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HomeMy WebLinkAboutProcession - Notre Dame Cycling Club1316 COUNTY -CRY BDEAING 227 W. JEFFERsoN BOULEVARD SOUTH BEND. INDIANA 46601-1830 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS March 28, 2017 Erin Hoffman Notre Dame Cycling Club 100 Rolfs Sports Recreation Center Notre Dame, IN 46556 RE: Event Name: Notre Dame Cycling Classic Date: April 2, 2017 Dear Ms. Hoffman: PHoNE 574/235-9251 FAX 574/235-9171 The Board of Public Works, at its meeting held on March 28, 2017, approved your request to conduct your bicycle procession on April 2, 2017, beginning at 8:00 a.m. and ending at approximately 3:00 p.m. on the designated route as submitted. Enclosed please find copy of your approved permit. Participants must obey all traffic laws. Please coordinate your event with Lieutenant Eugene Eyster of the Police Department. 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 Ed Gleckler, Traffic & Lighting Marcia Qualls, Streets Department GARY A. GILOT SUZANNA M. FRrrZBERG ELIZABETH A. MARADIK JA1vfEs A. MUELLER THERESE J. DORAU TO: FROM: SUBJECT: SPONSOR DATE OF EVENT: DATE DUE: FAX OR E-MAIL TO: INTER -OFFICE MEMORANDUM BOARD OF PUBLIC WORKS Jd Gleckler, Traffic & Lighting ederico Rodriguez, Fire Department JMatt Longfellow, Engineering /Kara Wood, Park Department Lt. Gene Eyster, Police Department ill Sciccitano, Downtown South Bend Marcia Qualls, Streets Legal Department Linda M. Martin, Clerk PROCESSION RECOMMENDATION Notre Dame Cycling Club April 2, 2017 March 21, 2017 97-1111 4&1l =1 011 iw1` Bypily, IFl 235-9171 1 Imartin(c southbendin.gov RECOMMENDATIONS AND COMMENTS: By Date 2/13/2017 Applica1ien2017 South Bend NC Cycling Race_Me2.jpeg . o4g00rH 6��1f APPLICATION FOR USE OF u o PUBLIC RIGHT-OF-WAY FOR PROCESSIONS 0 The Board of Public Works must have FOUR (4) weeks prior notice of the event! 1965 " Sponsor: Wre Nme C�c�ny C14 Submitted By: Address: _ loo Rolf% SPA l�(Mkt/on (enter - City: Notre D ,, e- state: .TN Zip: NGSSG Phone: 6,3, - 3,,6g Sponsor may use the public right-of-way described as (describe route and attach map) PLEASE NOTE: THE SOUTH BEND POLICE DEPARTMENT RESERVES THE RIGHT TO CHANGE YOUR ROUTE FOR SAFETY PURPOSES Evert name: I]„t- 7 w C. ; ,. a u St � LN The Board of Public Works must lt9ve FOUR (4) weeks prior notice before event occurs 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 A-er•k 2 20 1-t- and no other date Registration time for the event starts at 8 G"m./p.m. [[� Starting time of the procession is 9 aO)./p.m. Estimated completion time is 3 a.m./I tip This event involves the use of the following roadways LE 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 from 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 [f Participants must stay on the sidewalk and obey all traffic laws. This event is a loca a ion ational event (Please circle the appropriate event type) This event will be coordinated with the property ownerlbusiness where staging will take place Updated 4/06/16 1 hfps://mal l.google.com/mail/,✓1/ginboxtl5a3651bffdOd6Mprojmtor=l 1l1 2/13/2017 Applicallon2017_SaAh Bend ND Cycling Race_page3jpeg PERMIT/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, runs, 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 famish 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. Notylcatlon of approval/denial 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 false or incomplete informamR v RSITY OF NOIRE DAME Sponsor Signature By; Printed Name grin Hoffmann Harding Title OF /P esident MemberVL Member �a v/ate 7 Member Member Date RETURN FORM TO: Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard Soulh Bend, IN 46601 Phone: (574) 235-9251 • Fax: (574) 235-9171 • G-Mail: publicwks@southbendin.gov hUps://mall.google.com/mail/all/Mnbox/l5a365lbfFdDd569?projectw=l 1/1 USACYCL-01 MRODRIGUEZ Acoira' CERTIFICATE OF LIABILITY INSURANCE `.--� DATEIMMI'20117Y) 02/2112017 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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 Fairly Consulting Group, LLC 1800 S. Washinggton, Suite 400 Amarillo, TX 79102 NACONTAME:CT Fairly Group Certificates _ PHONE FA% INC, No, Ext): (806) 376.4761 Iwc, No):(806) 337.1859 nooaEss: carts@fairlygroup.com INSURERS AFFORDING COVERAGE NAIC# INSURER A: Lexington Insurance Company 19437 INSURED INSURER B : INSURER C : USA Cycling, Inc. INSURER D: 210 USA Cycling Point, Suite 100 Colorado Springs, CO 80919 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 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 OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. INSR TYPE OF INSURANCE ADOL D SUER MD POLICY NUMBER POLICY EFF pp POLICY EXP pY1 LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR X 015375404 12/3112016 12/31/2017 DAMAGE TO RENTED P E ISES Ea occunence 1,000, $ 000 MED EXP (Any oneperson) $ Excluded PERSONAL &ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 3,000,000 POLICY JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 X $ OTHER: per Event AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY Per person)$ ANY AUTO _ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ PROPERTY AMAGE PPer acci0dent $ ___ AUTOS ONL71 Y AUTO�ONLV $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED RETENTION$ S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER 10 STAT TE ETH- ANY PROPRIETORIPARTNERIEXECUTIVE ❑ �pFICEq/MEMBER EXCLUDED? (Mandatory in NH) NIA E.L EACH ACCIDENT S E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Job 2017-803 Endorsement LEXD00O21 (LX0404) SCHEDULE OF NAMED INSUREDS: Event Organizers and/or Promoters are Named Insureds. It shall be a condition of coverage that all organizers/promoters for whom coverage is afforded under this policy execute a USAC Event Permit Application and coverage will be afforded only for the specific event and date on the permit. The General Liability policy includes a blanket automatic additional Insured endorsement that provides additional Insured status to the certificate holder only when there is a written contract between a named insured and the certificate holder that requires such status. Please see attached endorsement LX4309 SEE ATTACHED ACORD 101 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof South Bend THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 227 West Jefferson South Bend, IN 46601 -- AUTHORIZED REPRESENTATIVE 1 ACORD 25 (2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved. 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