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HomeMy WebLinkAbout244 N COLLEGE AVE SUITE 105 - Filed P-PERMITS -Cityof ktColli� Planning, Development & Transportation Engineering Department PO Box 580 281 N College Ave Fort Collms, CO 80524 970-221-6605 P 970-224-6134 F Revocable Encroachment Permit for Portable Sign in the Right-of-Way (minimum of 5 business days required for approval) Applicant Name: � o V\W.we.�J O 'vll....--Phone: 9'. 70 �1 CJ 00 1/4 Company: Co rrw-Mv Se D:s:h'\lex:� � Address of Sign Location: -'2-t t tL G, //.e3..e..,, t STE: \0-.S City, State , Zip: ti vf-(' o 11 (V\,� Co �o s=z cf Company Address if different than Sign Address: _____________________ _ City, State, Zi p: ________________________________ _ Contact Name : --c(SoV'\ l:k-J el� I ContactEman:0oiSoy@ �£&:tl/4S€, UJM Applicant agrees to submit with this permit application a minimum 8 1/2" x 11" dimensional drawing that illustrates the location of the proposed portable sign, obstruction(s) or other structure or amenities in the public right-of-way. Applicant must also submit the Indemnity Agreement and a copy of the Certificate of Insurance with the City of Fort Collins Engineering Dept as Additional Insured. This permit Is non-transferable, is personal to the Applicant and is non-assignable. Applicant agrees that anytransfer of ownership of the business holding the permit will terminate this permit and require a new application to be filed by the new owner. Applicant has read this permit and agrees to abide by the current City of Fort Collins Municipal Codes, Standard Specifications and any such ecial conditions, restrictions and regulations that may be imposed by the City Engineer. Engineering Approval:�===�:..:::::�..:::::::::..-..::::==-------­ Application Fee: $ __ I D"'--.(Jt)----------- Date a 7� cwJ:" 1>0 r -,-_il_ ,., Total Due: $ __ , .... D"--, _____ ___.c ... k.: .... 'F-_-I g'- Conditions: _________________________________ _ Permit Number: ____________ _ evised 04/15/2011 23-15016 � COPPINC-01 1�,;-•--'ETI ACORD" CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDO/YYYY) � 1/13(2023 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 INS URER(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 Secu� Insurance Group LLC8219 20th Street Oreeley, CO 80634 INSURED CopperMuse, Inc. 244 N College Ave, STE 105 Fort Collins, CO 80524 COVERAGES CERTIFICATE NUMBER: S2Hv.-CT rft. Ellll: (970) 378-4818 I F� Nol:(970) 378-48201:lWlo ••. siatmsecurltvinsurancegroup.net JNSURERISl AFFORDING COVERAGE NAICt INSURER A: Philadelohia Insurance Co. INSURER&: INSURERC: INSURERD: INSURERli: INSURERF: 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. ·�TYPE OF INSUMHCE � ,21� POLICY NUMBER POUCYEFF POLICY EXP LIMITS ... X COMMEltCIAL GENERAL UABIUlY EACH OCCURRENCE " 1,000,000 I CLAIMS-MADE [Kl OCCUR X X PHPK2609038 1/1712023 1/17/2024 DAMAGE TO RENTED s 100,000 ,r=-MED EXP /A..., one D811Mlnl " 5,000 PERSONAL & NJ\/ INJURY 'It 1,000,000 2,000,000 �'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE " POI.ICY □ WBr □ LOC PRODUCTS • COMP/OP AGG " 2,000,000 OTHER: s �TOM0811.£ UABIUlY ��!!_!��!_>.�INGLE LIMIT s '---ANY AUTO BODILY INJURY {Ps lllll'90n) s O'IIYNED � SCHEDULEDAUTOS ONLY AUTOS B0011. Y INJURY {Per accidenll s 1----��ONLY 1--�arafflq �Of'f:RT\�AMAGEer aecldenl s s UMBRELLA LIA8 HOCCUR EACH OCCURRENCE s EXCEU LIAS ClAIMS,IMOE AGGREGATE OED I I RETENTION$'It WORKERS COMPEMSATION I ��fTUTI' I ll?� ANO IEIFLOYERS' LIA8IUTY YIN AJ,N PROPRIETOR/PARTNER/EXECUTIVE □ E.L. EACH ACCIDENT 'It �='j..."1ffl EXCLUDED? NIA E.L. DISEASE • EA EMPLOYEF "H �· d'"'7fJ& under E.L. DISEASE · POLICY LIMIT " D SCRIPTION � OPERATION� below DESCRIP110N OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Addttlonal Remalt(s StMdule, ma, be .nached If morespace 11 requlrwd) City of Fort Collins is included as addlttonal Insured. City of Fort Collins Attn: Engineering Department POBox580 Fort Collins, CO 80522 ACORD 25 (2016/03) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPfRATION DA're THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOIUZEDREPRESENTATIVE ;/,. ,�,,;!(- © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD