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Home My WebLink AboutTUP APPLICATIONType of Event: _ Public Concert _Fair _ Festival _ Parade _ Demonstration _ Circus _ Motion Picture _Grand Opening Other Event Title: c0ri) tC -i'" C:%i.-r' _ Community vent _ Block Party Event Location:Or3L L 9? r Lh" \61ri `'>tI I Event Date(s): From J / i3 to S i; `t'•)/- Actual Event Hours: ;:tip al-0/pm to am/ Total Anticipated Attendance: •:)c:c ( )C Participants Spectators) Setup/assembly/construction Date: f i 3 Start time: 1 0(3 6 m Please describe the scope of your setup/assembly work (specific details): �"-VlCIL S ► S Z� � �k r- 5 ) ciLL c;c -14 >I S Dismantle Date: • 3u � i'n Completion Time: l.�% � 3 am/ ryi 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. • �c Sponsoring Organization: C.) p J ;(u Yri. i 1 ci. n Chief Officer of Organization (Name) -TC' ' n Utu 'Cl Applicant (Name): 4 ,:L Address: dpd--\ 614,1 i . Cuk""lNALL.0 Ctt 9151g0 Daytime Phone: (1picj) L 1'1"-i ut 1 � ' `�)). Evening Phone: (t t) g q0 Fax: t 41) 4 2 L —Li S j q E-Mail: C\ L L;_ c px r-nck ka n - c . f cr_ 4 rya s Contact Person "on site" day of the event: ( ; k r' 7-.- Cellular: (..6'/V - Y`10 - c`jr 3 3 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): $ Estimated Gross Receipts including ticket, product and sponsorship sales from this event. $ 2) S CO 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. Cv . `> (,t. rn + ,rr' `� l,c i, yr, 1 c) com Ck n Y`tit,1,c. `.. -k:, v .e. YLf Pttkr1,uc (' 1c1 C_;-',0lc' ct.I1Ai (C,1 10,' D_rc1 lo- 4v,,,. 1.illtar) `` ti ►71 nvo. y` ►'4t, 6i, 'TW r 5 , I W -C-0 C t S 04- 4- - iv '"Yl.. 1 S Ni-t1 Y pre mc:,\ 6 [ , v-1 c' (.L0 car r- c 0-- (kvf 14 ► \ cti. (.. r (c d_%I r,j art()) Si Y ►/ ce% t Yl N ct,-I-10 n (') 1., a. 'z)t _fir cuz )-I- S. -,� v ► L ' rc v i CLL. Q-M c y,-1,,1: Y -47, r r �--I (Apo IJ 0-- V< '1 — .4 c , c�12' e.h Y 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 vNO Does the event involve the sale or use of alcoholic beverages? YES V O Will items or services be sold at the event? If yes, please describe: YES 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 3 "_ S-- Sizes 10 A 1 0 NOTE: A separate Fire Department permit is required for tents or canopies. YES'' 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 conclusi n of the event the area must be returned to a clean condition.) Number of trash cans: Trash containers with lids: C Describe your plan for clean-up and removal of waste and garbage during and after the event: Please d scribe your procedures for both Crowd Control and Internal Security, L) & V- (o c -tf2 A- - -- uj � � .160 L R5 `emu. P (-D f (YES _ NO Have you hired any Professional Security organization to handle security arrangements for this event? If YES, please list: 1 1 Tcb to 1 \ ' `v-ka Security Organization Address: ? 1 `') A r-e_ . 10492 �. 1�t3a- Security Director (Name): Phone: ([%) 6i —t-i-)!5 C 0 _YES VNO 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: Security Organization: Please indicate what arrangement you have (L !'v UC-. r' -cki C,i.4.1) ` 1-7" I- (1c.it\K._ l ,A i h, 1 i_ tot C i•I l.i4/ - made for providing First Aid Staffing and Equipment. I . tU. • in . CI “:1 sC Please describe your, Accessib lity Plan for access at your event by individuals with disabilities: . VN, p s tutZiAJ Please provide a detailed description of your PARKING plan: uckr - ci L t:C� c Please describe your plan for DISABLED PARKING: LL,• _ ti . C. % �—cLt C �.� c� i ��, ►� ��.� , ar K r-,( Please describe your plans to notify all residents, businesses`and churches impacted by the event: I,,tf u 1 q S-Lrti�t.t1 OW- C. C4ir L rA. Lir-5L1 C - -\-0 iE S', C , v} S lc i —1/11 r A 3 Ho Ctc_ 1,'c,c1 t4S NOTE: Neighborhood residents must be notified 72 hours in advance when events are scheduled in the City parks. Z'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: l Number of Bands: Ji U Type of Music: Lc` a 1 Jh L' ZYES _ NO Will sound amplification be used? If YES, please indicate: Start time: 1. 