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PERMIT NO.EN-O~
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. Full name of applicant and complete address including phone number:
BAKERSFIELD RESCUE MISSION
Phone No.325-0868
2. Nature or decription of the encroachment for which this application is made:
PLANTING TREES
3. Location of proposed encroachment is
830 BEALE AVE
830 BEALE AVE
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:
PHILADELPHIA INDEMNITY INS
Applicant acknowledges the right of the City Engineer, pursuant to Bakersfield Municipal Code Chapter 12.20 to revoke
the permit at any time.
Date:04/12/1999
S' nature of Applicant (Owner/Agent)
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
Date:04/12/1999
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Signature of City Engineer
'a
PHILADELPHIA INDEMNITY INSURANCE COMPANY
COMMERCIAL GENERAL LIABILITY COVERAGE PART
DECLARATIONS
. JLICY NO. PHPG301302
EFFECTIVE DATE: 10/01/98
12:01 A.M., Standard Time
LIMITS OF INSURANCE
I
GENERAL AGGREGATE LIMIT (Other Than Products-Completed Operations) $ 2,000,000 I
PRODUCTS-COMPLETED OPERATIONS AGGREGATE LIMIT $ 1,000,000 I
PERSONAL AND ADVERTISING INJURY LIMIT $ 1,000,000
EACH OCCURRENCE LIMIT $ 1,000,000
FIRE DAMAGE LIMIT $ 100,000 Any One Fire
MEDICAL EXPENSE LIMIT $ 5,000 Any One Person
RETROACTIVE DATE (CG 00 02 only)
Coverage A of this Insurance does not apply to "bodily injury" or "property damage" which occurs before
the Retroactive Date, if any, shown here:
(Enter Date or 'None" if no Retroactive Date applies)
BUSINESS DESCRIPTION AND LOCATION OF PREMISES
Form of Business:
o Individual DJoint Venture o Partnership D Corporation
00 Other NON-PTOFIT ORG.
Business Description:
NON-PROFTI0RGANIZATI0N
Location of All Premises You Own, Rent or Occupy:
1 830 BEALE AVE., BAKERSFIELD, CA
-
_ .,EMIUM
RATE ADVANCE PREMIUM
Products! Products!
CLASSIFICATION CODE NO. PREMIUM BASIS Completed Completed
All Other Operations All Other Operations
LOC 1
Shelters, Mission, 67017 12,744 93.632 $1,193.00
Settlement or Halfway Area
Houses - Not Church
or Office Building
(Products-completed
operations are
subject to the
General Aggregate
Limit)
'1'ERR -005
FORMS AND ENDORSEMENTS (other than aoolicable Forms and Endorsements shown elsewhere in the policy)
Porms and Endorsements applying to this Coverage Part and made part of this policy at time of issue:
';'0001 (10-93), CG 00 54 (03-97), CG 00 55 (03-97), CG 20 21 (01-96),
CG 20 26 (11-85), CG 2147 (10-93), CG 2149 (01-96), PI NP 003 (04-96),
PI SO 005 (07-95), PI SS 2 (02-92), CL 170 (01-86)
ORIGINAL
TIIESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND THE POLICY PERIOD.
CL J 50 (! ! -8;;) Includes copyrighled material of Insurance Services Office. Inc., with its permission. Copyright. Insurance Services Office. Inc.. 1983. 1984
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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:
April 19, 1999
SUBJECT:
Encroachment Permit Application for 830 Beale Avenue
Bakersfield Rescue Mission
Planting trees in parkway between back of curb and front of sidewalk.
Engineering and Traffic staff have reviewed the attached encroachment permit to allow the planting of
various trees in-between the back of curb and the front of the sidewalk next to the rescue mission. The site
is located at 830 Beale Ave.
The applicant has provided proof of appropriate insurance coverage to Risk Management.
Based on their review, staff recommends approval of the permit.
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Applicant
Reading File
Construction Inspection
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MEMORANDUM
TO:
Scott Manzer, Risk Manager
FROM:
John Ussery, Engineering Tech. 1, Subdivisions
DATE:
April 13, 1999
SUBJECT:
Encroachment Permit Application for 830 Beale Ave.
Bakersfield Rescue Mission
Planting trees in parkway between back of curb and front of sidewalk
Please review the insurance certificate with the attached encroachment permit and return to me at your
earliest convenience.
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S:\PERMITS\ENCROACHIINSURANC\830 Beale Ave.wpd
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TO:
FROM:
DATE:
SUBJECT:
MEMORANDUM
Ryan Starbuck, Civil Engineer III
John Ussery, Engineering Tech. 1, Subdivisions
April 13, 1999
Encroachment Permit Application for 830 Beale Ave 9
Bakersfield Rescue Mission
Planting trees in parkway between back curb and front ,dewalk
Please review the attached encroachment permit and return to me at your earliest convenience.
S:\PERMITSIENCROACHITRAFFICI830 Beale Ave.wpd
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