"Newsrack Permit Application" - City of Fort Worth, Texas

Newsrack Permit Application is a legal document that was released by the Planning and Development Department - City of Fort Worth, Texas - a government authority operating within Texas. The form may be used strictly within City of Fort Worth.

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Newsrack Permit Application
Planning and Development Department, City of Fort Worth
1000 Throckmorton St, Fort Worth TX 76102
www.fortworthgov.org/planninganddevelopment
Submit information to
DevCustomerService@FortWorthTexas.gov
Attn: Newsrack Permits
____________________
DATE:
Renewal
THIS APPLICATION IS SUBMITTED BY:
Company applying for permit
_________________________________________________________________________
Name:
_______________________________________________________________________
Address:
_________________________________
________________________________
Phone:
Fax:
Applicant
_________________________________________________________________________
Name:
_______________________________________________________________________
Address:
_________________________________
________________________________
Phone:
Fax:
_________________________________________________________________________
Email:
_____________________________________
1. Number of permits requested in the downtown area:
2. Publication name(s) for each requested newsrack (add attachment if needed):
______________________________________________________________________
3. Indicate publication issue frequency:
4. $20 application fee per applicant, $5 fee per newsrack
____ at least 5 days per week
If using Credit Card
:
____ between 2 and 4 days per week
____ once a week
*For your protection, we do not accept credit card
____ less frequent
information by email. Please provide a valid contact
number for credit card payment.
Attachments required:
th
Detailed proposed location for each newsrack including exact location. (example: NW corner of Throckmorton & 9
by
Public Safety Building OR Location and Spot ID if noted on Permit Locations list). If requested location is not on the
Permit Locations list, please provide a map with each requested location that indicates all existing buildings, building
entrances, light poles, trees, tree grates and planters, fire hydrants, handicap ramps and other elements within 20 feet of
the requested location(s) of the newsrack(s). (as specified in Ordinance No. 17529-05-2007, Division V., Sec. 30-106)
Type or brand of newsrack. Include an illustration and description of the newsrack and whether the newsrack will have a
coin-box attachment or equivalent.
A sworn statement under penalty of perjury executed by an officer, director or authorized agent of the applicant that the
applicant shall not sell, assign, or transfer by any method, the permit for the newsrack location to any other publisher,
distributor, entity or individual person.
Proof of Insurance: …any such permittee shall be required to maintain a policy of general liability insurance in an amount
acceptable to the City, naming the City of Fort Worth and its employees, agents, etc. as “Additional Insureds”…(please
refer to Ordinance No. 17529-05-2007, Division IV., Sec. 30-105., J. Insurance). The minimum coverage limit for the
General Liability insurance is $500,000.
The applicant agrees to indemnify and hold harmless the City, its officers, directors and employees against any loss or
liability or damage, including expenses and costs for bodily or personal injury, and for property damage sustained by any
person as the result of the installation, use or maintenance of a newsrack within the City of Fort Worth. In addition, the
applicant certifies that the enclosed information is correct and complete to the best of the applicant’s knowledge. The
applicant further certifies that they have read, understand, and will comply with all the information contained in the City
Ordinance No. 17529-05-2007, adopted 5/1/07. (Ordinance can be found at www.fortworthgov.org/planninganddevelopment,
Ordinances and Related Info)
_____________________________________________________________
Applicant (please print):
______________________________________________________________________
Signature:
Newsrack Permit Application
Planning and Development Department, City of Fort Worth
1000 Throckmorton St, Fort Worth TX 76102
www.fortworthgov.org/planninganddevelopment
Submit information to
DevCustomerService@FortWorthTexas.gov
Attn: Newsrack Permits
____________________
DATE:
Renewal
THIS APPLICATION IS SUBMITTED BY:
Company applying for permit
_________________________________________________________________________
Name:
_______________________________________________________________________
Address:
_________________________________
________________________________
Phone:
Fax:
Applicant
_________________________________________________________________________
Name:
_______________________________________________________________________
Address:
_________________________________
________________________________
Phone:
Fax:
_________________________________________________________________________
Email:
_____________________________________
1. Number of permits requested in the downtown area:
2. Publication name(s) for each requested newsrack (add attachment if needed):
______________________________________________________________________
3. Indicate publication issue frequency:
4. $20 application fee per applicant, $5 fee per newsrack
____ at least 5 days per week
If using Credit Card
:
____ between 2 and 4 days per week
____ once a week
*For your protection, we do not accept credit card
____ less frequent
information by email. Please provide a valid contact
number for credit card payment.
Attachments required:
th
Detailed proposed location for each newsrack including exact location. (example: NW corner of Throckmorton & 9
by
Public Safety Building OR Location and Spot ID if noted on Permit Locations list). If requested location is not on the
Permit Locations list, please provide a map with each requested location that indicates all existing buildings, building
entrances, light poles, trees, tree grates and planters, fire hydrants, handicap ramps and other elements within 20 feet of
the requested location(s) of the newsrack(s). (as specified in Ordinance No. 17529-05-2007, Division V., Sec. 30-106)
Type or brand of newsrack. Include an illustration and description of the newsrack and whether the newsrack will have a
coin-box attachment or equivalent.
A sworn statement under penalty of perjury executed by an officer, director or authorized agent of the applicant that the
applicant shall not sell, assign, or transfer by any method, the permit for the newsrack location to any other publisher,
distributor, entity or individual person.
Proof of Insurance: …any such permittee shall be required to maintain a policy of general liability insurance in an amount
acceptable to the City, naming the City of Fort Worth and its employees, agents, etc. as “Additional Insureds”…(please
refer to Ordinance No. 17529-05-2007, Division IV., Sec. 30-105., J. Insurance). The minimum coverage limit for the
General Liability insurance is $500,000.
The applicant agrees to indemnify and hold harmless the City, its officers, directors and employees against any loss or
liability or damage, including expenses and costs for bodily or personal injury, and for property damage sustained by any
person as the result of the installation, use or maintenance of a newsrack within the City of Fort Worth. In addition, the
applicant certifies that the enclosed information is correct and complete to the best of the applicant’s knowledge. The
applicant further certifies that they have read, understand, and will comply with all the information contained in the City
Ordinance No. 17529-05-2007, adopted 5/1/07. (Ordinance can be found at www.fortworthgov.org/planninganddevelopment,
Ordinances and Related Info)
_____________________________________________________________
Applicant (please print):
______________________________________________________________________
Signature: