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Home My WebLink AboutTUPType o1 Event: _ Pub is Concert _ Fair _ Festival _ Panide _ Demonstration _ Circus Motion Picture _ Grand Opening X Other Carnival _ Community vent Block Party Event Title: National City Host Lions Club Annual Independence Day Carnival Event L Dcation: Kimball Park, 12th and D Avenue Event C ate(s): From 07/02/14 to 07/06/14 Actual (Event Hours: Wed July 2, 5:00pm to 11:00pm, Thurs July 3, 12:00prn to 12:00am, Fri July 4, 5:00pm. to 11:00pm, Sat July 5, 1:00pm to 11:00pm, Sun July 6, 1:00pm to 11:00pm. Total Anticipated Attendance: 1,000 Participants 20,000 Spectators Setup/a ssembly/construction Date: Monday,6/30/2014 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 40vd dumpsters, and port -a -potties. Set up for Miss National City Pageant. may\ Rfc/D N` MAR 9 2014 Dismar tle 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 121' street to the entrance to the Park parking lot. Closure will be from 6:00am Mon June 30, 2014 to 4:00pm ,Tues July 8, 2014 ORGANIZATION INFORMATION 'ION Sponsoring Organization: National City Host Lions Club Chief Officer of Organization (Name): Frank Pekarek Applicant (Name): Vincent Reynolds Addres3: 1243 Manchester Street, National City, CA 91950 Day Time: (619 ) 962-3756 Evening Phone ( 619 ) 479-8165 E-Mail: vincedepaul@cox.net Fax: (_ _) Contact Person "on site" day of the event: Brian Cellular: 619-962-9950 NOTE: THIS PERSON MUST BE IN ATTENDANCE FOR THE DURATION OF THE EVENT AND IMMEDIATELY AVAILABLE TO CITY OFFICIALS 1 FEES/PROCEEDS/REPORTING Is your c rganization a "Tax Exempt, nonprofit" organization? X YES _ NO Are adrr ission, entry, vendor or participant fees required? If YES, pease explain the purpose and provide amount(s): Vendors -ent kitchen and deli booths, rent is free to $300.00 $500(10.00 this event. YES X NO Estimated Gross Receipts including ticket, product and sponsorship sales from $ 20 000.00 Estimated Expenses for this event. $ 30.0(10.00 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 regarC ing 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`d through Sunday July 7h. This event will include, Carnival Rides, Carnival games, Food booths Talent show, watermelon eating contest, youth activities, Community displays, Fire work display, Bands. And othE r 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, list any additional dealers involved in the sale: 2 OVERALL EVENT DESCRIPTION (continued) _ YES X NO Does the event involve the sale or use of alcoholic beverages? X YE 3 _ NO Will items or services be sold at the event? If yes, please describe: Carniva rides & games, and food booths, toys 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 YE 3 _ NO Does the event involve a fixed venue site? If YES, attach a detailed site map showing all streets impacted by the event. X YE 3 _ 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' NOTE: A separate Fire Department permit is required for tents or canopies. X YES _ NO Will the event involve the use of the ray or your stage or PA system? SPECIFY: Both In addition to the route map required above, please attach a diagram showing the overall layout and set-up locations for the following items: 'I 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): —1 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 Ilost Lions Club will provide an additional 40 vd. Dumpster, and the trash cans will be emptied as required, and after each day 3 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 YES NO Have you hired any Professional Security organization to handle security arrangements 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 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: 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 qrc unds and sidewalks. There will be (2) H/C porta-a-potties on site, in additional to Park rest rooms PARKING PLAN/MITIGATION OF IMPACT Please provide a detailed description of your PARKING plan: We will utilize existing street and nearby public parking. Please cescribe your plan for DISABLED PARKING: We will utilize 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 notified as required NOTE Neighborhood residents must be notified 72 hours in advance when events are scheduled in the City parks. 