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Home My WebLink About18 - CC-9 - Attachment 2 - 7/7/2015ATTACHMENT 2 ALL APPLICATIONS MUST BE ACCOMPANIED BY SITE PLANS AND VICINITY MAPS Please complete the following application regarding the event you are proposing: DATEICA N; f� C�1 A PL,�GA`T' AME:STj RST) (MIDDLE) TE }i NE ,yJR: APPLWq f ESS�-�r�� STATE -,CO RESP S E P SON: (LAST) (FIRST) (MIDDLE) IEAlaPHONE NUMBER: t� ,G . FULL T NA E OF BUS ESSONDUCTINGIHOS EVENT TELEPHONE NUMBER BUSINESS ADDRESS CrfY: STATE: ZIPCODE: ADDRESS OF rT ! L UNIT NUMBER: APPROVED BUILDIN USE: YPE OF STRUCTURE: TYPSICIF EVENT' EVENT START DATE' EVENT START TIME: EVENT END DATE: EVENT END TIME: SET UP START TIME: SET UP END TIME: TEAR DOWN START TIME- TEAR DOWN END TIME: T AL TIME OF EVENT: urs 1. TYPE OF EVENT: 2. DESCRIBE PLANNED ACTIVITIES: 4 e STIMATED # OF PERSONS AT EVENT: 4. ESTIMATED # OF VEHICLES AT EVENT: 5. ESTIYATED# OF PARKING SPACES REQUIRED: S. LOCAT N OF EVENT: 7. WILL ALL OR A PORTION OF THE EVENT OCCUR ON PRIVATE PROPERTY WITHIN THE CITY OF COSTA MESA? F4 YES ❑ NO. IF YES. WHERE? 8. HAVE YOU OBTAINED WRITTEN APPROVAL FROM THE OWNERS FOR THE USE OF THE PROPERTY FOR THE EVENT? 9YES LINO If YES, attach a copy of the written approval to your application. If NO, you must file written approval with the Costa Mesa Police Department before a Special Event Permit will be issued. Please write your name, date of the event. and the Special Event Application number on the written apprayal. _ 9. WILL THERE BE ANY WATER "AID' STATIONS DISPENSING OF BEVERAGES IN DISPOSABLE CUPS? ❑ YES NO IF YES. WHERE? 10. WILL FOOD OR ALCOHOLIC BEVERAGES' BE SERVED OR SOLD AT THE EVENT? YE5 NO IF YES, DESCRIBE: 'Note: Alcohol is Amhtbited on City propertyexcept for inside at the Neighborhood Community Cenl 11. HAVE YOU OBTAINED A PERMIT FOR THE SALE OF FOOD OR ALCOHOL? YES NO IF YES, WHAT GOVERNMENTAL AGENCIES ISSUED PERMITS? -3- IN 12. Y ANIMALS BE DISPLAYED 1 EXHIBITED AT THE EVE T? YES NO,,IF YES• DESCRIBE: 13.IL ANY STRtSCPURES (i.e., tents, b Ihs, stages] BE ERECTED AT THE EVENT? YES NO. IF YES, DESCRIBE: 14. WILL THERE BE ANY SOUND AMPLIFICATION EQUIPMENT BEAT THE EVENT? ❑ YES NO. IF YES, DESCRIBE: 15. WILL THERE BE MONITORS OR SECURITY PERSONNEL A E EVENT? gLYES ❑ N0. IF YES, DESCRIBE NUMBER AND DUTIES: 24 � O -A, 16. 1F THERE IS GOING TO BE ANY MERCHANDISE SALES AT YOUR EVENT, HAVE YOU OBTAINED A CITY OF COSTA MESA BUSINESS PERMIT? [:3 YES [_1 NO. IF YES, PLEASE PROVIDE THE DATE OF ISSUANCE AND THE LICENSE NUMBER: /�fX./� LICENSE it: DATE ISSUED: 1 1 DATE EXPIRED: 1 1 IF YOUR EVENT WILL INVOLVE A PARADE, CYCLING EVENT, FOOT RACE, OR OTHER ACTIVITY WHICH WILL OBSTRUCT A CITY STREET OR RIGHT-OF-WAY OR REQUIRE A FULL OR PARTIAL STREET CLOSURE, PLEASE COMPLETE THE FOLLOWING SECTION. 17 ASSEMBLY TIME 18. START TIME OF EVENT] 19 ASSEMBLY LOCATION: 20. ESTIMATED DURATION OF EVENT: 21. DISBANDING LOCATION: 21. PRE -APPROVED ROUTE LOCATION JP7 22- DESCRIBE VEHICLES 1 FLEA fT (i.any size 0 by) ` 23. NUMBER AND TYPE F ARCHING UNITS IF APPLICABLE: r" IN INTERVALS OR SPACING IN FEET BETWEEN UNITS: 24. ANY PARADE MALS? YE NO. IF YES, DESCRIBE: ~ ►'rte / d -"- DECLARATION I, the undersigned, declare upon penalty of perjury that the above information listed within this City of Costa Mesa Special Event Permit Questionnaire AND Application is true and correct to the best of my knowledge. I further understand that knowingly providing any false information is cause for the immediate denial of a Special Event Permit, the suspension of a Special Event Permit if one has already been issued, and / or the denial of future Special Event permits being issued. I understand that in the event of a major incident, my event may be postponed or terminated for the sake of public safety and welfare (e.g., major crime incident, fire, flood, or any act of God). I have attached the following documents to this application that are, to the best of my knowledge, true and correct. dCompleted Application j Certificate of Insurance & Additional ❑ Commercial Liability Certificate Insured Endorsement [� Signed Indemnification Agreement ❑ Encroachment Permit [ Map and Traffic Control Plan [+ Signed Waiver & Release of Liability [Completed Checklist ❑ Copies of notifications to OCFD, OC E� Site plan showing locations of a y ❑ Structural plans of any structures Transit District, Local Businesses, structures (i e., blea her, tents, et, .), (i.e., bleachers, stages, platforms, Churches, and Residents elect is I g lumbi and sanitatio .� etc.) to be reviewed b City. (NAME O APPLICANT) &JGR A ] (DAT SIGN ) (NAMEO EVENT O GANIZ ) (SIGNATURE OF EN O GA 2ER} (Q E SI D) -5- Please check each item that will be present at your event, and provide a brief description of each item checked "YES". ITEM - YE —/NC-- ;LEASE D- SCRIBE ALL ITEMS CHECKED YES; ANIMALS Y ❑ N' ALCOHOLIC BEVERAGES ❑ Y ' N AUTOMOBILES I TRUCKS M Y ❑ N BICYCLES 1 FOOT RACES ❑ Y [ N BUILDINGS I STRUCTURES ❑ Y M N BOOTHSISTANDS ❑ Y A N CAMPGROUNDSIRV .AREAS Y ❑ N CONCESSIONS ❑ Y N OANCEIPARTYI CONCERT Y El N ELECTRICAL I PLUMBING I MECHANICAL o N EMERGENCY ACCESS REQUIRED ❑ Y N FLAMMABLE MATERIALS ❑ Y N FOOD SUPPLIES 1 SALES ON-SITE GRA61NG 1 CONSTRUCTION ❑ Y 19 N El Y N LIGHTING I ILLUMINATION ❑ Y N MEDICAL/FIRST AID STATIONS ❑Y N PARKING Y ❑ N POLICEISECURITY PROTECTION Y El N POLICE I TRAFFIC CONTROL Y ❑ N PYROTECHNICS (FIREWORKS EJ Y N RIDES-CARNIVALI MECHANICAL Y ❑ Y N SANITATION ❑ Y N -- SIGNS 1 BANNERS STREET/ LANE CLOSURES[Y ❑ Y MN E] N TENTS/ CANOPIES ❑ Y 9N CITY PROPERTY OR FACILITY USED Y El N WATER SUPPLY USED OR AFFECTED Y ❑ N W] OC Fair Cattle Drive Production/Event Schedule Pending - Dates TBD Event Coordination Meetings with CMPD, City Staff, OCSD and OCFEC Staff Wednesday, August 5 Pre -Event Site Walk-Through/Inspection with Site Representatives Cow Camp (OCC @ Adams & Pine Creek) Set Up Support Horse Camp Set Up 24 -Hour Security assigned to camp locations (OCFEC Staff) Wranglers and horses arrive @ Cow Camp Thursday, August 6 11 am - 12noon/Cattle arrive @ Cow Camp Request traffic control for off loading of livestock transport trucks (3 trucks) Wranglers work cattle Support horses arrive at Support Horse Camp Friday, August 7 6am - 10am/Live TV @ Cow Camp Wranglers work cattle Support horses arrive at Support Horse Camp 2pm - 11 pm/OCC Foundation sponsored