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HomeMy Public PortalAboutFILM SHOOT_NORTH BEACH 6(1 FgF \�y � %,� CITY OF TYBEE ISLAND ,i - TENT /CANOPY APPROVAL /REQUIREMENTS 1\g G Telephone: (912) 472 -5030 • Fax: (912) 786 -9539 ��'rt'Riaivsu ✓ Event: Film Shoot — Royal Pains on AMC Date(s) of Event: 03/19/2013 to 03/22/2013 Location of Tent: North Beach overflow lot Contact Person: Mac Gordon Phone: 310 - 339 -5201 Number of Tents: 1 Size: 40' x 40' Date Erected: 03/19/2013 Date Down: 03/22/2013 X DNR Permit required: Yes Received On 03/13/2013 Tent Provider: Ranco Tents Tent Erected by: Ranco Tents Address: 1200 West Bay St, Savannah, GA License number: Emergency phone number: 912 - 657 -0358 Wind resistance: 45 and above X On -site tent expert: Michael Kanweia Emergency phone number: 912 - 657 -2698 X Flame retardant certificate - Date of last treatment, name of chemical used in treatment, name of firm or individual treating fabric and testing agency and standard use. Labeling and /or other certification may be acceptable to the fire code official. X Site plan — See Tent and Canopy Policy for specifics Emergency access • No parked vehicles permitted within twenty (20) feet of tent. • For tents that have more than one exit, there shall be an unobstructed fire break passageway of not less than twelve (12) feet in width and free from guy ropes or other obstructions shall be maintained on all sides of tent. X Comprehensive general liability - Hosting organization, permit holder, or host establishment - Received X Liability insurance - Tent provider - Received Hold Harmless Agreement - Hosting organization, permit holder, or host establishment X Per Provider and provider's engineer, tent will be secured by ground by stakes and straps. Exits: 2 • Each exit must be marked and have emergency lights. • Each exit must remain open and shall not be obstructed. Required number of approved fire extinguishers: minimum of 1_ 3A4OBC with current inspection tag. Fire extinguishers must be visible and readily available for use within 75 feet of travel distance. Tables allowed: Yes How many tables: 13 with chairs Seats allowed: Maximum occupant load 107 Electrical Permit - Required for any electrical installations or wiring including, but not limited to, any lighting and power supply to the general area, electric motors and /or lights or any electrical installations relating to stages, stands, general lighting, emergency lighting, exit signs, concession stands or tents. Protective mats - Protective mats or other approved means shall be placed over electrical cables on walkways. Wiring and Lighting - All wiring and lighting shall be free from damage. All electrical connections, switches, and fuses shall be in approved enclosures and secured in place to prevent a tripping or safety hazard. Ramp and secure all electrical cables and /or electrical wiring. X Generators • Shall be located on a level area and secured in place. • Generators shall be arranged and isolated from the occupants / general public in a safe manner. • The exhaust shall be directed away from combustible material(s), people, and /or animals. • Generator fuel shall be stored in an approved container and located at a safe distance from the generator. • Generators shall be at least 20 feet from any structure or canopy and not accessible to the public. Cooking allowed in tent: No Flammable or combustible liquids must be located outside of structure. Note: Storage, use, or handling of flammable liquids or gases shall be prohibited at the site unless specifically approved and inspected by the Fire Marshal. • LP gas tank must be secured in place to prevent tipping with a minimum three foot clearance around tank. • Any LP tank larger than 20 lbs. shall be ten (10) feet from tent and have the proper size gas line secured. • Metal trash can with lid required. • Fire extinguisher readily available. X Food cooking concession trailers and structures of rigid construction must have commercial ventilation system and comply with fire extinguisher requirements. X No smoking permitted within the tent. Approved "No Smoking" signs posted. X Trash and Debris: Keep ground area and thirty (30) foot perimeter clear of trash and debris. No hay, straw, shavings, or similar materials shall be