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Home My WebLink AboutHLP2016-2218June 13, 2016 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 Permit will not be issued until FAAApproval 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: JUNE 13, 2016 Attached is a request for a helicopter lift are scheduled for June 17, 2016 at 12:00 P.M., for 2651 William D. Tate Ave., if it meets your approval, please sign below: iZ Bruno Rumbelow, City Manager a Melanie Hill, Risk 0 ACCook\HelicopterMemomndum HOLD HARMLESS AND INDEMNITY AGREEMENT PROJECT ADDRESS: 5 Star Subaru -Z v5'1 William D Tate, Grapevine, Texas NATURE OF OPERATION: Air Lifting Equipment DATE OF OPERATION: 6 -17 -2016 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) )tAz1- 20 ] 6 COMPANY: 5 -STATE HELICOPTERS, INC. BY: LINDA NORMAN (printed) L,; N( a /V TITLE: OWNER (signature) STATE OF COUNTY OF This instrument was acknowledged before me on this the �_ Day of/% , ,y _ 2016 NOTARY PUBLIC IN AND FOR THE STATE OF rr; `- "` My commission expires .S =G - /Z signature 1J � UNDA MAE VAUGHr MY Commission Eapi,es MaY 6 ?017 a W McGriff, Seibels & Williams, Inc. Certificate of Insurance Certificate No. 60274 Rev. pate: Jan 15, 2016 This is to certify that the policy(ies) of insurance as described below have been is ai d to the Insured for whom this Certificate is executed and is/am in force at this time. This Certificate is issued for information only and confers rto rights upon the holder. This Certificate neither affirmatively nor negatively amends, extends or alters the coverage afforded by such policy(its) or binder(s) stated herein. This certificate cancels and supersedes all previously issued certificates. Certificate Holder: City of Grapevine PO Box 95104 Grapevine, TX 76051 Named Insured: 5 - State Helicopters, Inc. and California Helicopter Airways, Inc. 285 Blackland Road Royse City, TX 75189 -4746 Policy Type: Aircraft Hull & Liability and Aviation General Liability Policy Policy Period: February 01, 2016 to February 01, 2017 both days at 12:0 1am Local Standard Time at the address of the Named Insured shown above Insurer(s): Company Policy No(s). StarNet Insurance Company through Berkley Aviation, LLC BA- 16- 02- 00011/BA -16 -02 -00010 Aircraft Covered: Sikorsky S58T, N4XY; Sikorsky S58T, N6BL versee & Limits Aircraft Liability Coverage Limit Combined Single Limit Bodily Injury, including Personal Injury and S10,000,000 each occurrence as respects Sikorsky S -58BT and Sikorsky Property Derange Liability(Excludiag Passenger Liability) S -58ET type aircraft. Cargo Legal Liability Coverage Limit Cargo Legal Liability including Slung Loads 5500,000 each occurrence, subject to a deductible of 51,000 each claim. Certificate Provisions Additional Insured It is agreed that the Certificate Holder is included as an Additional Insured under the Aircraft Liability Coverages, but only to the extent of liability vicariously imposed upon the Certificate Holder solely as the result of an act or omission of the Named Insured or its employees in connection with the Named Insured's Aircraft operations, subject to all policy terms, conditions and exclusions. Auth rizedRep tativt 3023 80th Avenue S.E., Suite 300 Mailing Address: P.O. Box 60, Mercer Island, Washington 98040-0060 Certificate No: Page I of 1 Phone: (206) 232 -9870 - Fax: (206) 232 -9515 60274 5- STATE IiEl.1C.'OPTERS INC. :AERIAL CRANE. SERVICE- 295 BLACKLAND ROAD ROYSE CITY. TEXAS 75189 971- 636 -4009 800 - 543 -8442 FAX 972 -636 -1300 FAA CERT. I.DUL599B PROCEDURES REQUEST PER 8900.1 CFIG. 89 DATE: 6-13 -3016 Congested Area Plan 5 -STATE IIELIC'OPTERS. INC. 285 Blackland Rd. Royse City. 