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Home My WebLink AboutTUP2013-1469rax Rpr 3 Z013 05:51pm P002 CITY OF GRAPEVINE. TEMPORARY USE & PUBLIC ENTERTAINMENT. — -- -- -- PERMIT APPLICATION .SEC. 15 -9. The application for the permit shall be filed not less than thirty (30) days before the first performance and shall contain the following information. 1. Applicant Name a for Regio.nal, Medical Center at Grajoevine Address 1650 West College Street 76051 Phone no. 817. 129.2542 fax no. 817. 481.2962 2. Property owner Name Bailor Regional Medical Center at Grapevine Address 1650 West Cole a Street, 76051 Phone no. 817.329.2542 fax no. 817.4 962 3. Address of temporary use or entertainment 16 60 st College Street 76051 4.' Date or dates of proposed entertainment 5/17/2013 to 5/17/2013 5. Kind or type of entertainment Outdoor meal for staff 6, Total number of off- street or highway parking space &L-rAov— A.=:::t2.2 7. Total capacity per capita of facility to be used for entertainment 8. Number of restrooms available within facility 9. Time and hours of temporary use 10:30 a.m. — 2:30 p.m. 10. Number of outdoor speakers Agne CITY OF GRAPEVINE, DEVELOPMENT SERVICES,P 0 SOX 95104. GRAPEVi NE .TEXAS.78099.(817)r10- 3154.FAX (817)410.3018 O:V=Formslapp.temp Use public ent.doc 2' rax rwr o cuia UU.Jrynr ruuoiuic A 0 use on property I own at Owner (print) Owner signature The State of j-�"°" County Of Before Me t _hereby. authorize.. request a temporary on this day personally appeared (property owner) known tome (or proved to me on the oath of card Al other document) to be the.- person whose name is subscri bed to th °e. .foregoing instrument and a knowledged to me that he executed the same for the purposes and consideration therein expressed. (Seal) Given under my hand and seal of office this &4Z day of A.D. 691.3 JONI M 01LENESS My Commission Expires Notary Si0hature December 5.2016 FOR OFFICIAL USE pN CITY MANAGER RISK MANAGER OK D IVELOPM6NT SERVICES( OIR FIRE POLICE HEALTH 1 CITY OF GRAPEVINE. DEVELOPMENT SERVICES.P 0 BOX 95104.GRAPEVINE. 5. 76499 .(847)410- 3154,FAX (817110 -3018' O:\70UTorm3\app.temp use public ent.doc i 6BAYLOR T Regional Medical Center at Grapevine VIA FAX — 817.410.3018 City of Grapevine Development Services PO Box 95104 Grapevine, TX 76099 Re: Permit Requested May 17, 2013 rax IAN IAN April 3, 2013 mpr J zuij Un:z)ipm ruui 16W West cQuese GmPe- inc,Te=s 76051 (Si7) 4si -15ss w" We will be hosting an employee event on May 17, 2013. The event is an all staff luncheon that will be served to staff from 10:30 a.m. — 2:30 p.m, on the 2n0 floor of one of our parking garages. Please let me know if you need additional information. Sincerely, Joni O'Bleness Special Projects Coordinator Administration Attachments O..(oo7 c 0 o" s c�� + 0 (D A :,, C 0 a) E t eu%Aodw It mo . IWTok d rum, mV Sri E V ru Iax Apr 3 2013 05;58pm P010/012 Te 51 AP UNN RojP91 40 Eli 9-1 Nv FE 0 _gyp 51 AP Fax Apr 3 2013 05:57pm POOd/012 d CERTIFICATE OF LIABILITY• INSURANCE °" WA 0`13 ' THIS CERTIFICATE IS ISSUED AS A NATTER 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. THIS CERTIFICATE OF' INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOR12Eb . REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certifcate holder Is an A00177ONAL INSURED, the poRcy(iss) must be endorsed. If SUBROGATION 18 WAIVED, eubject.to the• terms and conditiena of the policy, certain policies rosy require an endorsemerrL'A atallemant on this certificate does not eonfer rights to the certMkato holder in lieu of such endoreauwn a , PRO aD ACr Teresa elles ALLUWT INSURANCE SERVICES, INC Prestonwood Tower $151 Belt Line Rd., Suits 606 Dallas, TX 75254 -1460 TYPEOV INWIRANCE A 972-111110-11860 PNC 972 -9 7196 Eft. A/c No � � tglbe�alaallYnsurancs -corn PROD11cs1 VkN7OMER 0It INOMM IN3U S ArPORDSgcgY9FMGE NA1CR Baylor Health Caro System MUP" a Cohxnbia Casualty Company Baylor Regional- Medical Center at Grapevine 4005 Crutcher, Suite 300 INSURER C; Dallas, Texas 76246 INSURBRD. 