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CITE' OF TY EE ISLAND
SIDEWALK CAFE OR MERCHANDISE DISPLAY PE"11T
M.. CHU JUNG
. 13OX 700
TYBEE ISLAND, GA. 31328
BusinessLocation: 7 TYBRISA STREET
Certificate : 267
Date Issued: 1/14/2022
A clear pedestrian path of a minimum of 4 feet must be maintained at all times. Compliance with
ADA provision is required at all times. A sidewalk element shall not be permanently attached to
the sidewalk. Sidewalk elements shall be stacked/set aside immediately u on ceasing daily
operation and :midst be secured in such a manner as to prevent their use. Use of the right-of-way
may be temporarily suspended at the discretion of the city. Sale transactions shall not occur on
sidewalks. All sales must occur in the building.
islaT kits T 7F 3" T
HOURS OF OPERATION
Sunday 9 a h
Monday 9 a -- 9 la
Tuesday 9 a — 9 p
Wednesday 9 am - 9 pm
Thursday 9 ain — 9 pm
Friday 9 a
Saturday9arn-9pm
This r it and planst be displayedin a conspicuous lac in your business establishment.
The CityTybee Islandmust be notified change in status. This er it is not transferable
and is subject to beingrevoked if abused. This Permit expires on 12/3112022
George
Planning
P.O. Bay: 2749 -=403 Butler Avenue * T ybee Island, Georgia 31328-2749
i912i 786-4573 ® FAX (912) 786-5737
CITY OF TY EE ISLAND
r
SIDEWALK OR MERCHANDISE DISPLAYPERMIT APPLICATION
Business name
APPROVE OR DENY BY
DATE
Street address
41" 1 .
Mailing address
Sidewalk Use Fee $0.00
City Marshal
An application may require
30 days or more to process.
Name of business owner:
c-
Email ho
Phone numbers of owner:
Business
Home obile
DIRECT AN APPEAL OF PERMIT
Name of applicant if other than owner:
Email
Phone numbers of applicant:
Business
a mL, Home Mobile
Relationship of applicant to owner (same, employee, agent, etc.)
Mailing address of applicant
Application is for: Sidewalk Cafe Merchandise Display
-M
I . The length and width in feet of the public right-of-way to be used:
2. The number of tables and chairs to be provided at the Sidewalk Cafe:
3, -Hours of operation of the Sidewalk Cafe or Merchandise Display:
Sunday: C-4 c` until
Monday: ountil Ca
Tuesday: until_s l
Wednesday:r, until
Thursday:' until
v.
Friday: q C. untilONI
Saturday: t until
Sidewalk elements of cafes and merchandise displays must be secured daily when normal business operations cease.
The applicant shall not replace the approved items or change the layout without written authorization from the Planning and Zoning Manager.
DOCUMENTS REQUIRED WITH APPLICATION
Affidavit (must be notarized; seepage 2)
Indemnification Agreement (must be notarized; seepage 3)
Certific7te(s) of Insurance listing the City of Tybee Island as qst additional insured (see page 4)
A Site Plan to scale with measurements of the proposed sidewalk area and all items to be placed on or within it (see page 4)
Photograph(s) of the sidewalk area (optional)
Applicant's signature - Date
Printed name
ROUTING
APPROVE OR DENY BY
DATE
FEE
Sidewalk Use Fee $0.00
City Marshal
An application may require
30 days or more to process.
Planning & Zoning Manager
DIRECT AN APPEAL OF PERMIT
DENIAL TO THE CITY MANAGER.
403 Butler Avenue, P.O. Box 2749, Tybee Island, Georgia 31328
(912) 472-5033 FAX (912) 786-9539
_, c o f c cilyoftybee.org
Page 1 of 6 12/14/2012
AFFIDAVIT
I acting in the capacity of
name owner, agent, employee, etc.
on behalf of the establishment known as - vk ." located at
business name
Tybee Island, Georgia, attest to the following:
street address
o I have reviewed this application and all entries are correct and accurate to the best of my knowledge.
o There are no omissions of fact:
o There are no items located on the sidewalk where the Sidewalk Cafe or Merchandise Display is proposed that would prohibit the
Planning and Zoning Manager from issuing a Side valk Cafd or Merchandise` Display Permit.
