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HomeMy WebLinkAboutWestStar Application (2)Kittitas County,Washington ,BOARD OF COUNTY COMMISSIONERS I EVENT APPLICATION Thank you for your interest in holding a special event in Kittitas County.Please complete and return this applicationalong 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 deviationfrom the final agreed upon route and/or methodof operation described may result in the immediaterevocation of an issued permit.Specifics outlining Event Permits can be viewed at http://www.co.kittitas.wa.us/boc/countvcode/title05.asp Event Information Name of event:WestStar Team Roping Date(s)of event:Open -August 28,2019 and Summer Series -ad attache Hours of operation:noon -6 p.m. Description of the event:Team Roping Jackpots Has this event taken place before?Ás No Dates:2002 - Estimated attendance:varies -250 -300 ish How is your event being publicized?Northwest Ropers News,Daily Record,Ropers Sports News,Facebook Please attach any flyers,posters,etc.with your application submission. Contact Information Name of the organizer/contactperson:Scott and Jo Repp Address:1570 Robinson Canyon Road Phone number(s):509 929-1355 and 929-4144 Email address:jo.weststar@gmail.com JUN -3 EN Date of birth of applicant:10/27/45 KITTITAS COUNTY COURTHOUSE-205 WEST 56 ,SUITE 108 ELLENSBURG,WA 98926 (509)962-7508 FAX (509)962-7679 www.co kittitas.wa.us If the applicationis made on behalf of a partnership,please submit full names with their residence and post office address for a period of six months prior to the date of applicationtogether with the location of principal office or place of business of such corporation. Emergency contact name(s)and phone number(s)that can be contacted during the event: Scott Repp 509 929-1355 Name Phone Number Jo Repp 509 929-4144 Name Phone Number WRITTEN PERMISSIONTO ENTEREVENT 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 pursuantto my agreement and representationsmade in connection with this Event Application. SWORN STATEMENTOF COMPLIANCE I/We hereby acknowledge that I/We have read Kittitas County Code,have familiarizedmyself with County requirements.I/We agree that either my designated agent or I/we shall be on site at all times and shall be responsible for the operation 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. Scott Repp Applicant Name (Print)Applicant Signature Jo Repp Applicant Name (Print)Ap cant Sg ature KITTITAS COUNTY COURTHOUSE 205 WEST 5 ,SUITE 108 ELLENSBURG,WA 98926 (509)962-7508 FAX (509)962-7679 www.co.kittitas wa us 4.Kittitas County,Washington BOARD OF COUNTY COMMISSIONERS Fire Safety 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?Yes o If yes,you must attach a drawing including the dimensions.The structure may require an inspection by County staff prior to the event. Public Health/Environmental Health Will there be food served at the event?gs If no food will be served at the event then,no permit or applicationis required. If yes,is the food and beverage that you intend on preparing and serving at the event exemptfrom permit requirements h ttp://w ww.co.kiltitas.wa.usnie gfood.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 n considered exempt from permit,then does the person or organizationpreparing and serving the food have a food service permit, temporary food service permit,or catering permit from KCPHD? -If yes,please provide a list of foods and beverages that you intend on having prepared and served at the event along with the name and phone number(s)of the permitted person or orga ization. If yes,and the person or organization preparidg and serving the food does not already have a food service permit. -Then a temporaryfood 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. KITTITAS COUNTY COURTHOUSE -205 WEST 56,SUITE 108 ELLENSBURG,WA 98926 (509)962-7508 -FAX (509)962-7679 www co.kittitas.wa us Are there permanentor fixed bathroomfacilities already available at the location of the event? gs No 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 eventthat 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 must walk,and a service plan to ensure that sani-cans remain in a sanitary condition.You must include the location of the portable restrooms on a map/diagram of the event. KITITTAS COUNTY COURTHOUSE 205 WEST 5 ,SUITM 108 ELLENS JRG,WA 18926 (509)962-7508 -FAX (509)962-7679 www.co.kittitas.wa.us Kittitas County,Washington BOARD OF COUNTY COMMISSIONERS Law Enforcement/Security/Emergency Medical Services Will there be security on site during the event?Yes 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 ,1 If yes,please provide written verificationfrom the providers. Will there be music,sound amplification or any other noise impacts?gs 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 includedwith your applicationmaterials. Will you have traffic control?s No 'Af C If yes,please provide documentationon how the traffic control will be addressed. Will there be off-si parking?Yes If yes,please provide the location and a parking plan. Will there be shuttle buses provided for attendees?Yes If yes,provide a map of their route. Will there be alcohol served at the event?Vs If yes,a State permit is required from the WA State Liquor Control Board and must submittedwith your applicationmaterials. KITUTAS COUNTY COURTHOUSE 205 WEST 5 ,SUTIE 108 ELLENSBURG,WA 98926 (509)962-7508 FAX (509)962-7679 www.co kittitas.wa.us Kittitas County,Washington