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HomeMy Public PortalAboutWINDROSE.pdfCITY OF TYBEE ISLAND SIDEWALK CAFE OR MERCHANDISE DISPLAY PERMIT APPLICATION Business name II , 1 ‘1,16 �.nse_ c- it (..5- fj I v l. Street address 11, x. -�.1y,�4. r,, Ac. .-�-6 151ana_ UG Fk Mailing address ?.,0 x 2144, -Cctbec l5le4r-Q. , 3 ‘3.1fC - Name of business owner: `Vee s I cei yrQa1.e :1 lyn,l� GI .ern @ (Q.t4DO• eA>� Phone num f o Bus ess Home abk Q kg—cliV8illotSa- Name of applicant if other than owner: Email Phone numbers of applicant: Business Home Mobile Relationship of applicant to owner (same, employee, agent, etc.) Mailing address of applicant Merchandise Display Application is for: LJ Sidewalk Cafe LJ 1. 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: \ :e0 until 2 : Q 1 Monday: 1 V-00 until 2:- co lm Tuesday: 1 k . 00 until ^^�- '00 1�1 Wednesday: \ l no o/ L Pt'ryl Thursday: \ \' • CO until Q • 00 1A Friday: V- 0) until off-- O pay, Saturday: k V. ('i until L. n :, 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; see page 2) ❑ Indemnification Agreement (must be notarized; see page 3) ❑ Certificate(s) of Insurance listing the City of Tybee Island as an 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 Printed name 0_,6aft0Q,A SPA- 1 4 h 2 Lo ic1-12 Date FOR OFFICE USE ONLY Date Received New or Renewal License Number ROUTING APPROVE OR DENY BY DATE FEE City Marshal Sidewalk Use Fee 50.00 An ,,pplicatiort may require 30 days or more to process. DIRECT AN APPEAL OF PERMIT DENIAL TO THE CITY MANAGER Planning & Zoning Manager 403 Butler Avenue, P.O. Box 2749, Tybee Island, Georgia 31328 (912) 472-5033 FAX (912) 786-9539 Lschaaf@cityoftybee.org Page 1 of 6 12/14/2012 AFFIDAVIT I, I V- �'% `C✓I name ��� on behalf of the establishment known as IC T.01, r: street address , acting in the capacity of ift)�,,, rnse �wf business name A, efu owner, agent, employee, etc. , Tybee Island, Georgia, attest to the following: located at 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 Sidewalk Cafe 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: o 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 Cafe or Merchandise Display Permit. Notarized Signature: Date: Printed Name: STATE OF GEORGIA COUNTY OF CHATHAM The foregoing instrument was acknowledged before me this ( day of ,J f� n u'�� `� , 20 , by (t who is personally known to me or who has produced identification. Signature of Notary Public My Commission expir Page 2 of 6 DENISE T. FIELDS NOTARY PUBLIC S. CHATHAM County State of Georgia My Comm. Expires MARCH 24, 2026 12/14/2012 INDEMNIFICATION AGREEMENT (RELEASE AND HOLD HARMLESS AGREEMENT) 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 he 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 t y , Tybee Island, Georgia; and, WHEREAS, the APPLICANT has applied for a Sidewalk Cafe 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 Cafe 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 Cafe 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 Cafe 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 Cafe/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 Cafe 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 and assigns. Notarized signature: Printed name: Date: STATE OF GEORGIA COUNTY OF CHATHAM The foregoing instrument was acknowledged before me thisc2( day of \ (,t f\\L� , 20 1, by 3c who is personally known to me or who has produc identification. ss� �- j:-��� I p y Signature ofNotar} My Commission e Page 3 of 6 Public DENISE T. FIELDS NOTARY PUBLIC xpires: CHATHAM County State of Georgia My Comm. Expires MARCH 24, 2026 12/1 4/2012 i�^41 HADLE-1 AI C"rQ%?CP' CERTIFICATE OF LIABILITY INSURANCE OP ID: T DATE (MM/DD/YYYY) 02/06/2023 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 endorsement(s). PRODUCER 912-764-9896 Lee, Hill 8r Johnston Insurors 212 Savannah Avenue Statesboro, GA 30458-4935 Winfield J. Lee III J cT Winfield J. Lee III PHONE 912-764-9896 FAX FAX 764-8980 (A/c, No, Ext): (A/C, No): amiss, win@lhjIns.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Cincinnati Specialty Underwrit 13037 Hadley Family LLC PO Box 2654 Tybee Island, GA 31328 INSURER B : INSURER C : INSURER D INSURER E : INSURER F : COVERAGES 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 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF fMM7DD/YYYY1 POLICY EXP (MMDD/YYYYf LIMITS A X COMMERCIAL GENERAL LIABILITY CSU0201380 01/01/2023 01/01/2024 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) 100,000 $ MED EXP (Any one person) $ Excl PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PETO- 1 LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS W Ep A�TOS ONNLY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY acEcident) DAMAGE $ $ U UMBRELLA LIAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENT ON $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/ N N /A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) CERTIFICATEHOLDEF CITYTYB City of Tybee Island y 403 Butler Ave Tybee Island, GA 31328 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE k '-'.------------------- ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD