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HomeMy WebLinkAboutTUP2018-3877 13sTZ - V OCT 10218 CITY OF GRAPEVINE °T 8 K A S TEMPORARY USE PERMIT APPLICATION tA1,c E-VF�moxi- - 1. Applicant Name: .��`J4 k 9- SPe CN \o4-,ey.r% \e. L nAddress: Ism M �nn A , City: G,Care_ytnP_ State: I GX.AS zip: -1 to Olii�'I Phone No. Lk ag- sa I Fax No. 8\ -4 - A as- ,S% k l � a\q- 3k1b- k1B53 0AXam) 2. Property Owner Name: ca5i 0=kcbu ` )ebO"C's ,rL.P. Address:-71 N. 4--&c r, J, \AISA . k61 • 4iu._k�:*�',lh City: _ rv.C%r State: --T;K .. `� `` Zip: Phone No. 41 '-1'Io . ��C)Q Fax No. _ 1V I I) 3. Address of temporary use: 4. Total number of off-street or highway parking spaces: II �+ 5. Description of temporary use: �� ?nr\ur%c1 6-It -+r Gg•aS em o.Q.2,c>_. 6. Date or dates of proposed use: \I 1 \\ I 0. ao\i�, 7. Time and hours of temporary use: 8. If you are a non-profit, please provide your tax id#: 9. Number of outdoor speakers NONE_ (show location on site plan see instructions (a).) CITY OF GRAPEVINE.DEVELOPMENT SERVICES.P O BOX 95104.GRAPEVINE.TEXAS.76099.(817)410-3154.FAX(817)410-3018 OAZCUXForms\appAemp use outside display.sales.doc 2 1 �e U� ��L�'1�'S (property owner) hereby authorize ny%/ n (applicant) to request a temporary use on property I own at Ili�NQO ►00 (address):' Owners name (print): L Owner's signature: The State of \LXA S County Of KNZQ.At,� Before Me L\q Aft ,1 r`aoiU�n5 (notary) on this day personally appeared rce )L CI\�,S _ (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. '1 -- (Seal) Given under my hand and seal of office this CA day of A.D. N""""•. JOVIIA DAWN SCROGGINS `J,RRY Pye4 Notary Public, State of Texas Notary 'gnature r'• f� Comm. Expires 07-31-2019 Notary 1D 13031598-8 FOR OFFICIAL USE ONLY CITY MANAGER RISK MANAGER DEVELOPMENT SERVICES DDIrnIR FIREa.n���Q.('L POLICE lr\ HEALTH II tin 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 10/9/2018 Jovita Scroggins DSV AIR& SEA INC. 1300 MINTERS CHAPEL RD.#100 GRAPEVINE,TX 76051 CITY OF GRAPEVINE EVENT PERMIT GRAPEVINE COURT HOUSE CITY PERMIT On November 8m 2018 we will be holding an BBQ event for our customers appreciation event. It will begin in the morning of the 811 and end by 3PM on the 81h.The tent will be set up on the 7th and brought down on the 91h of November. It will be 1 tent in the size of 20 x 30'.To container 18 x 8'tables with approx. 90 chairs. Jovita Scroggins Admin. DSV AIR&SEA INC. , c i e S t r u m s c O 'A N 8 owl —n w Ono JL. IL mL Mas lop f y I - ti ��• _ �, , a 9 � fflc p� Page 1 of 2 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDrYYYY) V 10/11/2018 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 NAME: Willis of Connecticut, LLC c/o 26 Century Blvd Ase, . Er 1-877-945-7378 FAX No: 1-888-467-2378 E-MAIL P.O. Sox 305191 ADDRESS: Nashville, TN 372305191 USA INSURERS AFFORDING COVERAGE NAIL# INSURERA: Liberty Mutual Fire Insurance Company 23035 INSURED INSURER B: ACE American Insurance Company 22667 DSV Air s Sea Inc. 100 Walnut Avenue, Suite 405 INSURERC: Indemnity Insurance Company of North Amer! 43575 Clark, NS 07066 INSURERD: Agri General Insurance Company 42757 INSURERE: ACE Fire Underwriters Insurance Company 20702 NSURERF: COVERAGES CERTIFICATE NUMBER:W8485538 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 rypE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MWDDIYYYY)�(MMIDDIT'Pryl LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CI-AIMS-MADE a OCCUR DAMA SES Eaoccur ET RENT 2,000,000 PREMISES C $ A MED EXP(Any one person) $ 5,000 y 01/01/2018 01/01/2019 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY� PRO- POLICY 1XI LOU PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 its accitlent ANY AUTO BODILY INJURY(Per person) $ B OWNED X SCHEDULED 12/31/2017 12/31/2018 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED x NON-0WNEO PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOVERS'LIABILITY YIN STATUTE Eft C ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACHACCIDENT $ 1,000,000 OFFICEWMEMBEREXDLUDEDO No NIA 12/31/2017 12/31/2018 (Mandatory in NH) E.L.DISEASE EA EMPLOYEE $ 1,000,000 (yes,describe under 1,000,000 DESCRIPTION OF OPERATIONSbem E.L.DISEASE-POLICY LIMIT $ D Workers Compensation and 12/31/2017 12/31/2018 E.L. Each Accident $1,000,000 Employers Liability E.L. Disease -Pol Inat $1,000,000 Per Statute E.L. Disease Each E $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may beadached B more space is required) Re: Company BBQ being held on November 9, 2018 at 1300 Minters Road. , Grapevine, TX. Workers Compensation