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Home My WebLink AboutHLP2016-3968 GRAVVINE T E October 11, 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. flLP ILL- 3%es 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 11, 2016 Attached is a request for a helicopter lift scheduled for October 17, 2016 at 7:00 A.M., for 3000 Grapevine Mills Pkwy #525 with rain date of October 18, 2016 at 7:00 A.M. if it meets your approval, please sign below: Bruno Rtlllow, City Manager Melanie Hill, Risk M nager OACCook\HelicopterM emorandum HOLD HARMLESS AND INDEMNITY AGREEMENT PROJECT ADDRESS: Grapevine Mills Mall (Sea Life Suite 525) 3000 Grapevine Mills Pkw, Grapevine, Texas 76051 NATURE OF OPERATION: Air Lifting equipment DATE OF OPERATION: 10-17-2016 with rain date of 10-18-2016 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 JQi day and (month) t a 2016 COMPANY: 5-STATE HELICOPTERS, INC. BY: LINDA NORMAN (printed) TITLE: OWNER (signature) STATE OF COUNTY OF/&,AUI& This instrument was acknowledged before me on this the Day of(116d.z 2016 NOTARY PUBLIC IN AND FOR THE STATE OF T My commission expires - — signature� d> lnf Y ry4 LINDA MAE VAUGNT My Commission EVres May 6.2017 ra W McGriff, Seibels & Williams, Inc. Certificate of Insurance Certificate No. Rev.Date:Jan 15,2016 This is to certify that the policy(ies)of insurance as described below have been issued to the Insured for whom this Certificate is executed and War,in fore,at this time.This Certificate is issued for information only and confers no rights upon the holder.This Certificate neither affirmatively nor negatively amends,extends or alters the coverage afforded by such policy(ies)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 751894746 Policy Type: Aircraft Hull&Liability and Aviation General Liability Policy Policy Period: February 01,2016 to February 01,2017 both days at 12:O1am 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 Aircraft Covered: Sikorsky S58T,N4XY;Sikorsky S58T,N6BL Coverage&Limits Aircraft Liability Coverage Limit Combined Single Limit Bodily Injury,including Personal Injury and 510,000,000 each occurrence as respects Sikorsky 5-588T and Sikorsky Property Damage Liability(Excluding 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 SI,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. AuthpizedRepre'semative 3023 80th Avenue S.E.,Suite 300 Mailing Address:P.O.Box 60,Mercer Island Washington 98040-0060 Certificate No: Page 1 of 1 Phone:(206)232-9870-Fax:(206)232-9515 60274 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. 412 Congested Area Plan DATE: 10-10-2016 5-STATE HELICOPTERS, INC. If a problem or safety hazard exists 285 Blackland Rd, the ground persons/crew with radios will Royse City, Texas 75189 notify the pilot to move the helicopter to a 972-636-4009 safe area 800-543-8442 972-636-1300 FAX N6BL, N4XY CONTRACTOR: G&J Services 750 8"'Ave. SIKORSKY S-58T Ft. Worth,Texas 76104 STANDARD CATEGORY JOB SITE: Grapevine Mills Mall Sea Life Suite 525 3000 Grapevine Mills Pkwy PILOT: Bradford S. Ladue Grapevine,Texas 76051 Comm. Cert. . 