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HomeMy WebLinkAboutFellowShip of Christian AthIPPR - 3 144 VINTAGE FARM To: Kittitas County Board of County Commissioners Date: April 3, 2019 Re: Special Event Permit for small gathering of 100 to 130 guests at our Farm Dear County Commissioners, Attached please find the completed paperwork so that we may host a small gathering at our Farm Venue on Tuesday, May 21st from 5 to 8pm. The date was moved up by the group, and we are hopeful you can grant us the permit for their gathering which is now 7 weeks away ... This will be a low-key gathering of kids and their parents to celebrate their year with pie and ice cream, and presentation of awards and inspirational stories and testimonies in a slide show. The group is called Fellowship of Christian Athletes and this is their 5th year of having an end of year gather- ing, it is by invitation to their participants and they will have RSVPs, again expecting between 100 and 130 peo- ple to attend and they will come 3 or 4 people in each car, so 30 to 40 cars are expected. We have plenty of parking in our pasture and have parked more than 85 cars in the past. RE: Written Plan for Garbage? We will have 4 garbage cans, and expect very little garbage as they are only serving pie and ice cream. We will recycle any water bottles or pie tins. Their dessert plates, cups and silver- ware are being brought to our Farm by their Board of Directors, two members have their food servers permits. RE: Waiver of Penal Bond? We are requesting exemption from the $5,000.00 Penal Bond to "save & protect streets, pavements, bridges, etc. from damage" as this small amount of cars is within a normal range of normal traffic along Brick Mill Road to our farm and certainly won't cause any damage to streets. RE: Restrooms, we have a portable Executive Restroom trailer with flushing toilets, sinks, lights, heating & A/C that is located approximately 25 feet from the Party Tent. We have hard -surface walkways for ADA compli- ance and a ramp to access one of the end bathrooms in the restroom trailer. Heidi Bright, farm owner will keep the bathrooms stocked with toilet paper, hand sanitizer, soap & paper towels. A diagram as requested on this County Commissioner paperwork is attached. RE: Insurance naming Kittitas County as an additional insured "primary, non-contributory" as required, the Certificate of Insurance is attached here. Re: Fire Marshall Event Application, that has also been submitted to Fire Marshall Nicholson and he knows that our Tent is being installed by Bear Event Rentals, a professional installer with many years experience. Blessings &Best Wishes, 0�_ - s Heidi Bright, Owner—Brightside Vintage Farm LLC—cell: 425-417-4716 Joe Done, General Manager—Brightside Vintage Farm LLC—cell: 425-677-5381 ADDRESS: 511 Moreau Road, Ellensburg, WA 98926 Executive Restroom Trailer 71 Kittitas County, Washington _h BOARD of COUNTY COMMISSIONERS EVENT APPLICATION Thank you for your interest in holding a special event in Kittitas County. Please complete and return ti -kis application along with any other materials to the Kittitas County Board of Commissioners at least 60 days prior to the day upon the event is scheduled. Any misrepresentation in the application materials or deviation from the final agreed upon route and/or method of operation described may result in the immediate revocation of an issued permit. Specifies outlining Event Permits can be viewed at lit www.co:icitti tas.wa.us baccouxtcodetitleil5.as Name of event: Event Information D V'/5 �' f o. -F Ckyr i 5i14h Ovt 11 MO+ --n l� I e, -ie- -k Hours of operation: v ` 00 �—v +o 100 Description of the event: rVh�Ya�se� 4>v- a fll 1 ��s W ko PAA.)-t6iP i r�5�1���,�1-, 5-e-ke01 .j—�vllei ��►►�i'� Has this event taken place before?Yes No Dates: A r) n VA -I Estimated attendance: ® l w i How is your event being publicized? y a 119VY1 Vol Please attach any flyers, posters, etc. with your application submission. Contact Information Name of the organizer/ contact person: 4 e 13 y '- eyl� Phone number(s): Email a ddress: Date of birth of applicant: X117 -47 is -I'S -6z KITTITAS COUNTY COURTHOUSE • 205 WEST 5h, SUITE 108 • ELLENSBURG, WA 98926 (509) 962-7508 • FAX (509) 962-7679 www.co.kitfitasma.us M . eoev-1 If the application is made on behalf of a partnership, please submit full names with their residence and post office ad ress for a period of six months prior to the date of application together wi the 1oc "on of prmc� al office or place of business of such corporation. )10 �Q�' ft(Q; g7a1 vefl5 a � a� � c. , IM 0 (0 Emergency contact name(s) and phone number(s) that can be contacted during the event: � �.' • D ykC �T ���f � — Name �J o � i o y\ 6, Name �/ Phone Number & --? --� !