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HomeMy WebLinkAboutNon Res Block Party - St Joseph Catholic Church1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND. INDIANA 46601-1830 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS November 22, 2016 Matthew Blazejewski St. Joseph Catholic Church 711 East Colfax South Bend, IN 46617 RE: Event Name: Saint Nick 6K Street Closure: Hill St. from LaSalle to Colfax Date: December 10, 2016 Dear Mr. Blazejewski: PHONE 574/235-9251 FAX 574/235-9171 The Board of Public Works, at its meeting held on November 22, 2016, approved your request to close the above referenced street for your event scheduled for December 10, 2016 from 7:00 a.m. until 11:45 a.m. with a rain date of December 11, 2016. For your information, the South Bend Police Department will monitor this event. Enclosed please find a copy of your approved permit. The Bureau of Traffic and Lighting will deliver barricades necessary to close the street to the applicant's address. You will be responsible for their placement and removal at the conclusion of the closing of various streets. Please note that a ten foot (10') clear and unobstructed lane must be maintained at either curb or down the center of the street for emergency purposes and that no fires are allowed in the street. The Applicant will be liable for the replacement cost of $50.00 per cone as a result of any missing or damaged cones. If you have any further questions regarding this matter, please call this office at (574) 235-9251. Sincerely, Linda M. Martin, Clerk Enclosure c: Gene Eyster, Police Department Federico Rodriguez, Fire Department Marcia Qualls, Streets Ed Gleckler, Traffic & Lighting Adam Burck, Downtown South Bend GARY A. GILOT SUZANNA M. FRITZBERG ELIZABETH A. MARADIK JAMES A. MUELLER THERESE J. DORAU O`'0V fH & hQ APPLICATION FOR USE OF, AND BLOCKING OF ACCESS TO, THE PUBLIC ri RIGHT-OF-WAY FOR NON-RESIDENTIAL BLOCK PARTIES e 1965 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: St. Joseph Catholic Church Address: 711 East Colfax City: South Bend State: IN Zip: 46617 Phone: 574-234-3134 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 Saint Nick 6k Location Street Closure Date of Event East Race and East Bank Trail (see attached ma Name of Street From To December 10 (Describe Area/Route) Hill nbaler, MIS. and, 'M112MOTI,.r__,. •r •i a(� 20 16 X a.m. X a.m. X a.m. Time: Registration/Setup 7:00 ❑ p.m. Start 10:00 ❑ p.m. End 11:45 ❑ p.m. Approximate Number of Attendees 460 Answer the following appropriately: 1. This event will have music (live or other). Yes ❑ No a. I understand the Noise Ordinance described in the Agreement/Permit 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 Yes ❑ No additionally filed with the Office of the City Clerk, 4'h Floor, County - City Building, 227 W. Jefferson Blvd., South Bend, Indiana. c. Certificate of Insurance d. Maps, drawings of the area and setup plan 10 Yes ❑ No 3. a. This event involves City streets f9 Yes ❑ No b. This event involves County roads ❑ Yes [9 No c. This event involves State highways ❑ Yes No d. This event involves the use of the sidewalk Yes ❑ No Updated 4/2015 1 e. This event is k oc egional/national event (Please circle the Yes ❑ No appropriate event type) f. Affected property/business owners have been notified of this event. [ Yes ❑ No g. I understand that I must arrange a meeting with all affected governmental agencies to organize the above event (Call Marcia Yes ❑ No Qualls, Customer Service Manager, 235-5939 to organize meeting). IF ALCOHOL IS TO BE SERVED OR SOLD N/4' 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. City of South Bend, Indiana • Board of Public Works PERMIT AND AGREEMENT FOR THE USE OF THE RIGHT-OF-WAY FOR NON-RESIDENTIAL BLOCK PARTIES The Non-residential Block Party will be permitted to take place under the following terms and conditions: I. Pursuant to Local Ordinance No. 10224-13, there is a $125.00 non-refundable fee for non- residential Block Parties. Non-profit organizations meeting Section 501(c)(3) of the Internal Revenue Code are exempt from the fee provided copies of the 501(c)(3) Internal Revenue Exemption Status Document and a current copy of Form 990 of Form 990-EZ are filed with this application and with the Office of the City Clerk, 4th Floor, County -City Building, 227 W. Jefferson Blvd., South Bend, Indiana. 2. The APPLICANT must comply with all terms and conditions of this Permit and Agreement. 3. The APPLICANT shall reimburse the Board for the actual cost to the City for the event, if deemed necessary. 