ATTACHMENT 1
N Special Event Permit Application
CITY OF Recreation & Park Services Department
NORWALK 13000 Clarkdale Avenue • Norwalk, CA 90650
A Connected Community 562-929-5566 • www.norwalk.org • [email protected]
ONLY COMPLETE APPLICATIONS WITH PAYMENT WILL BE ACCEPTED Block Concert Festival/ Fundraiser Vendor Live Parade
Event Type: Party Music CITY STAFF
Carnival Market Processions
Race/ Sale/ Car Tournament Other: Food Distribution FEE:
Walk Expo Show
STAFF INITIALS:
2022
Is this a repeat event? Yes - If yes, what date was the event last held? APR. DATE:
Community Food Distribution
Event Title:
Sat., January 25, 2025 9:00 am to 12:00 p.m.
Event Date(s): Event Start & End Time:
Jan 25. 7:00 a.m. Jan 25. 12- 3p.m.
Setup Date & Time: Break Down Date & Time:
500 500
Attendance Per Day: Participants Per Day: _ Admission Fee: NO YES -Method?:
Fee Food Distibution
Open to Public?: NO YES - Describe: Phone /website for public info: (562) 356-7918 12440 E. Imperial Hwy. S/E Parking Lot
Event Exact Address: Site Plan Attached: NO YES
APPLICANT INFORMATION
(If a professional event organizer is applying for this permit, a letter from the Chief Officer of the organization authorizing the organizer is required.)
Authorized For Profit
Norma Amezcua, President - Norwalk Lions
Applicant: X Non- Profit
Contact
Norma Amezcua [email protected]
Person: Email: Phone:
Address: City, State, ZIP: Cell:
List information of professional organizer or event planner hired for this event, if applicable:
Non Needed
Name: Email: Phone:
Address: City, State, ZIP: Cell:
Day of Event "on-site" contacts):
(Person(s) must be in attendance for the duration of the event and immediately available to City Officials.) Norma Amezcua
Name: Email Phone:
Rick Ramirez
Name: Email: Phone:
CITY OF NORWALK
RECREATION AND PARK SERVICESDEPARTMENT
Will all or any part of the event take place on City of Norwalk property? Does the event applicant have any employees that will be working at the event?
EVENT DETAILS
Describe parking arrangements in detail for event: Is plan attached? → NO YES See Plot Plan which is approved by property owners
Parking & Traffic
Traffic Equipment Required? | LINO YES, Describe: Deleniators (e.g. reader boards, barricades, cones, etc
List streets that require *closure for this event: None *Road closure permit required
Provide a detailed traffic plan for road closures. Is the plan attached? NO YES Entertainment (Amplified sound requires onsite contact) List ALL entertainment & related activities: No Entertainment Will event have
amplified sound? Outdoors Same & Number:
Indoors
Describe hours, sound equipment & type of use (eg. speakers, amplifiers, generators, etc.):
Will the Special Event include a valet or shuttle service? / NO YES, DESCRIBE:
Will there be fireworks or other pyrotechnics? NO YES, DESCRIBE:
Will there be a Drawing Casino - Company Name & Number:
As a reminder there is no gambling allowed in The City of Norwalk at any time.
Alcohol & Food
cohol at event? No Served so fams, So Num
Sold Name & Number
Food at event? •NO sered •sold Nam, &Number: _
Will food be prepared at the event? V NO DYES
Marketing
Describe marketing plan in detail for event: Is plan attached? I NO See attached Flyer
CITY OF NORWALK
RECREATION AND PARK SERVICESDEPARTMENT
Structures & Other Equipment
Will there be canopies or tents? ] NO YES, If yes, size & quantity Standard EZups Date installed: 12/25 Date removed: 12/25 Supplier Name:
Will booths, bleachers, stages,
or structures be erected? No Yes, Describe:
Will signs or banners be used? No Yes, Describe: 2 hung on property fence Will there be generators, vehicies
boats or other equipment? No Yes, Describe:
Will there be Carnival Rides Attractions, Describe: None Will there be commercial filming of this event? No
Any other commercial aspects? No
Additional information:
Basic Food Distribution
AGREEMENT & PAYMENT INFORMATION
I, the undersigned, acknowledge and understand that I am responsible to comply with the information, restrictions and conditions of the permit. I hereby acknowledge responsibility for penalties associated with non-compliance with the permit conditions, whether or not l am present at the time of the violation.
Initials
I hereby certify the foregoing statements to be true and correct, and agree to defend, indemnify and hold harmless the City of Norwalk, its City Council, officers, agents, employees and volunteers from and against any and all loss, claims, damages, liability, such claim or suit arising from or in any manner connected to the requested activity. I also agree, if approved, to comply with all permit conditions, and understand that failure to comply with any condition or any violation of law may result in the immediate cancellation of the event, denial of future events, and or criminal prosecution.
Failure to comply with permit conditions can result in revocation of the permit, forfeiture of deposit, administrative citations, fines and denial of future permit applications.
Norma Americ [12/12/24
Print Name Signature
Applications) must be complete with all necessary attachments in order to be accepted & processed. (Insurance, event diagrams, parking plans, community notification, vendor list, other permits, etc.)
COMMUNITY
FOOD
DISTRIBUTION
January 25, 2025
9:00 am - 12:00 pm
12440 Imperial Highway Raceway L.A. County Registrar
ary Express C.
12440 Imperial Highway
Norwalk, CA 90650
Los Angeles County
Registrar-Recorder/... Solterra at
Entrance on Bloomfield Ave
егіог
Drive Thru Distribution
Following All
s Angeles County Social Distancing
eriff Norwalk...
Civic Center Dr Barranca Ln Coyote Ln Safety Protocols
Anabella St Norwalk Manor O
TONS SON OF MACHAR SON OF MACHINE?
LOS ANGELES Labor
Community CITY OF
FEDERATION AEROSPACE
INTERNATIONAL Services NORWALK
O LABOR
LOS ANGELES
A Connected Community
DISTRICT 947 LOCAL LODGE 1957
Food Distribution Event January 25, 2025
ENTER
Trash Dumpster Sorting Area
Bloomfield Ave.
12601
Civic Center Dr.
Portable Restrooms Volunteer Food Station Drive Thru Food Station
DATE (MM/DD/YYYY)
ACORD® CERTIFICATE OF LIABILITY INSURANCE
12/10/2024
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 INSURERS), 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 endorsements).
PHONE FAX
1-800-316-6705 (AiC. No): 847-934-6186
DSP Insurance Services, Inc. (AIC No. Ext):
E MAIL [email protected]
1900 E. Golf Rd., Ste. 225 ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC *
Schaumburg, IL 60173 ACE American Insurance Company 22667 INSURER A:
INSURED INSURER B:
Lions Club of Norwaik California (002523) INSURER C:
Norwalk California
INSURER D:
INSURER E:
INSURER F:
COVERAGES 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
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
EXCLUISIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INSH LIMITS
I TR TYPE OF INSURANCE POLICY NUMBER (MM/ODYYYY)(MM/ODIYYYY EACH OCCURRENCE 1.000,000
A GENERAL LIABILITY
DALAGE TO RENTED
COMERC:AL GENERA: LABIL TY PREMISES IEa occurrence 1,000,000 X
X OCCUR HDOG48914445 "ED EXP Any che person, $ 5,000
CLAIMS MADE 09/01/2024 09/01/2025
PERSONAL & ADY INJURY 1.000,000
X Agg. Per Named Insured
is $2.000,000 GENERAL AGGREGATE $ 10,000,000
SENT AGGREGATE LIMIT AFPLIES DER ¡PRODUCTS. COMP OR AGG $ 2.000.000 X PRO-
POLICY JECI LL0C
COMBINED SINGLE LIMIT
A AUTOMOBILE LIABILITY $ 1,000.000
SODILY INJURY ¡Per personi
ANY AUTO ISAH10835549
09/01/2024 09/01/2025
SCHESULEC: BODILY INJURY; Per acc dents
AUTOS PROPERTY CAMACE
NON-OWNED ¡Per accidenti
X HIRED ALTOS X ¡ AUTOS
UMBRELLA LIAB LEACH OCCURRENCE
EXCESS LIAB CLAIMS LADE AGGREGATE
DEC RETENTIONS
IC STATI JOTH
WORKERS COMPENSATION TORY LISTS ER
AND EMPLOYERS LIABILITY YIN
ANY PROPR ETOR PARTNER EXECUTE EL EACH ACCIDENT
OF: CER MEMBER EXCLUDED? NIA
(Mandatory in NH) EL DISEASE EA EMPLOYEES.
BREASTION OPERATIONS DEKA EL DISEASE - POLICY LINI/S.
January 25, 2025
Food Distribution Event 12440 E. Imperial Hy. Norwalk, CA 90650 CBRE, Inc. c/o Sonnenblick del Rio Norwalk, LLC a DE Limited Liability Co is included as an Additional Insureds), but only with respect to General Liability arising out of the issuance of permits) to the Insured shown above and not out of the sole negligence of said additional insured.
PROVISIONS OF THE POLICY DO NOTAPPLY TO THE SALE OR SERVING OF ALCOHOLIC BEVERAGES
CERTIFICATE HOLDER CANCELLATION
CBRE, Inc.; C/0/ Sonnenblick del Rio Norwalk, LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 12440 E. Imperial Highway Ste 101 THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN Norwalk Califomia 90650 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
iệ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 12/18/24, 6:51 AM Request for use of Property - [email protected] - Gmail = M Gmail Q in:sent
13 o
Compose
Request for use of Property Inbox x
Inbox 3,821
Starred Anthony Garcia Thu, Dec
Hello Melissa, It was a pleasure talking to you. So, the city will be assisting with this project. The following attachment has the request let Snoozed
Sent
Garcia, Melissa @ Norwalk Thu, Dec 1
Drafts 14 Hello Anthony, I cannot speak for the Owners of the property, but I do know they have a heart for these types of events and the property More
Anthony Garcia Thu, Dec
Labels No problem, It will take place on Saturday, January 25. The event will be advertised from Bam to 12 noon. Use of the property would be f Garcia, Melissa @ Norwalk [email protected]> Thu, Dec 12, 12:21PM (6 days agr to Samantha, Melanie. [email protected], Wellington, [email protected], Anthony, me, Rick, Erick Hello Anthony, this has been approved by the property owner! As we get closer to the date, let us know when the portable restrooms will Melanie and Jesse. please do a passdown and put it on the board, so we all remember.
Sam. please do a communique to the tenants.
THANKS!
Melissa Garcia
Senior Real Estate Manager | Lic. 1386365
CBRE | Property Management
12440 E. Imperial Hwy., Suite #101 | Norwalk, CA 90650
T +1 562 864 3107
https://mail.google.com/mail/u/O/#sent/FMfcgzQXKhHQHrMssQcLRRMSZTHnmchR 1/1