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HomeMy WebLinkAboutAPPLICATIONType of Event: _ Public Concert Parade Motion Picture Fair _ Demonstration Grand Opening Event Title: Community Easter Egg Hunt Event Location: Las Palmas Event Date(s): From 03/30/13 to 03/30/13 Month/Day/Year Actual Event Hours:11:00 am/pm to 3:00 Festival Circus Other Community Event Block Party Total Anticipated Attendance: 2500 (1500 Participants) d 000 Spectators) am/pm Setup/assembly/construction Date: 03/30/13 Start time: 6:00 am Please describe the scope of your setup/assembly work (specific details): Set up stage and sound system, tables, chairs and canopies Dismantle Date: 03/30/13 Completion Time: 5:00 pm 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. This event will be contained within the park limits, no streets should be affected. Sponsoring Organization: Cornerstone Church of San Diego For Profit �C Not -for -Profit Chief Officer of Organization (Name) Sergio De La Mora Applicant (Name): Mike Ramirez Address: 1914 Sweetwater Rd. National City, CA 91950 Daytime Phone: ( 425-9333 Evening Phone: (619 414-2480 Fax: ( ) Contact Person "on site" day of the event: Eddie Palato Pager/Cellular: 619-342-6912 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? XYES NO Are admission, entry, vendor or participant fees required? YES X NO If YES, please explain the purpose and provide amount(s): $ 0.00 Estimated Gross Receipts including ticket, product and sponsorship sales from this event. $ 8,000.00 Estimated Expenses for this event. $ 0.00 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. Roped off areas for appropriate age group egg hunt. Face painting, music stage monitored sound system. Eating areas/ tables and chairs. Free Games provided. YES _ NO If the event involves the sale of cars, will the cars come exclusively from National City car dealers? If NO, list any additional dealers involved in the sale: 2 YES X NO Does the event involve the sale or use of alcoholic beverages? X YES _ NO Will items or services be sold at the event? If yes, please describe: Food Vendors: Rodeo Meats/ Sodas, ice cream, tacos, candy... _ YES X NO 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. X YES _ NO Does the event involve a fixed venue site? If YES, attach a detailed site map showing all streets impacted by the event. X YES _ NO Does the event involve the use of tents or canopies? If YES: Number of tent/canopies 10 Sizes 10X10 NOTE: A separate Fire Department permit is required for tents or canopies. YES X 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: BBQ If you intend to cook food in the event area please specify the method: GAS ELECTRIC X CHARCOAL OTHER (Specify): ➢ 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.) 0 Number of trash cans: 6 Trash containers with lids: Describe your plan for clean-up and removal of waste and garbage during and after the event: 3 Please describe your procedures for both Crowd Control and Internal Security: Cornerstone Security and Cornerstone Traffic Ministries _ YES X 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 X 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 Equipment. A First Aid Tent will be on site throughout the event with church staff manning the station. Please describe your Accessibility Plan for access at your event by individuals with disabilities: Event will be held on public property that complies with ADA reauirements. Please provide a detailed description of your PARKING plan: Parking will be on the two parking lots in the park as well as available street parking Please describe your plan for DISABLED PARKING: Las Palmas Park Parking lot provides disabled parking. 4 Please describe your plans to notify all residents, businesses and churches impacted by the event: Flyers, radio NOTE: Neighborhood residents must be notified 72 hours in advance when events are scheduled in the City parks. X 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: One Number of Bands: One Type of Music: Christian Worship Music X YES _ NO Will sound amplification be used? If YES, please indicate: Start time: 11am am/pm Finish Time 3Pm am/pm X YES NO Will sound checks be conducted prior to the event? If YES, please indicate: Start time: 10am am/'pm Finish Time 11am am/pm Please describe the sound equipment that will be used for your event: Speakers, sound system, microphones and musical instruments YES X NO Fireworks, rockets, or other pyrotechnics? If YES, please describe: X YES _ NO Any signs, banners, decorations, special lighting? If YES, please describe: Event Banners indicating activities and hours of the event Revised 08/10/05 5 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. Organization Cornerstone Church of San Diego Person in Charge of Activity Eddie Palato Address 1914 Sweetwater Rd. National City, CA 91950 Telephone 619-425-9333 Date(s) of Use 03-31-2013 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 permit by the permittee or its agents, employees or contractors. ,"- Signettiike of Applicant r_ Official Title Date —1'�� C13cy For Office Use Only Certificate of Insurance Approved Date 7 V ni 1 0 Church&Casualty4 To:9-1-619-336-421 6193364217 (1 of 1) 01-31-2013 09:38 AM -0800 A4.......----CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDlYYYY) 1/31/203 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER1THIS CERTIFIQATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORLLNT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the term:. and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificat>. holder In Ileu of such endorsement(s). PRODUCER Church k Casualty 3440 Irvine Ave Newport Beach CA 92660 INSURED CORNERS'"ONE CHURCH OR SAN DIEGO 1920 SW:,ETWATER RD NATIONAL CITY CA 91950-7628 INSURER F : COVERAGES CERTIFICATE NUMBER:CL1313181784 REVISION NU THIS IS TC CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVEBER: FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRAG I OR OTHER DOCUMENT WITH 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, EXCLUSIOIIS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER LTR CONTACT NAME; Yolanda Barron PHONE 5 FAX (NC No. FxIV: (NC No E-MAIL Yolanda@churchandcasualty. CO ADDRE$5,- Yi1 (800)995-752 INSURER(S) AFFORDING COVERAGE INSURER A:Church NSutua INSURER Insurance Co (0001995-7sz1 NAIC 18767 NSUR ER C NSURER D A TYPE OF INSURANCE GENERAL LIABILITY X COM AERCIAL GENERAL LIABILITY ELAIMS-MADE X OCCUR GEN'L AG( IREGATE LIMIT APPLIES PER: X POLICY _.. PRO- JECT LOC AUTOMOB LE LIABILITY ANY i UTO ALL C WNED AUTOS HIRE() AUTOS UMBF ELLA LIAB EXCE IS LIAR DEC SCHEDULED AUTOS NON -OWNED AUTOS INSR Wvn POLICY NUMBER 0168013-02-480299 INSURER E : POLICY EFF JMM(DDM'YY) _ImamEXP YYV1 7/5/2012 7/5/2015 LIMITS EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea ancia-renne; MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS • COMP/OP AGO COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per aooidenq $ 1,000,000 15,000 1,000,000 3,000,000 1,000,000 OCCUR CLAIMS -MADE RETENTION S WORKERS COMPENSATION AND EMPL )YERS' LIABILITY ANY PROP 1IETOR/PARTfiER1EXEGUTIVE OFFICER/UOMEER EXCLUDED? (Mandatory in NH) If yes, desci be under DCSCRIPTI ON or OPERATIONS below Y/N N/A EACH OCCURRENCE AGGREGATE INC STATU- TORY IIMITS OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT a DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Evidence of insurance for Church Easter Egg Hunt looted at Las Palmas Park, National City, CA on March 30, 2013. Certificate holder is named additional insured but only with respect to the activities of the Named Insured on the above described premises. All activities/operations not specifically ran/or conducted by the Named Insured are excluded. CERTIFICATIE HOLDER City of National City, its Dfficials, agents and empl)yees 1243 National City Blvd., National City, CA 91950 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE J Taheri Kenari/JANIC ACORD 25 (2)10/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 p01005 01 The ACORD name and logo are registered marks of ACORD