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Home My WebLink AboutTUPType of Event: _ Public Concert Fair _ Festival Community vent _ Parade Demonstration Circus _ Block Party Motion Picture _ Grand Opening y Other 3oce(3Ac=-L Event Title: 1 4717t1U0i - ��J rr✓i Event Location: ' irnfr14- PMZjC Event Date(s): From 4MJL2O to PRIG av Actual Event Hours: S. ov 0/pm to 6 : am/CD Total Anticipated Attendance: /4/® ( eve Participants 7V Spectators) Setup/assembly/construction Date: OP2/6 iW Start time: S:cdY•+» Please describe the scope of your setup/assembly work (specific details): The_ S e" 7-u e___1,t____._jJrLc S[1r7A6 j cri"4- it vig-j /O x •eO� cam_ 3f,- 1" _ Di -(/ _ /a9ir c tiii�,, J Dismantle Date: 40.6 ?v Completion Time: 7-Sf,'-n am/0' List any street(s) requiring closure as a result of this event. Include street name(s), day and time of closing and dayand time of reopening. 1 cr 1 Z3 Sponsoring Organization: D w _ C Cij '11Pkj C-64 Chief Officer of Organization (Name) 1t ' ,JAc- cw Applicant (Name): gi'- 1—¢+ Address: 11'2_ C_Q -J C- V f >= .t,► LA. -A 33 Sc`c,/ o C '2r i'y Daytime Phone: (617) 7d Evening Phone: ( 6?J Fax: 01,1) b?1--4"/2$ E-Mail: Jack5o7 dc,..:01 cr).L e- Contact Person "on site" day of the event: Jxb.v Cellular: 6-S7a. ' NOTE: THIS PERSON MUST BE IN ATTENDANCE FOR THE DURATION OF THE EVENT AND IMMEDIATELY AVAILABLE TO CITY OFFICIALS Is your organization a "Tax Exempt, nonprofit" organization? ,✓YES _ NO Are admission, entry, vendor or participant fees required? ✓YES _ NO If YES, please explain the purpose and provide amount(s): $ i. Scwo V _Estimated Gross Receipts including icket, poduct and sponsorship sales from this event. $ ,u,770.2>Estimated Expenses for this event. $ What is the projected amount of revenue that the Nonprofit Organization will receive as a result of this event? y yci,?t3 cle5.2L& 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. OVERALL EVENT DESCRIPTION FOR TEMPORARY USE PERMIT THrty Bocce Ball Courts will be layed out in the park (see map), ten courts each for the Open, Novice, and Junior Divisions. Teams consist of two members, and they will play a double elimination to arnament. Prizes will be awarded to the top three teams in each division. Hot food will be served frc m a pizza and soda vendor area, (water and sodas) and bags of chips. The tournament will continue as long as there are teams competing, but not to exceed 5:00 pm. There appears to be ample room at the park for spectators, participants and their families. We are planning to have two Astro Jumps, supervised by adults.Astro Jumps will be self-contained, norequirement for electricity. _ 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: YES NO Does the event involve the sale or use of alcoholic beverages? y YES NO Will items or services be sold at the event? If yes, please describe: YES )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. e'YES NO Does the event involve a fixed venue site? If YES, attach a detailed site map Oa - showing all streets impacted by the event. '"YES _ NO Does the event involve the use of tents or canopies? If YES: Number of tent/canopies 15 ?'t''q5 Sizes InScs.� 5£,•r-mot �. er NOTE: A separate Fire Department permit is required for tents or canopies. YES 'NO Will the event involve the use of the QIN or your stage or PA system? SPECIFY: In addition to the route map required above, please attach a diagram showing the overall layout and set-up locations for the following items: x 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): Ctkxt) 'J�:.r.°»+n( .1e.✓t Portable and/or Permanent Toilet Facilities Number of portable toilets: 2 (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 # 6 and Chairs # r 2 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 ehicles 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: �-� (2) 3yd ` / i›h 4-1-u er; 4-aj 3 ' d '17.r.e"c_ 0.1a-5 '.47 p Describe your plan for clean-up and removal of was and garbage during and after the event: P "` '° 17),...115 A- A Scat-z:', 7X►t'sh 5t,.c.;c..e ✓J 3 `S 2s , e a . >br- z s' �r n*/ Please describe your procedures for both Crowd Control and Internal Security: Setgoc.. h?€ ' _ Ri - c- 4 ciA41 fir-- _ YES XNO Have you hired any Professional Security organization to handle security arrangements for this event? If YES, please list: toilsco___ 2)12/97Vi7?g 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_providin First Aid Staffing and Equipment. Please describe your Accessibility Plan for access at your event by individuals with disabilities: ot (/ 4Ceedo Ter AEG.