BOARD OF COUNTY COMMISSIONERS Public Roads Will the event obstruct,interfere or require the closure and free use of any public road,street or right-of-way?Yes * 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 KITTITAS COUNTY COURTHOUSE 205 WEST 56,SUITE 108 ELLENSBURG,WA 98926 (509)962-7508 -FAX (509)962-7679 www co.kittitas.wa.us Kittitas County,Washington .'BOARD OF COUNTY COMMISSIONERS Garbage/Recycling Do you have a plan for garbage and recycling?Yes A written plan for garbage and recycling must be attached to your application materials.For questions or assistance contact the Kittitas County Solid Waste Departmentat 509-962-7542.24.bd p ÛQ >o <2e Q-drad x &lo UL 1 Have you obtained a Certificate of Insurance and endorsements,specifically naming "Kittitas County"as an insured?gs No A copy of the Certificate of Insurance amd endorsements must be included with your applicationmaterials.Kittitas County must be named as an additionalinsured in the amountof $1,000,000.00 per occurrence and $2,000,000.00 aggregate coverage.This insurance must apply first and on a primary non-contributmgbasis in relation to any other insurance or self-insurance available to Kittitas County. Penal Bond -Bond of Indemnity 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 Commissionershas certified no damage has been done and that the County has not incurred additional expenses Are you submitting a $5,000.00 Penal Bond -Bond of Indemnity with your Event Application?Yes Vo If no,you must request a letter in writing to the Board of County Commissioners requesting a waiver to the Penal Bond -Bond of Indemnity and outline the specific reasons why it should not be required of your event. County Filings and Registration Is there a cost to attend the event?Vs No How much are you charging to attend your event?i0 cÁø, KlTTlT b COUNTY COURTHOUSE 205 WEST 5",SUITE 108 ELLENSBURG,WA 98926 ¿LÁ'LL (509)962-7508 FAX (509)962-7679 www co.kittitas wa.us AMERCOW-02 BSINCLAIR CERTIFICATE OF LIABILITY INSURANCE °^',E 2DOD 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 ADDIT10NAL 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 License #26480 |c cT Becky Sinclair 2H6UOO srenati nSaLMbou0ntain States Limited c.NNEo.Ext):(208)433-1000 (A^tŠ,No):(866)898-4905 PO Box 5815 ss:Boise,ID 83705 INSURER(S}AFFORDING COVERAGE NAIC # l INSURERA:Mesa Underwriters Specialty Insurance 36838 INSURED INSURER B : American Cowboy Team Roping Association INSURER C: 4710 William Ave INSURER D : Winnemucca,NV 89445 INSURERE: INSURERF: WVERAGES 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 HEREINISSUBJECTTOALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE D SnR POLICY NUMBER gy gYO1 O LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X occuR MPOO25002002876 12/1/2018 12/1/2019 giggy"e"occumincel 5 100,000 MED EXP (Any one person)$ 5,000 PERSONAL &ADV INJURY s 1,000,000 GE TL AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ 2,000,000 POL1CY LOC PRODUCTS -COMP/OP AGo s Included I GmER HIRED NONOWNED 1,000,000 COMBINED SINGl.E LIMITAUTOMOBILELIABILITYI(Ep acddepl)i ANY AUTO BODILY INJURY (Per person)8 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident)$ RT S ONLY ASW "$°¾""JAMAGE UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE I AGGREGATE 5 DED i RETENTION $$ l WORKERS COMPENSATlON AND EMPLOYERS'LIABILITY Y I N STATUTE I _ER ANY PROPRIETORIPARTNERIEXECUTIVE I EL EACH ACCIDEWT $ OFFICERIMEMBER EXCLUDED?N I A (Mandatory in NH)EL DISEASE -EA EMPLOYEE $ If yes,doscribe under iIDESCRIPTIONOFOPERATIONSbelowE.L DISEASE -POLICY LIMIT I $ i DESCRIPTlON OF OPERATIONSI LOCAT10NSI VEHICLES (ACORD 101,AddtNonni Remarks Schedule,may be attachud If more space is required} Cerdficate holder is an additional insured with regards to General Liability if required by written contract per form CG 20 11 04 13. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED INKittitasCountyACCORDANCEWITHTHEPOLICYPROVISIONS.2015 West 5th Ellensburg,WA 98926 ACORD 25 (2016/03)©1988-2015 ACORD CORPORATION.AII rights reservi The ACORD name and logo are registered marks of ACORD ELLENSBURG,WA2019SUMMERJACKPOTSERIESSignupby11:30AM,ropeat12msharpAwards:•May18•August10•FASTTIME:•3une1•August16-17YetiProduct•3une22YetiWeekend•2ndFASTTIME:•July13•September14EngravedWestStarKnife•July27•BuckletoTopHeader8.5Pick/DraworDrawonly--$60andTopHeelereachday.80%Payout;mayenter4timesROpeoffallties.7.SDrawpot-$30;mayenter5times5.52SteerSnakeRopingPick1/Draw3-$100orDrawonlyfor$251570RobinsonCanyonRoad,EHensburgWAScottand3oRepp(509)929-4144sAvETHEDATE!Wed.,August28Managementreservestherighttorefuseorrestrictanyentry.WestStarOpenRoping/ProAmNote:1/3CattleCharge&$1OfficeCharge Kittitas County Ollice Of The Treasurer Amy Criske,Treasurer 205 W Eth Amenue,Suite IU2 ...-owww.s.__EHemburg,Wa 98926 Phone (509)962-7535 Fax (509)933-8212 Cash Receipts Receipt Number:2019-2943 Date:06/03/2019 Received From:MANDY BUCHHOLZ -DEPUTY CLERK OF THE BOARD II Check Amount:$200.00 Cash Amount:$0.00 Other Amount:$0.00 Total Amount:$200.00 Deputy:KYLEEW Receipt Type:CHK Template: Comments: CSR 2019-2018 WESTSTAR TEAM ROPING 2019 SUMMER JACKPOT SERIES MAY 18,JUNE 1,JUNE 22,JULY 13,JULY 27,AUGUST 10,AUGUST 16-17 -YETI WEEKEND,SEPTEMBER 14 FundCode GlCode Descripnon Amount 001 1632171 SPECIAL EVENTS FEE $200.00 Total Amount:$200.00 Kittitas County Treasurer's Office Submitted By:KYLEE WUESTHOFF (c)2002 Cashtax All Rights Reserved www.balancedaction.com