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Home My WebLink AboutProcession - Rwandan Community - Walk to Remember..- 9 INTER -OFFICE MEMORANDUM BOARD OF PUBLIC WORKS DATE SENT: 5/8/2017 TO: Ed Gleckler, Traffic & Lighting ederico Rodriguez, Fire Department Matt Longfellow, Engineering Kara Wood, Park Department Lt. Gene Eyster, Police Department Jill Sciccitano, Downtown South Bend ..Marcia Qualls, Streets Legal Department FROM: Linda M. Martin, Clerk SUBJECT: PROCESSION RECO MENDATION-Walk to Remember SPONSOR: Rwandan Community IN DATE OF EVENT: May 19 2017 DATE DUE: May 16 2017 FAX OR E-MAIL TO: 235-9171 1 lmartin southbendin. ov RECOMMENDATIONS AND COMMENTS: By Date it Ir 'C,-frvror iw I L�� -s I IL ONO �1 lm. PERWHUAGREEMENT FOR A pitoCIBMSION l . Sponsor shall reimburse thu Boal'd for tile: aetufll cost to the City fol' (lie event, if clecnled necessary. Sponsor shall provide to the Board a Certificate of Ills lira►ice showing a liability policy in full force and effect with limits of $300,000.00 per occurrence and $5,000,000.00 agpref ate an(l the City of South Bend listed as au additioual nalned ins►IMCI for tl1FS event. 3. Sponsor shall provide to the Board all additional licenses, permits and documentation required for tile, 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 tho Board oil March 3, 1985. 5, it,orclel• to ensure public safety during the evc►lt, the Board agrees to furnish traffic Planning, materials, equipmollt and pursomiel as declned accessary by the Pollco Department 'rra:ffic Bureau, the Bureau of Traffic and Lighting, and, where applicable, the Board of Park Conm'issioFlers. G. S-ponsor aclulowledges that the Police Department reserves the right to change this route for safety purposes. 7. In consideration for approval by the Board alxl ille. use of (lie sidewalks for the purposes scat out above, the undersigned agrees and undertakes to Bole/ the Civil City of SO11111 Bond, Indiana, free and harmless from any liability loss, costs, costs, damages or expenses, including attorney Pecs, which the Civil City of South Fiend may suffer or incur, as a result of any claims or factions which may be made by atly person, including a participant in said activity, arisilig out of the approval of the request to use file sidewalks indicated in the City of South Bend. 'f'he undel•signed certifies that he/she is authorized to bind the above mentioned spollsor to the leans he1•eof. 8. lv(lliflcation Oj' appr(rlurb'deni(rl q dais request will he issued by relm", oj' dris fb(-111, rrpotr signed al(ihorization by the Board of Public Barks f undorstand the above rules and Yegliiatlolls 111(1 that t111S appiieation may be denied bused oil ally false or incomplete information. S lsor Signature Printed Name L)-- Title 13 ARD OF PUB qMen-i-ber 4Mib ber / e1• C WORKS APPROVAL Member Date RETURN FORM TO; 13uttrd of Public Works 1316 Counly-City Building 22.7 West Jefferson I30111evird South Bend, IN,16601 Phone: (574) 235 9251 o Fox: (574) 235�9171 0 FAVIIIH: l]lltlllftvlts�solEiIEl7Cnclln,gnu' PA @77 Us I om EMBAOFT-03 MCHO ACORO" CERTIFICATE OF LIABILITY INSURANCE �—� DATE(M 1/311201YYY) 2017 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(les) 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 (301) 231-5447 NAME: Martens -Johnson Insurance Agency, Inc 6227 Executive Blvd Rockville, MD 20852 PHONE FAX AIc No Ext : fAIC, No : E-MAIL ADDRESS: ENSURERS AFFORDING COVERAGE NA1C # INSURER A:Ph€ladel hia It1SCEranCe COITt anies 6777 INSURED Embassy of the Republic of Rwanda INSURERB: INSURERC: 1875 Connecticut Ave NW #418 Washington, DC 20009 INSURER D : 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 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, INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE rx] OCCUR Y N PHPK1605720 1/31/2017 1131/2018 EACH OCCURRENCE $ 1,000,00 PR SEeEgDEaoccurrenee $ 100,00 M ED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ PRO - POLICY ❑ LOC OTHER: GENERAL AGGREGATE $ 2,000,00 PRODUCTS-COMPIOP AGG $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS N N PHPK1606720 1131/2017 1/31/2018 COMBINED SINGLE LIMIT Ea accident $ 300,00 BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ A UMBRELLA LIAR EXCESS LIAR OCCUR N N PHUBS71392 1/31/2017 1/31/2018 EACH OCCURRENCE $ 4,000,00 HCLAIMS-MADE AGGREGATE $ 4,000,00 DED I X I RETENTIONS 1(),000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIE.XECUTIVE ❑ OFFICEWMEMBER EXCLUDED? (Mandatory in NH) €f Yyes, describe under ❑ESCRIPTION OF OPERATIONS below N ! A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L DISEASE - POLICY LIMIT I S DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Excess policy is over General Liability policy only. Certificate Holder is listed as Addiitional Insured on the listed General Liability Policy. This is for a 1 day event on May 19,2017 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Board of Public Works THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 227 West Jefferson ACCORDANCE WITH THE POLICY PROVISIONS. 1316 County- City Building AUTHORIZED REPRESENTATIVE South Bend, IN 46601-0000 O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD