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Home My WebLink AboutLicenses & Permits Block Party-Non-Residential Sunnyside Presbyterian Church S. Frances St. from Washington St. to Jefferson Blvd.1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND- INDIANA 46601-1830 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS October 25, 2016 James B. Miller, Pastor Sunnyside Presbyterian Church 115 South Frances Street South Bend, IN 46617 PHONE 574/235-9251 FAx 574/235-9171 RE: Event Name: Story/Oslan Outdoor Wedding Street Closure: South Frances Street from East Washington Street to Jefferson Boulevard Dear Mr. Miller: The Board of Public Works, at its meeting held on October 25, 2016, denied your request to close the above referenced street for your event scheduled for November 5, 2016 from 3 p.m. until 6 p.m. The Board noted this is a private event and a street cannot be closed for a private event, only a public gathering that is open to the public. If you have any further questions regarding this matter, please call this office at (574) 235-9251. Sincerely, Linda�M. Martin, Clerk c: Gene Eyster, Police Department Federico Rodriguez, Fire Department Marcia Qualls, Streets Ed Gleckler, Traffic & Lighting GARY A. GILOT SUZANNA M. FRITZBERG ELIZABETH A. MARADIK JAMES A. MUELLER THERESE J. DORAU INTER -OFFICE MEMORANDUM BOARD OF PUBLIC WORKS DATE SENT 9/7/2016 TO: /! Ed Gleckler, Traffic & Lighting ene Eyster, Police Department att Longfellow, Engineering ,Chris Dressel, Community Investment Federico Rodriguez, Fire Department Marcia Qualls, Engineering Paula Garis, Park Department Adam Burck, Downtown South Bend (aburck@downtownsouthbend.com) FROM: Linda M. Martin, Clerk - SUBJECT: Non- Residential Blodk Party LOCATION: S. Frances from E Washington to Jefferson Blvd. DATE AND TIME: November 5, 2016 SPONSOR: Sunnvside Presbyterian Church DATE DUE: September 20, 2016 FAX OR E-MAIL TO: 235-9171 / Imartin(dsouthbendin.gov RECOMMENDATIONS AND COMMENTS: By Date APPLICATION FOR USE OF, AND BLOCKING OF ACCESS TO THE PUBLIC RIGHT-OF-WAY FOR NON-RESIDENTIAL BLOCK PARTIES The Board of Public Works must have FOUR (4) weeks prior notice of the event. A NON-REFUNDABLE APPLICATION FEE OF $125.00, IN THE FORM OF A CERTIFIED CHECK OR MONEY ORDER, PAYABLE TO THE CITY OF SOUTH BEND, MUST BE INCLUDED WITH APPLICATION. ❑ Fee Paid Applicant Name: Sunnyside Presbyterian Church 115 South Frances Address: Street City: South Bend State: IN Zip: 46617 Phone: _ J-7q _ 2)7-/J ZV This application is made to the City of South Bend, Indiana, Board of Public Works, for the use of the specified public right-of-way by Applicant for the holding of the hereinafter described event: Event Name Story/Oslan Outdoor Wedding Location Sunnyside Presbyterian Church —Front Lawn (Describe Area/Route) Street Closure Name of Street South Frances Street From East Washington Street To Jefferson Boulevard Date of Event November 5, 20 16 El a.m. El a.m. El a.m. Time: Registration/Setup ❑ p.m. Start 3 PM ❑ p.m. End 6 PM ❑ P.m. Approximate Number of Attendees 150 Answer the following appropriately: 1. This event will have music (live or other). X Yes ❑ No a. I understand the Noise Ordinance described in the Agreement/Permit X Yes ❑ No 2. Required Information to Accompany Application a. Certified Check or Money Order in the Amount of $125.00, or: b. For Certified Nonprofit Organizations: Copies of the 501(c)(3) Internal Revenue Exemption Status Document and a current copy of Form 990 of Form 990-EZ are included with this application, and X Yes ❑ No additionally filed with the Office of the City Clerk, 4s` Floor, County - City Building, 227 W. Jefferson Blvd., South Bend, Indiana. c. Certificate of Insurance d. Maps, drawings of the area and setup plan X Yes ❑ No 3. a. This event involves City streets X Ws ❑ No b. This event involves County roads ❑ Yes X No c. This event involves State highways ❑ Yes X No Updated 4/2015 1 d. This event involves the use of the sidewalk X Yes ❑ No e. This event is a local/regional/national event (Please circle the ❑ yes X No appropriate event type) f. Affected property/business owners have been notified of this event. X Yes ❑ No g. I understand that I must arrange a meeting with all affected governmental agencies to organize the above event (Call Marcia X Yes ❑ No Qualls, Customer Service Manager, 235-5939 to organize meeting). IF ALCOHOL IS TO BE SERVED OR SOLD Alcoholic beverages will be served ❑ Alcoholic beverages will be sold ❑ Certified Check or Money Order for $400.00 must be submitted with application. ❑ • Application cannot be processed without