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HomeMy WebLinkAboutAPPLICATIONType of Event: _ Public Concert Parade Motion Picture Event Title: _ Fair _ Festival _ Community vent _ Demonstration _ Circus _ Block Party — Grapd Opening X Other Community event Community Hardest Fest 2014 Event Location: Cornerstone Church of San Diego Event Date(s): From 10-31-14 to 10-31-14 Actual Event Hours: 5 PM am/pm to 8 PM am/pm Total Anticipated Attendance: 600 (50 Participants 550 Spectators) Setup/assembly/construction Date: 10-31-14 Start time: 3 PM Please describe the scope of your setup/assembly work (specific details): Set up 12' x 16' stage with amplified sound and light towers. Set up inflatable obstacle course. rock climbing wall, booth games, and food booths. Dismantle Date: 10-31-14 Completion Time: 11 PM am/pm 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. N/A Sponsoring Organization: Cornerstone Church of San Diego Chief Officer of Organization (Name) Sergio De La Mora Applicant (Name): Harvey Warren "Jay" Address: 1914 Sweet Water Rd., National City CA 91950 Daytime Phone: (619) 425-9333 Evening Phone: (619) 246-0354 Fax: (619) 425-8271 E-Mail: jayshav2288@gmail.com Contact Person "on site" day of the event: Harvey Warren "Jay" Cellular: (619) 246-0354 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? x YES _ NO Are admission, entry, vend or participant fees required? _ YES x NO If YES, please explain the purpose and provide amount(s): $ N/A Estimated Gross Receipts including ticket, product and sponsorship sales from this event. $ N/A Estimated Expenses for this event. $ N/A 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. We will have live amplified music on a portable stage during the event. Tower lights to provide extra lighting. Inflatable obstacle course, rock climbing wall, mini train ride, booth games, booth food, and mechanical bull ride. _ 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 X NO Does the event involve the sale or use of alcoholic beverages? X YES NO Will items or services be sold at the event? If yes, please describe: _ 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 YES _ 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 4 Sizes 10 x 10 NOTE: A separate Fire Department permit is required for tents or canopies. .YES a< 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 x ELECTRIC x 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: Trash containers with lids: Describe your plan for clean-up and removal of waste and garbage during and after the event: Please describe your procedures for both Crowd Control and Internal Security: Cornerstone security and Cornerstone Traffic Control YES x NO Have you hired any Professional Security organization to handle security arrangements for this event? If YES, please list: Security Organization: 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: Portable light towers and existing property lighting Please indicate what arrangement you have made for providing First Aid Staffing and Equipment. One First Aid station manned by qualified church personnel Please describe your Accessibility Plan for access at your event by individuals with disabilities: The venue has ADA access throughout (ramps, striped walkways etc.) Please provide a detailed description of your PARKING plan: Property is on commercial shopping center with plenty of common parking Please describe your plan for DISABLED PARKING: Parking lot has ADA parking and access available. Please describe your plans to notify all residents, businesses and churches impacted by the event: Flyers and City Council public meeting. NOTE: Neighborhood residents must be notified 72 hours in advance when events are scheduled in the City parks. 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: 1 Type of Music: Contemporary Christian x YES _ NO Will sound amplification be used? If YES, please indicate: Start time: 5 PM am/pm Finish Time 10 PM am/pm 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: YES X NO Fireworks, rockets, or other pyrotechnics? If YES, please describe: X YES _ NO Any signs, banners, decorations, special lighting? If YES, please describe: Banners and food signage 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 Cornerstone Church of San Diego Person in Charge of Activity Jay Warren Address 1914 Sweet Water Rd. National City, CA 91950 Telephone (619) 246-0354 Date(s) of Use 10-31-2014 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 Fqf Offrce/tlse On/ Ce`rfificate of Insurance Approved Date winlialli A`� o CERTIFICATE OF LIABILITY INSURANCE Dii8i oDl4 THIS CERTIFIC/LTE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE C OES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS :ERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION 1S WAIVED, subject to the terms and Cllnditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Michael EhrElnfeld Company 2655 Camino Del Rio North # 2 00 San Diego CA 92108 CONT NAMEACT Nick Marovich (NEo. Fxf): ( ) PA/HC. NO619 683-9990 FAX (AA:. No): () 619 683-9999 ADDR%MAIESS: nickm@ehrenfeldinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Liberty Surplus Ins. Corp. 10725 INSURED Party Pals, General Partnership Juegos y Ma:, Inc., Party Pals, Inc 10427 Roselle Street San Diego CA 92121 INSURERS Nationwide Mutual Insurance 23787 INSURERC: INSURERD: INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER:CL1471847077 THIS IS TO CERT FY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAX BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL X LIABILI TY COMMERCIP L GENERAL LIABILITY 100001072406 7/15/2014 7/15/2015 EACH OCCURRENCE $ 1, 000, 000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 50,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L X AGGREGA "E LIMIT APPLIES POLICY I PST PER: LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE X LIA BILITY ANY AUTO ALL OWNED SCHEDULED ACP7815282020 12/16/2013 12/16/2014 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA I.IAB EXCESS LIA', 3 O OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED ETENT ON $ $ WORKERS COMP ENSATION AND EMPLOYER:' LIABIL TY ANY PROPRIETOF /PARTNER/EXECUTIVE OFFICER/MEMBEF EXCLUDED? (Mandatory in NH; If yes, describe unc er DESCRIPTION OF OPERATIONS below Y/ N N/A WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HC LDER Proof of Insurance 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 Jamie Reid/NICKM ACORD 25 (2010/ )5) INSn95 onlnns nt ©1988-2010 ACORD CORPORATION. All rights reserved. Tho Amon name anr1 Innn arc rcnicfercrl mark* of ACr1Rn 4 T UE DOCUCHECK ' NfA4T4RryM-rAM43 i$1131-4FISQijS NESS LICENSE CERTIFICATE NTTO CITY ORDINANCE THIS LICENSE IS HERE BUS DESCRIPTION CHURCH CAFE BUSINESS ADDRt a ., ,4 GWEETWATE BUSINESS NAME ATTN: MAIUNG ADDRESS THIS D CORNERS T ON E cHU Rf a . CORNERSTONE Ca, 1944`SWEETWATER RD !: ATtO'NAL CITY; CA 91950-7638 POST* A CI C.* =1'4;00 0,3 =.1.; GU . T IS ALTERATION PROTECTED AND' REFt C i 'FIBERS UNDER UV LIGHT RMARK AND VISIBLE FIBERS DISCERNIBLE FROM BOTH SIDES 63679 CITY OF NATIONAL CI'"( BUSINESS LICENSE CERTIFICATE PURSUANT TO CITY 01 Vl.k I I"NIS LICENSE iS HEREBY l;4#'4 to f [[ i u 1 E1,14 i3 :=L:i1POSE STATF-0 BUS DESCRIPTION i BUSINESS ADDREE s 1920 SWEETWATER BUSINESS NAME ATTN: MAIUNG ADDRESS _E CORNERSTONE CHURCH 1914 SWEETWATER RD T .'N.AL CITY, CA 91950.162R POST IN A C `4 If ,;` t ,ut L. • KEEP FOR YOUR RECORDS BUSINESS TAX RECEIPT License No. 65549 TOTAL 1 KEEP FOR YOUR RECORDS BUSINESS TAX RECEIPT License No. 63679 TOTAL i CAROLB THIS BINDER 15 A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN COMPANY DATE(MMIDDA.yyY) ON THE AGENCY 7/10/2014 OF THIS FORM. 201 Cajon Street ChurchWest Insurance Services (ACG) Redlands, CA 92:73 Brotherhood Mutual Ins. Co. INSURANCE BINDER AM, No, Ext): (800) B43-6054 No : (009) 307-1245 CUSTOMER ID: COR VCH U-03 INSURED SUB CODE: License # 860285 Cc merstone Church of San Diego 19' 4 Sweetwater Rd Na:ional City, CA 91950 COVERAGES TYPE OF INSI TRANCE PROPERTY CAUSES OF LOSS BASIC BF GOAD GENERAL LIABILITY X X SPEC COMMERCIAL GE JERAL LIABILITY CLAIMS MADE X OCCUR VEHICLE LIABILITY ANY AUTO ALL OWNED AUTO; , SCHEDULED AUTO HIRED AUTOS NON -OWNED AUTC 3 VEHICLE PHYSICAL DAP AGE COLLISION: OTHER THAN COL: GARAGE LIABILITY ANY AUTO DED Total Property Values RETRO DATE FOR CLAIMS MADE: COVERAGFJFORMS Date EFFECTIVE Time X AM 7/5/2014 12:01 AM PM 8/4/2014 THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANY PER EXPIRING POLICY #: DESCRIPTION OF OPERATIONSIEHICLESIPROPERTY (Including Location) Expiration DEDUCTIBLE 1,000 BINDER 329 Date LIMITS COINS % 100 X Tine 1201 AM NOON AMOUNT $11,011,000 EACH OCCURRENCE $ 1,000,000 RENTED PREMISES $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000 000 GENERAL AGGREGATE $ 5,000 000 PRODUCTS - COMP/Op AGG $ 5,000,000 COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ MEDICAL PAYMENTS $ PERSONAL INJURY PROT $ UNINSURED MOTORIST $ ALL VEHICLES SCHEDULED VEHICLES ACTUAL CASH VALUE STATED AMOUNT EXCESS LIABILITY x UMBRELLA FORM OTHER THAN UMBF ELLA FORM WORKER'S CON PENSATION and EMPLOYER'S _IABILITY SPECIAL CONDmONS 1 OTHER COVERAGES Name & Address RETRO DATE FOR CLAIMS MADE: MORTGAGEE LOSS PAYEE AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY EACH ACCIDENT $ AGGREGATE $ EACH OCCURRENCE $ AGGREGATE $ SELF -INSURED RETENTION WC STATUTORY LIMITS 1,000,000 1,000,000 E.L. EACH ACCIDENT $ E L DISFASE - EA EMPLOYEE $ E L DISEASE - POLICY LIMIT $ FEES TAXES ESTIMATED TOTAL PREMIUM $ ADDITIONAL INSURED LOAN # AUTHORIZED REPRESENTATIVE l ,e 1 _. ACORD 75 (2010134) Page 1 of 2 @ 1993-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CONDITIONS Thie Company binds the kind(s) of insurance stipulated on the reverse side. The Insurance is subject to the terms, conditions and limitations of the policy(ies) in current use by the Company. This binder may be cancelled by the Insured by surrender of this binder or by written notice to the Company stating whe-i cancellation will be effective. This binder may be cancelled by the Company by notice to the Insured in accordance with the policy conditions. This binder is cancelled when replaced by a policy. If this binder is not replaced Corr pany. by a policy, the Company is entitled to charge a premium for the binder according to the Rules and Rates in use by the CORNCHU-03 CAROLB APPLICABLE IN CALIFORNIA When this form is used to provide insurance in the amount of one million dollars ($1,000,000) or more, the title of th13 form is changed from "Insurance Binder" to "Cover Note". APPLICABLE IN COLORADO With respect to binders issued to renters of residential premises, home owners, condo unit owners and mobile home owners, the insurer has thirty (30) business days, commencing from the effective date of coverage, to evaluate the issue ince of the insurance policy. Applicable in Delaware The mortgagee or Obligee of any mortgage or other instrument given for the purpose of creating a lien on real prop.3rty shall accept as evidence of insurance a written binder issued by an authorized insurer or its agent if the binder includes or is accompanied by: the name and address of the borrower; the name and address of the lender as loss payee; a description of the insured real property; a provision that the binder may not be canceled within the term of the binder unless the lender and the insured borrower receive written notice of the cancellation at least ten (10) days prior to the cancellation; except in the case of a renewal of a policy subsequent to the closing of the loan, a paid receipt of the full amount of the applicable premium, and the amount of insurance coverage. Chapter 21 Title 25 Paragraph 2119 APPLICABLE IN FLORIDA Exceat for Auto Insurance coverage, no notice of cancellation or nonrenewal of a binder is required unless the duration of the binder exceeds 60 days. For auto insurance, the insurer must give 5 days prior notice, unless the b rider is replaced by a policy or another binder in the same company. APPLICABLE IN MARYLAND The nsurer has 45 business days, commencing from the effective date of coverage to confirm eligibility for coverage uncle- the insurance policy. Applicable in Michigan The ;policy may be cancelled at any time at the request of the insured. APPLICABLE IN NEVADA Any person who refuses to accept a binder which provides coverage of less than $1,000,000.00 when proof is required: (A) Shall be fined not more than $500.00, and (B) is liable to the party presenting the binder as proof of in: urance for actual damages sustained therefrom. Applicable in the Virgin Islands This binder is effective for only ninety (90) days. Within thirty (30) days of receipt of this binder, you should request an insurance policy or certificate (if applicable) from your agent and/or insurance company. ACORD 75 (2010 04) Page 2 of 2