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Home My WebLink AboutTUP2018-0648""' � OL��lB J� 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 Address 37-00 Phone no. 2 2. Property owner 3. 4. 5. 6. 7. 8. 9. 10 Name ice 16WS4;-1 Address fax no. -I ter, ,7 V Phone no.A 7lLS-20-0 —fax no. Address of temporary use or entertainment Date or dates of proposed entertainment to Kind or type of entertainment Total number of off-street or highway parking space _ 0' < o &05 / Total capacity per capita of facility to be used for entertainment 7%.e-- /,y a_� v Number of restrooms available within facility EO k' b"d.A64t I 4'7' Time and hours of temporary use Number of outdoor speakers CITY OF GRAPIEVINEDEVELOPMENT SERVICES.P 0 BOX 95104.G RAPEVI NE.TEXAS.76099.(817)410-3154. FAX (817)410-3018 OAZCU\Forms\appAemp use public ent.doc I T M Tops T[ FEB 13 2018 II I'll-, 11 RAI use on property i own at Owner (print) Owner signature The State of County Of Aknft�--- -- Before Me -b; hereby authorize to request a temporary (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 R.D. .tia'V Pwo MARY BASKETTE r° .. Notary Public, State of Texas tiQnture a__�..a. w MY Commisslon Expires '•%„n?;``` June 04, 2014 FOR OFFICIAL U ONL CITY MANAGER RISK MANAGER ! , DEVELOPMENT SERVICES DIR FIRE O i4\ POLICE O r` HEALTH CITY OF GRAPEVINE. DEVELOPMENT SERVICES.P O BOX 95104.GRAPEVINE.TEXAS.76099.(817)410-3154.FAX (817)4103018 OA\ZC0Forms\app.temp use public enl.doc 3 xLi � t J 2-t 1 ;4!3 ALCOR" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYVY) �....--� 5/l/2018 2/13/2018 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 have ADDITIONAL INSURED provisions or 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 Lockton Companies CONTACT NAME: 1 185 Avenue of the Americas, Suite 2010 PHONE FAX New York NY 10036 Ext : A!C No E-MAILo 646-572-7300 ADDRESS: INSURERS) AFFORDING COVERAGENAIC # LIABILITY N N A$2 -Z11-262112-017 5/1/2017 5/1/2078 MBINED SINGLE LIMI I $ Ea accident) 1,000 000 INSURER A: Liberty Mutual Fire Insurance Company 23035 INSURED Marquee Event Group, Inc. 1411816 INSURER B: Liberty Insurance Corporation 42404 2161 Hutton Drive INSURER C : Carrollton TX 75006 INSURER D INSURER E INSURER F: $ XXXXXXX COVERAGES CERTIFICATE NUMBER: 15209001 REVISION NUMBER: XXXXXXX 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. INSR j �ADDL SUSUBR�: LTR TYPE OF INSURANCE IN POLICY NUMBER T POLICY EFF POLICY EXP MWDDNYYY MM/DDNYYY LIMITS COMMERCIAL GENERAL LIABILITY A X Y N TB2-Z11-262112-027 ' 5/1/2017 5/11/2018 EACH OCCURRENCE $ 1,000 OOO CLAIMS -MADE OCCUR i y DAMAGETORENTED ! PREMISESJEa occurrenceL _$ I00,000 (Any one person) i $ 5,000 4 MED EXP An j PERSONAL _& ADV INJURY _ $_ 1,000,000__ GEN'L AGGREGATE LIMIT APPLIES PER: ^, GENERAL AGGREGATE $ ')000,000 PRO- ;—� PRO- X POLICY LOC JECT � PRODUCT S COMP/OP AGG $ 2,000,000- '� —" OTHER: $ A AUTOMOBILE LIABILITY N N A$2 -Z11-262112-017 5/1/2017 5/1/2078 MBINED SINGLE LIMI I $ Ea accident) 1,000 000 X ANY AUTO BODILY INJURY (Per person) $ XXXXXXX OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) , $ XXXXXXX HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE$ XXXXXXX Per accident $ XXXXXXX B X UMBRELLA LIAB X OCCUR N N ! TH7-Z11-262112-067 5/1/2017 i 5/1/2018 EACH OCCURRENCE $ 5,000,000 _ EXCESS LIAB CLAIMS -MADE j I_ AGGREGATE __$_ 5,000,000 DED I X I RETENTION $ 10,000 $ XXXXXXX B WORKERS