deposit. • Deposit will be returned upon inspection of event area by the Board of Public Works. Names and phone numbers of THREE security guards ❑ • To monitor underage drinking. • Qualifications must be listed (e.g. Off -duty police officer, professional security guard, or event APPLICANT). A drawing must be submitted showing: ❑ • Fencing around serving area • Trash receptacles. o Ample trash receptacles must be provided to ensure proper disposal of refuse. Temporary liquor license. ❑ • Call the Alcohol & Tobacco Commission at (317) 234-4315 for more information. + Application cannot be processed without a copy of this license. information. Application cannot be processed without a copy of this license. 12. APPLICANT agrees to indemnify, defend and hold harmless the Civil City of South Bend, Indiana, from any liability, loss, 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 the activity, arising out of the approval of this request by the Board of Public Works to close a portion of the public right-of-way for the event described above. I have read the Application and Permit and the Agreement for the "Use of Right -of -Way for Special Events" and I understand and agree to the above rules and regulations. I also understand that this application may be denied based on any false or incomplete information. Dated this 6tl' day of September 20 16 APPLICANT Signature ` Printed Name ernes B. Miller. Pastor President Member BOARD OF PUBLIC WORKS APPROVAL Member Member Member Date 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 • E-Mail: publicwks@southbendin.gov C�Urc I I�j f��- I U ek& Entity Type: Dumestie UluuproBt Corporadimn Business Status: Active Creation Date: 03/14/1951 Business Entity Report 03/31/2017 Due Date: Principal Office Address: 115 SOUTH FRANCES STREET, SOUTH BEND, IN, 46617 - 3120, USA Domicile of State: Indiana )>dfii7if kist�z Jxc fn - 1a Title Name Address President Chuck Viater 115 SOUTH FRANCES STREET, SOUTH BEND, IN, 46617, USA Secretary Paula Horvath 115 South Frances Street, South Bend, IN, 46617 - 3120, USA Treasurer D SCOTT DIX 115 SOUTH FRANCES STREET, SOUTH BEND, IN, 46617, USA Type: individual Name: D. SCOTT DIX Address: 115 SOUTH FRANCES STREET,, SOUTH BEND, IN, 46617 - 3120, USA A� of CERTIFICATE OF LIABILITY INSURANCE BAN IAAMADD ) THIS CERTIFICATE 1S 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 lo,tr*. certificate holder In lieu of such endorsement(s). PRODUCER NAME: Susan Thompson Leven Insurance Agency Inc. 2628 S. MICHIGAN STREET PHONE (574)291-5510 FAC .(579)291-0505 OnK .suet@laveninsurance. am INSURE AFFORDING COVERAGE NAICM P. O. BOX 2379 msURERAAmeri.cen States Insurance CO. 19704 SOUTH HIM IN 46680 INSURED INSURER B Sunnpsida Presbyterian Church Corp. NSIIRERC: 115 N, Fiances Street INSURER D: NSURER E: South Bend IN 46617 INSURERF: COVERAGES CERTIFICATE NUMBER:16/17 Master 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 CF 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 MAYHAVE SEEN REDUCED BY PAID CLAIMS. ILSR 'rypE OF INSURANCEAM] SUBM OLICYNUMBER PODCV EFF MWD POLICY UP MMID LIMITS ATIED MERCUILGENERALLIABNTY WMSMADE OOCCUR To 02CESBd17090 1/1/2016 1/1/2017 EACH OCCURRENCE Is 1, 000, ODO 1 Es�A 1@O9fr $ 1,000,000 GEN'LAGGREGATE X MED UP (Any one paten) s 10,000 PERSONAL&ADVINJURY $ 1,000,000 LIMIT APPLIES PER: POUCY0JEd OLOG OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OP AGO $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL AAU OS ED SCHEDULEDAUTOS IAJOOTN� E HIREDAUTOS M 02CUS417090 1/1/2016 1/1/2017 COMBINED SINGLE UM aurdanD $ 1,000,000 BOOILY INJURY(PMpeavn) If BODILY INJURY (Par accident) $ X R01 DAMAGE $ A X UMBRELLA DAB X EXCESS.LIAB OCCUR I CWMS.MADE 01SU39987390 1/1/2016 1/1/2017 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DEO I X I RETENTIONS 01 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILIry YINTUN OFFIC ddEANY IMBERWEXCLNEEDE7ECU� EN (Mandatory In NH) I(ppes. dIPTION OF O DESCRIPTION OF OPERATINS bebw 02RC587069-20 1/1/2016 1/1/2017 X PER - I EL. EACH ACCIDENT $ 500,000 E.L. DISEASE -EA EMPLOYE[ $ 500 00o EL. DISEASE -POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS l LOCATIONS] VEHICLES (ACORD 101. Addltlemal Remarks Schedule, may be atached If mWe space Is required), SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of South Bend THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN South Bend, IN 46601 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOWED REPRESENTATIVE Susan Thompson/SMT I. ®1988;2014ACORD CORPORATION. All rights reserVot ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS026rm14O11