'I'exas 75189 972 - 636 -4009 800- 543 -8443 973 -636 -1.00 FAX CONTRACTOR: Venture Mechanical 2222 Centun, Circle Irving. Texas 75062 ,1013 SITE: 5 Star Subaru �4.Sf William D Tate (irapc%ine,'fexas 76051 ItEIGHT OF BUILDING: 40 Ft. TOTAL OF LIFTS: 19 riu's - 6 fans, 3 plywood '000 lbs and dorm in weight DATE OF LIFTS: 6 -17 -2016 Time: approximately 12 (noon) If problem or safety hazard exists the ground personti'erew with radios will notify the pilot to mote the helicopter to a safe area N6BL. N4XY. N6VY SIKORSKY S -58T STANDARD CATEGORY PILOT: Bradford S. Ladue Comm. Cert.. 2760587 PILOT: Scott Bradford Ladue Comm. Cen, 3250744 Length of the cables estimated 75 Ft. APPROVEDV1 NTX BY: DATE: 6 �y l6 CONI ACTF,D: Cin ofGtapevine. Texas: Scott Williants(Connie Cook) 817 - 410 -3158 Police and Fire Dispatch: Karat Ballard (Supervisor() OF W: FAA Keith Alexander. Wayne 1- ckenrede. Gio Vatnti Dipierro. (;re--- Juro, Lam, Allen 973 -615 -2650 ` SIGNATURE OF RESPONSIKE• G0,NIPANY OFFICIAL Linda Norman ' IN r 5 -STATE HELICOPTERS. INC. 235 BLAC'KLAND ROAD ROYSE CITY. TEXAS 75139 972- 636 -4009 300 -LIFT -442 FAX 972- 636 -1300 FAA CERTIFICATE'; LDUL -59913 DATE: 6 -13 -2016 TO: FAA OFFICE: C'ONGES "FED AR17A PLAN - EXTERNAL. LOAD LIFT' 214- 277 -9500 JOB SITE 5 Star Subaru ;263 i William D Tate Grapevine. Texas 76051 SCI ILDULED DATE AND TIME OF OPERATION: 6 -17 -2016 approximately 12 (noon) CONTRACTOR: Venture Mechanical 2222 Century Circle Irving, Texas 75062 CONTACT PERSON: Jim Horton 972 - 334 -6340 AIRCRAFT: 5 -58'r N -6BL . N4XY , N6VY STANDARD CATEGORY PILOT: BRADFORD S. LADUE COMM CERT. # 2760537 SCOTT BRADFORD LADLIE COMM. CERT. #3250744 LOADS: NUMBER 19 rut's , 6 fans. 3 plywood 2000 Ibs and down in weight CARRYING HA7..ARDOUS MATERIAL.: no DESCRIPTION: CONTACTS: TYPE WEIGHTS APPROVED NTX W19 BY: DATE: ro l v /` City ot'Grapevine, Texas: Scott Williams (Connie Cook) 317-410-3 158 Police and Fire Dispatch: Karen Ballard (SupervisorU DFW: FAA Keith Alexander, Wayne Eckenrode, Gin Vanni Dipierro, Greg Juro, L.am, Allen 972-615-2650 SIGNA'FLIRE OF R�rONSIOLE COMPANY OFFICIAL Linda Norman ff}1 Jam; NARRATIVE OF PLAN OF OPERATIONS: -STATE HELICOPTERS. INC. Congested Area Plan Job Site: 5 Star Subaru .1651 William D Tate Grapevine. Texas 76051 DATE OI' J013: 6 -17 -2016 END OF JOB: 6 -17 -2016 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 Iloors 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 new construction Building. 'I he Building 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 south 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 oil 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 Stale 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. Plight path will be within operational area. SIUN.ATURE OF RESPONSIBLE COMPANY OFFICIAL Linda Norman APPROVED l� N O W19 BY: DATE: 6 /6 PAGE d 5 -STATF HELICOPTERS. INC. Congested Area Plan JOB SITE :: i Star Subaru .X9William D Tate Grapevine. "Mesas 7601 I DA IT, OF JOB: 6 -17 -2016 TIME: Approximately' 12 (noon) There are power lines and light poles in the area but. will not cause a safety hazard to the lift. TODAY'S DATE: 6 -13 -2016 PLAN PREPARED BY : Linda Nomian 4 Should a weather. mechanical or material delay he experienced this CAP is approsed for the date and time lifted above plus 10 days. "(`with this extension 6 State Helicopters. Inc. will rc- notify all Contacts listed on CAP APPROVED N 19 FAA: NORTII TEXAS FSDO BY: DAT . 