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HomeMy WebLinkAboutTUPEXTENT INFORMATION Type o ' Event: _ Public Concert _ Fair _ Festival _ Parade _ Demonstration Circus Mot on Picture _ Grand Opening X Other Carnival Community vent Block Party Event 1 itle: National City Host Lions Club Annual Independence Day Camival Event Location: Kimball Park, 12th and D Avenue Event C►ate(s): From 07/03/2013 to 07/07/2013 Actual Event Hours: Wed July 3, 5:00pm to 11:00pm, Thurs July 4, 12:00p►n to 12:00am, Fri July 5, 5:00pm. to 11:pm, Sat July 6, 1:00pm to 11:00pm, Sun July 7, 1:00pm to 11:00pm. Total A iticipated Attendance: 1,000 Participants 20,000 Spectators Setup/Essembly/construction Date: 07/01/2016 Start time: 07:00am Please describe the scope of your setup/assembly work (specific details): Set-up carnival rides and booths, set-up food and deli booths, move in stage, set-up and fence off fireworks area move in 40yd dumpsters, and port -a -potties. Set up for Miss National City Pageant. Dismartle Date: Sun, July 7, 12:30am Completion Time: Tue, July 9, 4:00pm 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. We will ieed to close D Avenue from 12t street to the entrance to the Park parking lot. Closure will be from 6:00am Mon July 1, 2013 to 4:00pm ,Tues July 8, 2013 APPLICANT AND SPONSORING ORGANIZATION INFORMATION Sponso ring Organization: National City Host Lions Club Chief C►fficer of Organization (Name): Brian Clapper Applicant (Name): Vincent Reynolds Addres >: 1243 Manchester Street, National City, CA 91950 Day Time: (619 ) 962-3756 Evening Phone ( 619 ) 479-8165 E-Mail: vincedepaulAcox.net Fax: (_ _) Contact Person "on site" day of the event: Brian C Cellular: 619-962-9950 NOTE: THIS PERSON MUST BE IN ATTENDANCE FOR THE DURATION OF THE EVENT AND IMMEDIATELY AVAILABLE TO CITY OFFICIALS 1 • • PROCEEDS/REPORTING Is your prganization a "Tax Exempt, nonprofit" organization? X YES _ NO Are adriission, entry, vendor or participant fees required? _ YES X NO If YES, please explain the purpose and provide amount(s): Vendors rent kitchen and deli booths, rent is free to $300.00 $ 50 0)0.00 Estimated Gross Receipts including ticket, product and sponsorship sales from this event. $ 20 0)0.00 Estimated Expenses for this event. $ 30.0 )0.00 What is the projected amount of revenue that the Nonprofit Organization will receive as a result of this event? OVERALL EVENT DESCRIPTION ROUTE MAP/SITE DIAGRAM/SANITATION 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. National City Host Lions Club will sponsor the annual Independence Day Carnival and Fireworks in Kimball Park from Wednesday July 3'h through Sunday July 711-1. This event will include, Carnival Rides, Carnival games, Food booths Talent show, watermelon eating contest, youth activities, Community displays, Fire work display, Bands. And other amateur and professional entertainment. X YE:, _ NO If the event involves the sale of cars, will the cars come exclusively from National City car dealers? If NO, ist any additional dealers involved in the sale: 2 a VERALL EE..NT DESCRIPTION continued ) _ YES X NO X YE:3_NO Carnival rides & Does the event involve the sale or use of alcoholic beverages? Will items or services be sold at the event? If yes, please describe: ames and food booths toys _ YES X NO Does the event involve a moving route of any kind along streets, sidewalks or highways? If attach a detailed map of your proposed route indicate the direction of travel, and provide a written narrative to explain your route. X YE€; 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 30 Sizes 10' x 10' & 15' x 15' separate Fire Department permit is required for tents or canopies. NOTE: A X YE:3 _ NO Will the event involve the use of the Oly or your stage or PA system? SPECIFY: Both In additior to the route map required above, please attach a diagram showing the overall layout and set-up locations ix 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: 20 Trash containers with lids: 0 Describe your plan for clean-up and removal of waste and garbage during and after the event: The NC HDst Lions Club will provide an additional 40 yd. Dumpster, and the trash cans will be emptied as required, aiId after each day 3 • • SECURITY/ACCESSIBUI UTY Please describe your procedures for both Crowd Control and Internal Security: Security Plan will be by NCPD, utilizing the Senior Volunteers, and the Police Explorers X YE:; _ NO Have you hired any Professional Security organization to handle security arrangeinents for this event? If YES, please list: Security Organization: To be determined as required by security plan. Security Organization Address: Security Director (Name): Phone: X YE:S _ 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: Park lights and lights from the carnival rides and booth Please indicate what arrangement you have made for providing First Aid Staffing and Equipment. We will utilize 911 if an emergency occurs. For minor cuts and bruises we will have first aid kits at the Lions Train, and at the Carnival office. Please describe your Accessibility Plan for access at your event by individuals with disabilities: Park grounds and sidewalks. There will be (2) H/C porta-a-potties on site, in additional to Park rest rooms P/�►RKING PLAN/MITIGATION OF IMPACT Please provide a detailed description of your PARKING plan: We will utilize existing street and nearby public parking. Please c escribe your plan for DISABLED PARKING: We will itilize the handicapped parking spaces at the towers and the public parking lots. Please describe your plans to notify all residents, businesses and churches impacted by the event: _ They will be notifi ad as required NOTE: Neighborhood residents must be notified 72 hours in advance when events are scheduled in the City parks. 