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HomeMy WebLinkAboutTUP2018-1472 �- JLJ�-a CITY OF GRAPEVINE INE TEMPORARY USE & PUBLIC ENTERTAINMENT PERMIT APPLICATION SEC. 15-9. The application for the permit shalt be flied not less than thirty (30) days before the first perfonnance and shall contain the following Information. 1. Applicant Name0(*,�, Address( Phone no�A[ Email. 2. Property owner Name Addrea Phone 3. Address of temporary use or entertainment &10i) 4. Date or dates of proposed entertainment r ►f<' - -- - to au 5. Kind or type of entertainment) - 6. Total number of off-street or highway parking space l 7. Totalt(tjumblLt er of people participating In the event at thislocation Q r 8. Number of restrooms available within 9. Time and hours of temporary use DO - CRY OF CiWEVINEX EV&OPM W SMVICESP 0 BOX 85104.GkAPEV1W-TEXAS.7WW.(81 S+LFfi�t tS��103tlttr � allCtAl Fomu t w tunp tme pAk WAoc ` $ 2 E# 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. hereby authorize A-G.C.. Q S.5 To X4 to request a temporary use on property I own at x.00 1 A • ale -s 0,���rw�r�,.tirTX_." Owner (print) Owner signature The State of County Of Before Me _ __ uI Irl w � cote nm r i cy— (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 A-10 h , A.D.Q *0 IV I "" ERIN NICOLE HfDRIGK ' t t 1 Q Notary Public, State of texas Comm. Expires 02-011-2020 Notary Signature Notaty ID 130316888 FOR OFFICIALQUJSE ONLY L CITY MANAGER RISK MANAGER t DEVELOPMENT SERVICES DI -'e" POLICE HEALTH Ofd C17Y OF GRAPEVINE.MELOPMENT SERVICES.P O BOX 95104.GRAPEVINE.TEXAS.76099.(BlT)410.3154.FAX (817)414-3018 O-VECu11 Fomn *p.temp use PUMC ent.doc 3 On Friday, May 11, 2018, ACCESS Texas will be utilizing Austin Ranch and their outdoor facilities for a company picnic for Nationstar. A total of 3,500 guests will arrive in waves, on a come -and -go basis, from 11:OOAM — 3:OOPM. We will have minimal decor to include an entrance, tables and directional signage. The DJ and Speaker will be located on the Upper Lawn area (location noted on diagram), facing away from Anderson Gibson Road, and will be powered from a generator. On the lower area, we will have a variety of carnival games, skee ball and pop -a -shot basketball. There will be (1) 120'x 50' tent where we will have the majority of guest seating. We will also have 10'x 10' tents for staffing, food stations, food preparation and the DJ. We will have (2) comfort station restroom trailers and necessary generators for that as well. We will have (2) EMTs onsite for the duration of the program. \0 7 a ACI OREll' CERTIFICATE OF LIABILITY INSURANCE DA TE F 4/(2/2ols Y) 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 ANBTX Insurance Services, Inc. 12400 Coit Road, Suite 1100 Dallas TX 75251-2039 CONTACT Stephanie An fano NAME: P PHONE (972)419-7500 FAX No: (972)419-7555 E-MAIL INSURER S AFFORDING COVERAGE NAIC _ INSURER A:Emp lovers Mutual Casualt Company _# 21415 INSURED Outstanding Productions, Inc. DBA: ACCESS Texas 8888 Governors Row Dallas TX 75247 INSURER B :Evanston Ins. Co. INSURERC:Underwriters at Llo rds INSURER D: _ INSURERE: $ 1,000,000 INSURER F: CLAIMS -MADE X❑ OCCUR COVERAGES CERTIFICATE NUMBER:18/19 REVISION NUMBER: 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/DDNYYY) (MM/DDNYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE X❑ OCCUR DAMAGE TED PREMISES (E. ofcagrence) $ 500,000 MED EXP (Any one person) $ 10,000 4/1/2018 4/1/2019 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO JECT ❑ LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY CEa OMBINED SINGLE LIMIT accident $ 1,000,000 BODILY INJURY (Per person) $ p' ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS 4/1/2018 4/1/2019 