The URL can be used to link to this page

Home My WebLink AboutHLP2015-3891October 22, 2015 The attached application is for a Helicopter Lift Request. Please sign the attached memo and forward packet to the City Manager's Office, Once City Manager has signed please return to Connie Cook, Development Services. Melanie Hill, Risk Manager Bruno Rumbelow, City Manager Thank you, Connie Cook Development Services (817) 410 -3158 NO HELICOPTER LIFT PERMIT TO BE ISSUED UNTIL FAA APPROVAL HAS BEEN RECEIVED MEMORANDUM CITY OF GRAPEVINE, TEXAS TO: BRUNO RUMBELOW, CITY MANAGER MELANIE HILL, RISK MANAGER FROM: SCOTT WILLIAMS, DEVELOPMENT SERVICES DIRECTOR / BUILDING OFFICIAL SUBJECT: HELICOPTER LIFT REQUEST DATE: OCTOBER 22, 2015 Attached is a request for a helicopter lift are scheduled for October 29, 2015 at 7:00 A.M., with a rain date of October 30, 2015 at 7:00 A.M., for 3000 Grapevine Mills Parkway #613, if it meets your approval, please sign below: G Hill, Risk Manager O:ACCook \HelicopterMcmorandum HOLD HARMLESS AND INDEMNITY AGREEMENT PROJECT ADDRESS: Grapevine Mills Mall Suite #163, Round One Entertainment Grapevine, texas 75235 NATURE OF OPERATION: Air lifting air conditioning units DATE OF OPERATION: 10 -29 -2015 with rain date of 10 -30 -2015 I, Linda Norman , the undersigned, representing 5 -State Helicopters, Inc., binding my heirs, executors, administrators, administrators, estate and assigns, do hereby agree to completely and wholly release, indemnify the hold harmless the city of Grapevine, its officers, agents, Independent contractors, and employees from any and all claims, damages, Harm personal injury, including death, property damage, lawsuits and judgments, including court costs, expenses and reasonable attorney's fees, and all other expenses resulting from any and all activities conducted within the city of Grapevine, Texas. It is the understanding of all parties that this release, indemnity, and hold harmless agreement shall apply whether or not the claims, damages, harm, personal injury, including deaths, property damage, lawsuits, judgments, court costs, attorney's fees and any other expenses arise from the negligence of whatever nature, omissions, willful and intentional acts of this individual, company or company's officers, agents, employees, independent contractors, other representatives, invitee, licensee, or guests. I the undersigned individual and/or company or company's officer certifies, warrants and represents that the individual whose signature appears below is duly authorized to execute this agreement on behalf of the firms, corporation partnership or other entity who will operate within the city of Grapevine, Texas. In witness whereof, this agreement has been executed this day and (month) be 2015 COMPANY: 5 -STATE HELICOPTERS, INC. BY: LINDA NORMAN (printed) q grin TITLE: OWNER (signature) STATE OF ,,, g COUNTY OFJ9&6.1— This instrument was acknowledged before me on this the 2 z. Day of 2015 NOTARY PUBLIC IN AND FOR THE STATE OF Tom,; w 5 My commissign expires signature LINbr\ NIAE YAUGNT My CMiwNStion EiW " May 6.2017 .•Y.l•i Caledonian Insurainw tiiroup,Ine. CerdficateofIngdrance Certifinse Number. This is in certify 001 the poky ") anmummot as described below have bom Issued In the Insured for whom this Certificate is executed and Wide in toms atihis time. This Cerafinte b Issued lmwmfomemon only and confers no nghb upon the holder. This Cenlficare utithe, sRrm "ly nor negatively amends, extends oralten the coverage afforded by such policy(in) or b:ndon0 stated herein. This ocrufxeta cancels end supersedes all previously issued anifiaka. Certificate Holder: CiryofGrapaivinc PO Box 95104 Grapevine, TX 76051 Named Insured: 5 - State Helicoptem, Inc. 285 Blackland Road Royale City, TX 75189 -4746 Policy Typr. Aircraft Hull & Liability and Aviation General Liability Policy Policy Period: February 01, 2015 to February ry 01, 2016 both days at 12:01am Local Standard Time at the address of the Naimoli insured shown above. Insurer(s): Company Po0cy NO(s). StarNct Insurance Company through Berkley Aviation, LLC Aircraft Covered: Sikorsky S58T, N4XY; Sikorsky S58T, 746BL Coverages & Lim[ts Aircraft Liability Coverage Limit Combined Single Limit Bodily Injury, including Personal Injury an ru d Property 510,000,000 each occr mcc as respects Sikorsky S-58BT and Sikorsky S -58ET Damage Liability(Excluding Passenger Liability) type aircraft Cargo Leo Wabli ty Cargo Legal Liability including Slung Loads Coverage Lindt $500,000 ach occurrence, subject m a deductible of 52,000 each claim. Certificate Provisions Additional Imulmd It is agrted that the Certificate, Holder is included as an Additional Insured under the Aucaft Liability Coverages, but only m the extent of liability vicariously imposed upon the Certificate Hold" solely as the result often sat or omission of the Named Insured or its employees in connection with the Named Insured's Aircraft opcmtions, subject to all policy terms, conditions arM "elusions. Certificate Date: 11222015 N�,z Avthongcd Ruprescntative 3023 80th Avenue SE,, Seim 300 Mailing Address: P.O. Box 60, Mercer Island, Washington 98040.0060 Phone: (206) 232-9870 - Fox: (206) 232-95 15 5- STATE HELICOPTERS INC. "AERIAL CRANE SERVICE" 285 BLACKLAND ROAD ROYSE CITY, TEXAS 75189 972 - 636 -4009 800 -543 -8442 FAX 972 - 636 -1300 FAA CERT. LDUL599B PROCEDURES REQUEST PER 8900.1 CHG. 89 DATE: 10 -22 -2015 5 -STATE HELICOPTERS, INC. 285 Blackland Rd. Royse City, Texas 75189 972 -636 -4009 800 -543 -8442 972 -636 -1300 FAX CONTRACTOR: Quality 1 Energy Systems 10870 Plano Rd. Dallas, Texas 75238 JOB SITE: Grapevine Mills Mall 3000 Grapevine Mills Pkwy Suite 163 Round One Entertainment Grapevine, Texas 76051 HEIGHT OF BUILDING: 40 Ft. TOTAL OF LIFTS: I I rtu's off 1500 Ibs 7 fans 700 lbs off DATE OF LIFTS: 10 -29 -2015 with rain date of 10 -30 -2015 Time: approximately 7:00 am Congested Area Plan If a problem or safety hazard exsists the ground persons/crew with radios will notify the pilot to move the helicopter to a safe area N6BL or N4XY SIKORSKY S -58T STANDARD CATEGORY PILOT: Bradford S. Ladue Comm. Cert.. 2760587 PILOT: Scott Bradford Ladue Comm. Cert. 3250744 Length of the cables estimated 75 Ft. CONTACTED: City of Grapevine Scott Williams (Connie Cook) 817410 -3158 Police and Fire Dispatch: Supervisor Karen Ballard 817410-8127 DFW AIRPORT: FAA � SIGNATURE OF RESPONSIBLE COMPANY OFFICIAL 5 -STATE HELICOPTERS, INC. 285 BLACKLAND ROAD ROYSE CITY, TEXAS 75189 972- 6364009 800- LIFT -442 FAX 972 - 636 -1300 FAA CERTIFICATE # LDUL -599B DATE: 10 -22 -2015 CONGESTED AREA PLAN - EXTERNAL LOAD LIFT TO: FAA OFFICE: NORTH TEXAS FSDO 214- 277 -8500 214 - 277 -8570 fax JOB SITE Grapevine Mills Mall 3000 Grapevine Mills Pkwy Suite 163 Round One Entertainment Grapevine, Texas 76051 SCHEDULED DATE AND TIME OF OPERATION: 10 -29 -2015 with rain date of 10 -30 -2015 approx. 7:00 am CONTRACTOR: Quality 1 Energy Systems 10870 Plano Rd. Dallas, Texas 75238 CONTACT PERSON: Mohammad Gharbieh 469 -831 -6315 cell AIRCRAFT: S -58T N -6BL OR N4XY STANDARD CATEGORY PILOT: BRADFORD S. LADUE COMM CERT. # 2760587 SCOTT BRADFORD LADUE COMM. CERT. #3250744 LOADS: NUMBER 11 rtu's off 1500 Ibs 7 fans 700 lbs off CARRYING HAZARDOUS MATERIAL: no DESCRIPTION: TYPE WEIGHTS CONTACTS: City of Grapevine Scott Williams (Connie Cook) 817410 -3158 Police and Fire Dispatch: Supervisor Karen Ballard 817-410-8127 DFW AIRPORT: FAA 165 SIGNATURE F RESPONSIBLE COMPANY OFFICIAL NARRATIVE OF PLAN OF OPERATIONS: 5 -STATE HELICOPTERS, INC. Congested Area Plan Job Site: Grapevine Mills Mall 3000 Grapevine Mills Pkwy Suite 163 Round One Entertainment Grapevine, Texas 76051 DATE OF JOB: 10 -29 -2015 with rain date of 10-30 -2015 END OF JOB: 10 -29 -2015 with rain date of 10 -30 -2015 ENCLOSED ON SKETCH ATTACHED TO THIS REQUEST Flight path from the