OAKPORT PROPERTY RENTAL 2017 LEASE INFORMATION
|
|
- Mervin Hudson
- 5 years ago
- Views:
Transcription
1 OAKPORT PROPERTY RENTAL 2017 LEASE INFORMATION The 12 + acre EBMUD Oakprt Prperty is available fr temprary, shrt-tmedium term leases n a first cme-first served basis t qualified parties. GENERAL LEASE REQUIREMENTS: 2017 Lease Rate $0.26/sq.ft./mnth Nn-Refundable Applicatin Fee $ Security Depsit r Cashiers Check $10, Applicable City f Oakland Land Use Permits Cmmercial General & Aut Liability, Pllutin Liability and Wrkers Cmpensatin Insurance (must be n EBMUD frms) PROPERTY CONDITION: Natural, relatively flat dirt lt, rented as-is. SECURITY FENCING: 4 high fencing in place alng Oakprt Street bundary f prperty. Lessee is respnsible fr site security and installatin f temprary fencing arund the perimeter f the leased area. Lessee respnsible fr the installatin and remval f its wn lcks n the access gate t the Prperty. UTILITIES: Electrical Lessee respnsible at its wn cst and expense. Water Temprary hydrant meters are available fr nnptable uses such as dust cntrl. N sewer available Lessee respnsible fr prta-jhns at its wn cst and expense. N refuse cllectin Lessee respnsible fr cllectin and remval f all refuse at its wn cst and expense. Fr mre infrmatin, please cntact: Amber Sarkari (510) amber.sarkari@ebmud.cm
2 MH 880 NIMITZ FWY N 12TH ST BART 50TH U P R R U P R R SAN LEANDRO ST COLISEUM WAY 66TH AVE AVE OAKLAND 880 FD PROP. MON. EP AC WM UTIL MH 225 FD PROP. MON. 218 HYD WM PARCEL D AREA=1.52 AC OAKPORT WELL WELL BARBED FENCE ST HYD TO 66TH AVE. & ZHONE WAY HIGH ST VICINITY MAP (NO SCALE) ST LESSER TIDEWATER AVE OAKPORT FD PROP. MON. ST SITE SAN LEANDRO BAY ZHONE WAY CONC CHAIN LINK FENCE CURB CURB PARCEL B AREA=3.58 AC HYD 272 PARCEL A FD PROP. MON. Pipeline Training Academy PARCEL A AREA=5.00 AC (REMAINING=3.60 AC ) Apprximately Acres available fr rent TO ZHONE W AY EP PARCEL C AREA=4.06 AC 4 PALMTREE H:\JOB-2006\ \OAKPORT\DGN\3836-B-2D LEASE_rev2.DGN REFERENCES: 1. E.B.M.U.D. DRAWINGS: 3816-B, & 4695-G. 2. E.B.M.U.D. PROPERTY NO. 548, RE: 1188, IM: 608, 4/28/1964. EDGE OF BRUSH Prperty lines in green NO. DATE REVISION BY EXHIBIT A DRAWN BY C. CHOU CHECKED BY R. HOLMAN APPROVED SURVEYING SUPVR. L.S. NO. REC. APP SCALE: 1" = 100 EAST BAY MUNICIPAL UTILITY DISTRICT OAKLAND, CALIFORNIA PROPERTY STRUCTURE, PROJ. CODE, OR ZONE DESIGNATION SCALE 1" = 100 DATE 9 DECEMBER OAKPORT LEASE AREAS-REVISED CITY OF OAKLAND - ALAMEDA COUNTY NAD B B 460
3 File N: APPLICATION FOR USE OF EBMUD PROPERTY OR REQUEST FOR INFORMATION (Please cmplete this frm with as much infrmatin as pssible. Incmplete applicatins cannt be prcessed and will result in delays in the District s respnse time.) APPLICANT NAME: FIRM (if applicable): ADDRESS: PHONE: Hme: Cell: ADDRESS/LOCATION OF EBMUD PROPERTY (Street address, Map exhibit r Assessr s Parcel Number): USE REQUESTED (Give a cmplete descriptin f yur prject. Attach an extra sheet, if necessary): ARE OTHER COUNTY/CITY APPROVALS OR PERMITS REQUIRED? YES NO If yes, please give details: Under the Califrnia Envirnmental Quality Act (CEQA) yur request t use EBMUD prperty may be cnsidered a prject which requires cmpletin f envirnmental dcumentatin. Has any type f envirnmental dcumentatin (Negative Declaratin r Envirnmental Impact Reprt) already been cmpleted fr this prject? If s, please submit a cpy f that dcumentatin, highlighting the area(s) which specifically deal with yur requested use f EBMUD prperty. ADDITIONAL COMMENTS/REMARKS: NOTE: If yur prject invlves any sils studies, engineering plans r envirnmental dcumentatin, these dcuments must be attached in duplicate with this applicatin. M Rev. 1/19/17
4 EAST BAY MUNICIPAL UTILITY DISTRICT OAKPORT PROPERTY RENTAL - ADDITIONAL INFORMATION Date: Applicant: Cmpany: Phne: Acreage required (inc. preferred shape f rental area): Dates f peratin (inc. setup and packdwn): Hurs f peratin (eg. 7am - 5pm): Descriptin f prperty use (eg. visin, gal, examples f experience with similar uses): Estimated number f attendees: Fd and drink vendrs - Y/N: - Alchl - Y/N (if yes, please list types): - Fd vendrs (eg. fd trucks, mbile kitchens etc.): - Other beverages r hspitality: - Area required: Entertainment - Y/N: - Types f entertainment: - Area required: Utilities required - Y/N: - Types f utilities needed: - Cntact made with respective prvider - Y/N Temprary structures, site imprvements, ther installatins - Y/N: - Details regarding temprary imprvements: - Area required: Site security (EBMUD is nt respnsible fr prviding event r site security): Parking spaces (n. f spaces and area required): Are Cunty r City apprvals r permits required - Y/N: Under the Califrnia Envirnmental Quality Act (CEQA) yur request t use EBMUD prperty may be cnsidered a prject which requires cmpletin f envirnmental dcumentatin. Has any type f envirnmental dcumentatin (Negative Declaratin r Envirnmental Impact Reprt) already been cmpleted fr this prject? If s, please submit a cpy f that dcumentatin, highlighting the area(s) which specifically deal with yur requested use f EBMUD prperty. Any ther relevant infrmatin t accmpany applicatin: NOTE: If yur prject invlves any sils studies, engineering plans r envirnmental dcumentatin, these dcuments must be attached in duplicate with this applicatin. R Oakprt Prperty Rental - Applicatin fr Use
5 CERTIFICATE OF COMMERCIAL GENERAL, and AUTO LIABILITY INSURANCE THIS IS TO CERTIFY TO: East Bay Municipal Utility District (EBMUD) Real Estate Services (RL) th Street, MS: 903 P.O. Bx Oakland, CA THE FOLLOWING DESCRIBED POLICY HAS BEEN ISSUED TO: District Cntract Number: Insured: LOCATION AND DESCRIPTION OF PROJECT/AGREEMENT: TYPE OF INSURANCE: Cmmercial General and Autmbile Liability Cverage/Endrsements as required by agreement. LIMITS OF LIABILITY: (MINIMUM) $2,000,000/Occurrence, Bdily Injury, Prperty Damage-General Liability $2,000,000/Occurrence, Bdily Injury, Prperty Damage-Aut Liability SELF INSURED RETENTION ($): (AUTO) (GL) (if applicable) Aggregate Limits (AUTO) (GL) (if applicable) INSURANCE COMPANY(IES): (Aut) (GL) POLICY NUMBER(S): (Aut) (GL) POLICY TERM: Frm: (Aut) (GL) T: (Aut) (GL) THE FOLLOWING COVERAGES OR ENDORSEMENTS ARE INCLUDED IN THE POLICY(IES): 1. The District, its Directrs, Officers and Emplyees are Additinal Insureds in the plicy(ies) as t wrk being perfrmed under this agreement. ENDORSEMENT NO. 2. The cverage is Primary and nn-cntributry t any ther applicable insurance carried by the District. 3. The plicy(ies) cvers cntractual liability. 4. The plicy(ies) is written n an ccurrence basis. 5. The plicy(ies) cvers District s Prperty in Lessee s care, custdy and cntrl. 6. The plicy(ies) cvers persnal injury (libel, slander, and wrngful entry and evictin) liability. 7. The plicy(ies) cvers explsin, cllapse, and undergrund hazards. 8. The plicy(ies) cvers prducts and cmpleted peratins. 9. The plicy(ies) cvers the use f wned, nn-wned and hired autmbiles. 10. The plicy(ies) and/r a separate pllutin liability plicy shall cver pllutin liability fr claims related t the release r the threatened release f pllutants int the envirnment arising ut f r resulting frm Cnsultant s perfrmance under this agreement. 11. The plicy(ies) will nt be canceled nr the abve cverages/endrsements reduced withut 30 days written ntice t East Bay Municipal Utility District at the address abve. IT IS HEREBY CERTIFIED that the abve plicies prvide liability insurance as required by the agreement between the East Bay Municipal Utility District and the insured. Signed Address Firm Date Phne Insurance Certificates Rev. 4/5/2017 Page 1 f 3
6 CERTIFICATE OF POLLUTION LIABILITY INSURANCE THIS IS TO CERTIFY TO: East Bay Municipal Utility District (EBMUD) Real Estate Services (RL) th Street, MS: 903 P.O. Bx Oakland, CA THE FOLLOWING DESCRIBED POLICY HAS BEEN ISSUED TO: District Cntract Number: Insured: LOCATION AND DESCRIPTION OF PROJECT/AGREEMENT: TYPE OF INSURANCE: Pllutin Liability (If Claims Made Basis, need a three year tail) MINIMUM LIMITS OF LIABILITY: $1,000,000 each claim - $2,000,000 aggregate. INSURANCE COMPANY: POLICY NUMBER: POLICY TERM: Frm: T: POLICY TAIL: Frm: T: The plicy will nt be canceled nr the abve cverage reduced withut 30 days written ntice t East Bay Municipal Utility District at the address abve. IT IS HEREBY CERTIFIED the abve plicy prvides insurance as required by the agreement between East Bay Municipal Utility District and the Insured. Signed: Authrized Signature f Brker, Agent, r Underwriter Date: Firm: Phne: This certificate r verificatin f insurance is nt an insurance plicy and des nt amend, extend, r alter the cverage affrded by the plicies listed herein. Ntwithstanding any requirement, term r cnditin f any cntract r ther dcument with respect t which this certificate r verificatin f insurance may be issued r may pertain, the insurance affrded by the plicies described herein is subject t all the terms, exclusins, and cnditins f the plicies. Insurance Certificates Rev. 4/5/2017 Page 2 f 3
