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HomeMy WebLinkAboutNon Res Block Party - St Joseph Grade SchoolI INTER -OFFICE MEMORANDUM BOARD OF PUBLIC WORKS DATE SENT 4/28/2017 TO: Ed Gleckler, Traffic & Lighting Genp-Eyster, Police Department yOtt Longfellow, Engineering hjj8-[Yressel, Community Investment VKe rico Rodriguez, Fire Department arcia Quails, Engineering FROM: Linda M. Martin, Clerk SUBJECT: STREET CLOSURE R COMMENDATION LOCATION: St. Louis Blvd from Colfax Ave to LaSalle Ave DATE AND TIME: Mav 31, 2017 8:00am to 2:30pm SPONSOR: St. Joseph Grade School DATE DUE: May 2, 2017 FAX OR E-MAIL TO: 235-9171 1 Imartin southbendin. ov RECOMMENDATIONS AND COMMENTS: By Date APPLICATION FOR USE OF, AND BLOCI(ING 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: St. Joseph Grade School Address: 216 North Hill City South Bend State: IN Zip: 46617 574-210-9087 Jeb Phone: McNally 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 Nance St. Joseph Grade School Field Da Location St. Joseph Grade School and Parish Center (Describe Arei/Route) Street Closure Name of Street St. Louis From Colfax To LaSalle Date of Event May 31 20 17 ❑ ❑ a.m. X a.1a). 230 : X® Time: Registration/Setup SAM ❑ p.,17. Start 9AM ❑ p.m. End PM 1m)), Approximate Nninber of Attendees 600 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°i Floor, County - City Building, 227 W. Jefferson Blvd,, South Bend , Indiana. c. Certificate of Insurance d. Maps, drawings of the area and setup plan ❑ Yes ❑ No 3. a. This event involves City streets ® Yes ❑ No b. This event involves County roads ❑ Yes ® No c. This event involves State highways ❑ Yes ® No Updated 4/2015 d. This event involves the use of the sidewalk ® Yes ❑ No e. This event is a local/regional/national event (Please circle the ❑ yes ® No appropriate event type) f. Affected property/business owners have been notified of this event. ❑ Yes ❑ No & 1 miderstmid 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 Alcoholic beverages will e erved ❑ Alcoholic bevera s will be sold ❑ Certified Check or• Morey Order for $4 .00 must be stibmilted with plication. ❑ 9 Application caurrot be processed with 7t deposit. o Deposit will be returned upon inspeetioi of event area by the oard of Public Works. Narnes and phone numbers ofTHRl1E securi guards ❑ a To monitor underage drinking. 0 Qualifications must be listed (e.g. Off -duty p li officer, professional security guard, or event APPLICANT), A drawing must be submitted showing: ❑ a Fencing around serving area Trash receptacles. o Ample trash receptacle must be provided to e sure proper disposal of roalse, Temporary liquor license. ❑ o Call the Alcohol & Tobace onunission at (317) 234-4315 fo - more information. o Application caimot be p - eessed without a copy of this license. City of South Beard, bidiaiia a Boar(I of Public Works PERMIT AND AG + ENIENT 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 terns and conditions: 1. Pursuant to Local Ordinance No. 10224-13, there is a $125,00 rron-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 Corm 990 ofForrn 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 Certif cate of Insurance showing a liability policy in Rill 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 instLuments, phonographs and othersound 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 (lie City that the area will be closed during the tunes indicated on the application only. Event end times are pursuant to the recommendations of the South Bernd 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 ret-urned by the Board of Public Works upon inspection of (lie 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 3 information. Application camiot be processed without a copy of this license. 12. APPLICANT agrees to indemnify, defend and bold harniless the Civil City of South Bend, Indiana, front any liability, loss, costs, damages or expenses, inchiding 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 ill 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 4 day of April 20 17 APPLICANT Signature Printed Name Jeb BOARD OF PUBLIC WORKS APPROVAL 4� Pres'dent Me ber Member u,luvlll 7/.-)01-) Merrrber Member Date RETURN )<ORl1I TO: Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, IN 46601 Phone; (574) 235-9251 ® Pax: (574) 235-9171 * E-Mail: publiewks@southbendirr.gov �f -Y-� J1 X V,V 2017 St. Joseph Grade School Field Day May 31, 2017 8:30 AM _ 2:45 PM At both St. Joseph School and Ackles Center parking Lot Asking city to allow us to black off St. Louis, between Colfax and LaSalle for children crossing street between School and Ackles Center. All activities held on Parish grounds -- street to be closed for crossing of children Intor"al Rerrent-10 senroce P.O. Box 2508 Cirnciin nnfig QH 46201 Date.. June -12, 2013 United States Conference of Catholic Bishops 3211 4"' Street, NE Washington, DC 20017-1194 Dear Sir/Madam: Department of Persona to can4ar-fa Roger Meyer IDi# 0110429 ToOli Free Telephone l;tilum beva 877-829-5500 53-0196617 Grocip Exemption Number-. 