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HomeMy WebLinkAbout120 W LAUREL ST UNIT A&B - Filed P-PERMITS -Planning, Development & Transportation Engineering Department PO Box 580 281 N College Ave Fort Collins, CO 80524 970-221-6605 P 970-224-6134 F Revocable Encroachment Permit for Outdoor Eating Areas in the Right-of-Way (minimum of 5 business days required for approval) Applicant Name: _______________________________________________ Phone: _______________________ Company: ___________________________________________________________________________________ Address: ____________________________________________________________________________________ City, State, Zip: _______________________________________________________________________________ Dates of Encroachment: ________________________________________________________________________ Location of Encroachment: ______________________________________________________________________ Contact Name : _______________________________ Contact Email: __________________________________ Applicant agrees to submit with this permit application a sketch, drawing or plan that illustrates the location of the proposed outdoor eating area 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 any transfer 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 Standard Specifications and to any such special conditions, restrictions and regulations that may be imposed by the City Engineer. Applicants Signature: ________________________________________ Date: ____________________________ Engineering Approval: _____________________________________ Date: _____________________________ Outdoor Eating Encroachment Permit Fee: $_______________________________________________________ Conditions: _________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Permit Number: _______________________________ Revised 03/15/2010 John Lawyer 217-741-1439 RamaMama 120 W. Laurel St, Unit A&B Fort Collins, Co. 80524 120 W. Laurel St. Unit A&B John Lawyer JWL617@Gmail.com 4-11-21 4/21/21 50.00 21-8001 INDEMNITY AGREEMENT FOR OUTDOOR EATING AREA PERMITS The Permittee hereby convenants that it will indemnify and hold the Lessor harmless from all claims, demands, judgments, costs and expenses, including attorney’s fees arising out of any accident or occurrence causing injury to any person or property whosoever or whatsoever due directly or indirectly to the issuance of the outdoor eating area permit and the placement and use of the permitted outdoor eating area by the Permittee and its agents and employees, unless such accident or occurrence results from any tortuous misconduct or negligent act or omission on the part of the City, its agents and employees. Dated this _____________ day of ___________________________________, 20_________ Permittee Name: _____________________________________________________________ By: ________________________________________________________________________ Title: _______________________________________________________________________ Address of Outdoor Eating Area Permit: ___________________________________________ April 11 21 John Lawyer RamaMama Owner 120 W. Laurel St. Unit A&B Planning, Development & Transportation Engineering Department PO Box 580 281 N College Ave Fort Collins, CO 80524 970-221-6605 P 970-224-6134 F Revocable Encroachment Permit for Outdoor Eating Areas in the Right-of-Way (minimum of 5 business days required for approval) Applicant Name: _______________________________________________ Phone: _______________________ Company: ___________________________________________________________________________________ Address: ____________________________________________________________________________________ City, State, Zip: _______________________________________________________________________________ Dates of Encroachment: ________________________________________________________________________ Location of Encroachment: ______________________________________________________________________ Contact Name : _______________________________ Contact Email: __________________________________ Applicant agrees to submit with this permit application a sketch, drawing or plan that illustrates the location of the proposed outdoor eating area 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 any transfer 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 Standard Specifications and to any such special conditions, restrictions and regulations that may be imposed by the City Engineer. Applicants Signature: ________________________________________ Date: ____________________________ Engineering Approval: _____________________________________ Date: _____________________________ Outdoor Eating Encroachment Permit Fee: $_______________________________________________________ Conditions: _________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Permit Number: _______________________________ Revised 03/15/2010 John Lawyer 217-741-1439 RamaMama 120 W. Laurel St, Unit A&B Fort Collins, Co. 80524 120 W. Laurel St. Unit A&B John Lawyer JWL617@Gmail.com 4-11-21 INDEMNITY AGREEMENT FOR OUTDOOR EATING AREA PERMITS The Permittee hereby convenants that it will indemnify and hold the Lessor harmless from all claims, demands, judgments, costs and expenses, including attorney’s fees arising out of any accident or occurrence causing injury to any person or property whosoever or whatsoever due directly or indirectly to the issuance of the outdoor eating area permit and the placement and use of the permitted outdoor eating area by the Permittee and its agents and employees, unless such accident or occurrence results from any tortuous misconduct or negligent act or omission on the part of the City, its agents and employees. Dated this _____________ day of ___________________________________, 20_________ Permittee Name: _____________________________________________________________ By: ________________________________________________________________________ Title: _______________________________________________________________________ Address of Outdoor Eating Area Permit: ___________________________________________ April 11 21 John Lawyer RamaMama Owner 120 W. Laurel St. Unit A&B VINTAGE PENDANTS.1x6 PAINTED WOOD IN 2'x2' PATTERN. NOT IN SCOPE1' - 5 1/8"2' - 8"5' - 9 7/8"2' - 3 1/2"7 1/2"13' - 2 1/2"6' - 0"3' - 7"3' - 8 1/2"5' - 4" 19' - 3"1' - 6"1' - 6" 6' - 3" 3' - 0"NEW BARSTOOLSHOST?1' - 6" 2' - 0"NOT IN SCOPESHEET:6/24/2020 11:00:33 AM7I-101Level 1FP + RCP120 W. Laurel StreetFort Collins, CO 80524RamaMamaPLANNORTH1/8" = 1'-0"2NEW CEILING PLAN - MAIN LEVEL1/8" = 1'-0"1NEW FLOOR PLAN - MAIN LEVELPLANNORTHNOT FOR CONSTRUCTION 04/13/2021 Weedin Insurance Agency, Inc 1601 E Eisenhower Blvd Loveland CO 80537 JENNIFER HERL (970) 667-2145 (970) 669-9295 JENNIFER@WEEDINAGENCY.COM Lickskillet Llc 1544 Oakridge Dr Fort Collins CO 80525-7305 Auto-Owners Insurance Co 18988 Preferred Consumers 10194 Pinnacol Assurance 41190 CL214904145 A Y 74179535 11/15/2020 11/15/2021 1,000,000 300,000 10,000 1,000,000 2,000,000 2,000,000 Premises/Operations B 02945975-5 03/24/2021 03/24/2022 1,000,000 Medical payments 5,000 C Y 4191288 04/01/2021 04/01/2022 1,000,000 1,000,000 1,000,000 Certificate holder is additional insured if required by a written contract. City of Fort Collins Planning, Development & Transportation Engineering DepartmentPO Box 580 281 N College Ave Fort Collins CO 80524 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY