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PERMIT #: ENG121'76'2-�'
STREET USE AGREEMENT
PROPERTY OWNER NAME: Phone
f- /7-
BUSINESS NAME:
BUSINESS OWNER
ADDRESS OF PUBI
DESCRIPTION OF PUBLIC USE:
170/,
A51119CU-0 /9-r SI/ 3C
18.70 STREET USE AND ENCROACHMENT PERMITS
17.65 LIMITED OUTDOOR DISPLAY OF MERCHANDISE
17.70.040 TEMPORARY USES; Bistro and outdoor dining
20.60.080 TEMPORARY SIGNS
/�'-r Is, 16 0 /21-9
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PERMIT CONDITIONS:
The Property and/or Business Owner, b!%Vd4-VT agrees to meet all requirements of the
Code Sections referenced above as well as meet the conditi6ns listed below for the temporary object(s)
approved under Street Use pennit ENG
It has been concluded that the proposal will not adversely impact public space open to vehicular or
pedestrian travel or interfere with the rights of the public;
Requirements of the State Building Code, including but not limited to all provisions relating to disabled
accessibility and barrier-ftee design requirements shall be met;
)0- Architectural Design Board approval has been granted or has been administratively approved;
)0- Any mobile vending units shall be properly licensed pursuant to Chapter 4.12 ECC;
All temporary objects, excluding approved awnings and wall signs, that project more than 24 inches
into the right of way shall be removed each day at the close of business or by I Ipm whichever is
earlier.
Items shall be placed adjacent to the building and may encroach onto a maximum of two feet of the
public sidewalk; or in accordance with Bistro and outdoor dining code; or per an approved building
permit;
> The design and use shall comply with all requirements of State law, City ordinance and City policy;
hr
Storage Containers or Portable Storage Units, if approved, shall be limited to a maximum of t ee (3)
days in right of way. Such storage units will be approved per site specific determination of setback
from travel lane, etc. Approved reflective traffic control devices shall surround at all times;
> Safe pedestrian travel area, or clear zone, of 5 feet minimum width shall be maintained on City
sidewalks; (see definition of clear zone below)
> Exterior light fixtures, banners, signs and flags must be a minimum of 7 feet above City right-of-way;
> Noncommercial off -premise signs shall be only portable freestanding signs and are limited to six(6)sf in
size and no more than 3ft in height;
Revised 5111112 Page I of2
Noncommercial off-premisc signs are limited to a cumulative display time of 60 days per calendar year
(excludes campaign signs). If related to specific meeting or event then must be removed within 48hrs
following the conclusion of the meeting or event;
);o- Commercial off -premises temporary signage is prohibited, except for real estate signs as permitted by
ECDC 20.60.065.
Clear landings of 5 feet or no less than the width of the door (whichever is greater), measured toward
the street shall be maintained on the exterior side of all required exit doors;
Illumination from City light fixtures shall not be blocked;
No objects shall be hung from City light standards or Flower poles; and
)0- Three feet of clearance around fire hydrants, standpipes, manholes, water meters, blowoffs, cleanouts
and valves shall be maintained.
Clear Zone Definition: A Clear Zone refers to an area 7 feet in height and 5 feet in width providing a
level, safe walking surface along the public sidewalk. Clear zone on sidewalks shall not include any
curbing, planting strips or ramps.
PROPERTY/BUSINESS OWNER TO READ AND SIGN
NOTE: The issuance of this permit is understood by the property/business owner to be of a temporary
nature, shall vest no permanent right and shall be issued and may in any case be revoked at the sole
discretion of the Cityper ECDC 18.70.040. By signing this application, s1he accepts responsibilityfor all
existing andlorfuture street uses. Propertylbusiness owner is responsible to continually provide a current
copy of the insurance cerf�ficate to the City.
INDEMNITY. The properoAusiness owner understands and by his/her signature to this application,
agrees to hold the City of Edmonds harmlessfrom any injuries, damages or claims of any kind or
description whatsoever, foreseen or unforeseen, that may be made against the applicant or the City of
Edmonds, or any qf its departments or employees, including but not limited to the defense qf any legal
proceedings including defense costs, court costs, and attorneyfees by reason ofgranting this permit. In
addition, the propertylbusiness owner understands that helshe shallprovide and continually maintain
during the term of thepermit a certificate of insurance naming the city as an additional insured, with
respect to liability, andproviding that it shall beprimary as to any otherpolicy of insurance.
CODE APPLICA TION.- By signing below the prcper4�lhusiness owner warrants that s/he has read or had
the opportunity to read Chapter 18.70, 17.65, 17.70.040, and 20.60.080 of the Edmonds Community
Development Code and s/he understands that all terms of the adopted ordinance are incorporated herein
as ifsetforth infidl andpermits therefore are subject to the terms of those Chapters.