7 CERTIFICATE OF WORKERS COMPENSATION INSURANCE THIS IS TO CERTIFY TO: East Bay Municipal Utility District (EBMUD) Real Estate Services (RL) th Street, MS: 903 P.O. Bx Oakland, CA THE FOLLOWING DESCRIBED POLICY HAS BEEN ISSUED TO: District Cntract Number Insured: LOCATION AND DESCRIPTION OF PROJECT/AGREEMENT: TYPE OF INSURANCE: Wrkers Cmpensatin Insurance as required by Califrnia State Law. INSURANCE COMPANY: POLICY NUMBER: POLICY TERM: Frm: T: The plicy will nt be canceled nr the abve cverage reduced withut 30 days written ntice t East Bay Municipal Utility District at the address abve. IT IS HEREBY CERTIFIED the abve plicy prvides insurance as required by the agreement between East Bay Municipal Utility District and the Insured. Signed: Authrized Signature f Brker, Agent, r Underwriter Date: Firm: Phne: This certificate r verificatin f insurance is nt an insurance plicy and des nt amend, extend, r alter the cverage affrded by the plicies listed herein. Ntwithstanding any requirement, term r cnditin f any cntract r ther dcument with respect t which this certificate r verificatin f insurance may be issued r may pertain, the insurance affrded by the plicies described herein is subject t all the terms, exclusins, and cnditins f the plicies. Insurance Certificates Rev. 4/5/2017 Page 3 f 3
Zoning Bylaw Amendment Application
Zning Bylaw Amendment Applicatin Prir t submitting a frmal applicatin, yu may wish t cntact the Planning Department fr a preliminary cnsultatin. The Zning Bylaw is a set f regulatins which cntrls land
More informationCascades Wedding Show January 14 th 2017 Vendor Application
Cascades Wedding Shw January 14 th 2017 Vendr Applicatin Return t: LAY IT OUT EVENTS 704 NW Gergia Ave Bend, OR 97703 Att: Vendr Crdinatr Make Checks payable t: Lay It Out Events Business Name Applicant
More informationCRUHSD. Fieldhouse Bullhead City, Arizona. REQUEST for PROPOSAL (RFP) SIGNAGE PACKAGE. Instructions to Bidders
CRUHSD Fieldhuse Bullhead City, Arizna REQUEST fr PROPOSAL (RFP) SIGNAGE PACKAGE Instructins t Bidders DATE OF INVITATION: August 27, 2018 OWNER: PROJECT MANAGER: CONSTRUCTION MANAGER: ARCHITECT: Clrad
More informationTemporary Rental Unit - Zoning Clearance Application Packet
Temprary Rental Unit - Zning Clearance Applicatin Packet Cunty f Ventura Resurces Management Agency Planning Divisin 800 S. Victria Avenue, Ventura, CA 93009 (805)654-2488 www.vcrma.rg/divisins/planning
More informationMerchant Exhibitor Application
Merchant Exhibitr Applicatin August 5 th & 6 th / 1pm-5pm bth days / Keystne, Clrad This year we are celebrating the 21 st Anniversary f the Keystne Bluegrass and Beer Festival with tw day filled with
More informationMint Hill Athletic Park. & Mint Hill Stadium at Veterans Park. Trade Contractor Pre-qualification
Mint Hill Athletic Park & Mint Hill Stadium at Veterans Park Trade Cntractr Pre-qualificatin In filling ut this pre-qualificatin statement please carefully read and fllw all instructins. If yu have any
More informationHOME IMPROVEMENT CONTRACT
HOME IMPROVEMENT CONTRACT YOU ARE ENTITLED TO A COMPLETELY FILLED-IN COPY OF THIS CONTRACT, SIGNED BY BOTH YOU AND THE CONTRACTOR BEFORE ANY WORK MAY BE STARTED. CONTRACTOR S NAME: ADDRESS: PHONE: FAX:
More informationAlbemarle Police Department. Trade Contractor Pre-qualification
Albemarle Plice Department Trade Cntractr Pre-qualificatin In filling ut this pre-qualificatin statement please carefully read and fllw all instructins. If yu have any questins please cntact Jessica Pabalate
More information8722 S. Harrison St. Sandy, UT P.O. Box 4439 Sandy, UT Fax
8722 S. Harrisn St. Sandy, UT 84070 P.O. Bx 4439 Sandy, UT 84091 877-678-7342 Fax 801-304-5551 HANGAR General Infrmatin Prpsed Effective Date: Applicant s Name: Applicant s Mailing Address: E-Mail: Cunty:
More informationSalt Lake City Area Office 8722 S. Harrison St. Sandy, UT P.O. Box 4439 Sandy, UT Fax
Salt Lake City Area Office 8722 S. Harrisn St. Sandy, UT 84070 P.O. Bx 4439 Sandy, UT 84091 800-257-5590 Fax 800-478-9880 Chicag Office 303 W. Madisn Street Suite 2075 Chicag, IL 60606 800-456-4576 Fax
More informationFood Exhibitor Application
KEYSTONE 5 TH ANNUAL OKTOBERFEST 2017 Menu Guidelines: Fd Exhibitr Applicatin September 2 nd / 1pm-6pm / Keystne, Clrad All menu items must be priced between $1 - $5. Each exhibitr can serve up t 3 items.
More informationCity of South Gate Block Party Permit Application. CITY OF SOUTH GATE 8650 California Avenue South Gate, CA (323)
CITY OF SOUTH GATE 8650 Califrnia Avenue Suth Gate, CA 90280-3075 (323) 357-9657 Blck party permit applicatin per Reslutin 7529 Applicatins due t Public Wrks Department at least 30 days prir t blck party
More informationFORM 2. INDEPENDENT REGULATORY BOARD FOR AUDITORS (Established under Section 3 of Act 26 of 2005)
FORM 2 INDEPENDENT REGULATORY BOARD FOR AUDITORS (Established under Sectin 3 f Act 26 f 2005) APPLICATION BY A FIRM FOR ADMISSION TO THE REGISTER OF AUDITORS (Fr applicatin in terms f Sectin 38(2)) and
More informationREFERENCE NUMBER: PFS.PDS.115. TITLE: Patient Billing and Collections CURRENT EFFECTIVE DATE: 01/01/2018. PAGE 1 of 8 SCOPE:
PAGE 1 f 8 SCOPE: This Patient Billing and Cllectins Plicy applies t all Presbyterian Healthcare Services (Presbyterian) hspital facilities, including inpatient, utpatient, hme health care services and
More informationEmployee Hardship Assistance Policy
Emplyee Hardship Assistance Plicy Functinal Area: Human Resurces Applies T: All Faculty and Staff Plicy Reference(s): N/A Number: TBD Date Issued: March 4, 2013 Page(s): 6 Respnsible Persn The Directr
More informationHawaii Division of Financial Institutions 2019 Renewal Checklist
Hawaii Divisin f Financial Institutins 2019 Renewal Checklist Instructins Renewal requests must be submitted thrugh by the date specified by yur state regulatr(s). Click here t review all renewal deadlines,
More informationPARKS FACILITY USE RULES AND POLICIES
This Exhibit includes insurance, indemnificatin and Park Rules requirements fr use f Cunty parks. A Permit is required fr events that will include special activities r equipment, such as serving and cnsuming
More informationWorkers' Compensation Employee's Guide
Wrkers' Cmpensatin Emplyee's Guide Intrductin What is Wrkers' Cmpensatin? What is a Wrk-Related Injury? Wh Is Cvered by the UCSD Wrkers' Cmpensatin Prgram and When? Where D Yu Receive Initial Medical Treatment?
More informationVOLUNTEER REGISTRATION FORM
VOLUNTEER REGISTRATION FORM Office Use Only Prgram: Site: Day(s): Time: Name Email: Phne Number (cell) (hme) (Wrk) Address Birth date What is yur current ccupatin? Are yu r have yu ever been a member f
More informationOrganization Name: Event Organizer s Name: Date: *Responsible for communicating all aspects of the event and working with MCPC personnel.
Mrris Cunty Park Cmmissin: Event Applicatin Return t: Mrris Cunty Park Cmmissin Attn: Parks and Visitr Services Dept. P.O. Bx 1295, Mrristwn, NJ 07962 1295 events@mrrisparks.net Organizatin Name: Is this
More informationKEYSTONE OKTOBERFEST 2018
KEYSTONE OKTOBERFEST 2018 Fd Vendr Applicatin September 1 st / 1pm-6pm Saturday / Keystne, Clrad EVENT DETAILS Date: Saturday, August 18 th, 2018 Hurs: 1:00PM 6:00PM Lcatin: River Run Village, Keystne
More informationInsurance Program Overview
Office f Financial Services Office f Risk Management Insurance Prgram Overview The Ohi Stadium 1961 Tuttle Park Place, 2nd Fl. Clumbus, Ohi 43210 I. Purpse T establish cnsistent and standard funding and
More informationGolf Relief and Assistance Fund Application
Glf Relief and Assistance Fund Applicatin Eligibility The Glf Relief and Assistance Fund is designed t supprt individuals wrking in the glf industry and their husehld family members wh have been impacted
More information2017 Alaska Experience
Registratin Frm Serve ne anther in lve. GALATIANS 5:13 ( NLT) Jin Us in Alaska fr a week f service as we learn abut American Baptist hme missin wrk in the last frntier. Highlights include: Learn abut and
More informationAPPENDIX A TECHNICAL SPECIFICATIONS REWARDS AND RECOGNITION PROGRAM
APPENDIX A TECHNICAL SPECIFICATIONS 094-18 REWARDS AND RECOGNITION PROGRAM Backgrund JEA wns, perates and manages the electric system established by the City f Jacksnville, Flrida in 1895. In June 1997,
More informationARIZONA FIRE DISTRICT ASSOCIATION FINANCIAL PROCEDURES POLICY
FINANCIAL PROCEDURES POLICY 1. PURPOSE The purpse f these Financial Prcedures is t prvide cnsistent applicatin f cnduct and prper internal cntrls t safeguard the assets f the Arizna Fire District Assciatin
More informationAPPLICATION FOR PROJECT FUNDING REQUEST 2018 Charlevoix County Parks Millage 301 State St., Charlevoix, MI
APPLICATION FOR PROJECT FUNDING REQUEST 2018 Charlevix Cunty Parks Millage 301 State St., Charlevix, MI 49720 administratin@charlevixcunty.rg PROJECT APPLICANT INFORMATION Name f Municipal Applicant(s):
More informationAPPLICATION FOR MISCELLANEOUS MEDICAL PROFESSIONAL LIABILITY INSURANCE
APPLICATION FOR MISCELLANEOUS MEDICAL PROFESSIONAL LIABILITY INSURANCE Sectin I General Infrmatin 1. Full Name f Applicant: 2. Mailing and Lcatin Address: (Include all dba s and subsidiaries seeking cverage
More informationTemporary Use Permit Review Process
Temprary Use Permit Review Prcess Pre-applicatin Cnference (ptinal) Submit Applicatin Cntact Infrmatin Currituck Cunty Phne: 252.232.3055 Planning and Cmmunity Develpment Fax: 252.232.3026 153 Curthuse
More informationQuality of Life Equipment Grants
Quality f Life Equipment Grants Abut the Quality f Life Equipment Grants Prgram The MS Sciety f Canada makes available t individuals living with multiple sclersis (MS) a Quality f Life Equipment Grants
More informationNHCAC North Hudson Community Action Corporation
NHCAC Nrth Hudsn Cmmunity Actin Crpratin RFP 340B Prgram Auditing Services INQUIRIES SHOULD BE DIRECTED TO: Name: Title: Entity: Address: Manny Diaz Directr f Cmmunity Develpment Nrth Hudsn Cmmunity Actin
More informationHawaii Division of Financial Institutions 2018 Renewal Checklist
Hawaii Divisin f Financial Institutins 2018 Renewal Checklist Instructins Renewal requests must be submitted thrugh by the date specified by yur state regulatr(s). Click here t review all renewal deadlines,
More informationFull Facility Refers to exclusive use of the Entry Gallery, Library Gallery, and Upstairs Gallery. Studio is not included.
