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Home My WebLink AboutPublic Parking Facility - Episcopal Cathedral of St. JamesINTER -OFFICE MEMORANDUM BOARD OF PUBLIC WORKS §Iederico DATE SENT: TO: andy Wilkerson, Code Enforcement Rodriguez, Fire Department att Longfellow, Engineering Chris Dressel, Communi y Investment FROM: Linda M. Martin, Clerk SUBJECT: License Application for Public Parking Facility LOCATION: Episcopal Cathedral of St. James 117 N Lafayette Blvd DATE DUE: 02/07/2017 FAX OR E-MAIL TO: 235-9171 / Imartin@southbendin.gov RECOMMENDATIONS AND COMMENTS: By Date 1/1812017 For all municipal business license questions, contact: City of South Bend • Department of Community Investment 227 West Jefferson Blvd • Sulte 140o S -South Bend, Indiana 46601 • 574.235.5912 • F:574.235.902 �1< ��g� o LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY' MUNICIPAL CODE SECTION-- 4-39 I. APPLICATION TYPE Check One: New Renewal J II. BUSINESS DATA r A. Business Name: L%D 15 t u A� C0.�k e �'�e` �r �f • t�G WI CS B. Business Address: ^4twe. (�J VCt City: S0 U1RA. t3CA&& State: Zip: tjl�� b C. Mailing Address (If different from above): City: L State: Zip: D. Business Telephone Number: J��'t � XWL— 4_�77-7 E. Business Fax Number: F. E-Mail Address: G..Maximum Number of Vehicles that can be parked atfacilliifty at one time: H. Total Number of Parking Spaces at facility: OC 5— I. Hours during which vehicles may be stored: 0 d c o H. Premises are (check one): Leased by Applicant Owned by Applicant ✓ If Leased: Owner's Name Owner's Business Address: City: Owner's Residential Address: State: State: J. Insurance Carrier and Amount of Liability Insurance OR Bonding Agent For Office Use Only Zip: Zip: Amount of Bond: V-e-V&eh Application Filed JAN 13 2017blic Works_pr_v Application Fee Paid JAN 13 2017 License Fee Paid JAN 13 2017 Sent to Dept. License Number 1 %—InS PROVED Hoard of Public Works Not Approved Reason FEB 14 201%11�1— For all municipal business Ilcense questions, contact: City of South Bend • Department of Community Investment 227 West Jefferson Blvd • Suite 1400 S -South Bend, Indiana 46601 •574.235.5912 • F: 574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 III. PERSONAL DATA A. Applicant's Legal Name: B. Residential Address: City: State: Zip: C. Residential Telephone Number: D. Residential Fax Number: E. Cellphone Number: F. Position with Business: IV. OWNERSHIP A. Type of ownership (check one): Sole Proprietorship (If sole proprietorship, proceed to 1). Partnership (If partnership, proceed to 2). Corporation (If corporation, proceed to 3). 1. Sole Proprietor Name: Residential Address: City: Telephone Number:_ State: 2. Partnership (List at least two (2) partners) Name #1: Residential Address: City: Telephone Number: Name #2: Residential Address: City: Telephone Number:_ State: State:: 3. Corporation Legal name of corporation: Date and state of incorporation: 7 Zip: M Zip: For all municipal business license questions, contact: City of South Bend • Department of Community Investment 227 West Jefferson Blvd • Suite 14005 -South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION -4-39 IV. OWNERSHIP (Continued) A. Type of ownership (continued): 3. Corporation (continued) Resident Agent: 1 Name: Sfcve_v\ Ma5T Title: poxl§In )4-6y .lm,5`/�YI Business Address: p l (7 K. LOL T 0111 City: SO U TVA t"J"' State: Officers: Name#1: Dr. M( Title: 5C-K 8 f Business Address: 11-7 City: Residential Address: City: Name #2: O Title: U 'T U 11.1 Q r BusinessAddrests:: - ry�`y— City: St) V`CA` r U Residential Address: City: yAt Name#3: cm 0 Title: `rYPa$�tr Business Address: City: SO L41A lu Residential Address: City: 3 Ydtv1 . La fa State: v- . Zip: Zip: 0 1 State: Zip: State: �� Zip: 41L6 b 8 State: �- Zip: State: SN Zip:�_(�_�� State: Zip: For all municipal business license questions, contact: City of South Bend • Department of Community Investment 227 West Jefferson Blvd • Suite 14005 -South Bend, Indiana 46601 • 574.235.5912 • F:574.235.9021 MUNICIPAL CODE SECTION -4-39 V. INCLUDE COMPLETE RATE AND HOUR SCHEDULE WITH APPLICATION VI. INCLUDE A CURRENT INSURANCE POLICY OR BOND VII. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION Vill. AFFIRMATION I, hereby, certify and affirm that all of the information have given in this application is true and accurate to the best of my knowledge. I further certify that I have in no way attempted to mislead the City in this application by omitting facts known to me. I have read and understand the regulations of the Public Parking Facility license found in the City of South Bend Municipal Code, Section 4-39.. 11017 Signature Date Thursday, February 16, 2012 T-IiE QATKf)DRAL Of Current Parking Rates: SAINT'JAMES • $40.00 per month per vehicle AN EPISCOPAL CHURCH Hours of Service: • Monday through Friday 7:00 AM until 6:00 PM Yours In Service Sidney Dew Finance Secretary Cathedral of St Jame's 117:North Lafayette Blvd. South Bend, Ifi&666 466014507 (5774) 282=4837 office (574).. V03 fax s&n7e$6n,?1,chianAorq C,i1Ij I:'ti ( j �I ,j' +''I j CERTIFICATE OF INSURANCE The Church Insurance Company of Vermont January 09, 2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Insurer providing coverage: The Church Insurance Company of Vermont PRODUCER: The Church Insurance Company of Vermont EMAIL: CICVTcerts@cpg.org 210 South Street FAX: 802-753-1385 Bennington, Vermont 05201-5000 INSURED: Cathedral of St James 117 N Lafayette Boulevard South Bend, IN 46601 CERTIFICATE HOLDER: CITY OF SOUTH BEND 227 WJEFFERSON BLVD SOUTH BEND IN 46601 The policies of insurance listed below have been issued for 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, aggregate limits shown may have been reduced by paid claims. POLICY NUMBER: VPP0006095 CERTIFICATE EFFECTIVE DATE: 5/1 /2016 EXPIRATION DATE: 5/1 /2017 Commercial General Liability Occurrence Form General Aggregate applies per policy: Limits EACH OCCURRENCE/AGGREGATE $1,000,000 Occ/5,000,000 Agg FIRE DAMAGE (ANY ONE FIRE) $ 1,000,000 MEDICAL EXPENSE (ANY ONE PERSON) $ 30,000 Directors' & Officers' Liability $1,000,000 Employment Practices Liability $1,000,000 Commercial Property LOCATION: 111 -117 N Lafayette Blvd South Bend, IN 46601 COVERAGE INFORMATION: BLANKET BUILDING AND CONTENTS, REPLACEMENT COST, SPECIAL FORM, THEFT INCLUDED BLANKET BUILDING & CONTENTS LIMIT: $11255500 PROPERTY DEDUCTIBLE: $1,000 FLOOD DEDUCTIBLE: 2% OTHER REMARKS: AS RESPECTS PARKING LOT ADJACENT TO INSURED PROPERTY DISCLAIMER: The Certificate of Insurance does not constitute a contract between the issuing insurer, authorized representative, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policy listed thereon. CANCELLATION: THE POLICY IS SUBJECT TO THE PREMIUMS, FORMS, AND RULES IN EFFECT FOR EACH POLICY PERIOD. SHOULD THE POLICY BE TERMINATED, THE COMPANY WILL ENDEAVOR TO GIVE THE ADDITIONAL INTEREST IDENTIFIED 30 DAYS WRITTEN NOTICE, AND WILL SEND NOTIFICATION OF ANY CHANGES TO THE POLICY THAT WOULD EFFECT THAT INTEREST, IN ACCORDANCE WITH THE POLICY PROVISIONS OR REQUIRED BY LAW. AUTHORIZED REPRESENTATIVE STEVEFOLLOS For all municipal business license questions, contact: City of South Bend • Department of Community Investment 227 West Jefferson Blvd • Suite 1400 S -South Bend, Indiana 46601 •574.235.5912 • F: 574.235.902 C1 Kt�a & e9 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY' MUNICIPAL CODE SECTION- 4-39 I. APPLICATION TYPE Check One: New Renewal II. BUSINESS DATA J A. Business Name: COI S c b D N1 C0.1 1A 2 C/ Yam` �� c7 F -LTG WLCS B. Business Address: —7 & • L a �V t We- G T Vd City: O U� 1 C"6- 'State: Zip: b C. Mailing Address (If different from above): City: State: Zip: D. Business Telephone Number: E. Business Fax Number:A� F. E-Mail Address: � i CC. 6) 54 0.1M>1! SS 6 Y'BC G. Maximum Number of Vehicles that can be parked at facility at one time: �J H. Total Number of Parking Spaces at facility: IR 5- I. Hours during which vehicles may be stored: d LN H. Premises are (check one): Leased by Applicant Owned by Applicant ✓ If Leased: Owner's Name: Owner's Business Address: City: State: Zip: Owner's Residential Address: City: State: Zip: J. Insurance Carrier and Amount of Liability Insurance OR Bonding Agent and Amount of Bond: For Office Use Only Application Filed JAN 13 2017 (�Q.blic Works Approv Application Fee Paid JAN 13 Mt License Fee Paid JAN 13 2017 Sent to Dept. JAN 13 Z017 License Number I %—InS Not Approved Reason 1