SIGNATURE2� DATE
ProVerty OWWrillusiness Owner I
1A
MAILING ADDRESS: X/0 2±Zt
4 Ziftez.�ar ��QO-2-0 PHONE:
FOR CITY USE ONLY
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Engineering Approval:[ 1 1116-117 ( Date:
-')A/1/'t1-
Revised 5111112 Page 2 of2
LOCATIONS OF A -BOARDS
2018 Edmonds Jazz Connection Event: May 19, 2018
Edmonds Daybreakers Rotary
Recommendations — in order of distribution
#
Location
JC Today
Large A Board
I
Olympic View Dr. &
point west
JC Today #1
Puget Dr
2
Casper's & 91
point west
JC Today #2
3
3' Ave N & 4' Ave N
point towards ECA
JC Today #3
4
410 4' Ave N
ECA
Large A Board #1
5
4th & Bell
North Sound Center
L Board #2
6
41h& Main
point north towards
JC Today #4
North Sound Center
7
415 Main
Edmonds Theater
Large A Board #3
8
5th & Main
At the Fountain
Large A Board #4
9
51 & Dayton
Large Board #5
10
Dayton & SR104
point east
JC Today #5
11
Edmonds Way @ split
point to 51 Ave
JC Today #6
w/ (5' Ave.)
12
1 00th & Edmonds Way
point north west
JC Today #7
(QFC Comer)
towards town down
Edmonds Way
13
9th & Main
Point west down
JC Today #8
Main
14
5 comers
Point west down
JC Today #9
Main (place it on the
NW outer comer of
the intersection ... on
the sidewalk on the
old Mieko's fitness
comer)
NOTE: 5 A -Boards Rented from Miflers Rent AR —double sided.. 9 are Rotary "Jazz
Connection Today" signs
2-7-2018
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDIYYYY)
02/22/2018
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 riahts to the certificate holder in lieu of such endorsement(s).
PRODUCER
Arthur J. Gallagher Risk Management Services, Inc.
2850 Golf Road
Rolling Meadows IL 60008
INSURED
All Active US Rotary Clubs & Districts
Rotary District 5030
ATTN: Risk Management Dept.
1560 Sherman Ave.
Evanston, IL 60201-3698
....... Ali Sulita
-NAME,
PHONE 1-833-3ROTARY
JAIC.No..Ext);._
E-MAIL rotary@ajg.com
,ADDRESS:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
INSURER(S) AFFORDING COVERAC
Lexin ton Insurance Company
— mg -
r1r%%1=0Ar_i CERT!FICATE NUMRI:P- 899307648 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.
ADS�.l SUBL11 PoLICY EFF POLICYEXP LIMITS
INSR TYPE OF INSURANCE IN POLICY NUMBER IM /DDIYYYYi (MM1DDrfYYY)
LTR
•
X COMMERCIAL GENERAL LIABILITY
015375594 7/11/2017
7/1/2018
EACH OCCURRENCE
s2,000,000
DAMAGE TO RENTEU--
PREMta�__S(Fai ggg—mirice)
$500,000
: - —
I CLAIMS -MADE I x I OCCUR
MED EXP (Any one person)
' 7
$
�X
Lcuor Liability Included
PERSONAL & ADV INJURY
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGAqTE
$4,000,000
PRODUCTS - COMP/OP AGG
$4,000,000
POLICYFI WT D LOC
$
OTHER:
•
AUTOMOBILE LIABILITY
015375594
7/11/2017
7/11/20118
COMBINEU SINGLE 09lr
JEa acciden)
$2,000.000
BODILY INJURY (Per person)
$
ANY AUTO
BODILY INJURY (Per accident)
$
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY N AUTOS ONLY
PROPERTY DAMAGE
(Per itecklent)
$
Me L
U RELLA 'AB
OCCUR
NOT APPLICABLE
EACH OCCURRENCE
$
HCLAIMS-MADE
AGGREGATE
$
--E IIAI
S L
_!_ 1_!_ r
DED RETENTION S
—7--T—OTH-
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORIPARTNER/EXECUTIVE
NOT APPLICABLE
I SpUtUTE I I ER
$
E.L. EACH ACCIDENT
OFFICER/M MBER EXCLUDED?
(M andatory in NH)
N/A
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POUCY LIMIT
If yes, describe under
DESCRIPTION OF OPERATIONS below
$
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
The Certificate holder is included as additional insured where required by written contract or permit subject to the terms and. conditions of the
general liability policy, but only to the extent bodily injury or property damage is caused in whole or in part by the acts or omissions of the
insured.
CERTIFICATE HOLDER CANCELLATION
The City of Edmonds
121 Fifth Ave. No.
Edmonds, WA 98020
Rotary Club of Edmonds Daybreakers / Edmonds Jazz Connection
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
UZED REPRESENTATIVE
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