staging area to where the equipment is placed on the building will be cleared of unauthorized persons. Estimated of how many floors of the building will be penetrated if the load is released at the maximum height when lifted above the roof is none. But for safety reasons the area of the building being lifted over will be vacant. Estimated Length of cable in feet: Approximately 75 feet. Emergency landing area: Unless otherwise noted on the plot plan, the helicopter landing area and pick up site will be the emergency landing area. Additional Information: This is a exsisting Mall. The section of the Mall being lifted over will be vacant during the lifting of equipment. No unauthorized persons will be allowed into the operational area of the job site during the lifting of the equipment to the roof. The parking lot on the west side of the building will be used for landing, staging, and emergency area. Helicopter landing area will be secured before the helicopter arrives and will remain secured until the helicopter has left the area. Contractor and superintendent of the job site will close the operation area so no unauthorized persons will be allowed into the parking lot during the lift. The path between the staging area and where the units will be placed on the roof will be clear. No unauthorized persons will be allowed in the lifting area. Safety briefings that are given by 5 State Helicopters crew will be given before the lifting begins. The operational area will be surveyed by 5 State Helicopters crew for any safety hazards before the lifting of the equipment begins. If any safety hazards exist the contractor will be required to eliminate the hazard before the lifting of equipment begins. 5 State Helicopters crew has radio's and will taking with the pilot at all times during the lifting process. If for any reason there should be a safety factor arise they will immediately alert the pilot. The pilot will move the helicopter to a safe area until the risk has been corrected. Lifting area could be anywhere inside the operational area due to the contractor and or superintendent moving the equipment before the helicopter arrives. Flight path will be within operational area. I,& t C,ut,•.-- SIGNATURE OF RESPONSIBLE COMPANY OFFICIAL 10/22/2015 14:00 $726361300 PAGE 5 -STATE HELICOPTERS, INC. Congested Area Plan JOB SITE: Grapevine Mills Mall 3000 Grapevine Mills Pkwy Suite 163 Round One Eutwainment Grapevine, Texas 76051 5 STATE HELICOPTERS DATE OF JOB: 10 -29 -2015 with rain data of 10- 30.2015 TIME: approximately 7:00 am There are power lines and light poles in the area but, will not cause a safety hazard to the lift- TODAY'S DATE: 1022 -2015 PAGE 05!10 Should a weather, mechanical or material delay be experienced this CAP is approved for the date and time lifted above plus 10 days, FAA: NORTH TEXAS FSDO • ifs ,:. �.,, :C�Ri FAA SIAM APPROVED �NTX 9D 4 DATE :, ro - 23.2011 THIS COMPANY COMPLIES WITH THE "CODE OF ETHICS: OF THE HELICOPTER ASSOCIATION OF AMERICA.. LA d 00£L9£92L6 « USSLL2hL2 00v XIN VVJ 6£ 26 £2- 06-5602 5 STATE HELICOPTERS, INC GRAPEVINE MILL MALL SUITE 163 ROUND ONE ENTERTAINMENT i 3000 GRAPEVINE MILLS PKWY GRAPEVINE, TEXAS 76051 DATE: 10-29 -2015 WITH RAIN DATE OF 10-30 -2015 TIME: APPROX. 7:00 AM cr Lake Park L 26 rOPPE RD m U N320 58.017 12i W97° 02.497' SANDY LAM F W 3 +T liar Worth am HELICOPTER WILL NOT BE MORE THAN 125 FT, ABOVE A 40 FT. MALL WHEN All LIFTING EQUIPMENT TO THE ROOF: PILOT WILL BE IN CONTACT WITH DFW CONTROL TOWER I \ .. Y North Lake L r =: �r i z i t 7 A it, 0 2001 11ZLI . AL Mau 13.00 .. Thu Oct 22 10:54 2015 —Local Road Small Town Scale 1:62,500 (at center) — Trall — Airfield 1 Miles C lnterstate/Umtted Access Park/Reservation 2 km Major Connector d Service Airport State Route Locale Exit County Boundary Railroad Water Point of Interest RiverlCanal e i t 1� s i� e� a r �c � Z CC OF 5 C SV E MTV v p c 0 n id d r to o b x � �o E iy f 3