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HomeMy WebLinkAboutTUPType of Event: Public Concert Parade Motion Picture JC Other Festival Circus _ Community vent _ Block Party Event Title:W •Oval Cray Middle P E. Program (running r ii le) Fair Demonstration — Grand Opening Event Location: 'K al , p Event Date(s): From 2� t' to 2, 2 3 x per we•ei • axh -the dcty Actual Event Hours: t: ar /pm to 2:40 am/ fm rah* *rough Total Anticipated Attendance: (.YV ( Participants 0 Spectators) 3X perdc y Setup/assembly/construction Date: 1'1 I R Start time: n I Pt Please describe the scope of your setup/assembly work (specific details): no set-up necessary. su dents will simply run The rni le-±hrou3houf Field / st dkurn. Dismantle Date: n 1 Pi Completion Time: n t Pt 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. Sponsoring Organization: Nthional Ci+y Middle Chief Officer of Organization (Name) Ar-1-uro t-i • NIontai90 Applicant (Name):t1„J aArturo H • Monk -a -no �-*� G Address: ' to l . venu-e, N�ono' Ct+' 1 Ca q1"1 Jo Daytime Phone: ( ) 33to• 21000 ' Evening Phone: ( ) 33 co-- 2000 Fax: ( )14-1L 1151OE-Mail: arturO• rr\Or1+000 swe r SGh S • Contact Person "on site" day of the event: carNo Cellular: 33co-a tOdO r.5 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 NOl Are admission, entry, vendor or participant fees required? _ YES J NO If YES, please explain the purpose and provide amount(s): $ 0 Estimated Gross Receipts including ticket, product and sponsorship sales from this event. $ o Estimated Expenses for this event. $ d 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. NCM S-1udersiS have I i mi I ed space on o u r Cornpus +O run rnit-e. We wouId oppreda-Fe -�1ne oppor+urw -for our S u d-en-t- to run -+-hie rni 1e on kirnba I I park. S-tudert S Witt run on West side oP park cIeid 1cy/r\\ear S-t'adi um • _ 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? _ 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. _ 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 �NO Does the event involve the use of tents or canopies? If YES: Number of tent/canopies Sizes NOTE: A j separate Fire Department permit is required for tents or canopies. — YES J NO Will the event involve the use of the City 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: 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): 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: nt Please describe your procedures for both Crowd Control and Internal Security: Q Cer-4i-�ica-�ed +each-er Ludt Sup€rvist stud: . Teacher has ce I, phone J wa Ikit-+al kie In case emergency Sri-u ors• _ YES v 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: ec _ 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 Equipment. school srEe leaCer-iicttd ress s-ler€d nurse On Cc mpUS . Please describe your Accessibility Plan for access at your event by individuals with disabilities: rIl P1 PI � provide a detailed description of your PARKING plan: Please describe your plan for DISABLED PARKING: Please describe lans to no y all residents,�l�y 1r ror r edoTurs.�Tar O event: orechow yr. NOTE: Neighborhood residents must be notified 72 hours in advance when events are scheduled in the City parks. _ YES v 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: _ YES NO Will sound amplification be used? If YES, please indicate: Start time: am/pm Finish Time am/pm _ YES "NO Will sound checks be conducted prior to the event? If YES, please indicate: Start time: am/'pm 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: 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 SU 1-IS c — Narhonal Q-r-y Middlt. School Person in Charge of Activity Arturo H. MonicreCo Address 11O t D . P er ue , Nc i or1a( Ct' , Ca c1 iqS0 Telephone 331.0- 21000 Date(s) of Use 2121)13 — 2421 I14 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 1/(44 For Office Use Only pincpal ,--121 113 Certificate of Insurance Approved Date Llo,f 1 A. Kimball Park National City, CA (619) 336-4241 4 reviews m �1f idatI(4)al City Planntxj [bait Kimball Park, National City, CA n N Get Google Maps on your phone Text the word"GMAPS"to466453 m2t,1ipc%gle - Map data ©2013 Google 1 • ACCRD,r CERTIFICATE OF LIABILITY INSURANCE MMNDIYYYY) WDDIY DATE (s/2o/2012 THIS CEF TIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFIC ATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 'rHIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESI:NTATWE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORT NT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certlflcati l holder in lieu of such endorsement(s). PRODUCER BB&T-Jot n Burnham ins Services 750 B Street Sulte 2400 San Diegc, CA 92101 619 231-11110 ," E^CT Terrie Carney wo, Eat). 619 525-2836 Mk No): 8883281310 EE-MAiLADDREsa: IN9URER(S)AFFORDINOCOVERAGE NAIC 9 INSURER A: San Diego County Schools Ris 10227 INSURED San Diego County Schools/JPA Sweetwater Union H.S. District 1130 Fifth Avenue Chula Vista, CA 91911 INSURER a : Permissively Seif-insured 23043 INSURER c : AWAC/CRC* 10690 INSURER D: ARCH Specialty/CRC* INSURERE: ContinentaUGA/CRC* INSURER F : I: REVISION NUMBER: r THIS IS T D CERTIFY THAT 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 DOCUMENT WITH RESPECT TO WHICH THIS CERTIFIC) TE 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID LTR TYPE OF INSURANCE INNSR 8SUBDR POLICY NUMBER (M j) tiB Y) ppCLLAIMS. (Mi611DDlYYY17 UMITS A GENER,J.LIABILTIY X CC MMERCIAL GENERAL LIABILITY SDJPA070112 *Inca EPLI- Wrongful Acts 07/01/2012 07/01/2013 EACHOCCURRENCEs5,000,000 PREMISES (E6 ac 541.el S MED EXP (My one person) S 1 CLAMS -MADE X OCCUR PERSONAL a ADV INJURY $ X $:100,000SIR GENERAL AGGREGATE $10,000,000 X Professional Liab* PRODUCTS - COMPIOP AGG $ 10,000,000 GENLPGGREGATEUMITAPPLIESPER: 7 PC LICY n jECI ' I LOC S A AUTOM X X X )81LE LIABILTIY AN Y AUTO AL .OWNED ALTOS HII lED AUTOS $501,000 SIR _ X SCHEDULED AUTOS AUTOOSS ED AUT SDJPA070112 07/01/2012 07/01/2013 ( McBIdEeleNGLE LIMIT $5,000,000 BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ PRERTY (Pr acciDAMAGE S $ U! BRELLA UM EY GESS LIAB O OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE 5 $ DE D RETENTION $ B WORD RS COMPENSATIONWC AND EN PLOYER8' LlAB1LrIY ANY PR )PR�ETOR,PARTNERIEXECUTNE OFFIGEI t/MEMBER EXCLUDPJ)7 (Mande' ory In NH) if yyeess d� ecAbe under OESCR PTION OF OPERATIONS below Y f N N N f A JPA MEMORANDUM OF COVERAGE 60 Days Notice of Cancellation 07/01/2012 07/01/2013 STATLF OTH- X TORY LIMTrs ER E.L EACH ACCIDENT $1,000,000 E.LDISEASE -EAEMPLOYEE $1,000,000 E.L DISEASE - POUCY UMIT $1,000,000 C D E Biani:et Prop Slant et Prop Blanket Prop 030567751N ESP005053600 PSR2083564156 07/01/2012 07/01/2012 07/01/2012 07/01/2013 07/01/2013 07/01/2013 $5,000,000/$100,000 SIR $20,000,000 XS $5M $225,000,000 XS $25M DESCRIPTIOI 1 OF OPERATIONS! LOCATIONS !VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace b required) *issued C RC Permission. Certificate is subject to policy limits, conditions and exclusions. Memorandum of Coveragr approved Self -Insurance Program reinsured by Munich Reinsurance America Inc. Property poi Inc' Special Form/Replacement Cost. 90 Day Notice of Cancellation except 10 Days for Non -Payment. Re: Use of premises. City of National City, Its officials, agents and employe) is are additional insureds (general liability policy) per attached form. CERTIFIC,'\TE HOLDER City of National City 1243 National City Boulevard National City, CA 91950 ACORD 2 i (2010/05) 1 Of 1 #58 783015/M8782949 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 '?fl44ci,5. OAVA, Sdloll8—r 101988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD TTCAR SAN DIEGO COUNTY SCHOOLS RISK MANAGEMENT JOINT POWERS AUTHORITY (SDJPA) Additional insured Endorsement WHO IS A COVERED MEMBER (Per section 11 item 3 of the MOC — Memorandum of Coverage) Any person(s), entity(ies), or organization(s) you are required by a covered member contract to include as an additional insured solely with respect to bodily injury and property damage and arising out of: a. Premises leased, used or occupied by you; b. Automobiles leased or rented by you; c. Equipment owned, leased or rented by you; d. Mortgagees and Loss Payees of a Covered Member; or e. Property owners and property managers of property owned, leased, rented or occupied by you However, the additional insured status and coverage does not apply to: (1) Any occurrence which takes place prior to or after you cease to occupy the premises as stated in the covered contract; (2) Any structural alteration, new construction or demolition operations performed by or on behalf of the additional insured; (3) Any wrongful act, employment practices wrongful act or employee benefit wrongful act. This coverage will be further limited to the extent and Limits of Liability required by the covered member contract and will not increase the limits stated in SECTION ill -LIMITS) OF COVERAGE nor alter any of the terms of coverage stated in this MOC. The covered member contract must be effective and executed prior to a covered occurrence. San Diego County Schools Risk Management Joint Powers Authority. #tSDJPA070112 July 1, 2012 to July 1, 2013 City of National City, its officials, agents and employees are additional insureds per this form. MOC Effective 7.1.12