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Home My WebLink AboutProcession - Michiana Runners Association1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND. INDIANA 46601-1830 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS September 13, 2016 Ms. Ann Amico Moran Michiana Runners Assoc 4124 Old Cleveland Rd. South Bend, IN 46624 RE: Event: Game Day Chase 5k & I Ok Date: September 17, 2016 Dear Ms. Amico Moran: PHONE 574/235-9251 FAX 574/235-9171 The Board of Public Works, at its meeting held on September 13, 2016, approved your request to conduct the above referenced event on September 17, 2016, from 6:30 a.m. to 9:00 a.m. on the designated route as submitted. Enclosed please find copy of your approved permit. The South Bend Police and Traffic and Lighting Departments will supply traffic control. If I can be of any further assistance to you in this matter, please call me at (574) 235-9251. Sincerely, Linda M. Martin, Clerk Enclosure c: Gene Eyster, Police Department Ed Gleckler, Traffic & Lighting Stephen Cox, Fire Department Federico Rodriguez, Fire Department Marcia Qualls, Engineering GARY A. GILOT DAVID P. RELOS ELIZABETH A. MARADIK JAMES A. MUELLER THERESE J. DORAU INTER -OFFICE MEMORANDUM BOARD OF PUBLIC WORKS DATE SENT: 3/2/2016 TO: d Gleckler, Traffic & Lighting /Federico Rodriguez, Fire Department V Corbitt Kerr, Engineering Paula Garis, Park Department Lt. Gene Eyster, Police Department JJill Scicchitano, Downtown South Bend Marcia Qualls, Engineering Legal Department FROM: Linda M. Martin, Clerk SUBJECT: PROCESSION RECOMMENDATION SPONSOR: Michiana Runners Association DATE OF EVENT: September 17, 2016 DATE DUE: March 15, 2016 FAX OR E-MAIL TO: 235-9171 / Imartin(a)southbendin.gov RECOMMENDATIONS AND COMMENTS: By Date 4 APPLICATION FOR USE OF ® c PUBLIC RIGHT-OF-WAY FOR PROCESSIONS i PEACE The Board of Public Works must have FOUR (4) weeks prior notice of the event. " 1865 ' `c Qunn Sponsor: Im cu I a l I Jo_ bmitted By: Anr) ,` 1 Y n (((o I V oa' ( Address: G C) / Oxy� kd ' City:` I � !nA State: �1 Zip: XQC� Phon Sponsor may use the public right-of-way described as (describe route and attach map) PLEASE NOTE: THE SOUTH BEND POLICE DEPARTMENT RESERVES THE RIGHT TO CHANGE YOUR ROUTE FOR SAFETY PURPOSES Event name: " Ul& `��/ I [� The Board of Public Works must RUVC 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 -",11rx 0 The event shall be held on efk . '=' 20 1 L-p and no other date � I, [� Registration time for the event starts at in p.m. �� y Starting time of the procession isin. Estimated completion time is This event involves the use of the following roadways This event involves City streets ❑ This event involves County roads ❑ This event involves State highways 0 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 Ej " Participants must stay on the sidewalk and obey all traffic laws. This event is a local/regiona national event (Please circle the appropriate event type) This event will be coordinated with the property owner/business 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. Not feation of approval/denial 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 Printed Name CQ Title CC— k :{ Q er MR l� B ARD OF PUBLIC WORKS APPRC `Prdside "_/ Member Memo Member JAL Member 1 Dale RETURN FORM TO: Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, IN 46601 Phone: (574) 235-9251 • Fax: (574) 235-9171 9 E-Mail: publicwks@southbendin.gov a � s Q n ;z!A L C _o N d 1 L E m E r O U R„r— n,,,. �b p y iR T /^` f Yi 1 <Z C� C (d a N Eddy St O Z � 0 a � .N L N L _ J m d m C Q s w <Z 0 v LL N 0 O E Duey St 0 U a� in -ra E i❑ N a B'ns Ave"6� p w N N Eddy St O Z O L N N > Notre Dame Ave i m � ro a c N O� (O O C 4 O � � a i ,O aAHjadaaj 3 x Ac, EZ P2l ales in U x c u 0 r A� Qe CERTIFICATE OF LIABILITY INSURANCE DATEWD TEI /2oiYe ) 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 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 STAR Insurance - Fort Wayne Office 2130 East Dupont Road Fort Wayne IN 46825 NAMEA Margaret M. Mayers NONE (260)467-5689 FpIXC No:(26D)467-5691 p.margaret.mayers0starfinancial.com INSURE 6 AFFORDING COVERAGE NAICS INwRERA National Casualty Coompany 11991 INSURED Road Runners Club of America/2016 and Its Nember Clubs 1501 Lee Highway, Suite 140 Arlington VA 22209 INSURERS Nationwide Life Insurance Co. 66869 INSURERC: INSURER D: WSURERE: NSURERF: COVERAGES CERTIFICATE NUMBER:2016 $21A A.I. 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. SR TYPEGFNSURANCE SUER Pol1CYNUMBER POLL EPY POLICYEXP LIMITS A R COMMERCIAL GENERAL LIABILITY ClNMB-MADE OX OCCUR EACH OCCURRENCE 5 2,000,000 ENTED mrm&i IFNa ..I S 500,000 R MED FXP(My em Waon) $ 5,000 Lacal Liability to MOOOD0005888100 12/31/2015 12/31/2016 Participant $2,000,000 PERSONAL& ADV INJURY $ 2,000,000 12:01 AM 12:01 AM AGGREGATE UNAPPLIES PER: GENERAL AGGREGATE 5 Unlimited GEHL R POLICY JpECT LOC Abuse S Molestation PRODUCTS-COMPX)PAGG S 2,000,000 Abmoa tlMokclmlon S 500,000 OTHER. Aggregate 05,000,000 AUTOMOBRE LIABILITY EelNEO U S 2,000,000 BOULYINAMY(Pe,pamcn) S A ANY AUTO AUTOS 0 AUTOS SCHEDULED AUTOS AWES EE00000005888100 12/31/2015 12/31/2016 BODILY INJURY ('mA a10 S R HIRED AUTOS R ALTOS 12: 01 AM 12:01 AM E waa- PROPERTY DAMAGE S S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CIANSWADE DUD i I RETENTIONS $ WORSERS CONPENSATION AND EMPLOYERS' LwBu1rY YIN ANY PROPRIEV; PARTNERRECUDW OFFICEWMEMBER EXCLUDED? �N/A STA T ER E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYE1 S aMsdalmy In NHl WS yyees desuibs wds DESCRIPTION OF OPERATIONS belay E.L. DISEASE -POLICY UNIT S B Excess Medical i Accident t aMW0000272D1500 12/31/2015 12/31/2016 ram. Madlrel 010,000 (0250 Deductible/Claim)I 12:01 AM 12:01 AM AD&SpedfmLoss 62,500 DESCRIPTION OP OPERATIONS! LOCATIONS I VEHICLES (ACORD 101, AddRipoal Roo mse Scboduft, may be aleched It mom $paw Is w9umad) CERTIFICATE BOLDER IS NAMED AS AN ADDITIONAL INSURE➢ AS RESPECTS THEIR INTEREST IN THE OPERATIONS OF THE NAMED INSURED. DATE OF EVENT(S): 09/27/16 Game Day Chase 5k/10k INSURED RRCA CLUB/EVENT MEMBER: Michdana Runners Association Inc., Att'n: Ryan Fensteemaker, 4124 Old Cleveland Road, South Bend, IN 46628 09/17/16 City of South Bend 731 S. Lafayette Blvd. South Bend, IN 46601 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 w Diller/MMA-'�7�"'-}T R-:��i7✓L,G�PCU ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025t201nn11