The Charles H. Taylr Arts Center Rental Infrmatin This infrmatin package is intended t assist prspective tenants in understanding the established prcedures and csts relative t bking The Charles H. Taylr
More informationInstructions Fee Schedule
City f Lndn Tree Prtectin By-Law C.P.-1515-228 Tree Prtectin Area Permit Applicatin Cemetery r Glf Curse Planning Services - Urban Frestry 267 Dundas Street, 3rd Flr Lndn, Ontari N6A 1H2 Telephne: 519-661-CITY
More informationDiscretionary Use Application
Discretinary Use Applicatin Prir t submitting a frmal applicatin, yu may wish t cntact the Planning Department fr a preliminary cnsultatin. The City f Regina Zning Bylaw has tw categries f uses that may
More informationUse the included checklist to ensure that the plan(s) include at least the minimum required information.
RCOC Applicatin Instructins CHELMSFORD CONSERVATION COMMISSION Request fr Certificate f Cmpliance Applicatin Instructins Certificates f Cmpliance (COC) are the final permit issued by the Cnservatin Cmmissin
More information8722 S. HARRISON ST. SANDY, UT P.O. BOX 4439 SANDY, UT FAX
8722 S. HARRISON ST. SANDY, UT 84070 P.O. BOX 4439 SANDY, UT 84091 877-678-7342 FAX 800-478-9880 HOT AIR BALLOON PROPOSED EFFECTIVE DATE: A. General Infrmatin Applicant s Name: Applicant s Mailing Address:
More informationSalt Lake City Area Office 8722 S. Harrison St. Sandy, UT P.O. Box 4439 Sandy, UT Fax
Salt Lake City Area Office 8722 S. Harrisn St. Sandy, UT 84070 P.O. Bx 4439 Sandy, UT 84091 800-257-5590 Fax 800-478-9880 Chicag Office 303 W. Madisn Street Suite 2075 Chicag, IL 60606 800-456-4576 Fax
More informationTENANT CONSTRUCTION RULES AND REGULATIONS. MALL NAME: Charlotte Premium Outlets
TENANT CONSTRUCTION RULES AND REGULATIONS MALL NAME: Charltte Premium Outlets Date:9/12/17 PRE-CONSTRUCTION MEETING A minimum f five (5) days prir t starting cnstructin, the CONTRACTOR shall cntact the
More informationLincoln LifeGuarantee UL (2013)
Lincln LifeGuarantee UL (23) life insurance prjectin Flexible Premium djustable Life Insurance Plicy Frm UL6 and state variatins theref. Prepared fr: Presented by: lec Smith 35 Mntfrd Ct Sugar Land, TX
More informationRenewal of Manager s Certificate
Applicatin fr Renewal f Manager s Certificate Sectin 219, Sale and Supply f Alchl Act 2012 General infrmatin: Yu must renew yur manager s certificate befre it expires. Once yur manager s certificate has
More informationo o o o o o PLEASE ANSWER ALL QUESTIONS COMPLETELY
Deerfield Insurance Cmpany Evanstn Insurance Cmpany Essex Insurance Cmpany Markel American Insurance Cmpany Markel Insurance Cmpany Assciated Internatinal Insurance Cmpany CONTRACTORS AND CONSULTANTS APPLICATION
More informationIndependent Contractor Registration Form and Questionnaire
Independent Cntractr Registratin Frm and Questinnaire PLEASE COMPLETE THIS REGISTRATION FORM AND ATTACHED QUESTIONNAIRE. YOU MUST SUBMIT ALL REQUIRED ITEMS LISTED BELOW VIA EMAIL TO: VENDORMANAGEMENT@SAMJV.NET
More informationInformation Package CAFETERIA 125 PLANS
Infrmatin Package CAFETERIA 125 PLANS Shaffer Insurance Services, Inc. Benefits Divisin 902 E. Ave Q-9 Palmdale Ca. 93550 Tll Free (866) 412-5872 Office Tel (661) 575 9331 Fax (661) 280 2016 Sectin 125
More informationWestern Management 1654 The Alameda Suite 100 San Jose, California
Fax COMMUNITY NAME PROPERTY MANAGER FROM FAX PAGES PHONE DATE REGARDING Rental Applicatin CC Urgent Fr Review Please Cmment Please Reply Please Recycle Cmments: Western Management 1654 The Alameda Suite
More informationRegion 5 Student Paper Reimbursement Procedure
Regin 5 Student Paper Reimbursement Prcedure Prcedure fr student cmpetitin awards winners fr receptin f their prize mney frm Regin 5. This includes the prcedure fr Area student papers awards mnies receptin.
More informationProviding Value-Added Risk Management. Accomplishing Operational and Strategic Goals
Prviding Value-Added Risk Management Accmplishing Operatinal and Strategic Gals Agenda Our Backgrund Early Successes and Value-Added Risk Management Q&A Our Backgrund/Stry Risk and Safety as an Additinal
More informationMICRO GROUP EMPLOYER DOCUMENTATION REQUIREMENTS
Seattle, Washingtn 98101 MICRO GROUP EMPLOYER DOCUMENTATION REQUIREMENTS D nt cancel any existing plicies until yu receive cnfirmatin f final rates and/r acceptance f the grup by Regence BlueShield (Regence).