permitted to be used within any structure used as assembly occupancy. Emergency Plan - Tybee Island Police and Fire Departments will be briefed by Event Organizer on Emergency Plan. X High Winds: 45 Comments: City Official Signature Approval Date: March 15, 2013 City Official Printed Name: Planning and Zoning Administrator STATE OF GEORGIA ) HOLD HARMLESS / INDEMNIFICATION COUNTY OF CHATHAM ) AGREEMENT i C-f k THIS AGREEMENT is made the IS day of IA arc,,k , 20 3 , by 0 eY, I (A 5 neSS PC o,A(A ±t vr'5 L LC . (hereinafter referred to as "Owner ") WITNESSETH Owner hereby agrees to protect, defend, indemnify and hold haiiiiless the City of Tybee Island, Georgia, (a political subdivision of the State of Georgia), its Mayor and Council, officers, agents, and employees (hereinafter referred to as "City ") from and against any and all liability, damages, claims, suits, liens, and judgments of whatever nature, including any claims for contribution and /or indemnification for injuries to any person or persons, or damage to the property or other rights of any person or persons, caused in any manner pertaining to the location of privately constructed or any other privately owned structures and plants, which protrudes into the right -a -way of any City street. The undersigned further recognizes and agrees that this license does not confer upon the undersigned any rights, title, estate, or interest in said licensed premises; nor does this license agreement confer upon the undersigned a license coupled with an interest or easement. This license merely gives the undersigned a revocable privilege, it being expressly understood and agreed that, regardless of any improvements or investments made, expense and harm incurred or encountered by the undersigned, this agreement shall be subject to revocation, cancellation or termination, this license shall be null and void. TN WITNESS THEREOF, Owner has hereunto set its hand and affixed its seal on the day and year first above written. / 132-1712-- ""�� —vim -- OCC,i / t1 "5 Ada r —� Owner 1 .1. f7 +er rNat l nc& I Dr, 56,4e01,0 Address • � 0‘r■ a1-\ CAA 311/o _I1 I/L.1 i W tness f f r4/ ,e/ ( e 1 1 )16. ./ C ete Mk; 1200 West Bay Street Savannah, GA 31415 Phone: 912 - 944 -6200 Fax: 912 - 944 -0990 March 14, 2013 To Whom it May Concern, 1, Robert Eichhorn, of Savannah Special Events by Ranco, require as a safety precaution, that the 40'X40' Tent to be used at the North Beach parking lot on Tybee Island (March 19 -22 2013), will be taken down and removed if winds reach or exceed 45mph. If you have any further questions or concerns, please feel free to contact the office at the number listed above. Thanks and we look forward to your business. Sincerely, Robert Eichhorn Operations Manager 1 2013 4:45PM No. 0468 P. 1 CITY OF TYBEE ISLAND TENT /CANOPY PERMIT APPLICATION I '. Telephone: (912) 472 -5030 • Fax: (912) 786 -9539 Applicant's Name: ief(',. ©p') Applicant's Telephone: 3f6 – 337 Applicant's Address: 2 0 3 MP, Ce r . r r grow A /L // Z2 - ' Date(s) of Event: -3// 3 `i:� Type of Event: F 61061 Number of Tents /Canopies: / Size 4'17 ' x '�-() ' Number of Exits 'per tent Number of Tents /Canopies: Size _ ' x Number of Exits per tent Number of Tents /Canopies: Size ' x Number of Exits per tent Number of Tents /Canopies: Size ' x Number of Exits per tent Name and address of Tent Provider 44) GAI ew-g 11 ' We J f ey v . J X11 6 57 - o3s� Tent Site Location(s) A4f4 &@a, (91AR,. i4 ) Date Erected 3//7 Date Down: 3/77-- Will electrical power be provided? Yes =a'S No Wi1I cooking be done inside the tent(s)? Yes No� I have received and read a the Tyb- 'Island Tent and Canopy Policy. f Applicant Signature I 1 Date f-.2 Anti Applicant Printed Name , :++� / Pr Approvals: Signature Date Planning & Zoning Manager Building Official City Manager Attachments to Permit Application r ✓ Slte Plan ✓ A letter by the Tent Contractor (stating size(s) of the ✓ Provide a seating/table arrangement floor plan tent/canopy, date(s) of event, date to be Installed and ✓ Certificate of Liability insurance removed, and that the tent /canopy will be dismantled if the ✓ Tent providers Liability insurance wind speed exceeds the tent capacity.) ✓ Emergency Plan ✓ Wind resistance data to be provided by tent manufacturer or ✓ Hold Harmless Agreement engineer ✓ Flame Retardant Certificate ✓ Name, address, phone number, license number, emergency ✓ Information on staking method to be used phone number of tent contractor *, s,. v.Z> * w . ,t N f ,sj t ' fit' 1. � ' ' _: ' ' 4 4. \ t • ^ t i • ' L 0 t _ Y i bD u ` CD Q) �' - a • W N . Ile, • y I *i_ . { fir �.e 'a. -- 1 "ea M w; T .. g i 1 L PP- ., s �— - +, 0 •� - * c .r ? F a, • . A ►f ' ,� i. ,, 'V Ulppe • ' _..401:4111 Op `" � GEORGIA DEPAMI Mrirr OF NATURAL Rrsou nrrs COASTAL RESOURCES DIVISION MARK WIt.LIAMS A.G.'SKID WQODWARD COMMISSIONER DIRECTOR V i0 UD13 Mac Gordon Location Manager Royal Pains on AMC c/o City of Savannah Film Office RE: Letter of Permission (LOP), Filming on Beach and Dune Crossovers, North Beach, City of Tybee Island, Chatham County, Georgia Dear Mr. Gordon: This Letter of Permission (LOP) is in response to your recent request dated March 1, 2013, to film a segment of the AMC Television Show "Royal Pains" on the beach and dune crossover located adjacent to North Beach parking lot on Tybee Island in the State's jurisdiction. The film segment involves dialogue sequences between actors on the north beach and the north beach crossover. This one day event is scheduled to take place Wednesday, March 20, 2013 with a potential rain date of Thursday, March 21, 2013. The work day is scheduled from 6:00 am — 8:00 pm on the day of filming. The film sequence will take place on the beach. Scene props will include beach chairs, umbrellas and surf boards. This request includes the use of the North Beach parking lot to stage equipment, vehicles and other necessary materials. This request also includes the use of three (3) all- terrain vehicles (ATV) to facilitate the movement of film equipment to the beach from the parking area on the scheduled work day. The Department acknowledges use of the parking area, dune crossover and beach for filming Royal Pains on March 20, 2013. You are responsible for contacting Department Staff if filming is to take place on the authorized rain date of Thursday, March 21, 2013. If approved by the City of Tybee Island, the use of ATV's to move equipment from the parking area to the dry sand beach seaward of the sand dunes is authorized on the date of filming only. Access to the beach from the North Beach parking lot may only occur though the Gulick Street Access point. The ATV's will be used solely for the movement of film equipment. The use of the ATV's is not authorized to transport crew to and from the filming location, nor may the ATV's be used to run errands for crew or other ancillary staff on site during this one day event. The Department authorizes the Royal Pains filming request provided all Best Management Practices (BMPs) will be used to prevent any impacts to jurisdictional shore areas. This Letter of Permission is not meant to exempt the above referenced activity from future environmental laws. No equipment, materials or debris may be placed, disposed of, or stored in jurisdictional ONE CONSERVATION WAY BRUNSWICK, GEORGIA 31520 -8686 912.264.7218 ! FAX 912.2623133 WWW.CoASTALGADNR.ORG EAR 4)13 2013 Royal Pains LOP Page 2 of 2 areas. No activity is authorized in or near the sand dunes. All personnel must be directed to stay off the dunes and dune vegetation during the event. No vegetation is to be disturbed during the event. Any incidental impacts to the dunes or vegetation must be restored to pre - project vegetated and topographic conditions. Any backfilling must be done beach quality and obtained from an upland source and not from the beach. This LOP is valid for the above referenced project. Any change in the use location, or activities of the approved project, without prior notification and approval from this office could result on the revocation of this permission and in the required removal of the materials and related structures. This project must comply with all other Federal, State, and local statutes, ordinances and regulations. If you have any questions or concerns about this project feel free to contact Deb Barreiro at 912.266.3695 or deb.barreiro @gadnr.org. Sincerely, Brad Gane Chief Ecological Services Section Attachment: Royal Pains NB site plan cc: Chantel Morton City of Tybee Special Events Coordinator P.O. Box 2749 Tybee Island, GA 31328 File # 072911.0000AM _RoyalPains ONE CONSERVATION WAY I BRUNSWICK. GEORGIA 31520-8686 912.264.7218 I FAX 912.262.3143 WWW.CoAsTAtGADNR.orRG IP ' • , .r •*•'••• ' ' ,.. -,', . ''`I ' ' ;. , f)..$1;k4 , '. t . s_i• '; ''' „,--., .. .- ■-,' * -, 4: ' • '1 ,_ .4 ...' ,.. . ..,,, 7'.. . 1. A -.- • ,.-+ , . * ,r, , -.„...„,;.,,,..; -,. , . -"I' . . --- , - • ';‘ .- • '; "i•-•:,‘' ' '''',V.,,V1‘0%.,t ' . . ' ' ''' " - '' 7; .. .,,,,' ;`, ''''.... 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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 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 CONTACT Marsh USA Inc. NAME: 1717 Arch Street PHONE FAX (A/C. No. Eat): (A/C, No): Philadelphia, PA 19103 - 2797 E - MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 298523 -NBCU. CAS -12 -13 INSURER A : National Union Fire Insurance Co. 19445 INSURED INSURER B : ACE Property And Casualty Ins Co 20699 NBCUniversal Media, LLC its Parents and its Subsidiaries INSURER C : Insurance Company Of The State Of PA 19429 30 Rockefeller Plaza INSURER D , New Hampshire Insurance Company 23841 New York, NY 10112 INSURER E : INSURER F : COVERAGES 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 'ADDL SUBR LTR TYPE OF INSURANCE , RR WVD POLICY NUMBER POLICY EFF POLICY EXP (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A GENERAL LIABILITY GL 9645211 12/01/2012 12/01/2013 EACH OCCURRENCE $ 5,000,000 © COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 5,000,000 PREMISES (Ea occurrence) $ CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 5,000,000 GENERAL AGGREGATE $ 10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 10,000,000 X POLICY I PRO- — — JFCT LOC "SEE ATTACHED $ A AUTOMOBILE LIABILITY CA 5196176 (AOS) 12/01/2012 12/01/2013 COMBINED SINGLE LIMIT 5,000,000 (Ea accident) _ A X ANY AUTO CA 5196175 (MA) 12/01/2012 12/01/2013 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS ( ) NON -OWNED PROPERTY DAMAGE HIRED AUTOS _ AUTOS (Per accident) $ $ B X UMBRELLA LIAB X I OCCUR 1 X00 027049175 12/01/2012 12/01/2013 EACH OCCURRENCE $ 10,000,000 EXCESS LIAB I CLAIMS -MADE 1 AGGREGATE $ 10,000,000 j DED RETENTION $ $ C WORKERS COMPENSATION WC 018112519 12/01/2012 12/01/2013 X WC STATU OTH- AND EMPLOYERS' LIABILITY TORY I NITS ER Y / N WC 018112521 12/01/2012 12/01/2013 5,000,000 0 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT D OFFICER/MEMBER EXCLUDED? N N / A $ (Mandatory in NH) WC 018112522 12/01/2012 12/01/2013 E.L. DISEASE - EA EMPLOYE $ 5,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Show Name: ROYAL PAINS Production Entity:: OPEN 4 BUSINESS PRODUCTIONS, LLC Location or Description of Equipment: LOCATIONS (GEORGIA) Please refer to page 2 for additional coverage information /certificate holder information. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF TYBEE ISLAND THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 403 BUTLER AVE. ACCORDANCE WITH THE POLICY PROVISIONS. TYBEE ISLAND, GA31328 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee ._}4La",.�ou.. ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 298523 LOC #: Philadelphia A ® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc. NBCUniversal Media, LLC its Parents and its Subsidiaries POLICY NUMBER 30 Rockefeller Plaza New York, NY 10112 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance SUBJECT TO THE TERMS AND CONDITIONS, THE GENERAL, AUTOMOBILE AND UMBRELLA LIABILITY POLICIES INCLUDE THE CERTIFICATE HOLDER AS ADDITIONAL INSURED WHERE REQUIRED BY WRITTEN CONTRACT. THE WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICIES PROVIDE COVERAGE FOR USL&H AND JONES ACT COVERAGE AND ALL STATES" ENDORSEMENT. THE GENERAL LIABILITY POLICY PROVIDES COVERAGE FOR XCU, PRODUCTS /COMPLETED OPERATIONS HAZARD, BROAD FORM PROPERTY DAMAGE, BLANKET CONTRACTUAL ADVERTISING LIABILITY, INDEPENDENT CONTRACTORS, SEPARATION OF INSUREDS, PERSONAL INJURY, PREMISES/ONGOING OPERATIONS AND BLANKET ADDITIONAL INSURED. THE GENERAL LIABILITY AND WORKERS COMPENSATION POLICIES INCLUDES A WAIVER OF SUBROGATION THAT APPLIES TO ANY PERSON OR ORGANIZATION WHERE REQUIRED BY CONTRACT WE ENTER INTO PRIOR TO THE OCCURRENCE OF LOSS. THIS INSURANCE WILL APPLY AS PRIMARY INSURANCE WHERE REQUIRED BY CONTRACT, AND ANY OTHER INSURANCE ISSUED TO SUCH ADDITIONAL INSURED SHALL APPLY AS EXCESS AND NONCONTRIBUTORY INSURANCE. ADDITIONAL CERTIFICATE HOLDERS INCLUDE: ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 03/11/2013 02:11 FAX 9129440990 SAVANNAH SPECIAL EVENTS ZI003 _,.