- a.,1„)-b/ �•-t �c s Please •rovide a detailed description of your PARKI G plan: J %I/0v? /S '1 ��tk t/ V)Vbk �' c�►ze f.?iL ' , ,-v ,,z A4e %I7a► k) S /'4?' Please describe your plan for DISABLED PARKIN Please describe your plans to notify all residents, b sinesses and churches impacted by the event: -- _ 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: Number of Bands: Type of Music: NS'ES _ NO Will sound amplification be used? If YES, please indicate: Start time: q a /pm Finish Time S :ce am cra j Cib' cmJ /1%44 YES NO Will sound checks be conducted prior to the event? If YES, please indicate: Start time: amtpm Finish Time am/pm Please describe the sound equipment that will be used for your event: YES NO Fireworks, rockets, or other pyrotechnics? If YES, please describe: YES NO Any signs, banners, decorations, special lighting? If YES, please describe: r& cat de.'�r-_ '�- . J -fi Revised 02/29/12 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 0/41Z#n,n C. C,,4, Person in Charge of Activity?j E Address L t gZ Car (cC) Civict Sun 0/e130 - 72J Telephone bid'- clef-7-07e S Date(s) of Use 201102.4 2451 3 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. Signature of Applicant Official Title Date irect For Office Use Only Certificate of Insurance Approved Date C A'p1 BATE (MMIDDIMY) 02/20/2013 THIS CER' TFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICI,TE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PHIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESEI ITATNE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTAP IT: If the certificate holder is an ADDITIONAL INSURED, tho policy(les) must be endorsed. if SUBROGATION IS WAIVED, subject to the terms a and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER L(ICKTON COMPANIES,LLC K CHICAGO 52 i W. Monroe, Suite 600 C1 IICAGO 1L 60661 (3:2) 669-6900 INSURED CERTIFICATE OF LIABILITY INSURANCE. All Active US Rotary Clubs & Districts Att.): Risk Management Division 15(0 Sherman Ave. Ev,.nston,IL 60201-3698 COVERAGE ecin AT Lockton Companies, LLC .Ne,y; 1-800-921-3172 Ogg: Rotary@lockton.com INSURER8) AFFORDING COVERAGE No): 1-312-681-6769 INSURER ACE American Insurance Company INSURERS : ACE Property & Casualty Insurance Co INSURER C NAIC 1 22667 20699 INSURER 0 : INSURER E : INSURER F: • ----... _-..._ N VIUION NUMBER: THIS INDICATED. CERTIFICATE EXCLUSION INSRT IS TO 3ERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 5 AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAm_CLAIMS. TYPE OF INSURANCE SUER YUB POLICY NUMBER (MM POEFFLICY DIY�1- LIMITS A GENERAL X IJAINUTY C A ERCTAL GEN =' ' UTY N PMI G23861355 004 7/1/2012 7/1/2013 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 500,000 - -..: CLAIMS -MADE X OCCUR MED EXP /Any one moan) S XXX XXXX X (3EN1. 1,21.9 JOY Liability PERSONAL Al AOV INJURY $ 2,000,000 Inc tided GENERAL AGGREGATE $ 10.000.900 AGE RELATE POIJC Y LIMIT APPLIES PER: n J i l LOC PRODUCTS - COMPIOP A.Ge $ 4.000.000 $ A AUTOMOSI.EUABILIIY X A ANY AUTO ALL 0 ARCED X SCHEDULED N PMI G23861355 004 7/1/2012 7/1/2013 ( a ICGLELIMIT 1.000.000 BODILY INJURY (Per parson) $ XXXXXXX BODILY INJURY (Per accident) $ XXXXXXX PROPERTY DAMAGE Per acMdenn $ XXXXXXX $ XXXXXXX B X UM"EUALIA6 EXCE IS LIAB X OCCUR CLAIMS -MADE N MO0534092 004 7/1/2012 7/1/2013 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 10.000.000 DED RETENTIONS - $ XXXXXXX WORKERS COMPENSATION AND EMPL }YERS LUIBILITY Y f N ANY PROM IE ORMARTNEt1E}CEC UTIVE OFRCIER/M BASER IxcLUDED? n (Mandatory In NH) If yes, dem @e under DE CiRIFTI ao OF OPERATIONS below Al f A NOT APPLICABLE WC STATU TORY LBA(TSI OTH I ER E.L. EACH ACCIDENT $ X� E.L. DISEASE- EA EMPLOYEE $ XXXXXXX E.L. DISEASE - POLICY LIMIT $ X � DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) The Certificate Holder is included as Additional Insured where required by written and signed contract or permit subject to the terms and conditions of the General Liability policy, but only to the extent bodily injury or property iiamage is caused in whole or in part by the acts or omissions of the insured. CERTIFICATE HOLDER CANCELLATION The City o'National City, its officials, agents and employees Neighborhood Services Division 1243 Natic nal City Boulevard National C',ty, CA 91950/(619) 336-4364 Rotary Club District 5340/National City Rotary Club 1st Annual National City Rotary Club Bocce Ball Tournament Date of eve nt: 20 April, 2013 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITHTHE POLICYPROVISIONS. ACORD 25 (:1010f05) AUTHORMED REPRESENTATIVE The ACORD name and logo ere registered marks of ACORD 7- ( �`1988 1 ACORORPb ION—. rights reserved Legend Bowling Lanes Porta-Johns Face Painting Judges Tent First Aid Registration Tent Astro Jumps Food Court Area Lane Boundaries Benches SCALE:1/48"=1'-0" 103N1 £i0Z w aA -f