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HomeMy WebLinkAboutTUP APPLICATIONType of Event: _ Public Concert Parade Motion Picture Fair Festival Demonstration _ Circus Grand Opening Other Event Title: SL. 5kootr Community vent _ Block Party Event Location: D(QC& \ jam a' 1 2 8 L Event Date(s): From J?-j 19 to 6M-i/i Actual Event Hours: 8• 00 0/pm to 6:00 am/em Total Anticipated Attendance: 30 0 x Participants Spectators) Setup/assembly/construction Date: 5j211 i -1 Start time: ' : ODarvt PI pe describe the scope of your setup/assembly work (specific details): ARAf5 S a� 5 ; 5.e rs L�2 ('o �rx Dismantle Date: 3D Q m Completion Time: 10 : 0 0 am/e List any street(s) requiring closure as a result of this event. Include street name(s), day and time of cl sing and day and time of reopening. Sponsoring Organization: DQ-Q,COA‘‘ '5 OyMGli(1Cc (� Chief Officer of Organization (Name) V " 4 Sc XX() Applicant (Name): ,,11,,�r`11LX eQJ n' Address: 2 � k k\t OmtA A A. N �0 , 0 A -A, e,A "1 "t 6 t) Daytime Phone: ( a) 11 _ N N 61 X V °ZEvenin Phone: 5i-1 n - LI2 3 � g (w9) 3 Fax: WI) -('' 1-- Il5(1 E-Mail: a0ClrfVf0 0t{I'ck \on5AM*vjA.. org Contact Person "on site" day of the event:'/A Cellular: _ 84 0 - �� 33 �t�t 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 INO If YES, please explain the purpose and provide amount(s): Estimated Gross Receipts including ticket, product and sponsorship sales/from this event. $ What is the projected amount of revenue that the Nonprofit Organi —IT will receive as a result of this event? Estimated Expenses for 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. SOkt (YOr 5 kcen \ s ay bfvq 1, ev4,61/4\- ko vtrtp L\ art d Coo(' &notAck, (reca-Vlo Gdtmotticul SA -a r� 001\a'bocn,4-toil uoi WS �'� \lbw ComrnvnArkors.-P -COc,6 b rC `\ `AQ JR v1-k S \o -oA("Is AVA( 5 6c a\10M\ckNat t0 y Clt1n 5 GtNa c-Q <'‘A ys `i r1 KoXtiAa` C�ac� OA k 0 D Gavti-ey e- D � YES JNO 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 v 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 in olve the use of tents or canopies? If YES: Number of tent/canopies �j- `�-' Sizes 10 x 10 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): n 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) nTables # and Chairs # n Fencing, barriers and/or barricades n Generator locations and/or source of electricity nCanopies or tent locations (include tent/canopy dimensions) n Booths, exhibits, displays or enclosures n Scaffolding, bleachers, platforms, stages, grandstands or related structures nVehicles and/or trailers nOther related event components not covered above nTrash 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: 0 Trash containers with lids: ( 0 Describe your plan for clean-up and removal of waste and garbage during and after the event: Please describe your procedures for both Crowd Contro nd Internal Security: \At \04,4Q WA:tmef" w ,o 0 or 5 5a{t {y-15 OsoNlake coC\ . "YES _ NO Have you hired any Professional Security organization to handle security arrangements for this event? If YES, please list: Security Organization: 10 CO i ()'Gj 66k Il "TI-eq (� Security Organization Address: \ 25 ' 665 74d4 . km fief %al "each CA, It q 32- Security Director (Name): Phone: ct— iQ 6 6 o a _ 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: PI as=ate what rrangemennt, You have made fQrr provi in O Z A\ C i , a C frV . 28 t Wi �A\a n � 5 PI se describe your, Acce ibility Plan for access at your event v4A MavJ2. NSA Wit t ca (NG an A eIn4cl Se Cvccof Jsizi ICI (ctcv\5. first Aid Staffina and Equipment. o)C �.M&ri Ca�C C. A Q 06o by individuals with disabilities: kpla.A9 a5 welt as Please provide a detailed description of your PARKING pla �a(\ �� J'k\kCkb1 s �Q � c� `tA e v c w�0.se 1 lob k O n '°J ,2�+ S . PI as describe your,pla for DISAB D PARKJNG: 'Y`�t Vo.4'4 -'fro a l o T t✓+ i s ablt d Qctit'vo.An y Please describe your plans to notify all residents, busin s es and churches immpacted by tO�e�1 event: v`tt w'oX Q%3 0. Ciso-4t5 tttr -�o Ce5'otn.40, cArMil 'tn A ti ��etr1L co�C\US 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: Type of Music: Number of Bands: Y\ Y\� b(\--Yer(lock'l 1 - l i 140 -YES _ NO Will sound amplification be used? If YES, please indicate: Start time: \ \ 0 0 /pm Finish Time (;. d 0 am/6 J YES _ NO Will sound checks be conducted prior to the event? If YES, please indicate: Start time: it /pm Finish Time 1 0' d U 63/pm Please describe the sound equipment that will be used for your event: ovr� SAS O') A S IV a Vie Cs YES _ NO Fireworks, rockets, or other pyrotechnics? If YES, please describe: YES _ NO y signs, banners, decorations, special lighting? If YES, please describe: a„1�lC5 1��\ ‘02 acc 14A --\i1 Sarmaklco v'1\ %(\ r c-AC\) c- . 