o No violation(s) of Georgia Law, Federal Law, Local Ordinance, or any Rule or Regulation of the State Revenue Commissioner,
or any Rule or Regulation of the City of Tybee Island or Chatham County have been adjudicated against this business within the
last 12 months preceding the date of the application, or,
o The following violation(s) of Georgia Law, Federal Law, Local Ordinance, or Rule or Regulation of the State Revenue
Commissioner, or Rule or Regulation of the City of Tybee Island or Chatham County have been adjudicated against this
business within the 12 months preceding the date of the application:
a I have read the South End Policies and Procedures and will abide by said South End Policies and Procedures at all times during
the term of the Sidewalk Cafd or Merchandise Display Permit.
Notarized Signature: Date:
Printed Name: t" "
STATE OF GEORGIA
COUNTY OF CHATHAM
The foregoing instrument was acknowledged before me this l ' day of - 20 ,may
M / who is personally known to me or w o has produced identification.
Sign e of Notary Public NOTARY
PUBLIC
My Commission expires: / / - 011fl, !
A.
tog
Paget of 6 at ,,€. 12/14/2012
INDEMNIFICATION
This Indemnification, Release and Hold Harmless Agreement is made this day of 20 , by
("APPLICANT") for the benefit of the City Tybee Island, Georgia ("CITY"). When
referred to herein, the CITY means the Planning and Zoning Manager, the municipality, its City Council, and each member thereof,
and its officers, employees, advisory board members and representatives.
WHEREAS, the APPLICANT is the owner or lessee of the property located at Tybee
Island, Georgia; and,
WHEREAS, the APPLICANT has applied for a Sidewalk Cafd or Merchandise Display Permit for the temporary use of the sidewalk
area abutting the property described above pursuant to City Codes, ordinances, and policies and is required thereby to indemnify,
defend and hold and save the CITY harmless for its use of the public right-of-way (hereinafter collectively the "PROPERTY"); and,
WHEREAS, the APPLICANT is authorized to and has obtained all necessary approvals for this Agreement,
NOW, THEREFORE, in consideration of the CITY allowing the APPLICANT to use the public right-of-way for its Sidewalk Cafd
or Merchandise Display the APPLICANT agrees as follows:
1. The above recitals are true, and correct and are incorporated herein by reference,
2. The APPLICANT agrees to indemnify and hold and save the CITY harmless from any and all damages, loss or liability occurring
by reason of any injury of any person or property which may occur as a result or consequence of the issuance of the Sidewalk
Cafd or Merchandise Display Permit or the use of the PROPERTY by the APPLICANT or their family, officers, agents,
representative, guests, employees, invitees, or persons contracting with either or any of them or occasioned by an act or omission,
neglect, or wrongdoing of the APPLICANT or their family, officers, agents, representative, ,guests, employees, invitees, or
persons contracting with either or any of them. APPLICANT will, at their own cost and expense, defend and protect the CITY
against any and all such suits, claims or demands which may be claimed to have arisen as a result or consequence of or in
connection with the issuance of the Sidewalk Cafd or Merchandise Display Permit or the use of the PROPERTY by the
APPLICANT or their family, officers, agents, representative, guests, employees, invitees, or persons contracting with either or
any of them or occasioned by an act or omission, neglect, or wrongdoing of the APPLICANT or their family, officers, agents,
representative, guests, employees, invitees, or persons contracting with either or any of them. Notwithstanding the foregoing, this
should not be construed so as to require the applicant or anyone else to indemnify the CITY for claims arising from the sole
negligence of the CITY, its agents, employees, or officers.
3. The APPLICANT does hereby remise, release, satisfy, quit claim, and forever discharge the CITY from any and all actions, suits,
claims or demands that they ever had, now has, or may have in the future against the CITY as a result of the granting of the
Sidewalk Cafd/Merchandise Display Permit or because of the use of the PROPERTY by the APPLICANT or their family,
officers, agents, representatives, guests, employees, invitees, or persons contracting with either or any of them.