0928 This responds to your June 5, 2013, request for information regarding the status of your group tax exemption. Our records indicate that you were issued a determination letter in March 1946, that you are currently exempt from federal income tax under section 501(c)(3) of the Internal Revenue Code, and are not a private foundation within the meaning of section 509(a) of the Code because you are described in sections 509(a)(1) and 170(b)(1)(A)(i). With your request, you provided a copy of the Official Catholic Directory for 2013, which includes the names and addresses of the agencies and instrumentalities and the oducational, charitable, and religious institutions operated by the Roman Catholic Church in the United States, its territories, and possessions that are subordinate organizations under your group tax exemption. Your request Indicated that each subordinate organization is a non-profit organization, that no part of the net earnings thereof inures to the benefit of any individual, and that no substantial part of their activities is for promotion of legislation. You have further represented that none of your subordinate organizations is a private foundation under section 509(a), although all subordinates do not all share the same sub -classification under section 509(a). Based on your representations, the subordinate organizations in the Official Catholic Directory for 2013 are recognized as exempt under section 501(c)(3) of the Code under OEN 0928. Donors may deduct contributions to you and your subordinate organizations as provided in section 170 of the Code, Bectuests, legacies, devises, transfers, or gifts to them or for their use are deductible for federal estate and gifts tax purposes if they meet the applicable provisions of section 2055, 2106, and 252.2 of the Code. Subordinate organizations under a group exemption do not receive individual exemption letters. Most subordinate organizations are not separately listed in Publication 78 or the EO Business Master File. Donors may verify that a subordinate organization is Included Certificate of Coverage Da to: 4124:/21017 Cer•liricale linider ]'his Certificate is issued as a matter of itrfor•tnatfon only ,and Tito Diocese of Hor't Wayne -South Bend, luc. confers uo rights upon tiie holder- of this certificate. This cerfiflcate Chilii(:ory Office does not atnenti, extend or alter the coverage afforded below. P 0 Box 390 Cnnipany Affording Coverage For( Wayne, I N 46801 THE CATHOLIC MU'l'{]AI., RELIEF SOCIETY OFAMERICA 10843 OLD MILL RD Covered Location St. Joseph Grade School OMAHA, NE 68154 216 North Hill South Berid, IN 46617 Coverages This is to certify that file coverages listed below have been issued to the eertificate holder' Danced above for the certificate indicaled, notivilhstanding illy re(iuirctnent, term or conditfoil of any contract or other document with respect to ��°bleb frets certificate may be issued or may pertalo, the coverage afforded described Ital•cilt is subject to all the tennis, exclusions and c(rnditious of such coverage. Limits Shown may have been redileed by paid claims. Type of Coverage C'crtifientc rlunrber Coverage Effective Date Coverage Expiration Date Limits Property Real & Personal Property D, General Linen€ty Encir Occurrence 300,000 General Aggregate 2,000,000 Occurrence Products-ComplOP Agg 8679 I{}I112(}16 10/112017 Personal & AflS' Injury Li stead( Fire Damage (An)' one five) \led Exp (Any one person) Excess Liabitily 8679 1011/20I6 10/1I2017 Fach Occurrence Annual Aggregrale 1,000,000 Other Ench Occurrence Claims Made_ Annual Aggregrate LimitlCoverage l)rscriptiun of OperatipnslLocntionsfL'clriclrslSpeclal Items ((he following language supersedes any nther language in this endorsement or the Cer(lticate In conflict rvilh this language) Coverage only extends foe' claims arising out of St. Joseph Orade School's field day in which St. Louis Street will be closed from Colfax to LaSalle oil May 31, 2017. Holder of Cerillicate Cnncc€ration Additional Protected Person(s) Should any of the above described coverages be cancelled before file expiration (late flrereaf, tine issuing ecnnpany will endeavor to mail 30 days written notice to the holder' of City of South Bend, IN certificate uniued to the left, but failure to mall such notice shall 227 West Jefferson Blvd impose no obligation or liability of any Idnd upon the conipnny, South Bend, IN 46601 its agents or representatives. Authorized Representative 0067003068 ENDORSEMENT (TO 13E ATTACHED TO CERTIFICATE) Effective Date of Endorsement: 5/3 1/20 17 Cancellation Date of Endorsement: 6/1/2017 Certificate 1-foldor: The Diocese of Fort Wayne -South Bend, Inc. Chancery Office P O Box 390 Fort Wayne, IN 46801 Location: St. Joseph Grande School 216 North Hill South fiend, IN 46017 Certificate No. 8679 of The Catholic Mutual Relief Society of America is amended as follows: SECTION II - ADDITIONAL PROTECTED PERSON(S) It is understood and agreed that Section 11- Liability (only with respect to Coverage D - General Liability), is amended to include as an Additional Protected Person(s) members of the organizations shown in the schedule, but only with respect to their liability for the Protected Person(s) activities or activities they perform on behalf of the Protected Person(s). It is further understood and agreed that coverage extended under this endorsement is limited to and applies only with respect to llaWlily assumed by contract or agreement; and this extension of coverage shall not enlarge the scope of coverage provided under this certificate or increase the limit of liability thereunder. Unless otherwise agreed by contract or agreement, coverage extended under this endorsement to the Additional Protected Person(s) will not precede the effective date of this certificate of coverage endorsement or extend beyond the cancellation dale. Schedule -ADDITIONAL PROTECTED PERSON(S) City of South Bend, IN 227 West Jefferson Blvd South Bend, IN 46601 Remarks (the following language supersedes any other language in this endorsement or the Certificate in conflict with this language): Coverage only extends for claims arising out of St. Joseph Grade School's field day in lvhich St. Louis Street will be closed from Colfax to LaSalle on May 31, 2017. Autlnoriz� Representative PKS-122(10.11)