� - Phone Number WRITTEN PERMISSION TO ENTER EVENT SITE I/We hereby permit law enforcement and/or County officials to enter the site for which the Event Application has-been granted at the time of the event and up to five days prior to the event for the purposes of inspecting and enforcement of County Code and other applicable laws, and pursuant to my agreement and representations made in connection with this Event Application. SWORN STATEMENT OF COMPLIANCE I/We hereby acknowledge that I/We have read Kittitas County Code, have familiarized myself with County requirements. ]/We agree that either my designated agent or I/we shall be on site at all tunes and shall be res onsible for the o eration of the event and for compliance with all legal requirements in connection with this event. I/We understand that failure to comply with the rules, regulations and conditions set forth in Code may be deemed a gross misdemeanor and that drug or narcotics violations are crimes under RCW. R App xcant Name (Print) A n Signa Applicant Name (Print) piicant S>t.gnature KITTITAS COUNTY COURTHOUSE - 205 WEST 5h, SUITE 108 • ELLENSBURG, WA 98926 (509) 962-7508 - FAX (509) 962-7679 www.colittitasma.us Kittitas County, Washington BOARD of COUNTY COMMISSIONERS Law Enforcement(SecuribAmergency Medical Services Will there be security on site during the event? YesNo P1 &+ A e- C (� If yes, please provide a complete list of names and contact information for who will be providing the security. Will Emergency Medical Services (EMS) be on site during the event? Yes Ne If yes, please provide written verification from the providers. no +- ne-Ce Will there be music, sound amplification or any other noise impacts? �No If yes, Kittitas County has a noise ordinance in effect (see County Code for details). If your event is scheduled for outside of the allowed time, you must submit a written letter to the Board of County Commissioners requesting a waiver and it must be included with your application materials. 10 4 r e ve n+ mee45__ � e (O o-4 L ,� ®� � � OV' Al V<kKA CJ2 of �► wI ► ► not 11 0 .v e . a � Will you have traffic control? Yes (!Oi:) I •-�— f yo. s, please provide documentation on how the traffic control will be addressed. Il Will there be off-site parking? Yes No e- liave- If yes, please provide the location and a parking plan. 0!fl V provided for attendees. ? Ov+� cj3 Will there be shuttle buses p Yes If yes, provide a map of their route. n/ A--, Will there be alcohol served at the event? Yes CJN(l If yes, a State permit is required from the WA State Liquor Control Board and must submitted with your application materials. KITTITAS COUNTY COURTHOUSE • 205 WEST 5", SUITE 108 • ELLENSBURG, WA 98926 (509) 962-7508 • FAX (509) 962-7679 wwwxolit itas.wa.us Kittitas County, Washington _ BOARD of COUNTY COMMISSIONERS loll :lti� 11 til Fire Safe and Protection If more than 50 people are expected at your event, you must complete a separate application process which can be obtained through the Kittitas County Fire Marshal's office. You may contact the Fire Marshal's office at 509-962-7000. Will there be a temporary structure erected for the event. Y��s No ),r,(,n�, r _e s cture ma If yes, you must attach a drawing rnciuding thedimensions. Th tru y require an inspection by County staff prior to the event. i ju 9 �-/e at comp-vly eoLv, Pxv/ ecvvi- wa Public Heal vironmental Health Will there be food served at the event? (:Yes No + I�Ce- C e, e- 4 vNn ©may no permit orapplication lication is re aired. If no food will be served at the event then, p pp q f If yes, is the food and beverage that you intend on preparing and serving at the event exempt from permit requirements http://www.co.kittitas.wa.us/health/food.asp? - If yes, please submit an application for exemption from permit and proof of food handlers training to the Kittitas County Public Health Department (KCPHD). If yes, and the food or beverage is not considered exempt from permit, then does the person or organization preparing and serving the food have a food service permit, temporary food service