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Home My WebLink AboutHLP2018-1248 GRAPEVINE March 30, 2018 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 A Bruno Rumbelow, City Manager Thank you, Permit will not be issued until FAAApproval has Connie Cook been received. Development Services (817) 410-3158 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: MARCH 30, 2018 Attached is a request for a helicopter lift scheduled for April 4, 2018 at 7:00 A.M., for 3000 Grapevine Mills Pkwy #212 with rain date of April 5, 2018 at 7:00 A.M., if it meets your approval, please sign below: City Manager Development Services Director a 1 r- Risk Manager OACCook\HelicopterMemorandum 5 STATE HELICOPTERS 285 Blackland Rd.,Fate,Texas 75189 (o)972-6364009 officeta 5state.com (f)972-636-1300 Congested Area Plan FAA CERT.LDUL599B DATE:March 28,2018 Date/Time of Job: Job Site: Contractor: April 4,2018 Grapevine Mills Mall Comfort Tech 08:00-10:00 3000 Grapevine Mills Pkwy 7023 Flaxford Trail Cable Length: Grapevine,TX 76051 Arlington,TX 76001 Approx. 85 Feet Contact: Keil Tebbs 972-880-8524 Keil Tebbs 972-880-8524 There are power lines and light poles in the area but,the will not cause a safety hazard to the lift. Plan Prepared By: Chase Lutjen: Should a weather,mechanical or material delay be experienced this CAP is approved for the date and time lifted above plus 10 days. **S State Helicopters,Inc will re-nalijy al!Contacts listed on the CAP if an extension is required" FAA:North Texas FSDO 214-277-8500 APPROVED BY: ;- A 0 ,.W2-%d'j ANI ARX FSOo FAA STAMP: APPROVED NTX FSDO SW19 BY DATE: -30 - If T111S COMPANY COMPLIES WITH TH TI11""CODE OF E I I11[.S:OF 771E HELICOPTER ASSOCIATION OF AMERICA 3 HOLD HARMLESS AND INDEMNITY AGREEMENT PROJECT ADDRESS: Grapevine Mills Mall 3000 Grapevine Mills'Pkwy Suite 519 Grapevine,TX 76051 NATURE OF OPERATION:Air lifting air conditioning units DATE OF OPERATION: 04 April 2018 with rain date of 05 April 2018 I,Billy Walker,the undersigned,representing 5-State Helicopters,Inc.,binding my heirs,executors, 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,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 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 l day of srJN 2018 COMPANY:5-STATE HELICOPTERS,INC. BY:BILLY WALKER(printed) WN Z- *(-Aiklif TITLE:OWNER (signature) 15 STATE OF TleXAS C UNTY OF c M Z L This instrument was acknowledged before me on this the %19 day of AU ON 2018 NOTARY PUBLIC IN AND FOR THE STATE OF a s . My commission expires J v-1 u 23 kol ROBERT L.MCMI1lAN,JR. ,�� h!� _ _ ; � ' Notary Public,State xp Texos Signature Li]� g[ My Commission Expires July 23,2019 Scanned by CamScanner S McGriff, Seibels & Williams, Inc. Certificate of Insurance 1 Certificate No. Rev.Date:Jan 31,2018 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 is/are in force 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. 285 Blackland Road Fate,TX 75189-4746 Policy Type: Aircraft Hull&Liability and Aviation General Liability Policy Policy Period: February 01,2018 to February 01,2019 both days at 12:01 am 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 $10,000,000 each occurrence as respects Sikorsky S-58BT and Sikorsky Property Damage Liability(Excluding Passenger Liability) S-58ET type aircraft. Cargo Legal Liability Coverage Limit Cargo Legal Liability including Slung Loads $500,000 each occurrence,subject to a deductible of$1,000 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. - ,A4 C-C Authl I rizcdRepr6intative 7525 SE 24th Street,Suite 520,Mercer Island,Washington 98040 Certificate No: Page 1 of 1 Phone:(206)232-9870-Fax:(206)232-9515 82775 5 STATE HELICOPTERS 285 Blackland Rd.,Fate,Texas 75189 (o)972-6364009 officew 5state.com (f)972-636-1300 Congested Area Plan FAA CERT.LDUL599B DATE: March 28, 2018 TO: FAA OFFICE: North Texas FSDO 214-277-8500 REFERENCE: Congested Area Plan Request Date/Time of Job: Job Site: Contractor: April 4,2018 Grapevine Mills Mall Comfort Tech 08:00-10:00 3000 Grapevine Mills Pkwy 7023 Flaxford Trail Cable Length: Grapevine, TX 76051 Arlin=gton,TX 76001 Approx. 85 Feet Contact: Keil Tebbs 972-880-8524 Keil Tebbs 972-880-8524 Aircraft Registration: N-6BL,N4XY Aircraft Type: S-58T Standard Category Pilots: Dennis A. Banks ATP#3369851 Scott B. Ladue Commercial Certificate#3250744 Hazardous Material: No Description:N/A Height of Building: 40 Load Description: Number, Tvpe&Wei2ht Helicopter lift of 2 RTU's @ 2600 lbs. *If a problem or safety hazard exists the crew will contact the pilot to cease operations&move the aircraft to a safe area using two-way radios,or hand and arm signals* Cit), of Grapevine Contacts City Manager Connie Cook Fire Darrell Brown ccook @grapevinetexas.gov dbrown @grapevinetexas.gov 817-410-3155 817-410-4400 Dispatch 972-564-7600 Police Eddie Salame esalame @grapevinetexas.gov _ 817-410-3204 Fire Marshall Russell Batchelor ATC Dallas Fort Worth Intl. Airport ratchelor @grapevinetexas.gov Chase Lutj en 5 State Helicopters 1 5 STATE HELICOPTERS 285 Blackland Rd.,Fate,Texas 75189 (o)972-636-4009 office n 5state.com (f)972-636-1300 Congested Area Plan FAA CERT.LDUL599B DATE: March 28, 2018 Date/Time of Job: Job Site: Contractor: April 4, 2018 Grapevine Mills Mall Comfort Tech 08:00-10:00 3000 Grapevine Mills Pkwy 7023 Flaxford Trail Cable Length: Gra)evine, TX 76051 Arlington, TX 76001 Approx. 85 Feet Contact: Keil Tebbs 972-880-8524 Keil Tebbs 972-880-8524 Narrative Plan of Operations: Flight path from the staging area to where the equipment is placed on the building will be cleared of unauthorized persons. Estimate 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. 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 existing construction in a commercial area. The 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 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 lifting begins. The operational area will be surveyed by 5 State Helicopters crew for any safety hazards before lifting of equipment begins. If any safety hazard exists, the contractor will be required to eliminate the hazard before lifting of equipment begins. 5 State Helicopters crew have radios and will be communicating with the pilot 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. Chase Lutjen 5 State Helicopters 2 Z tM C.) 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