STREET CLOSURE APPLICATION
REQUIRING CITY COUNCIL
MERCED APPROVAL (OVER 400 FEET). MERCED
For current Fee, please see Planning & Development Fee Schedule Application:
Receipt:
CHECKLIST:
Prior to submitting your application, please confirm by checking (M) the boxes below that all the following have been completed.
Have you completed the "Description of Event" below and signed the application on page 3? (Incomplete information may delay your application.)
Have you allowed at least 8-10 weeks prior to the event for your application to be placed on a City Council agenda?
Have you obtained the required insurance and do you have proof of that insurance to submit- authorized representative of the sponsoring organization? After obtaining approval from the City, but prior to the event, please make sure you have done the following:
Have you read the conditions of approval and is your event prepared to abide by all conditions?
Have you given public notice of the street closure to all the surrounding businesses within ½ mile at least 72 hours prior to the event as required in Condition #2 below? A form is provided at page 6 which can be used to inform the public. A copy of the form should be șigned and returned to the Planning Division at least 24 hours before your event affirming L-
that notice has been given per the above requirements.
Have you posted "No Parking" at least 24 hours prior to the event as required in Condition #1 below and using the standards outlined on page 5? Demolin? the barricades for street closures. ME DE
Have you made arrangements for supplying any necessary electricity to your event? (Plugging outlets into City light poles is NOT allowed unless prior approval is obtained.
Please call City Public Works at 385-6800 for additional information.) perdog If you are selling alcohol at your event, have you obtained an Alcoholic Beverage Control NA (ABC) license or permit for this event?
DESCRIPTION OF EVENT:
APPLICANT/EVENT SPONSOR TaMaRa Cobb tineteenta Atebsatian Committer.
CONTACT PERSON TOMORE Cal PHONE
ADDRESS
DRIVER'S LICENSE NO. E-MAIL
Street Closure Application (Over 400 Feet) -Page 1
DESCRIPTION OF EVENT (Continued):
DESCRIPTION OF EVENT (include equipment, obstructions, etc National Hodau
aire parate
THIS EVENT WILL SELL OR SERVE ALCOHOL: or No X
ESTIMATED NUMBER OF PEOPLE IN ATTENDANCE 100 - 200
DATE(S) AND TIME(S) OF TISE (include time for setup and takedown as well as event time):
9:00 am - 11:00 Am
LIST ALL STREETS PROPOSED FOR CLOSURE:
CITY Loy 14, Ik FRom 18855 to l It st wetso
(PLEASE ATTACH A MAP TO IDENTIFY PARADÉ ROUTES, STREET CLOSURES, AND ANY
OBSTRUCTIONS TO BE PLACED WITHIN THE RIGHT-OF-WAY)
STANDARD CONDITIONS FOR STREET/PARKING LOT CLOSURES/PARADES
1. Event Sponsor shall be responsible for placing and removing traffic barricades and posting of parking restrictions. "No Parking" signs shall be posted at least twenty-four (24) hours prior to towing of vehicle(s) per California Vehicle Code Section 22651(m) —see page 5.
Event Sponsor shall contact all businesses affected by the street/parking lot closure or parade advising them of hours, conditions and reason thereof within one-half mile of the encroachment area at least seventy-two (72) hours prior to the event. Event Sponsor shall provide the City confirmation that the proper notification was given. (A form is provided on page 6 to help the applicant with this requirement.)
3. Event Sponsor must remove all equipment, trash and debris, including "no parking" signs, generated by the event prior to the expiration of the encroachment permit.
4. Street closures shall not include major arterial streets.
5. Supervision/security shall be provided by event sponsor to ensure the safety of event participants and the public if required by the Police Department.
6. Event Sponsor shall pay for any City services required for supervision/security.
7. Alcoholic beverages may be served or sold, subject to Alcoholic Beverage Control Licensing Requirements, and subject to the Liquor Liability Insurance Policy of the City (see page 4).
8. Provisions addressed in Ordinance #1941 Chapter 12.42 (Temporary Street Closures) shall apply.
9. Event Sponsor shall be responsible for insuring that all vendors involved with the event obtain a City of Merced business license.
10. The applicant shall arrange and pay for special event City Refuse service by contacting Public Works at (209) 385-6800.
11. The applicant shall comply with the Indemnification and Insurance provisions as outlined on page 3 of this application.
12. Event sponsor shall provide and maintain a minimum 22-foot-wide emergency vehicle access path into and through the closure area at all times via movable barriers. Fire hydrant access shall not be blocked at any time whatsoever.
13. 14.