permit, or catering pernadt from KCPHD? - If yes, please provide a list of foods and beverages that you intend on having prepared and sewed at the event along with the name and phone number(s) of the permitted person or organization. If yes, and the person or organization preparing and serving the food does not already have a food service permit. - Then a temporary food service permit or catering permit will need to be acquired from KCPHD prior to the event. Please allow at least 2 weeks to complete the food service permitting process. C k4 I p)<eVV1%-P+f 0v1 KITTITAS COUNTY COURTHOUSE • 205 WEST 5'h SUITE 108 - ELLENSBURG, WA 98926 (509) 962-7508 • FAX (509) 962-7679 1-- W. Mkilliwsmm 91 +/\0j PA.— ��►■ j� �� Kittitas County, Washington BOARD of COUNTY COMMISSIONERS Public Roads Will the event obstruct, interfere or re ilaethe closure and free use of any public road, street or right-of-way? Yescn If yes, please provide a detailed adequate traffic and detour plans at the time of submission of the application. Will there need to be road closure or detour signs posted? Yes Nv no 3OVI/A � �1 e i ✓ �. GJ\, 0Vti/1 Vin V v1 � 4 e, V�+S C e l 2, ✓� ✓�'7 1 �'l� L,,ji4'1AT in ova KITTITAS COUNTY COURTHOUSE - 205 WEST 5", SUITE 108 - ELLENSBURG, WA 98926 (509) 962-7508 - FAX (509) 962-7679 www.co.Idttitas.wa.us CIA WA Kittitas County, Washington _ BOARD of COUNTY COMMISSIONERS �l�i Fl A+c n11i1 Garbage ec clin Do you have a plan for garbage and recycling? CYes) No A written plan for garbage and recycling trust be attached to your application materials. For questions or assistance contact the Kittitas County Solid Waste Department at 509-962-7542. Insurance Have you obtained a Certificate of Insurance n rsements, specifically naming "Kittitas County" as an insured? Yes No A copy of the Certificate of Insurance amd en orsements must be included with your application materials. Kittitas County must be named as an additional insured in the amount of $1,000,000.00 per occurrence and $2,000,000.00 aggregate coverage. This insurance must apply first and on a primary non-contributing basis in relation to any other insurance or self-insurance available to Kittitas County. Penal Bond - Bond of Indemnfty A $5,000.00 Penal Bond - Bond of Indemnity is required to be deposited with the County Treasurer to save and protect the streets, pavements, bridges, etc. from damage. The deposit or its balance will be returned once the event has been held and the Board of County Commissioners has certified no damage has been done and that the County has not incurred additional expenses Are you submitting a $5,000.00 Penjal Bond - Bond of Indemnity with your Event Application? Yes Q If no, you must request a letter in writing to the Board of County Commissioners requesting a waiver to the Penal Band - Bond of Indemnity and outline the specific reasons why it should not be required of your event. Coun Filin sand Ite 'stration Is there a cost to attend the event? Yes How much are you charging to attend your event? t J KITTITAS COUNTY COURTHOUSE • 205 WEST 5h, SUITE 108 • ELLENSBURG, WA 98926 (509) 962-7508 • FAX (509) 962-7679 www.colittitas.wa.us Are there pern� t or fixed bathroom facilities already available at the location of �r- the event? If yes, please provide an estimated attendance for the event, a detailed map that identifies the name and address of the physical facility that will provide lavatory facilities for the event, quantity of toilette facilities available for each gender, and the distance from the event that patrons must walk. if no, please provide an estimated attendance for the event, specific information related to the number of portable restrooms that will be provided, the distance from the event that patrons tion. Y uum st include the locast walk, and a secetiol of the portable an to ensure trestroom.s on remain in a sanitary condition. map/ diagram of the event. �)G E>< -e C- Q-�ql \JIV ep Y"a-- 0 A 'r, t-') X, -1- e VC, Qe5�a c�VXcQ. I fro �..