4 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 YE:S _ NO Will sound amplification be used? If YES, please indicate: Start time: 7:00pm 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 3 _ 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 02/29/12 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 attach ed to this permit. Orgai iizali on Nalional City Host Lions Club Persc,n in Charge of Activity Frank Pekarek Addis les 814 platy Court. National City. CA 91950 Telephone 619-417-8529 Date(s) of Use 6/30/2014 to 7/9/2014 ijOLD 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 rind 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 contra ictors. Signature of Applicant Official - itle Event Chairperson Frank Pekarek, President, National City Host Lions Club Date Me rch 17, 2014 For Office Use Only Certificate of Insurance Approved Date 6 CERTIFICATE OF LIABILITY INSURANCE DATE (TAMIDD/YYYY) 01/26/2014 7i•IIS '''ERTIFIC ATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE )OES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BE.OW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTA'T WE OR PRODUCER. AND THE CERTIFICATE HOLDER. IMPORTANT: I r the certificate holder is an ADDITIONAL INSURED, the policy(Ies) must be endorsed. If SUBROGATION IS WAIVED, subject to The terms and C onditrons of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate DOD:il T In lieu of such endorsement(s). I---10tItICER Willis of Illinois, Inc. 425 N. Martingale Road, Suite 1100 Schaumburfi, IL 60173 CONTACT finfE: John Adams mow (A.c.16). Eat: 1-800-316-6705 i fatc ao 1-888-467-2378 AvoResEvait 5: lionschibs@winis.com BOLNIERIS) AFFORDING COVERAGE HAlOS nsuRER A: ACE American Insurance Company ' 22667 =SD National City Hod Lions Club - 4L6 National City Cal prnia *AMER B : INSURER C : INSURER D : Itt 1RER E : *ISMER f : CERTIFICATE NUMBER* • Hit IS TO CER1IFY THAT THE POLICIES OF INSURANCE LISTE7 17-1"-__-:: .7; Ha' 'E BEEN *SSUED TO THE 'INSURED NAMED ABOVE FOR THE P-rj+LICY PERIOD INDICATED NO1144THSTANDING ANY REOUIREkTENT TERM OR t.r.4%.77EN -11-1Y CONTRACT OR OTHER DOCUMENT WITH RESPECT TO *VHIGH THIS CERTIFICATE MA Y BE ISSUED OR It AY PERTAIN THE INSURANC-E AFTC:-:•1&E' SY T4E. POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE *TERMS, EXCLUSIONS AM i CONDITIONS OP SUCH POLICIES LI4IITS St-40WN 'JAY HAsti", BEEN L".-.EDII,`ED BY PAID CLAIMS INSR L TR TYPE OF INSURANCE sublz POLICY EFF f POLICEP PCitiTiti "CY NUMBER : VOWDretrYYYi i aisfgYtfirrXysTL LIMITS A GENERA! UMW tY COMME bt !GENERAL L=ADt!:"-Y OCCUR H0OG27022923 093O1J2013 I , - - ' 09101/2014 EACH OCCURRENCE S 1,000,000 X , DALIA4E ,C, HEN ED REtatczES tEa ocassencel 5 1-000:000 CLAM 4.'ADE X I "IEDEXP (kw cre person) s 1.000 X Ago, Per liamed Insured P ERSDNAL 4 Mr/INJURY $ 1.000,000 is 52.000.300 GEN-64AL AGGREGATE S 10,000,000 GENT_ —XI AGGREGA' E LILIT PoLic.Y El Ta- APPJES PER PRODUCTS , COUPCP AC-G $ 2,000,000 1 i Loc. A AUTOMOBILE LK MLITY ANY AUTO ISAH08721415 /01 3 109/01/2014 t 1 i COVENED SNM.E LIMIT fEa aeL-dett s Included Rooty Kr tc, $ ALL OWNED ' Ailt` 1--- i HIRED AUTO 3 i X SCIEDJLED AL.'"r NONONNED ALTOS BODIt 't• IN.11-11Y ;Per accdAnIi $ X ROpEnry LANIAC JPET acaden $ i s UMBRELLA t IA8 EXCESS UM OCCUR CLAmtS-LrAZ-,E EACH OCCURRENCE S AGGIC--GATE $ I DED I I /MEN-PONS WORKERS COMPI NSATIoN AND EMPLOYERS LIABILITY ANY PROPR ETOR PARTNEREXECLITKE OFF,CERATELTE-A EXCLUDED' (Mandatory in NH) :S A5CRPTION OF OPERATIONS YIN Ni A I I WC STAB). .0TE, 1 TORY I MIS PR_ EL EACH ACCIDENT 1 , I EL DISEASE . EA EMPLOYEE\ EUO EL DISEASE - POLICY LIMIT I 1 : DESC RIPTION OF OPERI DONS I LOCATIONS t VEHICLES (Ati4oi Provisions of the p ificy apply to the named insureds participation of July Carnival The City of Nabors I City and its Officers. Agents, and the issuance of per mit(s) to the Insured shown above PROVISIONS Of ' "HE POLICY DO NOT APPLY TO THE requtied) period shown above: National City Host lions Club 4th but only with respect to General Liability arising out of insured. ACORD 101, Adtrmonet RemarksSId8e. it more space As in the following activity during the policy Employees is included as an Additional Insured(s), and not out of the sole neqence of said additional SALE OR SERVING OFALCOHOUC BEVERAGES C _ ER CANCELLATION The City of Nation I City 1243 National City Blvd National City Callfc rnia 91950 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 ACORD 25 (20101€ 5) (c) 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD http: //maps.google.com/maps/place?cid=16896838253950330656&q=kimbal+park+91950... 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