(Additional conditions may be imposed as deemed necessary) Street Closure Application (Over 400 Feet)--Page 2
INDEMNIFICATION: Event Sponsor shall indemnify, protect, defend, (with counsel selected by the City) save and hold City, its officers, employees, agents, and volunteers harmless from any and all claims or causes of action for death or injury to persons, or damage to property resulting from intentional or negligent acts, errors, or omissions of Event Sponsor or Event Sponsor's officers, employees, agents, volunteers, and participants during performance of the Event, or from any violation of any federal, state, or municipal law or ordinance, to the extent caused, in whole or in part, by the willful misconduct, negligent acts, or omissions of Event Sponsor or its officers, employees, agents, volunteers, or participants, or resulting from the negligence of the City, its officers, employees, agents, and volunteers, except for loss caused solely by the gross negligence of the City. Acceptance by City of insurance certificates and endorsements required for this Event does not relieve Event Sponsor from liability under this indemnification and hold harmless clause. This indemnification and hold harmless clause shall apply to any damages or claims for damages whether or not such insurance policies shall have been determined to apply.
INSURANCE: Prior to engaging in the event, Event Sponsor shall complete and file with the City a special events, general liability and automobile policy of at least $500,000 combined limit for bodily injury and property damage which covers the entire event. Said policy shall stipulate that this insurance will operate as primary insurance and that no other insurance will be called on to cover a loss covered thereunder. Additional insured endorsements evidencing this special events, general liability and automobile coverage, naming the City and its officers, agents, and employees as additional insureds, must be submitted to the City prior to the event. This certificate shall provide that thirty (30) days written notice of cancellation shall be given to the City.
REFUSAL OR REVOCATION OF PERMIT: Failure to comply with any law, rule or regulation applicable to the use of said streets shall be grounds to revoke any such permit and, in such circumstances, the Chief of Police shall immediately revoke said permit. The Event Sponsor or permit holder, in such case, shall have the right to appeal said revocation to the City Council.
The undersigned declares under penalty of perjury that he/she has the authority to sign for and bind the Event Sponsor to the conditions imposed by the City upon the granting of this Application.
Tamara Coff
Signature: 1
Print Name: TamaRa (cpp
Date: 02/06 22
OFFICE USE
APPLICATION APPROVED SUBJECT TO CONDITIONS
BY DATE
Developmen: Services Department (385-6858)
BY DATE 5 23-27
Merced Police Dopartment (385-6913)
BY DATE
Merced Fire Department (385-6891)
Street Closure Application (Over 400 Feet)-Page 3
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 05/19/2022
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 endorsements).
Fluetsch and Busby Insurance
PO Box 780 (209)722-1541 FAC. No): (209)723-8189
Merced, CA 95341 ADDRESS: [email protected]
License #: 0358327 INSURERS) AFFORDING COVERAGE NAIC #
INSURERA: Nova Casualty
INSURED
INSURER B:
Merced County Regional Arts Council, Inc INSURER C :
645 West Main Street INSURER D:
Merced, CA 95340
INSURER E:
_ INSURER F:
CERTIFICATE NUMBER: 00014566-565170 REVISION NUMBER: 1
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
A CF1 ML 10001431-03 EACH OCCURRENCE 1,000,000
CLAIMS-MADE | X OCCUR DAMAGE TO RENTED
PREMISES (Ea occurrence) $ 100,000
MED EXP (Any one person) 10,000
PERSONAL & ADV INJURY 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO-
X POLICY : LOC PRODUCTS - COMP/OP AGG $ 2,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMI
Ea acciden
ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY (Per accident) $
HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY Per accident
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $
WORKERS COMPENSATION STATUTE
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? N/ A
(Mandatory In NH) EL. DISEASE - EA EMPLOYEE $
DESCRIPTTON OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Regarding The Juneteenth Parade June 18 2022
The City and its officers, agents, and employees are included as additional insured per the attached endorsement.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Merced THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS
678 W Main Street
Merced, CA 95340 AUTHORIZED REPRESENTATIVE
Mada Wamuight
(KDW)
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by KDW on 05/19/2022 at 11:43AM POLICY NUMBER: CF1-ML-10001431-04 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s):
THE CITY OF MERCED
678 W MAIN ST
MERCED, CA 95340
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A Section II - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III - Limits Of Insurance:
with respect to liability for "bodily injury", "property If coverage provided to the additional insured is damage" or "personal and advertising injury"
caused, in whole or in part, by your acts or required by a contract or agreement, the most we omissions or the acts or omissions of those acting will pay on behalf of the additional insured is the amount of insurance:
on your behalf:
1. Required by the contract or agreement; or
1. In the performance of your ongoing
operations; or • Available under the applicable Limit of nsurance shown in the Declarations
2. In connection with your premises owned by or
rented to you. whichever is less.
However: This endorsement shall not increase • the
applicable Limits of Insurance shown in the
1. The insurance afforded to such additional Declarations. insured only applies to the extent permitted by
law; and
2. If coverage provided to the additional insured
is required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1
INSURED
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