Loading...
COVID Encroachment Permit Application_Waiver 5.5.2020 rev. 5/5/2020 In order to support our local businesses during this difficult time, the City will be closing portions of the right of way so that social distancing can be achieved. Should you wish to utilize the right of way for line queuing or additional dinning space, please fill out the following application and submit requested documents listed at the bottom of this page. Once application and supplemental documents have been emailed to Madeline Kacsinta at mkacsinta@pismobeach.org, you will receive a confirmation email that your application was received. Once application is reviewed and approved you will receive an email requesting your signature on the approved permit. Please sign and send back a copy via email. Note that your permit is not valid without your signature on the approved permit. BUSINESS: ADDRESS: TELEPHONE #: OWNER: ADDRESS: CITY/STATE/ZIP: CONTACT PERSON: TELEPHONE#: Please circle type of telephone: Cell / Office / Home START DATE: _________________________________END DATE:______________________________ HOURS OF OPERATION: ________________________________________________________________ BUSINESS LICENSE NUMBER: ___________________________________________________________ Please circle yes if furniture is being placed in the right of way: Yes / No DESCRIPTION OF USE (i.e. Dinning or Line Queuing): ________________________________________ PERMIT SUBMITTIAL REQUIREMENTS/CHECKLIST (to be filled out by City Employee) All of the following items must be submitted prior to issuance of permit: ❑ Application (All information completed) ❑ Business License with the City of Pismo Beach ❑ Exhibit of Area Requested to be Used – Please submit a sketch over aerial imagery showing limits of use ❑ Liability Waiver Signed No markings, except non-residue tape (such as stucco tape), will be allowed on City sidewalk *Duct Tape is prohibited from being used in the City right of way Applicant is liable for any damage within the City right of way COVID-19 SUPPORT ENCROACHMENT PERMIT APPLICATION Email application to mkacsinta@pismobeach.org BE SMART. STAY APART. Visit www.pismobeach.org/CovidResponse rev. 5/05/2020 BUSINESS NAME _______________________________ PERMIT NUMBER_____________________ Permittee hereby agrees to indemnify and save harmless the City of Pismo Beach (“City”), its Council, officers, boards, commissions, agents and employees of and from any and all claims, suits or actions of every name, kind and description which may be brought against City, its Council, officers, boards, commissions, agents, or employees by reason of any injury to or death of any person or damage suffered or sustained by any person or corporation, caused by, or alleged to hav e been caused by, any act or omission to act, negligent or otherwise, of Permittee, its officers, agents or employees in connection with the use and/or occupancy of the area subject to the Encroachment Permit issued to Permittee. The duty of Permittee to indemnify and save harmless, as set forth herein, shall include a duty to defend as set forth in Section 2778 of the California Civil Code; provided, however, that nothing herein shall be construed to require Permittee to indemnify City, its Council, officers, boards, commissions, agents and employees against any responsibility or liability in contravention of Section 2782 of the California Civil Code. Permittee, at its sole cost and expense, shall acquire and maintain in full force and effect throughout t he term of this Permit commercial general liability insurance coverage relating to Permittee's use and occupancy of the permitted area covering City's risks in form subject to the approval of the City Attorney. Permittee acknowledges that the encroachment permit associated with this liability waiver may be revoked at any time without notice should the Permittee fail to abide by City ordinances, resolutions, or other regulations. PRINTED NAME ______________________________________________________________________ SIGNATURE________________________________________ DATE________________________ COVID-19 SUPPORT ENCROACHMENT PERMIT LIABILITY WAIVER Email to mkacsinta@pismobeach.org BE SMART. STAY APART. Visit www.pismobeach.org/CovidResponse