4 • ENTERTA LAMENT ATT RELATED EVENT ACTIVITIES 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: 1 Number of Bands: 2 Type of Music: Mexican, Rock & Roll, and the NC Community Band X YES _ NO Will sound amplification be used? If YES, please indicate: Start time: 7:OOpm Finish Time 11:00pm _ YES X 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: _X_YE:> _ NO Fireworks, rockets, or other pyrotechnics? If YES, please describe: General Fireworks display provided by Pyrospectaculars YE:3 X NO Any signs, banners, decorations, special lighting? If YES, please describe: Revised 1)2/29/12 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 National City Host Lions Club Person in Charge of Activity Brian Clapper Address 113 N. Belmont Street. National City. CA 91950 Telephone 619-962-9950 Date(s) of Use 7/1/2013 to 7/9/2013 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 Cily 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. Signatun: of Applicant Official Title Event Chairperson Date 4 / GI f ) 3 For Office Use Only Certificate of Insurance Approved Date 6 http://maps.google.com/maps/place?cid=1689683 8253950330656&N=kimbal+park+91950... 1 N To see all the details that are visible on the screen, use the "Print" link next to the map. ACORL CERTIRATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 08/03/2012 THIS CERTIFI CATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIF. CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTA TIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 certificate holde in lieu of such endorsement(s). PRODUCER Phone. 864-862-2838 Fax: 864-688-0138 COSSIO INSUR ONCE AGENCY LA JOLLA PAC FIC INSURANCE AGENCY 6302 DEL CERF;O BLVD SAN DIEGO C A 92120 INSURED NATIONAL CIT ( LIVING HISTORY FARM PRESERVE INC C/O VINCE REII NOLDS 1243 MANCHE: TER COURT NATIONAL CIT r CA 91950 Agency Lictk 0B23517 N EACT Cossio Insurance Agency PHONE (A/c, Ne Ext): 864-862-2838 EMAIL ADDRESS: 1YY@c ossioinsurance.com INSURER(S) AFFORDING COVERAGE [FAX 864-688-0138 A/C, No): NAIC # INSURERA : SCOTTSDALE INSURANCE COMPANY INSURER B INSURER C : INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 331922 REVISION NUMBER: THIS IS TO 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 CERTIFICATE I AAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS A ND CONDITIONS OF SUCH POLIC ES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD1 SUBR POLICY EFF POLICY EXP LTR T'PE OF INSURANCE INSR WVD 1 POLICY NUMBER (MMIDD/YYYY) (MMmD,YYYY) A GENERAL LIAI PLTY X I CPS1586219 08/23/12 08/23/13 X COMMER:IAL GENERAL LIABILITY CLAI MS -MADE I X '; OCCUR L GENT AGGRE SATE LIMIT APPLIES PER: X 1 POLICY 1 PRO- ECT AUTOMOBILE LIABILITY ANY AUTU ALL OWNED AUTOS HIRED Al TOS UMBRELLP LIAB EXCESS .WB DED I RETENTION $ LOC SCHEDULED UTOS ON -OWNED UTOS WORKERS COI IPENSATION AND EMPLOYE RS' LIABILITY OCCUR CLAIMS -MADE ANY PROPRIET DR/PARTNERIEXECUTIVE OFFICERMEMBE R EXCLUDED? (Mandatory In NH If yes, describe un per DESCRIPTION Of OPERATIONS below LIMITS EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurence) MED. EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE $ 1,000,000 !PRODUCTS - COMP/OP AGG $ 1,000,000 $ 1,000,000 $ 100,000 $ 5,000 $ 1,000,000 COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (per accident) EACH OCCURRENCE $ AGGREGATE $ WC STATU- I ! OTH t TORY LIMITS ER E.L. EACH ACCIDENT E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE f OLDER NAMED ADDITIONAL INSURED PER FORM CG2010 (07-04). *TEN DAYS NO I10E GIVEN IN THE EVENT OF CANCELLATION FOR NONPAYMENT OF PREMIUM. CERTIFICATE HOLDER CANCELLATION CITY OF NA' TONAL CITY 1243 NATIOI IAL CITY BLVD. NATIONAL C 1TY CA 91950 Attention: 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 Russell R Logan ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS DOGUMENT HAS A TRUE DOCUCHECKT" WATERMARK AND VISIBLE FIBERS DISCERNIBLE FROM BOTH SIDES CITY OF NATIONAL CITY 15420 3USINESS LICENSE CERTIFICATE )URSUANT TO CITY ORDINANCE THIS LICENSE IS HEREBY GRANTED FOR THE TERM & PURPOSE Date of ExpiraSTATED ton: 1213112013 BUS DESCRIPTION BUSINESS ADDRESS 4". CALIFORNIA «4+ 140 E 12TH ST NATIONAL C- LTy INC "Al BUSINESS NAME NATIONAL CITY HOST LIONS CLO AI I IN: w nea MAILING ry 6.7CXX .-.- ADDRESS NATIONAL CITY, CA 91951.0986 NON TRANSFERABLE POST IN A CONSPICUOUS PLACE THIS DOCUMENT IS ALTERATION PROTECTED AND REFLECTS FLUORESCENT FIBERS UNDER UV LIGHT City Manager FOR YOUR RECORDS TAX RECEIPT SIN License No. 15420 TOTAL