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HomeMy WebLinkAboutTUP2017-1617 -7 — I Co l --7 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 I doh Address fl /V /d /6 �fi�,Clt4 Phone no. fax no. Email: 2. Property owner Name 4 Address )-0 C01 411,11�-J(,yj C—;. .56jj f -j j4;r1Ar_t '4,t 77 Phone no. yf-i fax no. 3. Address of temporary use or entertainment (j A dea-&,, C--I'b5c� 4. Date or dates of proposed entertainment 1 -7 to 5. Kind or type of entertainment frVr,.�--Q- cwr,,tc evp,- r c-nd 6. Total number of off-street or highway parking space 7. Total number of people participating in the event at this location 1, �'00 8. Number of restrooms available within facility APR 017 9. Time and hours of temporary use 2 7 2 By CITY OF GRAPEVINEDIEVELOPMENT SERVICESP 0 BOX 95104. GRAPEVI NE.TEXAS.76099.(817)410-3154. FAX (817)410-3018 OAZCU\1 Forms\app.temp use public ent.doc 2 10. Number of outdoor speakers, all speakers shall face away from residential areas, please show location of speakers and the direction they are facing on site plan. "I,� �""'`✓` t hereby authorize St"t 1 � L' Ca-'- - — d t-/ 'e to request a temporary use on property I own at z 0 C1 1 ,-J 12 r peg+ ., ./ }C 7 W,3`/ Owner (print) C. 4: Owner signature The State of e /-a County Of I Qy rarx Before Me �� I 1�L' r r i,�' (notary) on this day personally appeared (property owner) known to me (or proved to me on the oath of card or other document) to be the person whose name is subscribed to the foregoing instrument and acknowledged to me that he executed the same for the purposes and consideration therein expressed. (Seal) Given under my hand and seal of office this day of &on A.D. 9(') --I , ERIN NICOLE EDRICK Notary Public. State of texas c. Comm. Expires 02-01-2020 a�9N`�+F Notaty ID 130518958 FOR OFFICIAL CITY MANAGER ti Notary Signature 11 RISK MANAGER OK DEVELOPMENT SERVICES DIR FIRE POLICE O HEALTH CITY OF GRAPEVINE.DEVELOPMENT SERVICES.P O BOX 95104.GRAPEVINE.TEXAS.76099.(817)410-3154.FAX (817)410-3018 O:\ZCU\1 Forms\app.temp use public ent.doc 3 9/16/2016 Dish Tent I jpg httpslimail.google.com/mafil/LdOt?zx=n8euglu9jzaz#searchIKathryn.Portillo%4ohilton.com/l5733c96f2bcbc28?projector=l 1/1 I kp� I Event date 5/18/17 Entertainment time machine band Times 8pm-11pm Band playing under tent on stage. Event type private corporate event for DISH Network 14u, H n 1 --e I t4 I I a ACC))Rtf CERTIFICATE OF LIABILITY INSURANCE D�J26�2DI �Y) CERTIFICATE MAY 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. THIS CERTIFICATE IS ISSUED AS A MATTER 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), 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 IS WAIVED, subject to the terms and conditions 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 CT Dustin Hulett MED EXP (Any one person) $ 5,000 NAME The Hulett Agency. PHONE (817461-3251 A/C No): (817)461-3254 3010 W Park Row ADDAIL RESS: Ste SOS INSURER�Sj AFFORDING COVERAGE NAIL # --- _- -----_ ---- ._ Arlington — — TX 76013 _ --- INSURERA:NOrthfield Insurance Company INSURED INSURER B Brilliant Events Inc INSURERC: ---- 3611 Shiloh Rd --------- - - INSURER D: INSURER E : 1 idlothian TX 76065 _ 1 INSURER F: wa.-•S12I M.11NME,' 111,1, 1 Z4= ..i• .ld. THIS IS 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 CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 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. INTRR 7 �ADDLISUBR POLICY EFF POLICY EXP j TYPE OF INSURANCE WVDPOLICY NUMBER MM/ !YY YY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A 1 CLAIMS -MADE X OCCUR ( DAMAGTO RENT€b -- PREMISES (Ea occurrence)$ 100,000 - — MED EXP (Any one person) $ 5,000 05/09/17 05/09/18 — —--- PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: _..--. j GENERAL AGGREGATE $ 2,000,000 PRO- X POLICY L_1 JECT LOC 1 r- --- - ;- - - ------ PRODUCTS - COMP/OP AGG ' $ 2,000,000 - OTHER: - $ AUTOMOBILE LIABILITY ( Ee IEDSINGLE LIMIT $ accident) ANY AUTO 1 BODILY INJURY (Per person ALL OWNED — SCHEDULED AUTOS AUTOS BODILY INJURY Per accident $ ( )I i NON -OWNED HIRED AUTOS IAUTOS PROPERTY DAMAGE $ Per accident i Medical payments $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB - - - - — CLAIMS -MADE --- � _ AGGREGATE $ t DED f RETENTION $ WORKERS COMPENSATION PER � OTH AND EMPLOYERS' LIABILITY Y/N, A UTE ER jANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? IN/Al E.L.EACH ACCIDENT $ (Mandatory in NH),, E.L. DISEASE - EA EMPLOYE If yes, describe under,_ DESCRIPTION OF OPERATIONS below F-- +- --- E.L. DISEASE -POLICY LIMIT $ i I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Grapevine is listed as Additional Insured v.- 11rryR IV. nvwcR lLANGCLLA I IUN City of Grapevine 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 Jennifer L. Sevy d,/ Z ©1988-2014 ACORD COROOWATION. All Whts reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) Susan Batte From: Robert Eberling Sent: Monday, May 01, 2017 8:09 AM To: Susan Batte Subject: RE: Temp Use App - Austin Ranch/Dish 01410�- ON -----Original Message ----- From: Susan Batte Sent: Thursday, April 27, 2017 11:47 AM To: Barry Bowling < ; Robert Eberling < ; Bryan K. Parker < ; Randie Frisinger < ; Renee L. Minnfee < ; Melanie Hill < Subject: Temp Use App - Austin Ranch/Dish Please see attached application and let me know if you approve Susan Batte Planning Technician City of Grapevine P 0 Box 95104 1 Grapevine, TX 76095 p: (817) 410-3155 1 f: (817) 410-3018 -----Original Message ----- From: Sent: Thursday, April 27, 2017 11:41 AM To: Susan Batte < Subject: Message from KMBT_C652DS Susan Batte From: Melanie Hill Sent: Thursday, April 27, 2017 12:31 PM To: Susan Batte Subject: Re: Temp Use App - Austin Ranch/Dish Approve Sent from my Whone > On Apr 27, 2017, at 11:46 AM, Susan Batte < wrote: > Please see attached application and let me know if you approve > Susan Batte > Planning Technician > City of Grapevine > P 0 Box 95104 1 Grapevine, TX 76099 > p: (817) 410-3155 1 f: (817) 410-3018 > > -----Original Message----- • From: > Sent: Thursday, April 27, 2017 11:41 AM > To: Susan Batte < > Subject: Message from KMBT_C652DS > <SKMBT C652D17042710410.pdf> 1 Susan Batte From: Bryan K. Parker Sent: Thursday, April 27, 2017 1:06 PM To: Susan Batte; Randie Frisinger Subject: Re: Temp Use App - Austin Ranch/Dish Approved With Comments: Tent must be permitted and inspected prior to event. Bryan K. Parker I Asst. Fire Marshal 1817.410.3520 1 This message may be confidential and/or privileged. If you are not the intended recipient, please notify the sender immediately then delete it - you should not copy or use it for any purpose or disclose its content to any other person. Internet communications are not secure. You should scan this message and any attachments for viruses. Under no circumstances do we accept liability for any loss or damage that may result from your receipt of this message or any attachments. On Apr 27, 2017,.at 11:46 AM, Susan Batte < wrote: Please see attached application and let me know if you approve Susan Batte Planning Technician City of Grapevine P O Box 95104 I Grapevine, TX 76099 p: (817) 410-3155 I f: (817) 410-3018 -----Original Message ----- From: Sent: Thursday, April 27, 2017 11:41 AM To: Susan Batte < Subject: Message from KMBT_C652DS <SKMBT_C652D 17042710410.pdf> Susan Batte From: Renee L. Minnfee < Sent: Tuesday, May 02, 2017 9:33 AM To: Susan Batte Subject: RE: Temp Use App - Austin Ranch/Dish Sorry for the delayed response. I was on vacation. I am okay with this. Renee Minnfee MPH, RS Tarrant County Environmental Health 1101 S. Main St., Rm. 2300 Fort Worth, TX 76104 Phone 817.321.4979 Fax 817.321.4961 Email: -----Original Message ----- From: Susan Batte [mailto: Sent: Thursday, April 27, 2017 11:47 AM To: Barry Bowling < ; Robert Eberling < ; Bryan K. Parker < ; Randie Frisinger < ; Renee L. Minnfee < ; Melanie Hill < Subject: Temp Use App - Austin Ranch/Dish Please see attached application and let me know if you approve Susan Batte Planning Technician City of Grapevine P O Box 95104 1 Grapevine, TX 76099 p: (817) 410-3155 1 f: (817) 410-3018 -----Original Message ----- From: Sent: Thursday, April 27, 2017 11:41 AM To: Susan Batte < Subject: Message from KMBT C652DS