2760587 PILOT: Scott Bradford Ladue HEIGHT OF BUILDING: 40 Ft. Comm. Cert. 3250744 TOTAL OF LIFTS: Length of the cables estimated 75 Ft, 1 I lifts : 2 rtu's up and 2 curbs up 2600 Ibs, 2 rtu's off 2600 Ibs, 1 relocate 2600 Ibs 2 compressors down and 2 compressors removed and relocated. Date: 10-17-2016 with rain date of 10-18-2016 Time: approximately 7:00 am CONTACTED: CONTACTS: City of Grapevine, Tx. Mr. Scott Williams 817410-3158 Police and Fire Dispatch: Supervisor: Karen Ballard 817410-8127 Grapevine Mills Mall Operations Manager: Cooper Black 972-724-4910 DFW FAA: SIGNATURE OF RESPgt ISIBLE COMPANY OFFICIAL Linda Norman 5-STATE HELICOPTERS, INC. 285 BLACKLAND ROAD ROYSE CITY,TEXAS 75189 972-636-4009 800-LIFT-442 FAX 972-636-1300 FAA CERTIFICATE# LDUL-599B DATE: 10-10-2016 CONGESTED AREA PLAN-EXTERNAL LOAD LIFT TO: FAA OFFICE: North Texas FSDO 214-277-8500 JOB SITE Grapevine Mills Mall Sea Life Suite 525 3000 Grapevine Mills Pkwy Grapevine,Texas 76051 SCHEDULED DATE AND TIME OF OPERATION: 10-17-2016 with rain date of 10-18-2016 approx. 7:00 am CONTRACTOR: G&J Services 750 8'Ave. Ft. Worth,Texas 76104 CONTACT PERSON: Greg George 817-800-0340 AIRCRAFT: S-58T N-6BL.,N4XY STANDARD CATEGORY PILOT: BRADFORD S. LADUE COMM CERT. #2760587 SCOTT BRADFORD LADUE COMM.CERT.#3250744 LOADS: NUMBER TYPE WEIGHTS 1 I lifts : 2 rtu's up and 2 curbs up 2600 Ibs,2 rtu's off 2600 Ibs, I relocate 2600 Ibs 2 compressors down and 2 compressors removed and relocated. CARRYING HAZARDOUS MATERIAL : no DESCRIPTION: CONTACTS: City of Grapevine,Tx. Mr. Scott Williams-817-410-3158 Police and Fire Dispatch: Supervisor: Karen Ballard 817-410-8127 Grapevine Mills Mall Operations Manager: Cooper Black 972-724-4910 DFW FAA: SIGNATURE OF , .SPONSIBLE COMPANY OFFICIAL Linda NormanO�a.[�b NARRATIVE OF PLAN OF OPERATIONS: 5-STATE HELICOPTERS, INC. Congested Area Plan Job Site: Grapevine Mills Mall Sea Life Suite 525 3000 Grapevine Mills Pkwy Grapevine,Texas 76051 DATE OF JOB: 10-17-2016 with rain date of 10-18-2016 END OF JOB: 10-17-2016 with rain date of 10-18-2016 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 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 existing 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 Mall 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. SIGNATURE OF KESPONSIB,nLTE COMPANY OFFICIAL Linda Norman 2016-10-11 08:42 FAA NTH FSDO 2142778570 >> P 1/1 PAIL a 5-5'l-ATE P11:LIC'011TI:RS. INC. Congested Area Plan JOB SITE: Grapevine Mills Mall Sea L.ilc Suite 535 3000 Gralievinc Mills Pkw% t irapevine.Texas 76051 DATE 01:J013: 10-17.2016 with rain date of 111.18.2016 TIME approximately 7:15 am There are power lines and light poles in the area hut,will not cause a safet% hazard 10 the [ill. TODAY'S DATE: 10-I0-2016 PLAN PREPARED BY : Linda Norman,%J l c� Should a wcathvt.mechanical or material delay he experienced this CAP is approved far the date and time lifted above plus 10 days. "with this extension 5 State I lelicoptcrs. Inc. will re-notifi all Contacts listed on C'AI' APPROVED I;AA: North Texas I'S170 NATF SDO SVJ1 9 BY: YUl.c APPROVED BY. DAT � FAA STAMP: I HIS COMPANY COMPLIES WI TH T11F"C ODE Up fi'l'l II('S:OF TI IF ELIC'OPTER ASSOCIATION UP AMERICA. PAGE 4 5-STATE HELICOPTERS, INC. Congested Area Plan JOB SITE: Grapevine Mills Mall Sea Life Suite 525 3000 Grapevine Mills Pkwy Grapevine,Texas 76051 DATE OF JOB: 10-17-2016 with rain date of 10-18-2016 TIME: approximately 7:15 am There are power lines and light poles in the area but, will not cause a safety hazard to the lift. TODAY'S DATE: 10-10-2016 PLAN PREPARED BY : Linda Norman Should a weather, mechanical or material delay be experienced this CAP is approved for the date and time lifted above plus 10 days. **with this extension 5 State Helicopters, Inc. will re-notify all Contacts listed on CAP FAA: North Texas FSDO APPROVED BY: FAA STAMP: THIS COMPANY COMPLIES WITH THE"CODE OF ETHICS: OF THE HELICOPTER ASSOCIATION OF AMERICA. 