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Home My WebLink AboutProcession - Corvilla, Inc.TO: FROM: SUBJECT: SPONSOR: DATE OF EVENT: DATE DUE: FAX OR E-MAIL TO: INTER -OFFICE MEMORANDUM BOARD OF PUBLIC WORKS DATE SENT: 4/3/2017 Ed leckler, Traffic & Lighting vFp�rico Rodriguez, Fire Department att Longfellow, Engineering .� Lt. Gene Eyster, Police Department arcia Qualls, Streets Legal Department Linda M. Martin, Clerk PROCESSION RECO �MENDATION Corvilla. Inc. August 20, 2017 April 4, 2017 235-9171 1 Imartin(c-D-southbendin.gou RECOMMENDATIONS AND COMMENTS: By Date a ,In IT W PERMIT/AGREEMENT FOR A PROCESSION l . 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 Iicenses, 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 furnish 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, S. Notification of approval/denial of this request will he 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 information. Sponsor Signature Printed Name Title ARD OF PUBLIC WORKS APPROVAL 4 Preside t Me ber Member ? 2b Member Member Date RETURN FORM TO: 2 Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, IN 46601 Phone: (574) 235-9251 a Fax: (574) 235-9171 a E-Mail: publicwks@southbendin.gov Corvilla Ride for a Cause 2017 Directions STAGE & DEPART FROM 3620 DEAHL CT/ CORVILLA PARKING AREA Turn Left on Cleveland Rd. Turn Right on N Bendix dr. Turn Right on Nimtz Pkwy. Turn Left on Primrose Rd. Turn Left on Darden Rd. Turn Right on Quince Rd. Turn Left on Auten Rd. Turn Right On Redwood Rd. Turn Left on Alden Rd. Turn Right on Rosewood Rd. Turn Left on Chicago Trail Turn Right on New York Rd. Turn Left on E 700 N. Turn Right on N 600 E. Turn Right on E 009 N Turn Lefton E. Sagunay Trail Turn Right on N. Potowatomi Trail Turn Right on E 800 N. Turn Left on E 009 N. Turn Right on E 925 N Turn Right on N 650 E Turn Right on N. Walker Rd. Turn Left on E. Chicago Rd. Turn Right on Redwood Rd. Turn Left on Brush Trail Turn Left on Adams Rd. Turn Right on Portage Rd. Turn Right on N. Bendix Dr. Turn Right on Cleveland Rd. Turn Right on Deahl Ct. RETURN TO CORVILLA PARKING AREA CORVINC-01 `-f CERTIFICATE OF LIABILITY INSURANCE QQM DATE(MMIDDIYYYY) 1 312812017 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 pollcy(les) 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 endorsements). PRODUCER The Campbell Group PG Box 1788 Grand Rapids, MI 49501 UNTACT Mallssa DeVormer PHONE 616) 541-1458 FAX (AIC, No, Ext): 1 (AIC, No): na,RLss: mdevormer@thecalnpbeilgrp,com INSURERS AFFORDING COVERAGE NAIC # INSURERA:West Bend Mutual Insurance Co 15350 INSURED Corvllla Inc 3620 Deahl Court South Bend, IN 46628- INSURER 9 : INSURERC: INSURERD: INSURER E INSURER F r.nVFRAr.F.% f'.FRTIFIrATF kil IURPP- RNAlr¢InN M"RARF17- 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 LTRrn TYPE OF INSURANCE A g L SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1K OCCUR Y N A260199 00 8120/2017 8/21/2017 EACH OCCURRENCE 1,000,000 F'EV Esn R nNTED - $ 100,000 MED EXP (Any one personi PERSONAL & ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY JECT LOC OTHER: GENERAL AGGREGATE 3,000,000 PRODUCTS- COMPIOP AGG 3,000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED F I SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY Alni OS ONLY COMBINLide.D SINGLE LIMIT Ea :r BODILY INJURY Perperson) BODILY INJURY (Per accident Panracc�en1DAMAGE UMBRELLA LIAR EXCESS LIAR HCLAIMS-MADE OCCUR EACH OCCURRENCE AGGREGATE DED I I RETENTION $ WORKERS COMPENSATION ANDEMPLOYERS'LiABILITY YIN ANY PROPRIETgO�R�IPARTNER)EXECUTIVE I F15afory n NW) EXCLUDED? If yes, describe under DESCRIPTION OF OPERATIONS below N I A PER OTH- STATLTfE ER E.LL EACH ACCIDENT E.L. DISEASE - EA EMPLOYE EL. DISEASE- POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may he attached If more space is required) City of South Bend 1200 County City Bldg South Bend, IN 46601-0000 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 ,- �,�, e�:��?.'�=