00 ( /pm Finish Time 00 am \7YES _ NO Will sound checks be conducted prior to the event? If YES, please indicate: Start time: C LI arr}/'pm Finish Time I U U �' 0/pm Please describe the sound equipment that will be used for your event: .S L PA c��YCI►C. _ YES V NO Fireworks, rockets, or other pyrotechnics? If YES, please describe: YES _ NO Any signs, banners, decorations, special lighting? If YES, please describe: Ck. 14-a-k-- Opx r C c,v►I Icti c%trk 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 U rl ,r'CL-4tCl\-. i r & hc. ►' t� ' `r 2';\_ Person in Charge of Activity Address 9 S } l `'i,` c4+�: `tit I\; C.cT'1tti:1,4L,P (14) C .` ► Telephone (Q1 9 11 , ()I Date(s) of Use O S) ()I t)(-) t J 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 For Office Use Only Certificate of Insurance Approved Date 2013 Safe Summer Slamcert.pdf • https://mail.operationsar an.org/service/home/./2013 Safe Summer... ACORD r CERTIFICATE OF LIABILITY IN THIS CERTIFICATE I5 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. TH S CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENT VINE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the polley(ies) must be endorsed. If SUBROGATION IS WAIVED. subject to the terms am I conditions of the policy. certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate ha [der In lieu of such andorsemengs). PROolleeltKAlacculTAct,Joanne The John L Raya Insurance Group 401 South Mission Drive (91776) P. O . Box 728 San Gabrill CA 91778 Raya UJC. Nei: (i2sl:s1-2972 P �,_ (526) 570-8611 FAX AeoNsa: eteuee IIJ AFFORDING COVERAGE NAIIC / asuRFRA:Nonprofits Ins Alliance of CA ms Operation Saaahan Inc 2835 Righ:.and Avenue Suite B National (aty CA 91950 INSURER e : INSURER C : NNW D: INSURER IE: _ INSURERF: TEE NUMBER:City of Notional Ci • THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. P ORWATHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NTH 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 . I ND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. IFfi LL1Rr 1 YPE OF INSURANCE AiNSit POLICY NUNS IvssaofrYYYYTI POLICY EXP 1 UNITS GENERAL LIP SILTY ,(MWOD EACH OCCURRENCE $ 1,000,000[WAA X COMMEI ECIAL GENERAL LIABILITY TO ROC kIJ P S s tEa ccarmAcel $ 500,000. $ 20,000 A ICUBASMADE OCCUR X 20121B073NPo 9/2e/2012 9/20/2013 MEOE%P(MYanepereor — PERSONA. AADvCMArRY 3 1,000,000 GENERAL AGGREGATE $ 2,000.000 GEM AGGRO ,,GATE UINT APf I. S PER Pn000CTS - COMMOP AGO s 2,000 , 000 7I POLICY 7 El LOC $ AUTORROBU L&aELnY — CCOMII MSINGLE LIP( ID $ ANY AU' 0 BODILY INJURY (Par parson, S OOSS FED ULED AUTOS INJURY e001LYRY(Poe aotiAent) $ HIRED P I!f W _ NON-0NNED AUTOS PROPERTY DAMAGE [Per eccemnnt $ s UMBREI LA USG _ OCCUR EACH OCCURRENCE $ EXCESS use CUUSIS LWAOE AGGREGATE s OED I I RETENTIONS $ AIDER EeK01 En' _ - Ip I TORY UNWC ITS IR- Y ANY PROPRI TOWPARTNE (ECUTNE / N OFACERAIEA SER EXCLUDE)? N I A E.L EACH ACCIDENT $ (INeet Gary Ir NH) EL DISEASE • EA EMPLOYEE I drat. dumb I 1/NAY DEBCRIPTI01 I OF OPERATIONS blow EL. DISEASE - POLICY LIAR s DESC IPmN OF C PERATIDN$ J LOCATIONS! VEHICLES (Attach ACORD 101, AddhJond Rnurb Schedule. II mart Name le Iagiii CERTIFICATE HOLDER City of National City 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. AUTHORED REP NTATNE Rocio Gutierros/RG ACORD 25 (2C 10105) INS025 mow A 1 of 1 01908-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 3/11/2013 11:42 AM • • S3 2011 FESTIVAL LAYOUT EXECUTIVE OFFICES Registration Entrance Photo Back Parking Lot TEEN CENTER Front Parking Lot Concrete Island