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HomeMy WebLinkAboutTUP2018-3837 T I . x t la s,!. 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 Chi K t Gh-( Address h '• Y- .?�v'i �C t20�71 Phone no. �"1 " ?�l �' U O U u fax no. Email: � 2. Property owner Name \JIrA Yh Address a 4 / ela.��Q ��- Phone no. 1'I `133 - 2. ,2 3 fax no. 3. Address of temporary use or entertainment _ Il (� . �rni �,, �{-- � I� �yll•e 4. Date or dates of proposed entertainment octobe,r- to 5. Kind or type of entertainment L•'1 V C V-q y f (11 6. Total number of off-street or highway parking space _l 7. Total number of people participating in the event at this location An 4ceg 8. Number of restrooms available within facility 'Fae jar 9. Time and hours of temporary use 9 9 ► p rvt CITY OF GRAPEVINE.DEVELOPMENT SERVICES.P O BOX 95104.GRAPEVINE.TEXAS.76099.(817)410-3154.FAX(817)410-3018 OAZCU11 Formslapp.temp use public ent.doc 2 r 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. ` e r�L� ,J er i hereby authorize to request a temporary use on property I own at , lyt- �- 11���n m z- JC p p Y �� "��'�1 h�. r r Owner(print) Owner signatur The State of 3 �S County Of _ aas Before Me �� �� Qy f OR—Q, (notary) on this day personally appeared °�-t �`p�l NlUV-v S (property owner) known to me (or proved to me on the oath of car 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 101ef , A.D. I z JULIA SIZEMORE rc� Qom-Notary Public, State of Texas Comm. Expires 05-24-2022 Notary' mature Notary ID 1044970 i FOR OFFICIAL USE ON n�, CITY MANAGER _ RISK MANAGER '�'C-1�K1fRi��4 DEVELOPMENT SERVICES DIR FIRE _ POLICE HEALTH �- CITY OF GRAPEVINE.DEVELOPMENT SERVICES.P O BOX 95104.GRAPEVINE.TEXAS.76099.(817)410-3154.FAX(817)110-3018 OAZCU11 Formslapp.temp use public ent.doc 3 wo Vl CA I ti �G 2a 2P •�rilr� �Wt'vL- ��►ry. � ol�,� - �-i I�'h�S (�. 1-e k,1 ir�FjrGi►-�. ��o S - �� (cccer.�e�,t- %( ►1� -ex i'K . fwLc-t 11�fi� Ir e G,uA p - Ce Ire - CA-CV X `LA Gl`—egp-5" l kCb LAA-A t C-e, fbr r-,j (lK C.("t4 � ��^�►� I,�� 21 X- 5'2ctL-> ' �� _ ! v t �M&7 WW1 Muni lift, a ACORN® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYI) Ilt. � 1 10108/2018 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 CONTACT T Millsa NAME: Y p Bradley Insurance Agency PHONE Fax _WC Na,.EXQ: 817)332_8288 1 IA1C.No): 1415 Summit Avenue E-MAIL INSURERS)AFFORDING COVERAGE NAIC# Fort Worth TX 76102 INSURERA: CONIFER INS CO 29734 INSURED INSURER B Backwoods Investments,LLC DBA Chill Bar and Grill INSURER c: 814 S.Main St INSURER D INSURER E: T Grapevine TX 76051 INSURER F: C_OVERAGES CERTIFICATE NUMBER: 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 ADDL'SUBR' POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER_ fMMIDDDM IMMIDDNYYYI, LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ❑X OCCUR DAMAGE TO RE I D — PREMISES SEaoccurrence, $ 1 00,000 MED EXP(Any one person) $ 5,000 A 06/01/2018 06/01/20191 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY E PRO JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ _. iEa accident,_ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED � AUTOS ONLY AUTOS BODILY INJURY(Per accident)' $ '' _ ' HIRED NON-OWNED PROPERTY DAMAGE___ k - - r AUTOS ONLY AUTOS ONLY Peraociden;. $ $ _TJUMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE) AGGREGATE $ DIED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN __STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE j E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA ! ----- (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE; $ If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ A Business Personal Property CICP013571 06/01/2018 06101/2019 $200,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Grapevine ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 200 S.Main Street cP1 Grapevine TX 76051 �f`0. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Connie Cook From: Renee L. Minnfee < Sent: Tuesday, October 09, 2018 2:41 PM To: Connie Cook; Melanie Hill; Robert Eberling; Barry Bowling; Bryan K. Parker; Lisa Cabrera; Russell Batchelor Subject: Re:Temporary Use I am okay with this. Get From: Connie Cook<ccook @grapevinetexas.gov> Sent:Tuesday, October 9, 2018 2:35 PM To: Melanie Hill; Robert Eberling; Barry Bowling; Bryan K. Parker; Lisa Cabrera; Russell Batchelor; Renee L. Minnfee Subject:Temporary Use EXTERNAL EMAIL ALERTI Think Before You Click! Please see attached & let me know if you approve. Event: October 28th Best Regards, Connie Cook Development Services Assistant City of Grapevine 200 S.Main Street Grapevine, TX 76051 (81 7J 410-3158 *** External email communication—Please use caution before clicking links and/or opening attachments *** 1 Connie Cook From: Melanie Hill Sent: Tuesday, October 09, 2018 2:43 PM To: Connie Cook Subject: RE:Temporary Use Approved. Melanie Melanie Hill, ARM City of Grapevine Risk Manager Office: 817-410-3114 Fax: 817-410-3013 m h i I lgrap evi netexas.gov -, . TIN , T F4 1 1 8 From:Connie Cook Sent:Tuesday, October 9,2018 2:35 PM To: Melanie Hill<mhill @grapevinetexas.gov>; Robert Eberling<reberling @grapevinetexas.gov>; Barry Bowling <bbowling @grapevinetexas.gov>; Bryan K. Parker<bparker @grapevinetexas.gov>; Lisa Cabrera <Ica brera @grapevinetexas.gov>; Russell Batchelor<rbatchelor @grapevinetexas.gov>; Renee Minnfee ( Subject:Temporary Use Please see attached & let me know if you approve. Event: October 28th Best Regards, Connie Cook Development Services Assistant City of Grapevine 200 S Main Street Grapevine, TX 76051 (817)410-3158 1 Connie Cook From: Robert Eberling Sent: Tuesday, October 09,2018 3:39 PM To: Connie Cook; Melanie Hill; Barry Bowling; Bryan K. Parker; Lisa Cabrera; Russell Batchelor; Renee Minnfee ( Subject: RE:Temporary Use Approved by PD From:Connie Cook Sent:Tuesday,October 9,2018 2:35 PM To: Melanie Hill <mhill @grapevinetexas.gov>; Robert Eberling<reberling @grapevinetexas.gov>;.Barry Bowling <bbowling @grapevinetexas.gov>; Bryan K. Parker<bparker @grapevinetexas.gov>; Lisa Cabrera <Icabrera @grapevinetexas.gov>; Russell Batchelor<rbatchelor @grapevinetexas.gov>; Renee Minnfee ( Subject:Temporary Use Please see attached & let me know if you approve. Event: October 28th Best Regards, Connie Cook Development Services Assistant City of Grapevine 200 S.Main Street Grapevine, TX 76051 (817)410-3158 1 Connie Cook From: Bryan K. Parker Sent: Tuesday, October 09, 2018 3:40 PM To: Connie Cook; Melanie Hill; Robert Eberling; Barry Bowling; Lisa Cabrera; Russell Batchelor; Renee Minnfee ( Subject: RE:Temporary Use Approved by FD. S " Evet yone's F Bryan K. Parker I Asst. Fire Marshal 1817.410.4421 1 bparker @grapevinetexas.gov 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. From:Connie Cook Sent:Tuesday, October 9, 2018 2:35 PM To: Melanie Hill<m hill @grapevinetexas.gov>; Robert Eberling<reberling @grapevinetexas.gov>; Barry Bowling <bbowling @grapevinetexas.gov>; Bryan K. Parker<bparker @grapevinetexas.gov>; Lisa Cabrera <Ica brera @grapevinetexas.gov>; Russell Batchelor<rbatchelor @grapevinetexas.gov>; Renee Minnfee ( Subject:Temporary Use Please see attached &let me know if you approve. Event: October 28th Best Regards, Connie Cook Development Services Assistant City of Grapevine 200 S.Main Street Grapevine, TX 76051 (817)410-3158 1