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Home My WebLink AboutProcession - A Positive Approach to Teen Health1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND. INDIANA 46601-1830 �'oUTq Od'.. E.Al W PE CF44 1865 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS September 13, 2016 Ms. Donna Golob A Positive Approach to Teen Health 5997 Carlson Ave Portage IN 46368 RE: Event: Turkey Trot Date: November 24, 2016 Dear Ms. Golob: PHONE 574/235-9251 FAX 574.1235-9171 The Board of Public Works, at its meeting held on September 13, 2016, approved your request to conduct the above referenced event on November 24, 2016 from 6:30 a.m. to 10:00 a.m. subject to submitting a weather contingency plan and set up of safety zone with police cars and warning ahead with cones. Enclosed please find copy of your approved permit. Please note, the South Bend Police and Traffic and Lighting Departments will not be available to supply traffic control. You will be responsible for hiring your own off duty police officers and safety personnel. Please call this office at (574) 235-9251 with further questions regarding this matter. Sincerely, / ! - Linda M. Martin, Clerk Enclosure c: Gene Eyster, Police Department Ed Gleckler, Traffic & Lighting Federico Rodriguez, Fire Department Marcia Qualls, Engineering GARY A. GILOT DAVID P. RELOs ELIZABETH A. MARADIK .TAMES A. MUELLER THERESE J. DORAU INTER -OFFICE MEMORANDUM BOARD OF PUBLIC WORKS TO: J/ DATE SENT: 8/2/2016 Ed Gleckler, Traffic & Lighting Federico Rodriguez, Fire Department 9Corbitt Kerr, Engineering Paula Garis, Park Department J Lt. Gene Eyster, Police Department Adam Burck, Downtown South Bend J(aburck@downtownsouth bend.com) Marcia Qualls, Engineering Legal Department ,) FROM: Linda M. Martin, Clerk SUBJECT: PROCESSION RECOMMENDATION SPONSOR: A Positive Approach to Teen Health DATE OF EVENT: November 24, 2016 DATE DUE: August 16, 2016 FAX OR E-MAIL TO: 235-9171 / Imartin(ftouthbendin.gov RECOMMENDATIONS AND COMMENTS: By Date APPLICATION FOR USE OF PUBLIC RIGHT-OF-WAY FOR PROCESSIONS The Board of Public Works must have FOUR (4) weeks prior notice of the Sponsor: A Positive Approach to Teen Health Submitted By: Donna Golob Address: 5997 Carlson Ave. City: Portage State: IN Zip: 46368 Phone: 219-254-2678 Sponsor may use the public right-of-way described as (describe route and attach map) 5k Run takes place at the Career Academy of South Bend, Nimtz Hwy (see attached map) PLEASE NOTE: THE SOUTH BEND POLICE DEPARTMENT RESERVES THE RIGHT TO CHANGE YOUR ROUTE FOR SAFETY PURPOSES Event name: -Ta( yk%\I Tfipi - ® The Board of Public Works must have FOUR (4) weeks prior notice before event occurs ® All certificates of insurance, pre -paid costs, maps, and any other applicable information requested or required by the Board of Public Works have been provided with this application ® The event shall be held on THURSDAY, NOVEMBER 24 2016 and no other date ® Registration time for the event starts at 6:30 a.m./p.m. ® Starting time of the procession is 8 a.m./p.m. ® Estimated completion time is 10 a.m./p.m. This event involves the use of the following roadways ® This event involves City streets ® This event involves County roads ❑ This event involves State highways ® I understand that I must arrange a meeting with all affected governmental agencies to organize the above event (Call Marcia Qualls, Customer Service Manager, 235-5939 to organize meeting) ❑ This event involves the use of the sidewalk ❑ Participants must stay on the sidewalk and obey all traffic laws. ® This event is a local/regional/national event (Please circle the appropriate event type) ® This event will be coordinated with the property owneribusiness where staging will take place Updated 6/25/12 PERMIT/AGREEMENT FOR A PROCESSION 1. Sponsor shall reimburse the Board for the actual cost to the City for the event, if deemed necessary. 2. Sponsor shall provide to the Board a Certificate of Insurance showing a liability policy in full force and effect with limits of $300,000.00 per occurrence and $5,000,000.00 aggregate and the City of South Bend listed as an additional named insured for this event. 3. Sponsor shall provide to the Board all additional licenses, permits and documentation required for the event. 4. Sponsor agrees to abide by all terms and conditions of the Board's policy governing walks, runs, parades or other similar event adopted by the Board on March 3, 1985. 5. In order to ensure public safety during the event, the Board agrees to furnish traffic planning, materials, equipment and personnel as deemed necessary by the Police Department Traffic Bureau, the Bureau of Traffic and Lighting, and, where applicable, the Board of Park Commissioners. 6. Sponsor acknowledges that the Police Department reserves the right to change this route for safety purposes. In consideration for approval by the Board and the use of the sidewalks for the purposes set out above, the undersigned agrees and undertakes to hold the Civil City of South Bend, Indiana, free and harmless from any liability loss, costs, costs, damages or expenses, including attorney fees, which the Civil City of South Bend may suffer or incur, as a result of any claims or actions which may be made by any person, including a participant in said activity, arising out of the approval of the request to use the sidewalks indicated in the City of South Bend. The undersigned certifies that he/she is authorized to bind the above mentioned sponsor to the terms hereof. 8. Notification of approvalldenial of this request will be issued by return of this form, upon signed authorization by the Board of Public Works I understand the above rules and regulations and that this application may be denied based on any false or incomplete information. Sponsor Signature (R Printed Name Title OARD OF PUBLIC WORKS APPROVAL Presid nt" Member Member �f/��.ot& Member Member Date RETURN FORM TO: Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, BQ 46601 Phone: (574) 235-9251 • Fax: (574) 235-9171 . E-Mail: publicwks@southbendin.gov .gC4��za® CERTIFICATE OF LIABILITY INSURANCE GATE (NN/aU/yYYYI DTr15raD1s THIS CERTIFICATE 19 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the carfifiCate holder is an ADDITIONAL INSURED, the poPey(les) must he endorsed. if SUBROGATION IS WAIVED, SU4)ect 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 to lieu of such endorsemant(s). PRODUCER ALVIN G DEMPSEY INSURANCE AGENCY INC. $fdtffOfRf 1110 119TH ST- WHITING, IN. 46394 CONTAGTLUCY SCHUSTER LSA5 ry ME: PtiNDo"ryE 219-650-2111 ac NO: :219-659.7139 E DDREss: INSURER($)AFFORCINO COVWAGE NAM KSURERA:State Farm Fire Bntl Casualty Company 261a1 INSURED PATH INC 5997 CARLSON AVE SUITE. A PORTAGE, IN-40368 INSURERBI MISUREIC: INSURER D: NKIIRER E: NallER F: ""'F-CATC NUMBRG• KCVis0.rn Nvmoua MV v�n�iVw vu� .. .�...�.-...•.��... 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 CONOMON 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, TNIRR LTR TYPEOPINSURANCE INXID ma POUCYNUMBER PDu P jMMMDA1TYI POLICY Wr rmmmpNyrn 1011212016 LIMITS A X COMMERCIALOENRRALLIABILITY CLAIMS -MADE OCCUR Y 94-FG-3230-4 191212015 EACN OCCURRENCE & 1.DD0,066 PREMISES Pauurtera]el s MED EXP (A W Wa p n) $ 5.000 PERSDNALGADVINJURY $ GEN'L AUTOMOBILE AGGREGATE UM)TAPP�UEjS PER. POLICY❑ jEOT F J LOC OTHER LIABILITY ANYATO SCHEDULEDBODILY S MTOS NON -OWNED AUTOS GENERAL AGGREGATE $ Z,000,060 PRODUCTS-COMPIOPAGG $ DaawG SINGLE MIT S $ BODILY INJURY (Per pemn) S INJURY(Par �Md ) S S B R OCCUR CLAIMS -MACE NIA 94•GE-U869-D 11f0212018 11f0212016 EACH OCCURRENCE AGGREGATENTION _ E R $ MN)RKERSCOMPENSATION ANO EMPLOYERS UANUTY ANY PROPRIETORiPARTNERIEXECUTVE Y❑ OFFIOERINEMBER EXCLUDEOI (Mmdatary's, NN) Ryes'�6 under OESCRIPTION U. OPERATIONS below __LER EL EACHACCIDENT $ 100,090 E.L. DISEASE - EA EMPLOY $ 1DO.1100 $ 600,000 E.L. DISEASE -.POLICY LIMIT DESCRIPTION OPOPERKDONS/ LOCATONS I VEHICLES (LOORD 101, AMNan'A R*MA!4e9eRedulq May be attached Rmom space Is regwmd) ADDL, INSURED: CITY OF SOUTH BENO, 227 WEST JEFFERSON, SOUTH BEND, IN. 46501 HOLDER CITY OF SOUTH BEND 227 WEST JEFFERSON SOUTH BEND ,INDIANA 46601 ACORD 25 (201IN01) 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 0 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and toga are registered Marks of ACORD 1001486 132849.9 02-04-201 TIII-1G-PL11C 1P-AZ C..,.„.- Tn-POTI-I_M[ PP Pam., Pine -thrill P-47X I / # \ m qiaipatuv , m .t, j?