Loading...
HomeMy WebLinkAboutTUP2018-3877 to to- D0 _ Y a�T 10201$ GRAPEVINE A S CITY OF TEMPORARY USE PERMIT APPLICATION 1. Applicant Name: ` '1I Ip+►%a m. Citl �eykn V%e IL Address: Cam. b \ • 1 � It City: GXCa X1e, State: l KAS zip:_71 ( f)'51 Phone No. 4 Fax No. Email� Vobile# ���' 3a'.� ���'� UXLAV } 2. Property Owner Name: re �» • Address:'! L V►. kk W jA . �Ua • � ` A city: State: . . Zip: Phone No.�I�IT1 " %'_„_. ,00 Fax No. t 3. Address of temporary use: 1?)QQ 1 5 4. Total number of off-street or highway parking spaces: 5. Description of temporary use: CnAe ? rr 1u r% -.1. Gwas S Qma� 6. Date or dates of proposed use: %I Mg 7. Time and hours of temporary use: 8. If you are a non-profit,please provide your tax 9. Number of outdoor speakers NQo (show location on site plan see instructions (a).) CITY OF GRAPEVINE.DEVELOPMENT SERVICES.P O BOX 95104.GRAPEVINE.TEXAS.76099.(817)410-3164.FAX(817)410-3018 O:1ZCU1Forms%app.temp use outside display.sales.doc 2 ul, (property owner) hereby authorize k*4 L. (applicant) to request a temporary use on property I own at E�NQQ Mk(N WcS too (address)." Owners name (print): Zc-- C ' Q n�t� �o�, L nl Owner's signature: ---`-''��. The State of S County Of Before Me +\bq%A11— enr (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 ofd.• A.D. <<Ypy JOVITA DAWN SCROGGINS ` Notary Public,state of Texas v Notary "gnature Comm.Expires 07-31-2019 ,,, „ Notary iD 13031598-8 FOR OFFICIAL USE ONLY DIR DEV SERVICES BUILDING OFFICIAL DEVELOPMENT MANAGER_ FIRE POLICE HEALTH CITY OF GRAPEVINE.DEVELOPMENT SERVICES.P O BOX 95104.GRAPEVINE.TEXAS.76099.(817)410 3154.FAX(817)410-3018 O:1ZCU1Forms%app.temp use outside dispiay.saies.doe 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 8th 2018 we will be holding an BBQ event for our customers appreciation event. It will begin in the morning of the 8th and end by 3PM on the 8th.The tent will be set up on the 71h 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. i y 4 m � � c dp AlL CD a 4v 0 g die ry f 1 -� -' -_� -i• ,lipid _- �+�r:�:J ter• { r' C Y ° � f z 71 4� MOW ate . . . / ^_pppp Page 1 of 2 ACOROQD DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 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(iss)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 ACT NAME: Willis of Connecticut, LLC c/o 26 Century Blvd PHONE 1-877-945-7378 FAX 1-888-467-2378 W.C.NQ. A/ No): EMAIL P.O. Box 305191 ADDRESS: Nashville, TN 372305191 USA INSURERISI AFFORDING COVERAGE NAICN INSURER A• Liberty Mutual' Fire Insurance Company 23035 INSURED INSURERS: ACE American Insurance Company 22667 DSV Air s Sea Inc. 100 Walnut Avenue, Suite 405 INSURER C: Indemnity Insurance Company of North Ameri 43575 Clark, NJ 07066 INSURER D: Agri General Insurance Company 42757 INSURER E: ACE Fire underwriters Insurance Company 20702 INSURER F: 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 TYPE OF INSURANCE s B POLICY NUMBER MMIDDNYYY MMM Y EXP LIMITS LTR X i COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE CLAIMS-MADE X OCCUR PREMISES(Ea occurrence $ 2,000,000 A � MED EXP(Any one person) $ 5,000 Y 01/01/2018 01/01/20191 $ PERSONAL GENERALAGGREGATE $ 2,000,000 POLICY ECT �LOC PRODUCTS-COM P/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 fEa accidentl_ 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-OWNED { PROPERTY DAMAGE $ X AUTOS ONLY AUTOS ONLY Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X AND EMPLOYERS' YIN LIABILITY PER ERH C ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED7 No N/A 12/31/2017 12/31/2018 (Mandatory In NH) E.L.DISEASE-,EA EMPLOYEE $ 1,000,000 It yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D Workers Compensation and 12/31/2017 12/31/2018 E.L. Each Accident 1$1,000,000 Employers Liability E.L. Disease -Pol Lmt$1,000,000 Per Statute E.L. Disease Each Emn$1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Re: Company BBQ being held on November 9, 2018 at 1300 Minters Road., Grapevine, TX. Workers Compensation Includes USL&H 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 N -- AUTHORIZED REPRESENTATIVE Attn: Susan Batts 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 SR ID: 16883879 ar.Tca: 906364 AGENCY CUSTOMER ID: LOC#: ACO ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Willis of Connecticut, LLC DSV Air & Sea Inc. 100 Walnut Avenue, Suite 405 POLICY NUMBER Clark, NJ 07066 See Page 1 CARRIER NAIC CODE — --......_. See Page 1 'See 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: WLR C64626516 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: SCF C64626528 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 ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 16883879 BATCH: 906364 CERT: W8485538