Loading...
HomeMy WebLinkAbout222 LINDEN ST - Filed P-PERMITS - (2)City of ktCoUir:s Planning, Development & Transporta!ion Engineering Department PO Box 580 . 281 N College Ave Fort Collins, CO 80524 970-221-6605 P 870-224-6134 F Revocable Encroachment Permit for Portable Sign in the Right-of-Way (minimum of 5 business days required for approval) App licant Name: Michelle Kimble Comp any: Hydrate IV Bar Phone: 970-672-8433 Address of Sign Location: .,,2,,.,2,,,2"'-'L""'-'-in.,_,d,,_e"'-'-'n'-S""-'t ________________ _ City, State, Zip: Fort Collins co 80524 Company Address if different than Sign Address: ____________________ _ City, State, Zip: _______________________________ _ Contact Name: Michelle Kimble contact Email: michelle@hydrateivbar.com 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 an y transfer of ownership of the business holding the permit will terminate this permit and require a new ap plication tobe filed by the new owner. Applicant has read this permit and agrees to abide by the current Cit y of Fort Collins Municipal Codes, Standard Specifications and any such special conditions, restrictions and regulations that may be im posed by the City Engineer.\ • ' r App licants Signature:! L(M,IA.1luif wt.1k,Date: ·1L-.. +-'\ 1--"'0+r ,z.,,_,·�.L.._ __ _ Engineering Approval: -•-/;1-'cYJ"""""'e::,,,=!..._�=c:::::.-'==---La c;&l.. App lication Fee: $---+'-.,/---------- Date: /4 J /z.?; aCP Total Due:$._�/�-------- Con di tions: ________________________________ _ evised 04/15/2011 Permit Number: ____________ _ 23-15022 Paid $10.00 01.31.2023 CC 1042 BMISC230045 INDEMNITY AGREEMENT FOR PORTABLE SIGN PERMITS _____.., BLENLLC-01 SARAM ACORD" CERTIFICATE OF LIABILITY INSU RANCE I DATE (MM/DD/YYYY) \,,_..----' 1/19/2023 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 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 endorsementfs). PRODUCER Home Loan & Investment Company 205 North 4th Street Grand Junction, CO 81501 INSURED §.fil!I�cr Sara Mendenhall rtE,"Jo, E,t), (970) 254-0846 Jr.Jfli_�i;;.,�• saram@hlic.com INSURERfSI AFFORDING COVERAGE I 1ffc, Noj,(970) 243-3914 NAIC# INSURER A: Nationwide Insurance (fka Allied) 23787 JNSURER.B: Pinnacol Assurance--·�-··--·---·-·-· 41J90 ··-----·"·- Blendan LLC DBA Hydrate IV Bar tNsuRER c: Landmark American Insurance Co 8 Ivanhoe Street INSURER D: Denver, CO 80220 INSURER E: JNSURERF: CO VERAGES 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 INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CON DITION 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. 1µ,!i� f.�E.!-�-'!�B-POLICY EFF POLICY EXP TYPE OF INSURANCE POLICY NUMBER LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE •1,000,000 I CLAIMS-MADE [K] OCCUR X ACP013029840902 8/19/2022 8/19/2023 DAMAGE TO RENTED $ 300,000; _ERl;Ml_�!;Lqru;ucrence\ �'L AGGREGATE LIMIT APPLIES PER, POLICY □ ��i □ LOG OTHER: AUTOMOBILE LIABILITY -ANY AUTO -OWNED -SCHEDULED -AUTOS ONLY � AUTOS -�lfl-1fls ONLY � �8¥&'/;"6'/1/.� UMBRELLA LIAB HOCCUR -EXCESS LIAB CLAIMS-MADE OED I I RETENTION s B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N 4225554 ANY PROPRIETOR/PARTNER/EXECUTIVE □ �FFICER/MEMBER EXCLUDED? N/A Mandatory In NH) g�sd�ftif�N �w�PERATIONS be!ow C Errors & Omissions LHM846920 A BPP ACP013029840902 9/1/2022 9/1/2023 8/19/2022 8/19/2023 8/19/2022 8/19/2023 MED EXP (Anv one oersonl PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS -COMP/OP AGG HIRED NON OWNED COMBINED SINGLE LIMIT (!;_<l...fil:fili;l_e.m) BODILY INJURY rPer norsonl 80D!l Y INJURY I Per accident\ }p�?�fc�d�NAMAGE EACH OCCURRENCE AGGREGATE W�f�TUJE I I 0TH-ER E.L. EACH ACCIDENT E.l. DISEASE -EA EMPLOYEE E.L. DISEASE-POLICY LIMIT Each Claim Limit Limit $ 5,000 $ 1,000,000 •2,000,000 $ 2,000,000 $ Included $ $ • • • $ $ $ 1,000,000 $ 1,000,000 $ 1,000,000 1,000,000 31,800 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES {ACORD 101, Addltlonal Rom11rks Schodule, may be 11ttachod If more space Is required) City of Fort Collins Is an additional insured in regards to General Liability. CERTIFICATE HOLDER CANCELL ATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN215 North Mason Street, 1st Floor, South Wing ACCORDANCE WITH THE POLICY PROVISIONS. Po Box 580 Fort Collins, CO 80522-0580 AUTHORIZED REPRESENTATIVE DC� I ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and loao are reaisterAd m::irk� nf Ar.nRn