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HomeMy WebLinkAbout3201 PANAMA LNENCROACHMENT PERMIT CITY OF BAKERSFIELD PUBLIC WORKS DEPARTMENT 1501 TRUXTUN AVE BAKERSFIELD CA 93301 (661) 326-3724 TO THE CITY ENGINEER OF TIE 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 . . . . . 09-30000040 Date 11/04/09 Property Address . . . . . . 3201 PANAMA LN Application type description PW - ENCROACHMENT PERMIT Owner Contractor - HOBIN HOUCHIN & ROSELLE LLC OWNER 3201 PANAMA IN BAKERSFIELD CA 93313 ( 66) 410-0794 Permit . . . . . . ENCROACHMENT PERMIT Additional desc . . Phone Access Code . 956318 Permit Fee . . . . 208.00 Issue Date . . . . 11/04/09 Valuation . . . . 0 Qty Unit Charge Per Extension 1.00 208.0000 EA PW ENCROACHMENT 208.00 Special Notes and Comments INSTALL 12" HIGH CONCRETE'CURB BEHIND 8' SIDEWALK 350' TO 480' EAST OF BUENA VISTA RD. ALONG SOUTH SIDE OF WHITE IN. CONTACT: RAYMOND ROSELLE, 809-4857. Fee summary Charged Paid Credited Due Permit Fee Total 208.00 208.00 .00 .00 Grand Total 208.00 208.00 .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 ge'n~ 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 E I E R S F I E L L~ PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Ralph Korn, Risk Manager FROM: Marian P. Shaw, Civil Engineer IV, Subdivisions DATE: November 6, 2009 SUBJECT: Encroachment Permit Application for: 3102 Panama Ln. Name of Applicant. Hobin Houchin & Roselle LLC Description of Encroachment: Install 12" high concrete curb behind 8' sidewalk 350' to 480' e% Buena Vista Rd. along s/s of White Ln. Please review the attached insurance certificate and encroachment permit and return to me at your earliest convenience. v1~, S:\PEPMITS\ENCROACH\INSURANC\3201 Panama Ln..doc A DRD,~ CERTIFICATE OF LIABILITY INSURANCE 05/226/20 ' PgODUCER (661)327-3300 FAX (661)327-3309 TWIW Insurance Services - #OE52073 InWest Insurance Services THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 5001 California Avenue Ste 150 'Bakersfield, CA 93309 INSURERS AFFORDING COVERAGE NAIC # "INSURED Mustang Square, LLC INSURERA: Colony Insurance Company 3201 Panama Lane INSURER B: Bakersfield, CA 93313 INSURER C: Y. INSURER D: I INSURER E: °CC9VFRAGFS THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIUU INUICAI tU. NV I VVI IN,:, I Hlvunv'z, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR ANY REQUIREMENT , THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH MAY PERTAIN , POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IiNSR DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION YYt LIMITS GENERAL LIABILITY GL165010 05/22/2009 05/22/2010 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000, CLAIMS MADE ® OCCUR MED EXP (Any one person) $ EXcl uded PERSONAL & ADV INJURY $ 1,000,000 I GENERAL AGGREGATE S 2 , 000 , OO t GEN 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 1,000,0001 5 POLICY PRO- LOC JECT AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ' ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) t HIRED AUTOS OWNED AUTOS BODILY INJURY (Per accident) $ y NON- Ic AMAGE (Per accident) $ AUTO ONLY - EAACCIOENT $ GAR AGE LIABILITY OTHER THAN FA ACC $ ANY AUTO AUTO ONLY: AGG $ .L'd. EACH OCCURRENCE $ EXCESSIUMBRELLA LIABILITY MADE FI AGGREGATE $ CLAIMS OCCUR $ DEDUCTIBLE S RETENTION S WC STA7U- OTH- WORKERS COMPENSATION AND EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ - 7 ANY PROPRIETORIPARTNER/EXECUTIVE ERIMEMBER EXCLUDED? E.L.OISEASE - EA EMPLOYE $ OFFIC it yes, describe under E.L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below OTHER a'. ii ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS r Employees and designated Volunteers are Agents Officers uncil C , , , o ty of Bakersfield, its Mayor, t F , aved as additional insured with respect to work performed by named insured. CG2010 07/04 endorsemen .:tlached. ' days notice for non payment of premium Lin 't City of Bakersfield Risk Management Department Attn: Rosa 1501 Truxtun Ave. Bakersfield, CA 93301 , ACORD 25 (2001108) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Shaun Kelly/KATHYT ©ACORD CORPORATION 1988 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons Or Or anization s : CITY OF BAKERSFIELD, ITS MAYOR, COUNCIL, OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS 1501 TRUXTUN AVENUE BAKERSFIELD, CA 93308 Location(s) Of Covered Operations: BUENA VISTA RD & WHITE LANE BAKERSFIELD, CA 93311 Information required to com lete this Schedule, if not shown above, will be shown in the Declarations. 7 A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0