
o
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-
TO: Raul M. Rojas, Public Works Director
FROM: 't-rt? Marian P. Shaw, Civil Engineer IV, Subdivisions
DATE: July 21, 1999
SUBJECT:
Encroachment Permit Application for Hall Ambulance Service
1001 2r Street
Three- 2" PVC conduits to be run under alley for future communications needs
Engineering and Traffic staff have reviewed the attached encroachment permit to allow the installation of
2" PVC communication conduits. The site is located at 1001 21't Street.
The applicant has provided proof of appropriate insurance coverage to Risk Management.
Based on their review, staff recommends approval of the permit.
S:\PERMITSIENCROACH\IOOI2Ist.wpd
xc: Applicant
Reading File
Construction Inspection
~\L\\t?
~
.
-
BAKERSFIELD
PUBLIC WORKS DEPARTMENT
MEMORANDUM
TO: Ryan Starbuck, Civil Engineer III
FROM: John Ussery, Engineering Tech. 1, Subdivisions
DATE: July 20, 1999
SUBJECT: Encroachment Permit Application for Hall Ambulance Service
1001 21'/ Street
Three - 2" PVC conduits to be run under alley for future communications needs
Please review the attached encroachment permit and return to me at your earliest convenience.
O~J
~
7/ Lo/r?
S:\PERMITS\ENCROACH\TRAFFIC\IOOI21st.wpd