Loading...
HomeMy WebLinkAboutPublic Parking Facility - LAZ Parking Midwest LLCINTER -OFFICE MEMORANDUM BOARD OF PUBLIC WORKS DATE SENT: 2/9/2017 TO: /Randy Wilkerson, Code Enforcement JFederico Rodriguez, Fire Department j�ilatt Longfellow, Engineering Chris Dressel, Community Investment FROM: Linda M. Martin, Clerk SUBJECT: License Application for Public Parking Facility LOCATION: LAZ Parking Midwest, LLC 1228 N. Eddy Street DATE DUE: 02/21/2017 FAX OR E-MAIL TO: 235-9171 / Imartin@southbendin.gov RECOMMENDATIONS AND COMMENTS: By Date 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 CK# 193os7 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 I. APPLICATION TYPE Check One: New Renewal x II. BUSINESS DATA A. Business Name: LAZ Parking Midwest, LLC B. Business Address: 1228 N. Eddy Street City: South Bend State: Indiana Zip; 46617 C. Mailing Address (If different from above): c/o Heather Mortimer 15 Lewis Street City: Hartford State: CT D. Business Telephone Number: 86U22.7641 x7793 E. Business Fax Number: 860.524.8249 F. E-Mail Address: hmortimer@lazparking.com Zip: 06103 G. Maximum Number of Vehicles that can be parked at facility at one time: 1200 H. Total Number of Parking Spaces at facility: 1200 1. Hours during which vehicles may be stored: 24 Hours H. Premises are (check one): Leased by Applicant x Owned by Applicant If Leased: Owner's Name: Kite Realty Eddy Street Garage Owner's Business Address: 1234 N, Eddy Street, Suite 115 City: South Bend State: Indiana Zip; 46617 Owner's Residential Address: City: State: Zip: J. Insurance Carrier and Amount of Liability Insurance OR Bonding Agent and Amount of Bond: Broker: Amity Insurance Agency/ Lexington Insurance Company For Office Use Only Application Filed FEB 0 8 2017 Public Works Approval Application Fee Paid FEB 0 8 m7lLicense Fee Paid FEB =7_ Sent to Dept_ FEB 0 8 2017 License Number I -7D38 Not Approved Reason 3041:d Of PeMac Work - I M For all municipal business license questlons, 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 Ill. PERSONAL DATA A. Applicant's Legal Name: Weather P. Nollez B. Residential Address: 15 Lewis Street City: Hartford State: CT Zip: 06103 C. Residential Telephone Number: 860.522.7641 x7793 D. Residential Fax Number: E. Celephone Number: F. Position with Business: Corporate Compliance Officer IV. OWNERSHIP A. Type of ownership (check one): Limited Liability Sole Proprietorship (if sole proprietorship, proceed to 1). Company Partnership (if partnership, proceed to 2). Corporation (If corporation, proceed to 3). 1. Sole Proprietor Name: Residential Address: City: State: Zip: 2. Partnership (List at least two (2) partners) Name #1: Residential Address: City: State: Zip: Name #2: Residential Address: City: State: Zip: 3, Corporation Legal name of corporation: LAZ Parking Midwest, LLC Date and state of incorporation: Connecticut - Dec 08, 2008 2 For all municipal business license questions, contact(;City of South Bend • Department of Community Investment 227 West Jefferson Bfvd - Suite 1400 S -South Bend, Indfana 46601. 574,235.5912 • F: $74.235,9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 IV. OWNERSHIP (Continued) A. Type of ownership (continued); 3. Corporation (continued) Resident Agent: Name: Corporation Service Company Title: Business Address: 251 East Ohio Street Suite 500 City: Indianapolis State: IN Z1p:46204 Officers: Name #1: Alan Lazowski Title: CEO Business Address: 15 Lewis Street City: Hartford State: CT Zip; 06103 Residential Address: 170 Scarborough Street City: Hartford State: CT Zip; 06103 Name 02: Michael J. Kuziak Title: COO — — — Business Address: 15 Lewis Street City: Hartford State: CT Zip; 06103 Residential Address: 120 Bashan Road City: East Haddam State: CT Zip: 00423 Name 0: Jeffrey N. Karp Title: President & Secretary Business Address: 3 Copley Place City: Boston State: MA Zlp; 02116 Residential Address: 36 Claypit Hill Road City: Wayland State: MA Zip; 01778 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 • r:574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION -4-39 i V. INCLUDE COMPLETE RATE AND HOUR SCHEDULE WITH APPLICATION VI. INCLUDE A CURRENT INSURANCE POLICY OR BOND i VII. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION i Vill. AFFIRMATION i I, hereby, certify and affirm that all of the information I 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 . l� Signature Date I I i i I I I I 4 C) UMBRELLA LIABILITY: CARRIER: FEDERAL INSURANCE COMPANY POLICY NO.: 79863543 TERM: 7-31-2016 to 7-31-2017 LIMITS: $50,000,000 E) EXCESS LIABILITY: CARRIER: AMERICAN GUARANTEE AND LIABILITY INSURANCE POLICY NO.: AEC011173102 TERM: 7-31-2016 to 7-31-2017 LIMITS: $25,000,000 EXCESS OF $50,000,000 F) EXCESS LIABILITY: CARRIER: THE OHIO CASUALTY COMPANY POLICY NO.: EC01757418875 TERM: 7-31-2016 to 7-31-2017 LIMITS: $25,000,000 EXCESS OF $75,000,000 ' OFREMARK COPYRIGHT 2000, AMS SERVICES INC. Ac6m b® CERTIFICATE OF LIABILITY INSURANCE 7/29/2016YY, 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 Amity Insurance Agency, Inc. 500 Victory Rd. Marina Bay North Quincy MA 02171 CNAME: ONTACT Frank Griffin PxoNE (617)471-1220 FAXoc (617)479-E147 AODRIEss:fgrif£in@amityins. com INSURERS AFFORDING COVERAGE NAIC q INSURER A:Lexin ton Insurance Company INSURED LAZ Parking Midwest, LLC 33 West Monroe Street Suite 270 Chicago IL 60603 INSURER 13:Liberty Mutual Fire Insurance - INSURER C:Federal Insurance Com an INSURER D:Liberty Insurance Corporation INSURER E'American Guarantee & Liability INSURERF:The Ohio Casualty Company COVERAGES r..FRTIFICATF NIIREVISION 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. ILTR WPEOFINSURANCE INAR ADOL SUED POLICY NUMBER MMID�Y EFF MMIO�/Y1'EVVY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 1,000,000 MED EXP(Any one person) $ EXCLUDED A CLAIMS -MADE OCCUR D13135971 7/31/2016 7/31/2017 PERSONAL& ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,000 $ POLICY PRO- X LOC. �j„ -.:- ` c AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 11000,000 X BODILY INJURY (Per person) $ ANY AUTO\`� \ B ALL OWNED SCHEDULED �' 1/2016 7/31/2017 BODILY INJURY (Per amsen0 $ AUTOS AUTOSX ( X PROPERTY DAMAGE Peraccidenl $ NON OWNED `"j�=='� \y f HIRED AUTOS AUTOS -- I X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 100,000,000 X AGGREGATE $ 100,000,000 EXCESS LIAB CLAIMS -MADE /2016 I /31/2017 DED I RETENTION $ D WORKERS COMPENSATION TH X TORYWCSTATIT EE AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE E.L. EACHACCIDENT $ 1 000 000 (mandatoryOFFICERIMIn H)EXCLUDED? (Mandatory In NH) NIA A761D260451026 7/31/2016 7/31/2017 EA E.L. DISEASE -EA EMPLOYE $ 1,000,000 E.L. DISEASE POLICY LIMIT $ 1,000,000 If yes, descums under DESCRIPTION OF OPERATIONS below A GARAGEKEEPERS LIABILITY 013135971 /31/2016 7/31/2017 $1,000,000 LIMIT C CRIME/EMPLOYEE DISHONESTY 82224802 7/31/2016 7/31/2017 $1,000,000 LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule, If more space is required) If agreed upon in a written contract or agreement, City of South Bend is included as an additional insured for general liability per CGL Form #LX9466, but only with respect to the operations of the named insured. Re: 220903 - Eddy Street Commons at Notre Dame City of South Bend Attn: Michelle Adams 227 W. Jefferson Boulevard 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 25 120101051 Griffin/FG ©1988-2010 ACORD CORPORAT INS02512m Onm nt The ACr1Rn name and Innn arc renicfcred mark. of Ar.npn COMMENTS/REMARKS C) UMBRELLA LIABILITY: CARRIER: FEDERAL INSURANCE COMPANY POLICY NO.: 79863543 TERM: 7-31-2016 to 7-31-2017 LIMITS: $50,000,000 E) EXCESS LIABILITY: CARRIER: AMERICAN GUARANTEE AND LIABILITY INSURANCE POLICY NO.: AECO11173102 TERM: 7-31-2016 to 7-31-2017 LIMITS: $25,000,000 EXCESS OF $50,000,000 F) EXCESS LIABILITY: CARRIER: THE OHIO CASUALTY COMPANY POLICY NO.: ECO1757418875 TERM: 7-31-2016 to 7-31-2017 LIMITS: $25,000,000 EXCESS OF $75,000,000 OFREMARK COPYRIGHT 2000, AMS SERVICES INC.