�Oj6A � V/� � �1 a Ve6+y00VV\ J rte. { KITTITAS COUNTY COURTHOUSE 205 WEST 5", SUITE 108 ELLENSBURG, WA 98926 (509) 962-7508 FAX (509) 962-7679 O \vww.co.kRtitas.wa.us CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 4/1/2019 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 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 TRUSS 9200 Ward Parkway Suite 500 CONOCT N,e,M Certificate Department PwoiE. PAX EI�(g0.61s-70&-0600 Ndi; 516-708-9193 Annus: 'Cer0fIcatesQTrussAdvantage eom _ .INSUMNM AFFORDING COVERAGE NAIC1f Kansas City MO 64114 INSURER A: Church Mutual Insurance CO 18767 INSURER EL,_ INSURED Fellowship Of Christian Athletes 8701 Leeds Road INSURER C INSURER D : Kansas City MO 64129 INSURER E: DAMA T PREMISES fEa orcurrence INSURER F _ COVERAGES CERTIFICATE NUMBER: 976962354 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. E7CP LIMITS IR9R TYPE OF INSURANCE POLICY NUMBER DOMYYI tam A X COMMERCIAL GENERAL LIABILITY Y 026165602145609 9/1/2018 911/2019 EACH OCCURRENCE $ 2,000.000 CLAIMS -MADE X OCCUR DAMA T PREMISES fEa orcurrence $ 300,000 MED EXP (Any one person) S $,000 PERSONAL & ADV INJURY $ 2.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $5 ' 000,000 X POLICY 1 PRO JECT n LOC PRODUCTS-COMP/OPAGG _ $2.000,000 OTHER $ AUTOMOBILE LIABILITY COhg2iI3EU5i GiFLiMR [_E9 ecddd�ill $ _ BODILY INJURY (Per person) ANY AUTO $ ALL OWNEDSCHEDULED AUTOS AUTOS $ BODILY INJURY (Per accident) PROPERTYDAMAGE t+tr NON -OWNED HIRED AUTOS AUTOS $ $ UMBRELLA LIAB OUR EACH OCCURRENCE . $ AGGREGATE EXCESS LIAB p AIMSQADE $ QED I RETENTIWN% $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY VIN PER - T T TE FR ANY PROPRIETOR/PARTNER/EXECUTIVE EL. EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? ❑ N / A — (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additlonal Remarks Schedule, may be attached If more space Is required) Re: Night of Champions Fundraiser - May 28, 2019. Kittitas County is primary, non-contributory additional insured as respects General Liability. CERTIFICATE HOLDER CANCELLATION Brightside Vintage Farm LLC 511 Monreau Road Ellensburg WA 98926 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 ,��7 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD KITTITAS COUNTY FIRE MARSHAL'S OFFICE 411 N. Ruby St., Suite 2, Ellensburg, WA 98926 Office (509) 962-7657 Fax (509) 962-7682 Fire Marshal "Special Event/Assembly" Permit Application Date: Initial ❑ Renewal Permit #: 'EcEvent Permit (Temporary) Title of Event: SGL . r C r`.1Q- II' +FLqN Dates/Times ofEvent: // r �1f �G 1j 0 �+ —1-a Physical Location of Event: p-�7 r } v�Vl tg ,p �4 (M ` L C ❑ Indoors Outdoors •L•i3 (j L1 G� Event Coordinator, j j �[►9� vey 't -+ Phone #: �� r, - Ln I i _ t Cell #. '4 C-1 ( 1 17I�ZiP`q- Mailing Address � 1 t ' I O�7Y �� ' \.k City ��� i� �"r�.l �lr St Email: �QI t G Fii (I iY? w LJ -Akserubly Occupancy (Permanent) Specific Use of Building: Physical A Building Tenant: I'iwrte Cell #: Mailing Address City St Zip .rn�iil Building Owner: Mailing Address City t Zip Esli Hours �X()pkm iun.Pnf, iieynncri fix Assembly Occupancy Pennils) SUN: MON: TUE: ED: I HU: is S Specific Description of Operation/Event: (Required for both permits) A p'I'f0 Y, t JCO -),o }.?a U &.44 e in pe -e S. v' i vi vi - d4 cavi a vl O JZtj V' F Ise Cep % fes a.0/41l✓05 pi,rt e-acoW,44 -f--aL;Hev1Oee-�- %II'S a✓ o 1Gc✓ pA+reVT1 FoodBeverage?i Y �4NO Alcohol Served? YES NO Live Entertainment? YRS NO Security On Site? YES NO Tents? #of �l/ ` _ NO Stages? #of YES NO Emergency Contact: -rlhun-ef After Hours: Phone #: I hereby state that the above information is correct. I agree to comply with all requirements related to this Event/Assembly Permit. I further agree to, and hereby grant to the Kittitas County Fire Marshal's Office the right to enter onto the premises as described for this permit application, for the purpose of making such inspections and tests as may be required. This permit is valid until renewed, revoked, or expired and is non- transferrable. Owner / Aut Signatea Print Name:)4e Title: LU liePi3one #: f (MA v 4 Z-5 ) — l? � y 7 ❑ate: - r<� %1 �o � ' . Version 2009.2 _} \0 �\ // § ! i� \( f |f ] ; \# 0 � k k \ Kittitas County Ofce Of The Treasurer N 9` Amy Cziske, Treasurer _ 205 W 5th Avenue, 5utte 1 U2 -•-__-- -..—..} .�_ Ellensburg, Wa 98926 Phone (509) 962-7335 Fax (509) 933-8212 Cash Receipts Receipt Number: 2019-1671 Date: Received From: MANDY BUCHHOLZ - DEPUTY CLERK OF THE BOARD Check Amount: Cash Amount: Other Amount: Total Amount: Deputy: JENN Template: Comments: CSR 2019-1167 FELLOWSHIP OF CHRISTIAN ATHLETES FundCode G1Code 001 1632171 Total Amount: $200.00 $0.00 $0.00 $200.00 Receipt Type: CHK Description SPECIAL EVENTS FEE Kittitas County Treasurer's Office Submitted By: Jennifer Golladay 04/03/2019 Amount $200.00 $200.00 (c) 2002 Cashtax All Rights Reserved www.balancedaction.com