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. r Organization (J et A11 OA- Sim a 1/16 Person in Charge of Activity A` M q C HOLD HARMLESS As a Condition of the issuance AGREEMENT public or private property, of a temporary use indemnify and hold harmless the undersigned permit to conduct its activities oand its mless the Citygeed hereby agree(s) ) employees and agents of National Cityto defend, nd itsofficers,demands, costs, employees s anty rfrom and the Parking damage, and against any Authority ge, or or anyany personal injury, and all claims, the costs ofr both,tigation, alitigation oiot andf other liability,including death attorneysor property activity taken under the or related to the use of public property fees and the contractors. permit by the permittee or its agents, employeesor or the Signature of Applicant Official Title Date 7 (.4 For Office Use Only https://mail o erat.onsamahan.org/service/home/-/?auth=co&loc=en... https://mail.operationsamahan.org/service/home/-/?auth=co&loc=en... ACORU� I DATE Wvita rro CERTIFICATE OF LIABILITY INSURANCE THIS CERTIICA"E I8 ISSUED AS A MATTER OF INFORMATION ONLY CERTIFICATE DIES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, BELCWU. THIS C ERT FICATE OF INSURANCE DOES NOT CONSTITUTE REPRESENTATA E OR PRODUCER, AND THE CERTIFICATE HOLDER. AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE THIS POLICIES A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED IMPORTANT: if t le certificate holder Is an ADDITIONAL INSURED. the policy(es) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and co editions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the cerdaaato holder In lieu of such endarsement(s). mourn The John L Rtya Insurance Group 401 South Miraion Drive(91776) P. O. Box 7211 San Gabriel CA 91778 COHORT a Jeanne Ra Nuya A so Eat (626)570-8611 IFa_Net (626U 2e1-2911 ADORES& INSURERS{ AFFORDING COVERAGE HAICI INsueuts:Nonprofita Ins Alliance of CA INSURED Operation Sal tahan Inc 2835 Highland Avenue Suite B National Gib CA 91950 Hl1\ire w,±e:! ...-..�.�.-•...—....---- -- .-. . e15URIER 8: INSURER C : INSURER D: INSURER E : INSURER ►: 'amnion —on numout; THIS IS TO CERTiF Y THAT THE OF N ISSUED INDICATED, NOTI THSTANDING ANY IREGuI INSURANCE IOD CTERM LISTED CONDITION OF ANY CONTRACT OR OTHER THE E DOCUMENT MTN RESPECT TO WHICH D NAMED ABOVE FOR 'THE POLICY RTHIS CERTIFICATE MAY OE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ANO I ANDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. [Sil TYPE C F EISUPUJCE ryj pi liffiNt Wp POLICY NUMBER POLICY Ym t YIDpry NIMAIDPoYYTI UNT$ SERE R&Lwo Sr.' EACH OCCURRENCE 3 1,000,000 X COMMERCIAL SENERALUABILnY PRAMALIE ISES(EaeCOMMERCIALenerer el $ 500,000 CWIe.4ADE n OCCUR X 201318073NP0 9/20/2013 9/20/2014 MEDF.RP(Ny Person) $ 20,000 ■ PERSONAL &ADV INJURY $ 1,000,000 OENERALAGGREGATE S 3,000,000 GEMLAGGREGATE UNIT APFtESPat © ■ n PRODUCTS-COMPKIPAGG 3 3,000,000 POLICY LOC 6 AUTOMOaLE • UAEIi ITT CtIEDIDNGLE UNIT 6 ■MINED ANY AUTO " SCHEDULED BODILY INJURY (PVMINS 1 II AUTOS -- AUTOS D RODLY INJURY (Per aoaOra) 6 ill HIRED AUTOS pMRQn WAWA 4r Kolas 6 1111 Ill UMBRELLAUA B EXCEss LIAR OCCUREACH OCCURRENCE $ CLAIMS -MADE ■ AGGREGATE f 0E0 RErENTpNs S COMPS RATION AND EMPLOYETEr t AmoyI Y! N ANY PROPRIETOR!' TAT S I 1 ER IUNARMS URTNEREXECUTIVE OFPIC�IMEIIBER E tCliJOEDT N J A E.L EACH ACCIDENT 6 lwndsouy in NN) ryya. aaaraeuMr E.L DISEASE - EA EMPLOYEE 3 DESCRIPTDN OF 0 IERAT10N8 below EL DISEASE - POLICY LIMIT $ 1 DESCRIPTION OF OPERA ONS! LOCATIONS/VEHICLES lANaoh ACORD 101, Aadgeeei Remarks Sehedub. Emote apses Is requited) CERTIFICATE 1ni 'Nos - - ----- City of National City 1243 National City Blvd National City, CA 91950 ACORD 26 (2010/01) INS025Rofo sLo' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. The ACORD name and logo are registered marks of ACORD AUTIIORIZED AEPRRe ATIVE Rocio Barajas/ ®19 -2010 ACORD CORP N. All rights reserved. 1 of 1 2/11P)n1A n.c-T Aa,r i'cLj',L,tutLcj'hLHL 2074 fe�ivaL Gacyout Administrative Building Registration Driveway Back Parking Lot Stage Front Parking Lot Concrete Island