More informationVisitor Safety Management Procedure
Visitr Safety Management Prcedure Visitr Safety Management Prcedure Related Plicy Wrk Health and Safety Plicy Respnsible Officer Executive Directr Human Resurces Apprved by Executive Directr Human Resurces
More informationTEMPORARY HOLIDAY SALES
TEMPORARY HOLIDAY SALES APPLICATION PACKAGE APPLICATION INFORMATION: Temprary hliday sales may nly be sld at nnresidential zning districts r frm areas immediately adjacent and utilized in cnjunctin with
More informationIndiana University Agreement Between Owner And Consultant for Non-Construction Projects
Indiana University Agreement Between Owner And Cnsultant fr Nn-Cnstructin Prjects This AGREEMENT is made: (Date) BETWEEN the Owner: The Trustees f Indiana University 1800 N. Range Rad Blmingtn, IN 47408
More informationCRG PATIENT REGISTRATION FORM
CRG PATIENT REGISTRATION FORM PATIENT INFORMATION Patient s Name: Birth : (Last) (First) (Middle) Scial Security Number: Male: Female: Hme Address: (Street / RR Bx # / Apt. #) (City/State) (Zip) Preferred
More informationTitle II, Part A Private School Principal s Consultative Meeting
2017 2018 Title II, Part A Private Schl Principal s Cnsultative Meeting HOSTED BY DCPS FEDERAL PROGRAMS THURSDAY, AUGUST 3, 2017 LOCATION: MOSH TIME 1:00 3:00PM Thursday, August 3, 2017 Agenda Welcme Title
More informationCONDITIONAL USE PERMIT & MINOR USE PERMIT APPLICATION GUIDE
Butte Cunty Department f Develpment Services PERMIT CENTER 7 Cunty Center Drive, Orville, CA 95965 Planning Divisin Phne 530.552.3701 Fax 530.538.7785 Email dsplanning@buttecunty.net FORM NO PLG-06 INTRODUCTION
More informationNURSE PROFESSIONAL LIABILITY
8722 S. Harrisn St. Sandy, UT 84070 P.O. Bx 4439 Sandy, UT 84091 877-678-7342 Fax 800-498-9880 NURSE PROFESSIONAL LIABILITY 1. General Infrmatin Prpsed Effective Date: Applicant is (check all that apply):
More informationTENANT CONSTRUCTION RULES AND REGULATIONS
TENANT CONSTRUCTION RULES AND REGULATIONS MALL NAME: Aurra Farms Premium Outlets PRE-CONSTRUCTION MEETING A minimum f five (5) days prir t starting cnstructin, the CONTRACTOR shall cntact the LANDLORD'S
More informationWheaton Chamber Member. Non- Wheaton Chamber Member. Dear Restaurant Owner:
Dear Restaurant Owner: Plans are currently underway fr Taste f Wheatn 2018 presented by the Wheatn Park District and Wheatn Chamber f Cmmerce. We are very excited abut this year s event, and anticipate
More informationaddress: Driver license number: Date of birth: Occupation:
MEMBERSHIP APPLICATION PRIMARY MEMBER INFORMATION Name: Scial security Member Number: Hme phne: Cell phne: Business phne: Mther s Maiden Name: Security passwrd: Mailing address: City: State: ZIP Cde: Street
More informationAll application submissions and questions may be sent to: CHECKLIST
Dear Vlunteers, Thank yu fr yur interest in the Kids Arund the Wrld playgrund build trip. We are excited fr the pprtunity t wrk alngside yu t impact the lives f these children. The need there is tremendus
More informationVODACOM BROADBAND FIBRE
VODACOM BROADBAND FIBRE SECTION A: Custmer Details & Package Selectin Surname First Names ID Number Street Address Estate Suburb City Prvince Phne Number (Hme) Phne Number (Wrk) Phne Number (Cell) Email
More informationPASSPORT INFORMATION:
Dear Vlunteers, Thank yu fr yur interest in the Kids Arund the Wrld playgrund build trip. We are excited fr the pprtunity t wrk alngside yu t impact the lives f these children. The need there is tremendus
More informationSmall Business Sustainability Program Payment Application Instructions/Process
Small Business Sustainability Prgram Payment Applicatin Instructins/Prcess Eligibility Requirements 1. Business must be lcated in the active cnstructin znes n Alum Rck Avenue between Highway 101 and Interstate
More informationContractors Rules & Regulations
Cntractrs Rules & Regulatins (1) Pre-Cnstructin Meeting Pg. 2 (2) Permits and Licensing Pg. 4 (3) Unin Affiliated Guidelines Pg. 5 (4) Temprary Prvisins Pg. 6 (5) Cnstructin Requirements Pg. 7 (6) Opening
More informationEnvironmental Health & Safety Requirements for Master Agreement of Services
Envirnmental Health & Safety Requirements fr Master Agreement f Services If Cntractr emplyees will perfrm Services n any Michelin premises, Cntractr must cmply with the fllwing requirements: Cmply with
More informationContractors Rules & Regulations
Cntractrs Rules & Regulatins (1) Pre-Cnstructin Meeting Pg. 2 (2) Permits and Licensing Pg. 4 (3) Unin Affiliated Guidelines Pg. 5 (4) Temprary Prvisins Pg. 6 (5) Cnstructin Requirements Pg. 7 (6) Opening
More informationWhat credit related information do we collect and hold and how do we collect it?