6 �y /6 APPROVED BY:_ ljjle -ea/S f-sz FAA STANIP: THIS COMPANY COMPLIES WITH TI IF -'CODE OF ETIIIC'S: OF THE HELICOPTER ASSOCIATION OF AMERICA. USTRIrLi �� / \\�•. _ -_- -_ ' �dl ENASy�S L" > 5 STATE HELICOPTERS, INC. .6 � .2 '5 STAR SL BAR '= "CAPITOL M2 " U2-N5 Rc j a6si l WILLIAM D i -ATE GRAPEVINE. TEXAS r;G fII DATE OF LIFT: HA1E!j� 6- 17-2016 �r„�" j TIME: 12 (NOON) BcnrCrr:k z HI= .LICOPTER WILL NO'F BE MORE THAN 125 FT. ALCOVE A 40 FT. BUILDING WHEN LN AIR LIFTING LQL'IPMENT TO TH E ROOF. t-H :'otvs DA FE: 6 -17 -2016 TIME: APPROX. (1-1 NOON) i I oa ' 20e1 p$.urme SrfW Adzcrl Mag 14.00 Mon Jun 13 15:05 2016 Scale 1:31.250 (at center) 2000 Feet 1000 Meters "USTANG Nir 54.393' A'97` 05.534' 7t" s S'1 EAT E n �n ID 'iTH g � i c Z ARGU.N - _ �- E GLAD n A, 2GT+ LHA.N6NGL yl ESb x.9j I +(+Hr OAK _!� '�,1• :i M1'C4`.47!j0Y TjNEY� CA TEkIJ 9JRY p K G. PR -9 -�� uV.�A JY 3 �� AGO NIRTH E4ERGENLr � i� I I `Minters Chapel I f a i F n 0 olw7: GUI lu RN 01 'OUI,m zl ! � ^�, a Local Road Cemetery O lnterslaterl-imited Access Water Mayor Connector River,'Canal State Route `- Exit Railroad Small Town AorLeld APPROVED N SW19 BY: DAT : 6 " Y l6 0 PA APPROVED BY: DATE FIVE STAR SUSAR :tc C:p It z ! '01 7- ! '01 Page 1 of 1 Linda Norman From: "Linda Norman" < com> Date: Monday, June 13,20165:10 PM To: < i Subject: Fw: request to enter into DFW Airspace 1 _From: Linda Norman Sent: Monday, June 13, 2016 3:51 PM To: 1dress is corrected to: Star Subaru 551 William D Tate rapevine, Texas 76051 See 5 State Helicopters, Inc. is requesting to enter into DFW Airspace for the purpose of doing a 133 external load job at: 5 Star Subaru 2651 William D Tate Grapevine, Texas 76051 Date: 6 -17 -2016 Time: approximately 12 (noon) Helicopter S68T Call Sign: N4xy or N6bl or N6vy Pilot: Bradford S. Ladue: Comm. Cert. 2760587 Scott B. Ladue Comm. Cert. 3250744 Pilot will request to enter into DFW Airspace. When permission is granted the pilot will let the control tower know when he is over the job site and will be landing for approximately 30 minutes to rig the helicopter and get crew on the roof. Then the pilot will radio the control tower and ask permission to lift up and start lifting (approximately one hour) ( 28 rtu's). When the pilot has completed lifting he will radio the control tower and let the tower know he has completed the lift and will be landing on the ground for approximately 30 minutes to load crew and rigging. Then the pilot will radio the control tower and ask for permission to lift up and depart DFW Airspace 5 State Helicopters Inc. Linda Norman Tel:972- 636 -4009 Fax:972- 636 -1300 Cell: 214- 212 -6062 www.5state.com 6/13/2016 TRANSMISSION VERIFICATION REPORT TIME : 06/13/2016 16:17 NAME : 5 STATE HELICOPTERS FAX : 9726361300 TEL : 9726361300 SER.# : A3J152697 DATE,TIME 06/13 16:17 FAX N0. /NAME 18174103260 002:00:28 PAGE(S) RESULT OK MODE STANDARD ECM 5 -STATE HELICOPTERS, INC. 285 BLACKLAND RD ROYSE CITY, TEXAS 75189 972 - 636 -4009 972 -636 -1300 FAX - linda@5"e.com Linda Norman City. of Grapevine, Texas Att: Dispatch Supervisor Karen Ballard and All Supervisors Ref. 5 -State Helicopters, Inc. landing for purpose of air lift equipment: 5 -State Helicopters, Inc. will be in the city of Grapevine, Texas, Date: 6 -17 -2016 For the p*?)'se of air liftig air conditioning units to the roof of: Location: 5 Star Subaru PW William D Tate Grapevine, Texas 76051 >ft This memo is to let Communications / dispatch know the helicopter will be at the site from approximately 12 (noon) to approximately 2:60 pm If you have any questions please call Linda Norman at 972 -636 -4009 or cell at 214- 212 -6062. i