5 STATE HELICOPTERS, INC. Roc ledge Park 1 i N W SANDY LAKE RD GRAPEVINE MILLS MALL L(I�}1 3000 GRAPEVINE MILLS vine e F I � SANDY R I 1I� 1 PKWY U SEALIFE AQUARIUM SUITE 525 26/1 tl GRAPEVINE,TX. 76051 � °o� i I BETHELR �o Copp'ellW@grHE ftD N3_ 58.008' "F DATE:/d-2? 3A��IO tb ;e Park � I W97`02.529' TIME: APPROX. q;ppgm o a` Non o pr W RTHW 26 III {fi--� L-EE�WBLL COPPEL RD 121 114 W WALL 3e2 II II -Grapevine S61 a / " 1 14 HELICOPTER WILL NOT BE rth L. Ali \ MORE THAN 125 ABOVE A '?_ `14 zP�H 40 FT.MALL WHEN AIR _D' 6I a LIFTING A+RF+EL " EQUIPMENT TO THE ROOF. / 9 121 1 � / N F PILOT WILL BE IN CONTACT IA I WITH DFW CONTROL TOWER. m 121 I C \ Z alias F1 Worth 1 I o 360 Creak > 114` / Y T 121 �� J 1 vl f. Minters Chapel W s " DE RD LAD RDFCLADE R W 29TH �� F J'001 2 1 360 '� CARBON RD m'161 I�f D,�y`ortna sil53A� 01�7-�ReL 01!2001 Mag 13.00 Wed Jul 14:22 2 — Local Road Small Town Scale 1:62,2,500(at center)er) — Trail — Airfield 1 Miles C==Interstate/Limited Access Park/Reservation 2 km Major Connector Schad Service Airport State Route Locale Exit Cemetery Railroad County Boundary Point of Interest Water t wo n W , 1 1 fit- ❑ �l �'`* c+�'1:a1r F�5+� -!'mss �` °moo S Q ro a G ji / ao. / v T� popa uos9!9 j• v3 � , TRANSMISSION VERIFICATION REPORT TIME 10/10/2016 13:35 NAME 5 STATE HELICOPTERS FAX 9726361300 TEL 9726361300 SER.0 A3J152697 DATE,TIME 10/10 13:35 FAX NO./NAME 18174103260 DURATION 00:00:29 / PAGE(S) 02 RESULT OK MODE STANDARD ECM .,� 5-STATE HELICOPTERS, INC. 285 BLACKLAND RD ROYSE CITY,TEXAS 75189 A*% � 972-636-4009 1!1 972-636,1300 FAX - - — Linda Norman City'dGrapevine, Texas Dispatch Att:Karen Ballard 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: 10-17-2016 with rain date of 10-18-2016r'' For the purpose of air lifting air conditioning units to the roof of: Location: Grapevine Mills Mall 3000 Grapevine Mills Pkwy Grapevine,Texas 76051 This memo is to let Communications/dispatch know the helicopter will be at the site from approximately 7:00 am to approximately 9:30 am Page I of I Linda Norman From: "Linda Norman"< Date: Monday,October 10,2016 2:29 PM To: < Attach: 2016-10-10-14-23-52-0I.pdf Subject: Request to enter into DFW Airspace See Attachment Grapevine Mills Mall 3000 Grapevine Mills Pkwy Grapevine, Texas 76051 Date: 10-17-2016 with rain date of 10-18-2016 Time: approximately 7:00 am Helicopter: Sikorsky S58T 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 Mall and will be landing for approximatley 30 minutes to rig the helicopter for lifting and get crew on the roof. Then the pilot will radio the control tower and ask for permission to lift up and start lifting. ( 11 lifts) approximatley 30 minutes.) When the lifting is completed the pilot will let the control tower know he has completed the lifting and will be landing on the ground for approximately 30 minutes to load crew and rigging equipment. Then the pilot will radio the control tower and ask for permission to lift up and depart to the east and leave DFW airspace 5 State Helicopters Inc. Linda Norman Tel:972-636-4009 Fax:972-636-1300 Cell: 214-212-6062 www.5state.com 10/10/2016