Loading...
HomeMy WebLinkAboutTUP APPLICATIONType of Event: — Public Concert — Fair _ Festival — Parade _Demonstration _Circus —Community vent — Motion Picture — Grand Opening — Other —Block Party Event Title: Put/Z , 01‹"7 ICr; DiiJ Zon/ fcv Fl4Z i Event Date(s): From 9/1 CI walla yt Actual Event Hours: m to 4, a Total Anticipated Attendance: ( Participants Spectators) Setup/assembly/construction Date: / - /34 Start time: 8'/ -t'7 Please�✓describe the scope of your setup/assembly work (specific details): itZie r2 , 4S'42 `t-- 7 Ni ci, S .�/ i.- Event Location: 5 Dismantle Date: a- ( Completion Time: a 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: Q Chief Officer of Organiizatio (Na L ,�l'APAS, i t6 J Applicant (Name): iL►/v 4 j i edo Address: /Pzo ,S eRob,'d/Q L) [M • 2 $a n P ' j d C' 94 /3 / Daytime Phone: ( ,S-ii 4, 7V� Evening Phone: ( ) Fax: �S^3d -fp7d E-Mail: /`vim. t9,441/..2 r -S •'W. &' -; Contact Person "on site" day of the event:0,4 ©s.,,✓� Cellular: -b J '1 /'j0 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? _ YESX NO Are admission, entry, vendor or participant fees required? YES NO If YES, please explain the purpose and provide amount(s): $4at2 Dt 0 Estimated Gross Receipts including ticket, product and sponsorship sales from this event. $ l 0) ©DI) 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. — 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 Li NO Does the event involve the sale or use of alcoholic beverages? XYES _ NO Will items or services be sold at the event? If yes, please describe: PROT INS) ►I LtlYk11 1410).e1 aera SI Seck 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. X YES _ NO Does the event involve a fixed venue site? If YES, attach a detailed site map showing all streets impacted by the event. XYES _ NO Does the event involve the use of tents or canopies? If YES: Number of tent/canopies Sizes NOTE: A separate Fire Department permit is required for tents or canopies. YES NO Will the event involve the use of the Cy 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 ,XiGenerator 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 I �[ Trash containers and dumpsters y _ (Note: You must properly dispose of waste and garbage throughout the term of your event and immediately upon conclusio of the event the area must be returned to a clean condition.) Number of trash cans: n Trash containers with lids: 3 Describe your plan for clean-up and re val of wq.ste and garbage during,and aft r the event: air 3- Li T/ vV & Q 5 n 4 Ple e describe your procedure��s/for both Crowd Control and Internal Security: yr (p-ie YID .451 — ct.L-5 LD 14 S.47. ,„PC._0 P I i „...9 _ YES NO Have you hired any Professional Security organization to handle security arrang ents for this event? If YES, please list: Security Organization: Security Organization Address: Security Director (Name): Phone: YES _ NO Is this a night event? If YES, please state how the event and surrounding area will be ill mi atedt erasure afety of the participants and spectators:14 X 4fht /t ver5 ' )9 j L5' S Plead� jjndic to what arrang ment �o have made f prov' ing rFi�r t Ai Staffin and Equip nt W.I.- ;q r e < i 7`/ f 7` /, f� S kg, As ;4 Ple_mlescribe your Accessibility Ian for ccess at our event by individuals with disabilities: 'Wf'04-4%�� t r+J a n _ c Please provide a detailed description of yogi -PARKING plan: Y�-6L p4 v...1� c1, .ia,1�.. G� z .g Q k i. f !_v t Bey Please describe your plan for DISABLED PARKING: &o Please describe your ans to notify all residents, businesses and churches impacted by the event: m YJ,� NOTE: Neighborhood residents must be notified 72 hours in advance when events are scheduled in the City parks. YES YES YES O 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: O Will sound amplification be used? If YES, please indicate: Start time: am/pm Finish Time am/pm 0 WII 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: yYES _ NO Any signs, banners, decorations, special lighting? If YES, please describe: Revised 02/29/12 See_ 941QG 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 thi permit. Organization gn.e Y Y/ S trnat S l y ' --1 h C Person in Charge of Activity /7 i l ‘o rz-" l 'e----_ Address A96 ear ZookY/e4V L h ���Ly7�/�P (d Ca Fa /3/ // Telephone ar fio�� '/�?) 9�� � Date(s) of Use ! /,‘ 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 ccP,v2i , K.:1- For Office Use Only Certificate of Insurance Approved Date Pumpkin Station ►3onita Plaza Shopping Center remporary Use Permit Application A)escription of Event• Pumpkin Station is a pumpkin patch and a children's carnival combined. We cater to children age 2-9. We offer numerous rides including a boat ide, car ride, swing ride, bumble bee swing ride, lil' toot ride, inflatable slide, inflatable pumpkin jump, and petting zoo. Pumpkin Station also provides free entertainment on Saturday & Sunday's which include magicians, ventriloquist, jugglers, live animal show and puppet show (3 shows per day each weekend). Also available are 4 different games for the children, Turtle Fishing, Pumpkin Toss, Tic Tac Toe, and Ping Pong Toss with a winner every t'me. Pumpkin Station also offers Group Packages to local schools, day care centers and other children groups. Pumpkins We offer a very large selection of pumpkins from 1# size to Bodacious Pumpkins weighing over 150#. We also offer bales of straw, corn stalks, gourds of all sizes, and other holiday decorating items. S iJnage five have 2 signs — on at our entrance (4' X 8') and one on our storage trailer (10' X 40'). I xperience This is our 16th year of experience operating Pumpkin Station —1 year at Plaza Camino Real in Carlsbad,11 years at Mission Valley Shopping Center in San Diego and 11 years at Bonita Plaza Shopping Center 7 years at Parkway Plaza in El Cajon and 7 years at the Del Mar 1 airgrounds. Westfie[ti July 24, 2013 City of National City Buildirg & Safety Department 1243 1\ ational City Boulevard National City, California 91950-4301 Re: Temporary Use Permit Pumpkin Station — Westfield Plaza Bonita To whcm it may concern: I hereby authorize Norm Osborne, acting as representative of Pinery Christmas Trees, Inc., to operator a busine:,s known as Pumpkin Station in parking lot #1 at Westfield Plaza Bonita during the dates of Septerriber 15, 2014— November 6, 2014. Norm Osborne has permission to install temporary power to poles in parking lot #1 to provide power during :he temporary use time if adequate power is not already in place. Norm Cisborne will obtain all necessary permits from National City for occupancy at Westfield Plaza Bonita. Please 'i eel free to call me if you have any questions at 619.267.2850. Sincere yc,-- Izamt` - - rn . ndez-. ook, RPA Ge s9 Manager Cc: retailers file AC R117► CERTIFICATE OF LIABILITY INSURANCE THIS CER"IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. 03/2O/2014 THIS CER "IFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 3ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORI2 ED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTAI T: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and :onditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate voider in lieu of such endorsement(s). PRODUCER McNeil and Co npany Insurance Services 78900 Avenue 47 Suite 208 La Quinta INSURED COVERAGES CA 92253 F finery Christmas Trees Inc., DBA: Pumpkin Station F 0 Box 26070 an Diego CA 92196 CONTACT Osmo Laine AIC No A/C, No, ADDRESS olalne@mcnellandcompany.com DATE (MMIDDIYYYY) (760) 360-4100 IeArx (760) 423-1331 PROUCE rUcTOMFain. 242756 INSURER(SI AFFORDING COVERAGE INSURER A: Burlington Insurance Company INSURER B: NAIC # 23620 INSURER C: INSURER D: INSURER E: INSURER F: CERTIFICATE NUMBER: 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. N, )TWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE NAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS \ND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INTR TYPE OF INSURANCE GENERAL LI, IBILITY COMMEF CIAL GENERAL LIABILITY nCLAIMS-MADE n OCCUR GEN'L AGGRE SATE LIMIT APPLIES PER. ^I POLICY n FR9J- nLOC AUTOMOBILE LIABILITY ANY AU- 0 ALL OWI IED AUTOS SCHEDL LED AUTOS HIRED A JTOS NON-0V1 NED AUTOS ADDL INER SUBR WVD POLICY NUMBER HGL0037651 POLICY EFF lMM/DD/YYYYI 3/19/14 POLICY EXP IMM/DDIYYYYI 3/19/15 LIMITS EACH OCCURRENCE PREMIS (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY $ 1,000,000 $ 50,000 $ 5,000 $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) UMBREL LA LIAB EXCESS LIAB OCCUR CLAIMS -MADE DEDUCT BLE RETENTIJN $ WORKERS CI )MPENSATION AND EMPLOYERS LIABILITY Y / N ANFERMEP TOR/PARTNER/EXECUTIVE ?ECUTIVE N ManCtorym NHEECLUDED If yyes describe under DESCRIPTIOf OF OPERATIONS below EACH OCCURRENCE AGGREGATE N/A TAR' T IMITS E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT DESCRIPTION OF C PERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) *10 Day Notice c f Cancellation for Non -Payment of Premium. Certificate holde is added as Additional Insured per form GSG G 010 08 09. CERTIFICATE IIOLDER City of National City 1 >43 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. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTOMATIC ADDITIONAL INSUREDS BY WRITTEN CONTRACT, WRITTEN AGREEMENT OR PERMIT This Endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Suction II - Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) with whom you agreed, because of a written contract, written agreement or permit, to provide insurance such as is afforded under this Coverage Part, but only: 1. With respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused by "your work" or maintenance, operation or use of facilities owned or used by you; and 2. When such written contract, written agree- ment or permit is fully executed prior to an "occurrence" in which coverage is sought under this policy. B. Wit h respect to the insurance afforded these additional insureds, the following additional exc Iusions apply: Thi3 insurance does not apply: 1. To any person or organization included as an insured by an endorsement issued by us and made part of this Coverage Part. 2. To any lessor of equipment if: a. The "occurrence" takes place after the equipment lease expires; or b. The "bodily injury", "property damage" or "personal and advertising injury" arises out of the sole negligence of the lessor. 3. To any engineer, architect or surveyor if the "bodily injury", "property damage" or "personal and advertising injury" arises out of the rendering of or the failure to render any professional services by or for you, including: a. The preparing, approving, or failing to prepare or approve maps, drawings, opinions, reports, surveys, change orders, designs or specifications; or b. Supervisory, inspection or engineering services. 4. To any: a. Owners or other interests from whom land has been leased; or b. Managers or lessors of premises if: (1) The "occurrence" takes place after you cease to be a tenant in that premises; or (2) The "bodily injury", "property damage" or "personal and advertising injury" arises out of structural alterations, new construction or demolition operations performed by or on behalf of the manager or lessor. 5. To any person or organization included as an insured under Paragraph 3. of Section II - Who Is An Insured. GS 3-G-010 08 09 Includes copyrighted material of ISO Properties, Inc., with its permission. Page 1 of 1