4. APPLICANT shall include a flyer or letter describing the details of the event. 5. Notification of approval/denial of this request will be issued by return of this form, upon signed authorization by the Board of Public Works. 6. The APPLICANT 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. 7. The APPLICANT assumes full responsibility for providing ample disposal containers for refuse/recycling and assures the area will be cleaned up upon the conclusion of the event. 8. Barricades will be delivered and picked up at the event location. The APPLICANT is responsible for seeing that all cones are maintained and returned undamaged. 9. The APPLICANT will follow the City of South Bend Noise Ordinance, which is in effect at all hours. Between the hours of 11:00 p.m. and 7:00 a.m. certain noises are particularly prohibited. These include operating radio receiving sets, musical instruments, phonographs and other sound reproduction devices if audible fifty (50) feet away, as well as shouting, yelling, hooting, whistling, or singing in the streets in a manner to disturb the peace (Municipal Code 13-57). 10. The APPLICANT assures the City that the area will be closed during the times indicated on the application only. Event end times are pursuant to the recommendations of the South Bend Police Department. 11. IF ALCOHOL IS TO BE SERVED OR SOLD a Certified Check or Money Order for $400.00 must be submitted with application. The application cannot be processed without a deposit. The deposit will be returned by the Board of Public Works upon inspection of the event area after the event, and provided there is no damage to the area. Names, phone numbers, and qualifications (e.g. Off -duty police officer, professional security guard, or event APPLICANT) of THREE security guards to monitor underage drinking, must be submitted with the application. A drawing must be submitted showing fencing around serving area, and trash receptacles. For a temporary liquor license call the Alcohol and Tobacco Commission at (317) 234-4315 for more 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 $KY4- day of Ala 04—h W 20 APPLICANT Signature /5� 1, v� Printed Name BOARD OF PUBLIC WORKS APPROVAL b President Member /"hd 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 9 Fax: (574) 235-9171 • E-Mail: publicwks@southbendin.gov Certificate of Coverage Date: I(/27/2016 Certificate Holder This Certificate is issued as a matter of information only and The Diocese of Fort Wayne -South Bend, Inc. confers no rights upon the holder of this certificate. This certificate Chancery Office does not amend, extend or alter the coverage afforded below. P Box Company Affording Coverage Fort Waynene,, IN 46801 THE CATHOLIC MUTUAL RELIEF SOCIETY OF AMERICA 10843 OLD MILL RD Covered Location St. Joseph Parish OMAHA, NE 68154 211 North St. Louis Blvd South Bend, IN 46617 Coverages This is to certify that the coverages listed below have been issued to the certificate holder named above for the certificate 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 coverage afforded described herein is subject to all the terms, exclusions and conditions of such coverage. Limits shown may have been reduced by paid claims. Type of Coverage Certificate Number Coverage Effective Date Coverage Expiration Date Limits Property Real & Personal Property D. General Liability Each Occurrence 500,000 General Aggregate ®✓ Occurrence ® Claims Made 8679 10/1/2016 10/1/2017 Products-Camp/OP Agg Personal & Adv Injury Fire Damage (Any one fire) Med Exp (Any one person) Excess Liability 8679 10/1/2016 10/1/2017 Each Occurrence 500,000 AnnualAggregrate Other Each Occurrence Claims Made Annual Aggregrate Limit/Coverage Description of Operations/LocationsNehicles/Special Items (the following language supersedes any other language in this endorsement or the Certificate in conflict with this language) Coverage is verified for claims arising out of St. Joseph Parish's St. Nick Six Race in the City of South Bend on December 10, 2016. Holder of Certificate Cancellation Should any of the above described coverages be cancelled City of South Bend, Park & Rec Dept & Board of Park Commissioners, 321 E Walter St, South Bend, IN 46614-2642 City of South Bend, Holy Cross College, Holy Cross Village at Notre Dame, University of Notre Dame 0067003010 before the expiration date thereof, the issuing company will endeavor to mail 30 days written notice to the holder of certificate named to the left, but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives. Authorized Representative01 rr