In this Credit Reprting Plicy, ORIX, we, us and ur mean ORIX Australia Crpratin Limited and ur related cmpanies. Thse related cmpanies may als have their wn privacy r credit reprting plicies which set
More informationEmployee Rights & Responsibilities Page 1 of 4 Traumatic Injury/Form CA-1
Emplyee Rights & Respnsibilities Page 1 f 4 Traumatic Injury/Frm CA-1 The Federal Emplyees Cmpensatin Act (FECA) utlines the benefits fr federal emplyees injured in the perfrmance f their duties. The Office
More informationPrivacy & Data Protection Policy
Privacy & Data Prtectin Plicy Whitby & District Fishing Industry Training Schl Limited and 54 Nrth Maritime Training ("Whitby Fishing Schl", WDFITS, 54 Nrth Maritime "we" r "us") are cmmitted t prmting
More informationThe Safety Net Foundation
The Safety Net Fundatin Instructins fr Kineret (anakinra) and Sensipar (cinacalcet HCl) Instructins The Safety Net Fundatin prvides temprary prduct assistance t financially needy patients wh meet predetermined
More informationApplication Checklist: Supporting documents you need to provide with your application: o Application fee
Applicatin fr Special Licence Sectin 138, Sale and Supply f Alchl Act 2012 General infrmatin: Office Use Only An applicatin fr a special licence MUST be ldged at least 20 wrking days befre the event(s)
More informationSiding Program Application
Siding Prgram Applicatin Please read the attached Plicy Guidelines and prvide the requested infrmatin. 1. Address f Prperty: 2. Applicant s name & mailing address: Telephne: ( ) - E-mail 3. Applying fr:
More informationHOC Works Program Requirements
HOC Wrks Prgram Requirements Last Revisin: March 2018 INTRODUCTION The Husing Opprtunities Cmmissin f Mntgmery Cunty (HOC) established the HOC Wrks prgram in 2015 in rder t guarantee that HOC emplyment
More informationVision Service Plan (VSP) New Group Implementation Guide
Visin Service Plan (VSP) New Grup Implementatin Guide Nrth Ranch Benefits Trust (NRBT) Administered by HealthSmart Benefit Slutins, Inc. Agents shuld submit the cmpleted New Grup Implementatin Guide back
More informationDraft Governance Working Group Summary of Issues, Research Questions and Possible Recommendations. EALI Governance Goal: Enhance Local Self Governance
Draft Gvernance Wrking Grup Summary f Issues, Research Questins and Pssible Recmmendatins EALI Gvernance Gal: Enhance Lcal Self Gvernance The fllwing summary is based n the EALI Gvernance Wrk Grup s answers
More informationENVIRONMENTAL STEWARDSHIP AND CLIMATE CHANGE GROUP PROGRAM
ENVIRONMENTAL STEWARDSHIP AND CLIMATE CHANGE GROUP PROGRAM APPLICATION PROPOSAL GUIDE Prject selectin criteria The fllwing utlines a list f brad criteria that will be taken int cnsideratin during the selectin
More informationCompany specific data
2014 Purchasing WOCO Grup f Cmpanies Cmpany (General Infrmatin) Name: Address: Hmepage: Subsidiary f: This frm sheet shuld give us a first verview f yur cmpany. It includes imprtant elements f a ptential
More informationCERTIFICATES OF INSURANCE PAGE
OAR (Online Assigned Risk) User s Guide Page 16 CERTIFICATES OF INSURANCE PAGE Clicking the Certificates f Insurance link in the menu bar at the tp f the OAR Hme Page will bring a prducer t the Certificates
More informationYou can get help from government organizations that are not connected with us
2011 Evidence f Cverage fr Medi-Pak Advantage MA (PFFS) Chapter 9: What t d if yu have a prblem r cmplaint (cverage decisins, appeals, cmplaints) BACKGROUND SECTION 1 Intrductin Sectin 1.1 What t d if
More informationRisk and Audit Committee charter
Risk and Audit Cmmittee charter 1. Intrductin The Bard f Cffey Internatinal Limited ( Cffey r the Cmpany ) has established a Risk and Audit Cmmittee ( Cmmittee ). It is nted that the Cmmittee is a sub-cmmittee
More informationREQUEST FOR PROPOSAL (RFP) FOR ENGINEERING DESIGN SERVICES FOR THE Electrical and Stage Lighting Upgrades at B Street Community Center.
REQUEST FOR PROPOSAL (RFP) FOR ENGINEERING DESIGN SERVICES FOR THE Electrical and Stage Lighting Upgrades at B Street Cmmunity Center March 15, 2018 Intrductin The City f San Rafael (City) hereby requests
More informationVA Mortgage Lender License New Application Checklist (Company)
VA Mrtgage Lender License New Applicatin Checklist (Cmpany) CHECKLIST SECTIONS General Infrmatin License Fees Requirements Cmpleted in Requirements/Dcuments Upladed in Requirements Submitted Outside f
More informationApplication for Coverage Under the Pre-Existing Condition Insurance Plan administered by the Arkansas Comprehensive Health Insurance Pool (CHIP)
P. O. Bx 1460 Little Rck, AR 72203 Applicatin fr Cverage Under the Pre-Existing Cnditin Insurance Plan administered by the Arkansas Cmprehensive Health Insurance Pl (CHIP) This Applicatin fr cverage thrugh
More informationVILLAGE OF SCHILLER PARK COOK COUNTY, ILLINOIS
VILLAGE OF SCHILLER PARK COOK COUNTY, ILLINOIS Prcedures and Applicatin fr Village f Schiller Park Cnsideratin f Ck Cunty Real Estate 6B Classificatin This applicatin is nly used fr petitin f a standard
More informationABORIGINAL ECONOMIC PARTNERSHIPS Program Application Guidelines
ABORIGINAL ECONOMIC PARTNERSHIPS Prgram Applicatin Guidelines The Abriginal Ecnmic Partnerships Prgram (AEPP) supprts Abriginal cmmunities, businesses and rganizatins t increase participatin in ecnmic
More informationTERMS AND CONDITIONS FOR APPOINTMENT OF INDEPENDENT DIRECTOR
TERMS AND CONDITIONS FOR APPOINTMENT OF INDEPENDENT DIRECTOR 1 PRIVATE & CONFIDENTIAL Date: T, Independent Directrs, Subject: Appintment as an Independent Directr InfBeans Technlgies Limited Dear Sir/Madam,
More informationGoldwater Bank N.A. Mortgage Division Construction-to-Permanent Loan Agreement and Acknowledgement Site Built Homes
Gldwater Bank N.A. Mrtgage Divisin Cnstructin-t-Permanent Lan Agreement and Acknwledgement Site Built Hmes Builders/Brrwer s utilizing Gldwater Bank s (Lender) Cnstructin-t-Permanent (C-t-P) lan prgram
More informationNon-Residential Building Permit Application Review Process
Nn-Residential Building Permit Applicatin Review Prcess Cntact Infrmatin Currituck Cunty Planning and Cmmunity Develpment Central Permitting Divisin Mainland Office 153 Curthuse Rad, Suite G107 Mainland
More informationRequest for Proposal. IT Managed Services
Tiltn-Nrthfield Fire District Request fr Prpsal Due by: Nvember 30, 2017 at 2:00 PM Chief Sitar Tiltn-Nrthfield Fire & EMS 12 Center Street Tiltn, NH 03276 1 Tiltn-Nrthfield Fire District TABLE OF CONTENTS
More informationDirect Entry Pre-Approval Requirements for Level II Technician Candidates
Direct Entry Pre-Apprval Requirements fr Level II Technician Candidates The Direct Entry prgram is intended t allw rpe access technicians wh have btained rpe access skills and experience n an industrial
More informationMedical Marijuana Activity Zoning Ordinance SUPPLEMENTAL APPLICATION PACKET Manufacturing
Medical Marijuana Activity Zning Ordinance SUPPLEMENTAL APPLICATION PACKET Manufacturing COMMUNITY DEVELOPMENT DEPARTMENT / PLANNING DIVISION 8130 Allisn Avenue, La Mesa, CA 91942 Phne: 619.667.1177 Fax:
More informationALAMEDA COUNTY BEHAVIORAL HEALTH CARE SERVICES (BHCS) INFORMAL REQUEST FOR QUOTATION (IRFQ) # SPECIFICATIONS, TERMS & CONDITIONS
ALCOHOL, DRUG & MENTAL HEALTH SERVICES MANUEL J. JIMENEZ, JR., MA MFT, DIRECTOR Netwrk Office 1900 Embarcader Cve, Suite 205 Oakland, Califrnia 94606 510. 567.8296 ALAMEDA COUNTY BEHAVIORAL HEALTH CARE
More informationFlexible Working Policy
Our HR Plicies Flexible Wrking Plicy Aim f the plicy The Kelda Grup is cmmitted t prmting flexibility in the wrkplace and believes that this flexibility can increase mtivatin, prmte wrk-life balance, wellbeing
More informationCity of Stevens Point Plan Commission Application Packet
City f Stevens Pint Cmmunity Develpment Department 1515 Strngs Avenue, Stevens Pint, WI 54481 P: (715) 346-1567 F: (715) 346-1498 cmmunitydevelpment@stevenspint.cm http://stevenspint.cm City f Stevens
More informationTERMS OF REFERENCE FOR THE PROVISION OF OUTSOURCED INTERNAL AUDIT SERVICE
W&RSETA Standard Bidding Dcuments Terms f Reference TERMS OF REFERENCE FOR THE PROVISION OF OUTSOURCED INTERNAL AUDIT SERVICE 1 W&RSETA Standard Bidding Dcuments Terms f Reference 1. BACKGROUND TO W&RSETA
More informationCanadian Association for the Study of the Liver Endorsement Policy
Canadian Assciatin fr the Study f the Liver Endrsement Plicy 1. Purpse: The purpse f this CASL plicy is t define the criteria and the prcess that will be fllwed fr requests frm utside rganizatins, agencies,
More informationSRP Business Solutions: Electric Technology Rebates Forklift Rebate Application (Customer)
SRP Business Slutins: Electric Technlgy Rebates Frklift Rebate Applicatin (Custmer) Instructins: Fill ut this rebate applicatin cmpletely and sign. Attach required dcumentatin: all invices shwing dates
More informationWestern Management PO Box San Jose, California
Fax COMMUNITY NAME PROPERTY MANAGER FROM FAX PAGES PHONE DATE REGARDING Rental Applicatin CC Urgent Fr Review Please Cmment Please Reply Please Recycle Cmments: Western Management PO Bx 26824 San Jse,
More informationThank you for your interest in the Professional Liability Insurance Plan for IEEE members.
Mercer Cnsumer, a service f Mercer Health & Benefits Administratin LLC PO Bx 8146 Des Mines, IA 50306-8146 Phne: 800-375-0775 Fax: 515-365-3043 Dear IEEE Member: Thank yu fr yur interest in the Prfessinal
More informationLANGIND E DOCNUM 2009-0311861I7 AUTHOR Zannese, Lisa DESCKEY 26 RATEKEY 2 REFDATE 100721 SUBJECT Issues par. 149(1)(c) and prpsed par.149(1)(d.5) SECTION 149(1)(c); 149(1)(d.5); 149(1.2) SECTION SECTION
More informationRaleigh Pediatric Associates Financial Policy
Welcme t Raleigh Pediatrics Assciates! We re glad yu ve chsen us as yur child s pediatrician and strive t give yur children the best in medical care. We understand that in additin t feeling cmfrtable with
More information