4. The APPLICANT will maintain liability or other insurance as required by City codes, ordinances, and policies which shall name
the CITY as an additional insured and for which the CITY will be given a current certificate. Said liability or other insurance
shall provide coverage for any suit or claim arising from the issuance of the Sidewalk Cafd or Merchandise Display Permit or the
use of the PROPERTY by the APPLICANT.
5. The terms of this Indemnification Agreement shall be binding upon and inure to the benefit of the parties and their heirs, legal
representatives, successors a.nda signs.
Notarized signature:
{
Printed name:
Date: c
STATE OF GEORGIA
COUNTY OF CHATHAM
The foregoing "instrument was acknowledged before me this day ofd 20 by
)�
who is personally known to me or who has produ ed identification.
Janet R Winer
Signa e o Notary Public
My Commission expires: / 0 Chatham GEORGIA
County,
Page 3 of 6 My Commissionl10/15/202412/14/2012
CERTIFICATE OF LIABILITY INSURANCE
DATE •I
01/14/2022
ADDL
Y
POLICY NUMBER
� '#i a r ♦ i::.
IMPORTANT: Or be endorsed.
If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions
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 tothe certificate holder in lieu of such endorsement(s),
PRODUCER
a
Remr Lane Insurance
M • I514
Box
8401 Waters Ave
C2VT Brinson Lane
N
PHONE 912-352-4444 912-352-2500
C
E41AIL
INSURERJS)AFFORDING COVERAGE
Savannah, GA 314161514
!— INIURERA: LLOYDS OF +r r•
EACH OCCURRENCE
• rCOMPANY,
P.O. BOX 700
k ISLAND, GA 31328
INSURER B:
CLAIMS -MADE OCCUR
Nr.UMR F
INSURER E:
PREsEs EaoNTu®nce
COVERAGEZI CERTIFICATE NUMBER:
r • r , ® r
• -• • •• i •' s r • - r r YmrIF, •• •• -.•r
Ali
00
INSR
TYPE OF INSURANCE
ADDL
SUBR
POLICY NUMBER
POLICY EFF
POLICY EXP
Mw2
LIMITS
A
.........403 BUTLERAVE.
coMMERCIAL GENE L LIABILITY
04
21699 APKG
08/12/2021
8/12/2022
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE OCCUR
PREsEs EaoNTu®nce
$ 100,000
MED EXP Any one rson
$ 5,000
PERSONAL &ADV INJURY
$ 1,000,000
GEN'LAGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS- COMP/OP AGG
$ 1,000,000
POLICY ❑ PRO- E LOG
JECT
OTHER:$
AUTOMOBILE LIABILITY
COMBINED SINGLE LtItiI'i
Ea accident
$
BODILY INJURY (Per person)
$
ANY AUTO
BODILY INJURY (Per accident)
$
- OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED"--
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
Per accident
$
_UMBRELLA LIAR
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS L
CLAIMS -MADE
DED L RETENTION
$
WORKERS COMPENSATION
D EMPLOYERS° LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
STATUTE ERH
EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$ —
OFFICER/MEMBEREXCLUDED? Li
(Mandatory In NH)
NIAE.L.
E.L. DISEASE - POLICY LIMIT
$
If yes, describe under
DESCRIPTION OF OPERATIONS below
B
Liquor Liability
LQ1005626
12/06/2021
12/06/2022
Occurrence
1,000,000
Aggregate
2,000,000
.,• .. .: .�. Y ,. ,
a•:m c®�ro�•�ama.en g»em.*r..¢, �• ... PAKU-CI 1 A'1InM
ACORD 2 (2016103
LJ T O B7 4 P5Li � YiI '.' t l Itl.miiwi9ntbiw;awivwu.
The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES NE CANCELLED BEFORE
E EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED I
CITY OF TYBEE ISLAND
ACCORDANCE WITH THE POLICY PROVISIONS.
PO BOX 2749
AUTHORIZED REPRESENTATIVE 1
.........403 BUTLERAVE.
TY EE ISLAND, GA 31328
04
ACORD 2 (2016103
LJ T O B7 4 P5Li � YiI '.' t l Itl.miiwi9ntbiw;awivwu.
The ACORD name and logo are registered marks of ACORD