0/fiURQR E: INWRPA F: - COMMERCIAL GENERAL LIABILITY DAMAGE TORENTRO .a�s.alVi7 P�ValOCf4 THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD. INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDMON OF ANY CONTRACT Oft OTHER DOCUMENT WITH RESPECT TO ViMH THIS CERTIFICATE. MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED By THE POLICIES DESCifMO HEREIN IS SUBJECT TO ALL THE TERM$, . EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ' INSR LTR TYPEOV INWIRANCE ADOL W ER PO,fCY EPF POLICY EXP . LoOTe GENERAL FACHOOOLMRENC'E S„ 7,000,004 COMMERCIAL GENERAL LIABILITY DAMAGE TORENTRO PREMISES (Ea 000unenQ) $ 100,000. CLAMaS -MADE X I OCCUR MED EXP {Any onq p0lapn S S OOO A X X 7012W2011 7HlZOt3 PFASONALLAwINJURY S 1,000,000• 2ENERALAGGRE0ATz $ 3,00,000 GEN'L AGGREGATE LIMIT APPLIESPER: PRODVCTS/CO4P/0PAGO $ 3,000,000, POLICY PROJECT LOC Z nUroM06Y.E WUULM COMBINED SINGLE LIMIT Me actide(A ANY AUTO BODILY INJURY (Per $ .. ALL OWNED AVr08 BODILY INJURY (Por Am S SCHEDULED AUTOS PROPERTY DAMAGE (Per °CO $ , HIREDAUTOS $ NON.OWNEDAUTOS $ CdAFA1315 EFERS _i3J4_ySJCAJ- DAMAGE E $ • UPMEU.A SCHEDULED LOCATf � B OCCUR EACH OCCURRENCE : EXCESSLIMM CLAIMSAIADE AGGREGATE $ DEDUCTIBLE S a RETEP -MON f $ worotERS OOAI-ENgAT1ON ARD STATII . ErI;oYERe'I,IApILrtY YM ORY LfMiTT3 R .. ANY P.ROPRfETON PARTNEREXECUTNE IC RnAEMBER EXCLUDED? E.L. EACH AOCgEhR' WA IA NH IlY°o- 008CADe under DESCR rION OP OPERATIONS below EL D1615ASE - EA EMPLOYEE E.L DISEASE. POCV LI"Ilr L.I DMCPJPTION OF OPERATIONS I LOCATIONS / VEMLES IA WO ADORD 161, Add W&"' RemxMe SOIIW WR¢ N MIS rpgp is mgldmdl Re: Special Event - HDapiial Week - Friday, May 17' - 2nd Floor, Northern And of Parking Garage .ERTIFICATI; HOLDER City of Grapevine P.O. Box 95104 Grapevine; TX 76099 CANCELLATION BMOULD ANY OF ABOVE DESCRIBED POLICIES BE CANCELLED DUO" THE EXPIRATION . DATE THEREOF, ,NOTICE WILL BE DELIVERED IN 01liY2000ACORD CORPOMTION: NI rfgla0 Rdelrad ACORD 29 (2010)") The ACORD m Ana "0 APr 0401011" eImIft- f ACDRD .. rax ro+r i cuii uo.urpm ruuo /u t[ OVA BLANKET AbDITIONAL INSURED ENDORSEMENT HEALTHCARE OACILITIES GENERAL LIABILITY COVERAGE This endorsement modifies insurance provided under: Commercial General Liability Coverage Form Occurrence G- 145567 -A Commercial General Liability Coverage Form Claims -Made G- 145S66 -A Healthcare Liability Policy Common Conditions (G- 144102 -A) A. SECTION 11 —WHO 13. AN INSURED of the Commercial General Liability Coverage Form is amended to include as an "Additional Insured" anyone whom you are required to add as an additional insured on this policy under a written contract or agreement or an oral contract or agreement where a certificate of insurance showing that person or organization as an . additional insured has been issued; but the written or oral contract or agreement must be: 1. currently in effect or becoming effective during the term of this policy; or 2. executed prior to the "bodily injury," "property damage" or "personal injury and advertising injury." B. SECTION V — DEFINITIONS is amended to add the following new definition: Additional Insured" means: 1. A state or political subdivision subject to the following provisions: (1) This insurance applies only with respect to the following hazards. for which the state or political subdivision has issued a permit in connection with premises you own, rent, or control and to which this insurance applies: (a) The existence, maintenance, repair, Construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk vaults, street banners, , or decorations and similar exposures; or (b) The construction, erection, or removal of elevators, or (c) The ownership, maintenance, or use of any elevators. covered. by this insurance. (2) This insurance applies only with respect to operations performed by, you or on your behalf for which the state or political subdivision has issued a permit. This insurance does not apply to "bodily injury," "property damage' or `personal and advertising injury' arising out of operations performed for the state or municipality. 2. Any persons or organizations with a controlling interest in you but only with respect to their liability arising out of, (1) Their financial control of you; or (2) Premises they own, maintain or control while you lease or occupy these premises. GSL648,4XX (6 -10) Policy No: HML 4031907827 -0 Page 1 Endorsement No,' 6 Columbia Casualty Company Effective.Date' 10/29/2011 Insured Name: Baylor Health Care System C�CNA NI Rlghts Reserved. Fax Apr 3 2013 05:57pm P006/012 This insurance does not apply to structural alterations, new construction and demolition operations performed by or for such "additional insured 3. A manager or lessor of premises but only with respect to liability arising out of the ownership, maintenance or use of that specific part of the premises leased to you and subject to the following additional exclusions: This insurance does not apply to: (1) Any "occurrence" which takes place after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such "additional insured ". 