�"' RANCO -2 OP ID: SC AC'CPRLY CERTIFICATE OF LIABILITY INSURANCE DATv (IA AUPOYYYY) 41R 03/11/2013 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 pollcy(iee) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on thls certificate does not confer rights to the certificate holder In lieu of such endorsement(s). . PRODUCER CONTACT -_ - -- Phone: 912.489 NAME: Glenn/Davis 8 Associates Inc 23462 Hwy 80 East Fax: 912.489-3717 P HA No . Extl: - FAX WC. Not; b Stasboro, GA 30461 nAI Sean P. Davis ADDRESS: INSURER($} AFFORDING GOV ERAOE NAIL S INSUn!RA:OWneI'S Insuranc_ a Co 32700 1 INSURED Ranco Tent Rental$, Inc. & - -- INsuRERe:Torus Specialty Insumnce Savannah Special Events Y .- , 1200 West Bay Street INSURER C: Savannah, GA 31416 INSURER D; INSURER E: .. INSUREB F I - 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 VNTH 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. (REA • '"'" ADDL SUER POLICY EFF POLICY Pin LTR TYPE OF INSURANCE , , POLICY NUMBER MM/DDNYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 48087107 1213112012 12/31/2013 DAMAGE TO RENTE 1 000 Q PREMItiES (Ea ocarrO enoa) $ , Q0 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 _ PERSONAL & ADV INJURY t 1,000,000 GENERAL AGGREGATE $ 2,000,00D GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AOQ $ 2,400,000 POLICY Ea LOC , — $ �, AUTOMOBILE L1AeeLI1Y ZoM91NED SINGLE LIMIT 1,000,000 _ {�° pcdgsnp $ A X ANY AUTO 4828486900 12131/2012 12/13/2013 BODILY INJURY {Poi pan on? $ AUTO NEO AUTO _ U LED BODILY INJURY (Per accident) 5 NON -OWNED PROPERTY DAMAGE $ HIRED AUTOS A AUTOS (Per tot:Wont) _ mm S UMBRELLA LIAR X OCCUR EACH OCCURRENCE a 2,000,000 A X EXCESS LIAR CLAIMS -MADE 70663F130ALi 01117/2013 0111712014 AGGREGATE .._ • $ 2,004,444 DED RETENTIONS 3 WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LABILITY TORY I IMITS FR_ A ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N 4849642E 12/3112012 12/31/2013 E. L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? J N 1 A - •• (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 11 ysi. do under ' DESC$IPTION OF OPE RATI S below E.L• DISEASE • POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS /VEHICLES {Attach ACORD 101, Additional Remarks Schoduie, It mots apace N Wired) CERTIFICATE HOLDER CANCELLATION CITYOFT SHOULD ANY OF THE ABOVE DESCRIBED RQUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1 City of Tybee Island ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 2749 Tytree Island, GA 31328 AUTHORIZED REPRESENTATIVE Sean P. Davis I m 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 0 e. r r >�, rdp till M P O RTANT DOCUMENT-3 cn c1 �>� a W Date of Shipment I , 5 rt1f irate Of Ian Res is • �j REGISTRATION A0 . ISSUED BY I b j o � <�a NM Date T • . ��� c a f . � .. � CNI 21zu2 C ! NUMBER . f _ tc 'rill 0 \ • - " INDUSTTA INC INQ r-, 2' . .. ", .r Tent Identification m • - EVANSVILLE, INDIANA 47725 �nf I r 4o.. 1 ;/_.46 ..:*>: MANUFACTURERS OF THE FINISHED u142 2sab ' :L41 TENT PRODUCTS DESCRIBED HEREIN 5 _ o k This Is to certify that the materials described have been flame-retardant rdant .treated :. - } (or are inherently noninflammable) and Were-supplied to: - _ , 269053 °i ce 4 RANCO TENT RENTAL Ii P . O ,BOX 1895 ITII d STATESBORO GA 30459 - � IF cn m I' Ill 1$ c Certification is hereby. made that_ y .2 The articles described ors this Certificate have been treated with a flame-retardant approved 5 `rI chemical and that the application of said chemical was done in conformance with California = 4 Fire Marshal Code.. All fabric has been tested and passes-NFPA 701 -99, CPA! 84, ULC 109. 5 Serial 1 8449000(2} Description of item certified: J FIESTA PLUS RET END 40WX20 NYDER WJ - IITE VINYI, 5 Flame Retardant Process Used Will Not Be Removed By 5 5 > fg Washing And Is Effective For The Life Of The Fabric N c, SNYDER MFG NEW PHIT.ADEI VHIA OH Signed: 9-..-41/L?7 f I i j ` ] SPECIAL EVENTS DIVISION - ANCHOR INDLISMIES INC. I c © Pc lcPP� a@1t rJrJ��1TUPr�c1MPr fclMPLPcJ �rJrlrJ�c �c PrJPr�ttE1'tlNIi?Jr1rAlfflfa�rSEIPP��Pr1 WILD