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HomeMy WebLinkAboutTUPContact Person "on site" day of the event: Type of Event: _ Public Concert Parade _ Motion Picture Fair _ Demonstration _ Grand Opening Festival circus ' Other _ Community Event Block Party Pc•5c Event Title: -i�'�L v�. �ri� C Cei,t4 e4 'oi Az_ VGv Event Location: 'F -{ Y1i L {, ►.-iC- Event Date(s): From 1j0i4/'i6 to �6 / Total onth/Day/Year Actual Event Hours: ` 5 am pm to 5: Cr' Setup/assembly/construction Date: ,t am/0 Anticipated Attendance: %� 2S / Y oiv illtrn� ab�, -f{ ot, (5 ° Participants) ( Spectators) Start time: A�i�- Please describe the scope of your setup/assembly work (specific details): 401_ Dismantle Date: 4* Completion Time: ,t,VA am/pm List any street(s) requiring closure as a result of this event. Include street name(s), day and time of closing and day and time of reopening. ,o/A Sponsoring Organization: � I-)-ie y-)4F4". /¢�� r SZA% For Profit Chief Officer of Organization (Name) J?GiS3p 42v'Not-for-Profit Applicant (Name): - Y1 Ct5 6 () rke/cr Address: 70 ( 10 0.t W Daytime Phone: (614) 330. Ogb$ Evening Phone: (04) 3.31b,MO4 Fax: vo1q) 55(' • 15�� rs. ' o5a Mande:a- Pager/Cellular: (7e::, ' 7V . 2776' NOTE: THIS PERSON MUST BE IN ATTENDANCE FOR THE DURATION OF THE EVENT AND IMMEDIATELY AVAILABLE TO CITY OFFICIALS 1 Is your organization a "Tax Exempt, nonprofit" organization? Are admission, entry, vendor or participant fees required? If YES, please explain the purpose and provide amount(s): YES NO YES V NO Estimated Gross Receipts including ticket, product and sponsorship sales from this event. Estimated Expenses for this event. What is the projected amount of revenue that the Nonprofit Organization will receive as a result of this event? Please provide a DETAILED DESCRIPTION of your event. Include details regarding any components of your event such as the use of vehicles, animals, rides or any other pertinent information about the event. it .4 p‘if,te.tir) a-14a-- lyg.,40 1.2-'1 -4" a s• Alimu)5: litoodia151 1:45- 1;45- ; /2:0 —3 f D.ti fn Otifa : 7: �� ' f• ��> /,2 6) -- / , ;2: t: / -rva - 3 /ach t 7 f t 5 >egfj 5t/ ,s a das i one-kkekvd /rn' l lam _ YES _ NO If the event involves the sale of cars, will the cars come exclusively from National Cit car dealers? If NO, list any additional dealers involved in the sale: A./ A. 2 YES 1 NO Does the event involve the sale or use of alcoholic beverages? YES /NO Will items or services be sold at the event? If yes, please describe: YES 40 Does the event involve a moving route of any kind along streets, sidewalks or highways? If YES, attach a detailed map of your proposed route indicate the direction of travel, and provide a written narrative to explain your route. YES /NO Does the event involve a fixed venue site? If YES, attach a detailed site map showing all streets impacted by the event. YES J NO Does the event involve the use of tents or canopies? If YES: Number of tent/canopies Sizes NOTE: A separate Fire Department permit is required for tents or canopies. YES /NO Will the event involve the use of the City stage or PA system? In addition to the route map required above, please attach a diagram showing the overall layout and set-up locations for the following items: ➢ Alcoholic and Nonalcoholic Concession and/or Beer Garden areas. ➢ Food Concession and/or Food Preparation areas Please describe how food will be served at the event: ;�- If you intend to cook food in the event area please specify the method: GAS ELECTRIC CHARCOAL OTHER (Specify): Jo)* ➢ Portable and/or Permanent Toilet Facilities Number of portable toilets: (1 for every 250 people is required, unless the applicant can show that there are facilities in the immediate area available to the public during the event) ➢ Tables and Chairs ➢ Fencing, barriers and/or barricades ➢ Generator locations and/or source of electricity ➢ Canopies or tent locations (include tent/canopy dimensions) ➢ Booths, exhibits, displays or enclosures ➢ Scaffolding, bleachers, platforms, stages, grandstands or related structures ➢ Vehicles and/or trailers ➢ Other related event components not covered above ➢ Trash containers and dumpsters (Note: You must properly dispose of waste and garbage throughout the term of your event and immediately upon conclusion of the event the area must be returned to a clean condition.) Number of trash cans: Trash containers with lids: Describe your plan for clean-up and removal of waste and garbage during and after the event: Piefr liz;idog /4z/ 3 � r� Please describe your si procedures for both Crowd Control and Internal Security: eadz loss API/W) Aei-tlk Cc 4a,i"ate -64civ,r' GZ aeiu 4/- yawl YES /NO Have you hired any Professional Security organization to handle security arrangements for this event? If YES, please list: Security Organization: Security Organization Address: Security Director (Name): Phone: YES /NO Is this a night event? If YES, please state how the event and surrounding area will be illuminated to ensure safety of the participants and spectators: Please indicate what arrangement you have made for providing,First Aid Staffing and Fquipment. Cad, -1 Jih ec. 064- Avid kJ tiA4d 5. i n t✓�iqai ✓ 4- ins 7 r ire al Ler Please describe your Accessibility Plan for access at your event by individuals with disabilities: 01- Please provide a detailed description of your PARKING plan: S Please describe your plan for DISABLED PARKING: 4 Please describe your plans to notify all residents, businesses and churches impacted by the event: /VA - NOTE: Neighborhood residents must be notified 72 hours in advance when events are scheduled in the City parks. YES ✓NO Are there any musical entertainment features related to your event? If YES, please state the number of stages, number of bands and type of music. Number of Stages: Type of Music: / YES " NO Will sound amplification be used? If YES, please indicate: Start time: am/pm Finish Time am/pm YES 410 Will sound checks be conducted prior to the event? If YES, please indicate: Start time: amfpm Finish Time am/pm Please describe the sound equipment that will be used for your event: Number of Bands: _ YES " NO Fireworks, rockets, or other pyrotechnics? If YES, please describe: _ YES Iv NO Any signs, banners, decorations, special lighting? If YES, please describe: Revised 08/10/05 5 Event: For Office Use OnCy Department Date Approved? Yes No Initial Specific Conditions of Approval Council Meeting Date: Approved: Yes No Vote: Kathleen Trees, Director Building & Safety Department 6 City of National City PUBLIC PROPERTY USE HOLD HARMLESS AND INDEMNIFICATION AGREEMENT Persons requesting use of City property, facilities or personnel are required to provide a minimum of $1,000,000 combined single limit insurance for bodily injury and property damage which includes the City, its officials, agents and employees named as additional insured and to sign the Hold Harmless Agreement. Certificate of insurance must be attached to this permit. r) 4,704" (14474— Person in Charge of Activity r fl€ s- L U he2rtt2- Address 701 PaP di i vC/. / RJR fJ a, ex q/q56 Telephone ?I'I. 334• OVA) Date(s) of Use 02700 -- 6/3/// Organization HOLD HARMLESS AGREEMENT As a condition of the issuance of a temporary use permit to conduct its activities on public or private property, the undersigned hereby agree(s) to defend, indemnify and hold harmless the City of National City and the Parking Authority and its officers, employees and agents from and against any and all claims, demands, costs, losses, liability or, for any personal injury, death or property damage, or both, or any litigation and other liability, including attorneys fees and the costs of litigation, arising out of or related to the use of public property or the activity taken under the perit by the permittee or its agents, employees or contractors. Signature of Applicant Official Title Date For Office Use Only Certificate of Insurance Approved Date 7 Non-profit organizations, which meet the criteria on page v of the instructions, will be considered for a waiver. If you would like to request a waiver of the processing fees, please complete the questionnaire below. 1. Is the event for which the TUP is sought sponsored by a non-profit organization? V Yes (proceed to Question 2) No (Please sign the form and submit it with the TUP Application) 2. Please state the name and type of organization sponsoring the event for which the TUP is sought and then proceed to Question 3. Name oft a sponsoring organization 644-P7 (`24i74 Type of Organization rut, WLc dt (Service Club, Church, Social Service Agency, etc.) 3. Will the event generate net income or proceeds t the sponsoring organization? Yes (Please proceed to Question 4) 47 No (Please sign the form and submit it with the TUP Application) 4. Will the proceeds provide a direct financial benefit to an individual who resides in or is employed in the city, and who is in dire financial ne d due to health reasons or a death in the family? `Yes (Please provide an explanation and details. ]__V) No (Please proceed to Question 5) 8 5. Will the proceeds provide a direct financial benefit to city government such as the generation of sales tax? NP` Yes (Please provide an explanation and details. 11 No (Please proceed to Question 6) 6. Will the proceeds provide a direct financial benefit to a service club, social services agency, or other secular non-profit organization located within the city such as Kiwanis, Rotary, Lions, Boys and Girls Club? 11I` Yes (Please provide an explanation and details. \\) No (Please proceed to Question 7) 7. Will the proceeds provide a direct financial benefit to an organization, which has been the direct recipient of Community Development Block Grant (CDBG) funding? Yes Year funds were received: Funds were used to: N No (P lease sign the form and submit it with the TUP Application) Signature 9 i2//gI D1te Client#: 1266225 303INTEGCHA ACORD,, CERTIFICATE OF LIABILITY INSURANCE PRODUCER BB&T-John Burnham Ins Services -T50 B Street Suite 2400 -,oan Diego, CA 92101 619 231-1010 INSURED San Diego County Schools/JPA Integrity Charter School P.O. Box 450 National City, CA 91951-0450 DATE (MM/DD/YYYY) 6/25/2010 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. INSURERS AFFORDING COVERAGE INSURER A: San Diego County Schools Risk - INSURERs:Permissively Self -Insured.- - NAIC # INSURER C: AWAC/CRC* 10690 INSURER D: Endurance/CRC* 41718 INSURER E: Continental/Gr.Am/CRC* 20443 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENTWITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L NSRC TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DDIYYf LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY *Per MOC on file 07/01/10 07/01/11 EACH OCCURRENCE $5,000,000 PREMISES1Ea RENTED $ CLAIMS MADE X I OCCUR MED EXP (My one person) $ X $500,000 S.I.R. PERSONAL 8. ADV INJURY $ GENERAL AGGREGATE $10,000,000 $10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n Zei n LOC PRODUCTS - COMP/OP AGG A AUTOMOBILE X X_ X X LIABILITY ANY AUTO *Per MOC on file — ---- — — —------- -- 07/01/10 — -- — — 07/01/11 — — -- COMBINED SINGLE LIMIT (Ea accident) $5,000,000 BODILY INJURY (Per person) $ BODILY INJURY — --- (Per accident) — — --- PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA — OCCUR DEDUCTIBLE RETENTION LIABILITY $ C CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under JPA MEMORANDUE OF COVERAGE 60 Days Notice of Cancellation 07/01/10 07/01/11 STATU- WCSTATU- OTH- TORY I limn ER E.L. EACH ACCIDENT $$1,000,000 E.L. DISEASE - EA EMPLOYEE $$1,000,000 E.L. DISEASE- POLICY LIMIT $ c D E OTHER Blanket Prop Blanket Prop Blanket Prop 030567751N CPN10002136200 RMP2083564156 07/01/10 07/01/10 07/01/10 07/01/11 07/01/11 07/01/11 $5,000,000/$175,000 SIR $20,000,000 XS $5M $225,000,000 XS $25M DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS *Issued CRC permission. Property policy incl Special Form/Rep acement Cost. Certificate is subject to policy limits, conditions and exclusions. *MOC Memorandum of Coverage -Approved Self Insurance Program reinsured by Munich Reinsurance America Inc. Re: Use of premises. City of National City, its officials, employees, agents and volunteers are named as additional insureds(general liability policy) per the attached form. City of National City 140 E. 12th Street, Ste. A National City, CA 91950 CANCELLATION 10 Days for Non -Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL An DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE - fMama L 504u1t8-- -- ACORD 25 (2001/08) 1 of 2 #S5196577/M5164833 MGGUE © ACORD CORPORATION 1988