fundraising event @ Cow Camp Saturday, August 8 6am VIP/Guest Wagons Arrive at Cow Camp 7am VIP's/Guests Assemble at OCFEC/Gate 4/Lot F 8:30am VIP's/Guests Shuttled to Cow Camp Support riders ride to Cow Camp through Mesa Del Mar 9:30am Support riders arrive at Cow Camp 10am VIP's/Guests load wagons Support riders pre -stage @ Cow Camp 10:15am CMPD stops east and west bound traffic on Adams between Harbor and Fairview 10:25am Support horses leave Cow Camp and assemble on the south side of Adams facing west 10:30am Cattle/lead riders leave Cow Camp Cattle herded through support horses by lead riders and dog teams VIP/Guest Wagons proceed to Adams by way of OCC Adams entrance west bound feeder lane Cattle Drive proceeds west on the south side of Adams towards Harbor Cattle Drive continues on Adams west to Mesa Verde Drive East Cattle Drive turns left at Mesa Verde Drive East and proceeds to Harbor Cattle Drive turns right at Harbor and proceeds to Fair Drive Cattle Drive turns left at Fair Drive and proceeds to OC Fairgrounds/Gate 2 Cattle Drive turns left at Gate 2 and proceeds to the southwest corner of the OCFEC parking lot (Fair Drive and Fairview) Estimated Mileage: 2.5 miles Estimated Event/Cattle Drive Time: One Hour Cattle Drive Procession: CMPD/OCSD Traffic Control OC Fair Media Truck Front Riders w/OCSD Motorcycle (Emergency Communication) Cattle Drive: Six Lead Riders Five teams of six riders on the right and left sides of the cattle Approximately 300 head of cattle Two sets of dog teams Ten additional support riders OCSD Mounted Unit VIP/Guest Wagons (8 - 10) Two trucks pulling livestock trailers (Cattle and Horses) Street sweepers and clean up personnel CMPD/OCSD traffic control INDEMNITY AGREEMENT a- pplicant/organization name) agrees to indemnify, defend (at City's option) and hold harmless the City of Costa Mesa, its officials, employees, representatives, and volunteers from any and all claims, demands, defense costs, liabilities or consequential damages of any kind or nature which rise out of the use of L rte 4 _ _ (location) in connection with the dc=� • (event) which will take place in Costa Mesa, California date(s) of event). This agreement includes any liabilities that may arise out of We use of booths, concessions or any other activities conducted, set up and/or used by all applicant during the event, including non-members or guests of aSR/ / i (applicant/organization name). Date: / f Authorized representative for, (organizatio name) / Print Nairne a Title WAIVER AND RELEASE OF LIABILITY I am the applicant and responsible p son for the e>(fl/-/ 41Z!! e- 40�exxr (event name, hereafter "event') to be hQi � -t�. '"' (dates) at Oe-r— (location) C=(location) in Costa Mesa, California. I hereby ASSUME ANY AND ALL RISKS associated with the event including but not limited to injuries sustained by participant arising out of strenuous physical activity or exertion; striking or being struck by objects, vehicles or persons; uneven or defective roadway surfaces; exposure to heat, cold or humidity. I APPRECIATE AND VOLUNTARILY ELECT TO ACCEPT ALL RISKS connected with the event and any property directly adjacent or appurtenant to the event location. I HEREBY FOR MYSELF, MY HEIRS, OR ANYONE WHO MIGHT CLAIM ON MY BEHALF AGREE NOT TO BRING ANY CLAIM AGAINST THE CITY OF COSTA MESA AND WAIVE, RELEASE AND DISCHARGE THE CITY OF COSTA MESA, ITS OFFICERS, AGENTS AND EMPLOYEES FROM ANY AND ALL LIABILITY FOR PERSONAL INJURY, DEATH OR PROPERTY DAMAGE INCLUDING LIABILITY ARISING OUT OF THE NEGLIGENCE OF THE CITY OF COSTA MESA OR ITS OFFICERS, AGENTS OR EMPLOYEES. THIS RELEASE AND WAIVER EXTENDS TO ALL CLAIMS OF EVERY KIND OR NATURE WHATSOEVER, FORESEEN OR UNFORSEEN, KNOWN OR UNKNOWN. I HAVE READ THE FOREGOING AND CERTIFY MY AC P"rANCE OF THE ABOVE PROVISIONS BY MY SIGNATURE ON THIS DATE, `r . (date). Authorized representative for: � ;fir - .�.�� C�•cam, (organization name) l -10- 1 CALIFORNIA FAIR SERVICES AUTHORITY May 19, 2015 To: City of Costa Mesa 77 Fair Drive Costa Mesa, CA 92626 Re; Orange County Fair/321" DAA 88 Fair Drive Costa Mesa, CA 92626 Please be advised that the Orange County Fair/32"DAA is a member of the California Fain Services Authority (CFSA), and participates in the following self-insurance and loss pooling programs which are administered by CFSA: I. GENERAL LIABILITY PROGRAM A. Coverage Limits $10,000,000 California Fair Services Authority Coverage continuous until cancelled 11. WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY PROGRAM A. Prh»ary Coverage $500,000 self-insured retention California Fair Services Authority Coverage continuous until cancelled B. Excess Coverage (a) Workers' Compensation: Statutory Limit in excess of $500,000 (b) Employers' Liability: $4,500,000 in excess of $500,000 Coverage provided by CSAC Excess Insurance Authority Term: 07/01/2014 to 07/01/2016 CFSA represents to the City of Costa Mesa that within the above limits, terms and provisions of the coverage stated, to the extent provided by law, CFSA will provide defense, payment, and indemnification on loss funding in accordance with the terms of the contractual assumption of the Orange County Fair/32"" DAA as set forth in the City of Costa Mesa's "Insurance Requirements". You will be given at least thirty (30) days notice of any change in the foregoing information. We host that this commitment will satisfy your insurance requirements. V ec to contact this office o :ill matters including possible claims. t 1 776 TRIBUTE ROAD, SUITE 100 SACRAMENTO, CA 9se is PHONE: (91 6) 921-2213 1 FAX: (91 6) 646.1 Z313 alp i''.': . � 3 �'. ` � � •r ' i � +w _ �� •� arm- v. � � `� x i 4 ✓v: - � � � 1 ?T v `� Iii �"••_ _ - �. �• i +. 'i �'L.•. ',�, r.� r -� _ }gip J { �'� fix. ►jr ff }-s JIM. fD! ...jr, grid 1 1 A-1Acts IL ri -r i J �.V Li�+'.s _a a ,� � /�{' � _i: 4$'k .•� 11 yra � F � $r► L . � ter, ► � ,' •, � iii s �...- --r, f_ •� .��' �d � � T �.� { . , ..�r�'� _ s i r• Y� i qw qv 40 it jr In fR' TTT�� : r� � •.may ' �' . J fff R y �r 1 '� •'!'?fk:^1 �\111 -' -�I� _ ' � 5 �' ifil•-E•j1�L' L ' f 4xj r�;�-�=4�,- �• '� elk Er ,ILL ty [hala Ave •a 'ti .mac, = E _._ r�4.�.. - ii r a � 'J '�r • P y, ' _jL',7-�• '�` 1.��r r'ri+yi�i:�1T7��r'_�� f � i7 � ��1� �� 'l � + �� y . q, • " �-, E •_ ;� ; : ; r.' t . • �'; - � � • ;!� ^•sat Al __ liz so 17 I IoV yr7; n PA 1 .. `v 1. �;�'r : •E��lf ? ,