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HomeMy WebLinkAboutProcession - Red Ribbon Committee1316 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. Gladys Muhammad South Bend Heritage Foundation 914 Lincoln Way West South Bend, IN 46616 RE: Event: 28`h Annual Red Ribbon March Against Drugs & Violence Date: October 21, 2016 Dear Ms. Muhammad: 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 October 21, 2016 from 9:30 a.m. to 11:00 a.m. Enclosed please find copy of your approved permit. Please note that participants must stay on the sidewalks and obey all traffic laws. Please call this office at (574) 235-9251 with further questions regarding this matter. Sincerely, ,n LYn a M. Martin, Clerk Enclosure c: Gene Eyster, Police 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: 8/12/2016 TO: J Ed Gleckler, Traffic & Lighting Federico Rodriguez, Fire Department Corbitt Kerr, Engineering Paula Garis, Park Department Lt. Gene Eyster, Police Department Adam Burck, Downtown South Bend (aburck@downtownsouthbend.com) J Marcia Qualls, Engineering Legal Department FROM: Linda M. Martin, Clerk SUBJECT: PROCESSION RECOMMENDATION SPONSOR: Red Ribbon Committee DATE OF EVENT: October 21, 2016 DATE DUE: September 6, 2016 FAX OR E-MAIL TO: 235-9171 / Imartin(&southbendin.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: L d J j i bboo Co njt» & r_ Submitted By: c�n ,th (z e nA 1&cc j4nQ e %XnaacH a r Address: 9 i`i.....� �anr r,,111 livtix._� City: State: 3A. zip: `` 66 4(o Phone: -'% `i --- 8 O - 76 9 Z Sponsor tray use the public light -of -way described as (describe route and attach ma ) ( CkK�C_n t7,4_C7-4r on 1_-ncolr,Wcw) Wei-}-- kern �tqh 4n r? ��n�s can -a- n Cross CLJV PLEASE NOTE: THE SOUTH BEND POL E DEPART NT RESERVES HE RIGHT TO LEA --to kcoc C�--tfL-CCHANGE YOUR ROUTE FOR SAFETY PURPOSES Eventname: . .o'l `tS?411 C nr1�t�1 i�tb�n matan j+onl� "1t�s UIo\-%)4' ❑ The Board of Public Works must have FOUR (4) weeks prior notice before event occufs ❑ 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 CDe1okG,a I , 201p -- and no other date +► ❑ ,Registration time for the event starts at ` t3 OQ./p.m. ❑ Starting time of the procession is IN30 4rM./p.m. ❑ Estimated completion time is 11.00 a./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 ❑ This event involves use of a park (Must obtain permission fiom Park Board) ❑ 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 4 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 owner/business where staging will take place Updated 4/06/16 PER112[T/AGREEMENT FOR A PROCESSION I. 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, nuns, 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. 7. 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 gpprovaUdenial 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 Use or incomplete inform Sponsor Signature gy, V`- Printed Name pat� (S1 t x,�) a.rn mock Title �, ^2 S © I Q �E 'D1 r° P' a,-tc -^l3 ARD OF PUBLIC WORDS APPROVAL res' nt ember Member zM Member Member Date RETURNFORMTO: Board otPublic works 1316 CouutyCity Building 2,27 West Jeftson Boulevard South Bend, IN 46601 Phone: (574) 235-9251 • Fox: (574) 235.9171 • E•Mai1: publicwks@southbeadin.gov Eisf dypot!gpn !Dprgby!DvrwsbMX od sILp!Sbz!' Google Kpbo!Lspd!lDpsqt!Dpn n vojuz!Df otf sJTpvU V oe Dpro)ylDvrrvsbtX od s : 25!4odpruD( bz!X f t u!Tpvd lCf oe-!-0157727 t I f beff bt Upo!Modpm!X bzlX ILpx bs:dDpLLbhf !Hspq IBW 492191 ....... F* Lkso!4hi UpoLp!Dvti johrru 1/31n j 4.1 LkaolffWpoLpD(!fvbt b*'Bvt 861gj- - ''.. - -- -.1-1 11 . ........ .... : .. ...... .. ... .......... .. ... ... � Lksof4hi UpoLp!EdN bsjo!Wd f dLjohlKct!ES 1/31n j t Dpoqovf 1poLp!Di bqjorru 1141n j ....... . . .. ....... . CERTIFICATE OF LIA131LITY INSURANCE DATE(MM11mrYW11 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. TMS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER, IMPORTANT: If the cetlflata holder is an ADDITIONAL INSURED, the pollcy(I ) must be endorsed If SUBROGATION IS WAIVED, subject t0 the terms and conditlone 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 endomemert(s). PRODUCER CONT 0!ha E:E'aBA Barns NAM Gibson Insurance Agency, Inc, PII NE (SD_)814-2122 I wal N0: (aoole36•alaz 130 S Main St, Eta 400 pDpft ;tburne@gibsonina.com PO BOX 11177 INSU B AFPORDINGCOVERAOE NAICe South ]9enfl IN 46601-0177 ........,�..-...,______—_ South Bond Heritage Foundation, Inc, 803 LxrHaolnmay Neat Bend ncnumFrt: THIS IS -to CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW WAVE BEEN ISSUED TO THE INSURED NAMIED NAMED ABOVEE 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. IN TYPE OF INSURANCE PO Y M F POLICYEXP OMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Q OCCUR XCTJ ERP0232816 3/2/2016 3/2/2017 EACH OCCURRENCE 3 1,000, 000 X A A E Tra R M OyreJca MED EXP An one 6mon E SDO, O00 $ 3,000 X COritYACtual LiabiltV PERSONAL&AW INJURY S 1, DOD, 000 GENT AGGREGATE UNIT APPLIES PER! POLICY ® JECT LOC OTHER: GENERAL AGGREGATE S 2,0110,000 PRODUCTS. COMP/OP AGO $ 2,000,0001 Employdeemft S 11000,000 A AUTOMOBILE LLA MI t Y ANY AVTO AOYYNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON-0NMED AUTOS sPP0232e16 3/2/2016 3/2/2017 COMBINED S E9 same E 1,000,000 X X BODILY INJURY (PxpersOn) E BODILY INJURY (PeraCcideOO S Po, E Mediml P mma S E 5,000 A IwORKHROCOMPENRATIoN B X UMBRELLA LIAO EXCESS LIAB X OCCUR CLAIMS -MADE NIA aRE0232816 SWCO24123301 3/2/2016 2/2,2016 3/2/2017 3/2/2017 EACH OCCURRENCE E 51000,000 AGGREGATE $ 51000,000 X RETENTION 0 AND EMPLOYERS' LIAOIUTY YIN ANY PROPRIETOR1PARTNER,E>ZCUnI OFFFIC R/MEMBER EXCLUDED? � (yy .Mdry M NR) OEBCRIPTIba.,*, ERATI0N8 bB10W ERH E E.L. EACH ACGDENT S 100.000 El, DISEASE -EA EMPLOYE 8 100 000 E.L. DISEASE -POLICY LIMIT I S 500 ,000 DESCRIPTION OFOPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AUtlaloml Remarks Sallr4uh, may ee MnFpatl a men!spacP h 1w1u1M) RE: Red Ribbon IM=ch Community Canter Ray and Joan Kroc 900 W Western Ave South Bend, IN 46601 SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, Ins REPRESENTATIVE I NO AVUKIJ name ana 1090 are registered marks of ACORD MS026t7o+dOn