4. A mortgagee, assignee or receiver but only with respect to their liability as mortgagee, assignee, or receiver and arising out of the ownership, maintenance, or use of a premises by you. This insurance does not apply to structural alterations, new construction or demolition operations performed by or for such "additional insured ". 5. An owner or other interest from whom land has been leased by you but only with respect to liability arising out of the ownership, maintenance or use of that specific part of the land leased to you and subject to the following additional exclusions: This insurance does not apply to: (1) Any "occurrence" which takes place after you cease to lease that land; or (2) Structural alterations, now construction or demolition operations performed ' by or on behalf of such `additional insured ". 8. A co -owner of a premises co- owned by you and covered under this insurance but only with respect to the co- owners liability as co -owner of such premises. 7. Any person or organization from whom you lease equipment, Such person or organization are insureds only with respect to their liability arising out of. the maintenance, operation or use by you of equipment leased to you by such person or " organization, A person's or organization's status as an insured under this endorsement ends when .their contract or agreement with you for such leased equipment ends. With respect to the insurance afforded these "additional insureds ", the following additional exclusions apply: This insurance does not apply: (1) To any "occurrence" which takes place after the equipment lease expires; or (2) To "bodily injury" or "property damage` arising out of the sole negligence of such "additional insured ". Any insurance provided to an "additional insured" designated under paragraphs 1. through 7. above does not apply to "bodily injury' or "property damage" included within the 'products - completed operations hazard ". C. As respects the coverage provided under this endorsement, HEALTH CARE LIABILITY POLICY COMMON CONDITIONS, Condition X. Other Insurance or Risk Tmnsfer Arrangements is deleted and replaced with the following: GSL6484XX (6 -10) Policy No:. HML 4031907827 -0 Page 2 Effective Date: 10/29/2011 Columbia Casualty Company Insured Name: Baylor Health Care System 0 CNA M Rights Reserved. Fax npr J LUIJ uD,Dopm ruuriult Other Insurance-Excess insurance This insurance is excess over Any other valid and collectible insurance available to the "additional insured' whether primary, excess, contingent or on any other basis unless a contract or agreement specifically requires that this insurance be either primary or primary and noncontributing. Where required by contract or. agreement, we will consider any other insurance maintained by the "Additional Insured' for injury or damage covered . by this endorsement to be excess and noncontributing with this insurance. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and Is for attachment to the Policy issued by, the designated Insurers, takes effect on the effective date of said Policy at the hour stated 'in said Policy, unless another effective date is shown below, and expires concurrently with said Policy, GSL6484XX (6 -10) Policy No: HML 4031907827 -0 Page 3 Effective Date: 10/29/2011 Columbia Casualty Company Insured Name: Baylor Health Care System 0 CNA Al Rights Reserved. rax Hpr a zuie u5:5bpm ruuulull CrA #A HEALTHCARE FACILITIES BLANKET WAIVER OF RIGHTS OF RECOVERY APPLICABLE TO COMMERCIAL GENERAL LIABILITY COVERAGE FORM It is understood and agreed that in consideration for premium paid, this endorsement amends under the HEALTHCARE LIABILITY POLICY COMMON CONDITIONS (G- 144102 -A). Condition -Xll., Transfer of Rights of Recovery of the HEALTHCARE LIABILITY POLICY COMMON CONDITIONS Is