COMPENSATION N AND EMPLOYERS' LIABILITY WC7-Z11-2621 12-037 PER OTH- 5/1/2017 5/1/2018 �; X STATUTE ER YI N ANY PROPRIETOR/PARTNER/EXECUTIVE- NIA' - E.L EACH ACCIDENT 1,000,000 :OFFICER/MEMBER EXCLUDED? N : (Mandatory in NH) E.L. DISEASE- EA EMPLOYEE; $ 1,000,000 j If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Grapevine is included as an additional insured with regards to the General Liability coverage as required by written contract. ucm I Irit+A I C MULL/CIM %,ANt..CLLA I IVN 15209001 City of Grapevine PO Box 95104 Grapevine TX 76099 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 REPRE$IiTATI n 1qRR-2n15 Ar.ORn rORPORATIr1N All rinhfc ra¢a—arl ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Susan Batte From: Melanie Hill Sent: Tuesday, February 13, 2018 12:51 PM To: Susan Batte Subject: RE: Temp Use App - Fellowship Church Approved Melanie Hill, ARM City of Grapevine Risk Manager Office: 817-410-3114 Fax: 817-410-3013 mhill@grapevinetexas.gov -----Original Message ----- From: Susan Batte Sent: Tuesday, February 13, 2018 11:38 AM To: Barry Bowling <bbowling@grapevinetexas.gov>; Robert Eberling <reberling@grapevinetexas.gov>; Bryan K. Parker <bparker@grapevinetexas.gov>; Russell Batchelor <rbatchelor@grapevinetexas.gov>; Melanie Hill <mhill@grapevinetexas.gov> Subject: Temp Use App - Fellowship Church Please see the attached application and let me know if you approve - FYI, the tent is already in use. Susan Batte From: Robert Eberling Sent: Tuesday, February 13, 2018 1:25 PM To: Susan Batte; Barry Bowling; Bryan K. Parker; Russell Batchelor, Melanie Hill Subject: RE: Temp Use App - Fellowship Church -----Original Message ----- From: Susan Batte Sent: Tuesday, February 13, 2018 11:38 AM To: Barry Bowling <bbowling@grapevinetexas.gov>; Robert Eberling <reberling@grapevinetexas.gov>; Bryan K. Parker <bparker@grapevinetexas.gov>; Russell Batchelor <rbatchelor@grapevinetexas.gov>; Melanie Hill <mhill@grapevinetexas.gov> Subject: Temp Use App - Fellowship Church Please see the attached application and let me know if you approve - FYI, the tent is already in use. Susan Batte From: Russell Batchelor Sent: Tuesday, February 13, 2018 1:26 PM To: Robert Eberling; Susan Batte; Barry Bowling; Bryan K. Parker; Melanie Hill Subject: RE: Temp Use App - Fellowship Church Approved. Russell Batchelor Fire Marshal, Grapevine Fire Department 0:817.410.4400 1 M:682.772.3191 I F:817.410.4410 rbatchelor@grapevinetexas.gov I fire.grapevinetexas.gov Grapevinetexas.gov 1007 Ira E. Woods Avenue Grapevine, Texas 76051 -----Original Message ----- From: Robert Eberling Sent: Tuesday, February 13, 2018 1:25 PM To: Susan Batte <sbatte@grapevinetexas.gov>; Barry Bowling <bbowling@grapevinetexas.gov>; Bryan K. Parker <bparker@grapevinetexas.gov>; Russell Batchelor <rbatchelor@grapevinetexas.gov>; Melanie Hill <mhill@gra pevinetexas.gov> Subject: RE: Temp Use App - Fellowship Church Approved by PD -----Original Message ----- From: Susan Batte Sent: Tuesday, February 13, 2018 11:38 AM To: Barry Bowling <bbowling@grapevinetexas.gov>; Robert Eberling <reberling@grapevinetexas.gov>; Bryan K. Parker <bparker@grapevinetexas.gov>; Russell Batchelor <rbatchelor@grapevinetexas.gov>; Melanie Hill <mhill@grapevinetexas.gov> Subject: Temp Use App - Fellowship Church Please see the attached application and let me know if you approve - FYI, the tent is already in use.