Includes USLSH and Maritime Coverage SEE ATTACHED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Grapevine Texas ACCORDANCE WITH THE POLICY PROVISIONS. Development services Planning Technician AUTHORIZED REPRESENTATIVE Attn: Susan Bette 200 South Main Street Grapevine, TX 76099 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD an ID: 16883879 snxcS: 906364 AGENCY CUSTOMER ID: LOC#: ADDITIONAL REMARKS SCHEDULE Page 2 Of 2 AGENCY NAMED INSURED Willis of Connecticut, LLC DSV Air 6 Sea Inc. 100 Walnut Avenue, Suite 405 POLICY NUMBER Clark, NJ 07066 See Page 1 CARRIER NAIC CODE See Page 1 Be- Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Certificate Holder is included as an Additional Insured as respects to General Liability as required by written contract. INSURER AFFORDING COVERAGE: ACE American Insurance Company NAIC#: 22667 POLICY NUMBER: MR 064626516 EFF DATE: 12/31/2017 EXP DATE: 12/31/2018 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Workers Compensation E.L. Each Accident $1,000,000 & Employers Liability E.L. Disease -Pol Lmt $1,000,000 Per Statute E.L. Disease Each Emp $1,000,000 INSURER AFFORDING COVERAGE: ACE Fire Underwriters Insurance Company NAIC#: 20702 POLICY NUMBER: SCE 064626528 EFF DATE: 12/31/2017 EXP DATE: 12/31/2018 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Workers Compensation E.L. Each Accident $1,000,000 S Employers Liability E.L. Disease -Pol Lmt $1,000,000 Per Statute E.L. Disease Each Emp $1,000,000 ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 16883879 BATCH: 906364 CERT: W8485538 Connie Cook From: Renee L. Minnfee < Sent: Wednesday, October 10, 2018 12:39 PM To: Connie Cook; Barry Bowling; Bryan K. Parker; Melanie Hill; Robert Eberling; Lisa Cabrera; Russell Batchelor Subject: Re:TUP 18-3877 I am okay with this. Get Outlook for iOS From: Connie Cook< Sent:Wednesday, October 10, 2018 3:33:13 PM To: Barry Bowling; Bryan K. Parker; Melanie Hill; Robert Eberling; Lisa Cabrera; Russell Batchelor; Renee L. Minnfee Subject:TUP 18-3877 i EXTERNAL EMAIL ALERT! Think Before You Click! Please see attached & let me know if you approve. Event: November 8, 2018 7a.m.to 3 p.m. Vendor Appreciation BBQ 1300 Minters Chapel Rd. #100 Best Regards, Connie Cook Development Services Assistant City of Grapevine 200 S. Main Street Grapevine, TX 76051 (817)410-3158 *** External email communication—Please use caution before clicking links and/or opening attachments *** 1 Connie Cook From: Robert Eberling Sent: Wednesday, October 10, 2018 10:49 AM To: Connie Cook Subject: RE:TUP 18-3877 Approved by PD From: Connie Cook Sent:Wednesday, October 10, 2018 10:33 AM To: Barry Bowling<bbowling @grapevinetexas.gov>; Bryan K. Parker<bparker @grapevinetexas.gov>; Melanie Hill <mhill @grapevinetexas.gov>; Robert Eberling<reberling @grapevinetexas.gov>; Lisa Cabrera <Icabrera @grapevinetexas.gov>; Russell Batchelor<rbatchelor @grapevinetexas.gov>; Renee Minnfee ( < Subject:TUP 18-3877 Please see attached & let me know if you approve. Event: November 8, 2018 7a.m.to 3 p.m. Vendor Appreciation BBQ 1300 Minters Chapel Rd. #100 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: Thursday, October 11, 2018 8:54 AM To: Connie Cook Cc: Russell Batchelor Subject: RE: TUP 18-3877 F.D. approves. Atent inspection will be required prior to event. 4pPE1rj2 � F (sR�t.1�ffL xe *tl Fr8 n Everyone's Fes . Bryan K. Parker Asst. Fire Marshal 1817.410.4421 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:Wednesday, October 10, 2018 10:33 AM To: Barry Bowling<bbowling @grapevinetexas.gov>; Bryan K. Parker<bparker @grapevinetexas.gov>; Melanie Hill <mhill @grapevinetexas.gov>; Robert Eberling<reberling @grapevinetexas.gov>; Lisa Cabrera <Ica brera@gra pevinetexas.gov>; Russell Batchelor<rbatchelor @grapevinetexas.gov>; Renee Minnfee ( Subject:TUP 18-3877 Please see attached & let me know if you approve. Event: November 8, 2018 7a.m.to 3 p.m. Vendor Appreciation BBQ 1300 Minters Chapel Rd. #100 Best Regards, Connie Cook Development Services Assistant City of Grapevine 200 S.Main Street Grapevine, TX 76051 (817)410-3158 1 Connie Cook From: Melanie Hill Sent: Thursday, October 11, 2018 3:23 PM To: Connie Cook Subject: RE:TUP18-3877 Approved. Thank you Melanie Melanie Hill, ARM City of Grapevine Risk Manager Office: 817-410-31 14 Fax: 817-410-3013 ref t; ' S S S From: Connie Cook Sent:Thursday, October 11, 2018 3:19 PM To: Subject:TUP18-3877 Good afternoon Melanie, I have the updated Insurance attached 1300 Minters Chapel Rd. #100 Office Hours 8—4:30, M-F Best Regards, Connie Cook t