amended by the addition of the following: Notwithstanding any terms of the policy to the contrary, and solely with respect to coverage under the applicable Commercial General Liability Coverage Form (G- 146567 -A or 6- 145566 -A), if any insured for whom we make payment under this policy has agreed in writing, prior to the date of loss, to waive the right to recover such amounts from any person or organization, we shall waive our right to the transfer of such interest from the insured and the right to recover any "damages based thereon provided that any such agreement by the insured is related to or arises from the operation of.the insured's business hereunder. All other temms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. GSL15685XX (4,11) Policy No: HML 4031947827.0 Page 1 Endorsement No: 10 Columbia Casualty Company Effective Date: 10/29/2011 Insured Name: Baylor Health Care System 0 CNA All Rights RAServed. rax npr j Zuis ua:5apm ruuaIu u 333 S. Wabash Ave., Chicago, !L 60604 Date: September 19, 2012 To: Teresa Giles Alliant Insurance Services, Inc. 5151 Belt Line Road, Suite 605 Dallas, TX 75254 From: Administrative Services Re: Baylor Health Care Systern HML 4031907827 -0 10/29/2011 — 10129/2012 Dear Teresa: Enclosed you will find the endorsement(s) as requested: • Healthcare Facilities Blanket Waiver Of Rights Of Recovery Applicable To Comrnercial GL Cov Fort.. (GSL 15685XX ed. 04/0112011) Once you have reviewed the information, please provide the insured with a copy. Please call your underwriter. Karen Pagan, if you have any questions at'972 -499 -4597. Thank you MDS Page 1 of 1 Susan Batte - RE: Temp Use App - Baylor Hospital From: "Renee L. Minnfee" < To: Susan Batte <Sbatte @grapevinetexas.gov> Date: 4/9/2013 4:43 PM Subject: RE: Temp Use App - Baylor Hospital I am okay with this. Renee Minnfee, MPH RS Sanitarian I 1101 S. Main Street, Rm 2300 Fort Worth, TX 76104 Rlminnfee@tarrantcounty.com 817.321.4979 (office) 817.321.4961 (fax) From: Susan Batte [Sbatte @grapevinetexas.gov] Sent: Tuesday, April 09, 2013 10:04 AM To: Craig Reed; Dan Hambrick; Melanie Hill; Randie Frisinger; Ronald Hudson; Tim Hall; Gary Rothbarth; Renee L. Minnfee Subject: Temp Use App - Baylor Hospital please see attached and let me know if you approve file: / /C:\Documents and Settings \sbatte \Local Settings\ Temp\XPgrpwise \51644522GRPVN... 4/9/2013 Page 1 of 1 Susan Batte - Re: Temp Use App - Baylor Hospital From: Ronald Hudson To: Batte, Susan Date: 4/9/2013 10:26 AM Subject: Re: Temp Use App - Baylor Hospital Approve Lt. R. Hudson Grapevine Police Department 817- 410 -3276 >>> Susan Batte 04/09/2013 10:04 AM >>> please see attached and let me know if you approve. file:HC:\Documents and Settings \sbatte \Local Settings \Temp\XPgrpwise \5163ECDCGRPV... 4/9/2013 rax Mr 3 2013 Ob:bfpm P0031012 4 — hereby authorise . request a temporary use on property I own at Owner (print) �,.i�d,`�. Owner signature The State of County Of pro Before Me �s,�, -} (notary) on this day personally appeared (property owner) known tome (or proved to me on the oath of card other document) to be the person whose name is subscribed to• the,. .foregoing instrument and a knowiedged to me that he executed the same for the purposes and consideration therein expressed. (Seat) Given under my hand and seat of office this _ day of A.D. A i t coat to OX mss My Commission EN,063 Notary S attire Decamber 5. 2016 �T I i FOR OFFICIAL USE ONLY CITY MANAGER RISK MANAGER O i ELOPMEWr SERVICES OIR FIRE POLICE I HEALTH CITY OF GRAPEVINE.DEVELOPMENT SERVICE&P 0 WX 95104.GRAPMNE. 76099,(847)41p,9154.FRX(817)49 019' OAZCU1Fortn3UW,temp use public eM.doc •' Page 1 of 1 Susan Batte - Re: Temp Use App - Baylor Hospital From: Craig Reed To: Susan Batte Date: 4/9/2013 1:24 PM Subject: Re: Temp Use App - Baylor Hospital CC: Randie Frisinger Do not block drive access with tables and chairs so that EMS/Fire equipment can get to the top of the parking garage. Craig Reed #749 Captain / Assistant Fire Marshal Grapevine Fire Department 601 Boyd Drive Grapevine, TX. 76051 creed@grapevinetexas.gov 817 - 410 -8100 >>> Susan Batte 4/9/2013 10:04 AM >>> please see attached and let me know if you approve. file:X:\Documents and Settings \sbatte \Local Settings\ Temp\XPgrpwise \51641696GRPVN... 4/9/2013