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident) $ X NON -OWNED HIRED AUTOSX AUTOS $ X UMBRELLA LIAB X_ OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 A EXCESS LIAB I CLAIMS -MADE DED I X I RETENTION$ 10,000 $ ISJ60161 4/1/2018 4/1/2018 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / A E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT -- $ B Excess Liability 7/19/2017 7/19/2018 Per Occurrence/Aggregate 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD tot, Additional Remarks Schedule, may be attached if more space is required) The General Liability policy includes a blanket automatic additional insured endorsement (provision) that provides additional insured status to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. The General Liability policy includes a blanket automatic waiver of subrogation endorsement that provides this feature only when there is a written contract between the named insured and the certificate holder that requires it. Coverage is Primary & Non -Contributory as required by written contract. Thirty day notice of cancellation, except 10 days for non-payment. lh.iilta[h-\Ia:Lei 451:4 �iLlily3RL'lila� City of Grapevine 200 S Main Street Grapevine, TX 76051 ACORD25 (2014/01) INS025 (201401) 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 i Breaux/STEANG .------ ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Susan Batte From: Russell Batchelor Sent: Wednesday, April 11, 2018 9:25 AM To: Susan Batte Cc: Lisa Cabrera; Bryan K. Parker Subject: RE: Temp Use App - Austin Ranch Fire Department approves. Tent permit required. Lisa Cabrera will reach out to organizer to initiate tent permit. Russell Batchelor Fire Marshal, Grapevine Fire Department 0:817.410.4400 ( M:682.772.3191 I F:817.410.4410 I 1007 Ira E. Woods Avenue Grapevine, Texas 76051 -----Original Message ----- From: Susan Batte Sent: Wednesday, April 11, 2018 8:50 AM To: Robert Eberling < ; Barry Bowling < ; Russell Batchelor < ; Bryan K. Parker < ; Melanie Hill < ; Renee L. Minnfee < Subject: Temp Use App - Austin Ranch Please see attached and let me know if you approve Susan Batte From: Renee L. Minnfee < Sent: Wednesday, April 11, 2018 9:18 AM To: Susan Batte Subject: RE: Temp Use App - Austin Ranch 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: Wednesday, April 11, 2018 8:50 AM To: Robert Eberling < ; Barry Bowling < ; Russell Batchelor < ; Bryan K. Parker < ; Melanie Hill < ; Renee L. Minnfee < Subject: Temp Use App - Austin Ranch Please see attached and let me know if you approve *** External email communication — Please use caution before clicking links and/or opening attachments *** Susan Batte From: Melanie Hill Sent: Wednesday, April 11, 2018 11:13 AM To: Susan Batte Subject: RE: Temp Use App - Austin Ranch Approved. -----Original Message ----- From: Susan Batte Sent: Wednesday, April 11, 2018 8:50 AM To: Robert Eberling < ; Barry Bowling < ; Russell Batchelor < ; Bryan K. Parker < ; Melanie Hill < ; Renee L. Minnfee < Subject: Temp Use App - Austin Ranch Please see attached and let me know if you approve Susan Batte From: Robert Eberling Sent: Wednesday, April 11, 2018 3:54 PM To: Susan Batte; Barry Bowling; Russell Batchelor; Bryan K. Parker; Melanie Hill; Renee L. Minnfee Subject: Re: Temp Use App - Austin Ranch Approved by PD Sergeant Robert Eberling Administration Division Grapevine Police Department 1007 Ira E. Woods Ave Grapevine, TX 76051 Office (817) 410-3213 From: Susan Batte Sent: Wednesday, April 11, 2018 8:49:30 AM To: Robert Eberling; Barry Bowling; Russell Batchelor; Bryan K. Parker; Melanie Hill; Renee L. Minnfee Subject: Temp Use App - Austin Ranch Please see attached and let me know if you approve 1