The URL can be used to link to this page

Home My WebLink AboutProcession - Maranatha Missionary Baptist ChurchW, elm 1ro Cho N TO: FROM: SUBJECT: SPONSOR: DATE OF EVENT: DATE DUE: FAX OR E-MAIL TO: INTER -OFFICE MEMORANDUM BOARD OF PUBLIC WORKS 3e DATE SENT: 6/28/2017 eckler, Traffic &Lighting rico Rodriguez, Fire Department rongfellow, Engineering ra ra'ood, Park Department tGene Eyster, Police Department Jill Sciccitano, Downtown South Bend Marcia Qualls, Streets Legal Department Linda M. Martin, Clerk PROCESSION RECO ENDATION- Ridinq for a Lift Maranatha Missionary Baptist Church Inc. August 5, 2017 8:00am to 12:45pm Julv 3. 2017 235-9171 1 Imartin(a7southbendin.gov RECOMMENDATIONS AND COMMENTS: By Date APPLICATION FOR USE OF PUBLIC RIGHT-OF-WAY FOR PROCESSIONS The Board of Public Works must have FOUR (4) weeks prior notice of the Maranatha Missionary Sponsor: Baptist Church, Inc. Submitted By: Sandy L. Combs Address: 19 19 Prairie Avenue City: South Bend State: IN Zip: 46613 Phone: 574-237-1899 Sponsor may use the public right-of-way described as (describe route and attach map) 1819 Prairie to Mayflower, to Sumption, to Oak, to Highway 6 east to Miami, north to Kern, west to Locus, north to Prairie, east to Ewing, east to Walnut Walker Field Park) PLEASE NOTE: THE SOUTH BEND POLICE DEPARTMENT RESERVES THE RIGHT TO CHANGE YOUR ROUTE FOR SAFETY PURPOSES Event name: Maranatha Accessibility — Riding for a Lift ❑ The Board of Public Works must have FOUR (4) weeks ekprior notice before p r 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 behold on Aug. 5 , 2017 and no other date ❑ Registration time for the event starts at 8:00 a.m./ ❑ Starting time of the procession is 11:00 a.md ❑ Estimated completion time is 12:45 a.m.. This event involves the use of the following roadways 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 ❑ Participants must stay on the sidewalk and obey all traffic laws. ■ tii This event is a(Local�egional/national event (Please circle the appropriate event type) This event will be coordinated with the property owner/business where staging will take place Updated 4/06/16 PERMIT/AGREEMENT FOR A PROCESSION 1. 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 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 8. Notification 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 information. Sponsor Signature �.. Printed Name Title C0 -1 �. C ' un A T-1 OF T)y T LIC WO S APPROVAL Wk Member Member Member Date 2&5Ld-01-7 RETURN FORM TO: 2 Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, IN 46601 Phone: (574) 235-9251 0 Fax: (574) 235-9171 a Y%Mail: publiewks@southbendin.gov I fit? rr, f� I Z. MARANATHA MISSIONARY BAPTIST CHURCH 1819 Prairie Avenue South Bend, IN 46613 RIDING FOR A LIFT Maranatha Missionary Baptist Church will conduct afiend-raising event on August 5 h, 2017 which will consist of a motorcycle ride by various motorcycle clubs and individuals from the Michiana area. The day's activities will culminate with a community -wide Family Fun Fair at Walker Field Park, located at Walnut and Ewing streets in South Bend. The goal of this event is to raise funds that will be used to improve the accessibility of the church to accommodate physically challenged congregants and members of the community. This will include a wheelchair lift, entry ramp, parking lot with handicap accessible parking, and other accessibility improvements. In order to meet this goal, we are asking for sponsorships from local businesses and individuals. Maranatha Missionary Baptist church is a 501(c)3 organization and a tax receipt will be provided for all donations. As a sponsor, your name will be included in materials advertising the event. We hope that we can count on you to help support our cause. If you would prefer to make a secure online donation, please go to www.gofundme.com and enter Maranatba MBC Riding For A Lift in the search box. If you have questions, concerns, or just want more information about this important effort, please contact us at 574. 2Sincery, i Rev. GtLeroy Thompson, Pastor Maranatha Missionary Baptist Church MARAMIS-01 KBLOSS CERTIFICATE OF LIABILITY INSURANCE DATEIMMlDDIYYYY) 0612612017 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 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 I st Source Insurance, Inc. 6909 Grape Road Mishawaka, IN 46545 INSURED Maranatha Missionary Baptist Church 1819 Prairie Ave South Bend, IN 46613 COVERAGES CERTIFICATE NUMBER: NONEAc- Kris Blosser A-----_._._..,......._.... _.._..m._, (Arco, No, Exq: (574) 271-5200 _ FAX , No):(574) 271.5240 E-MAIL blosserk@istsource.com ADDRsS -- - - . - — -- --- ----- IN5UiRER(S} AFFORDING COVERAGE NAIL f INSURER A, NSI / West Bend Mutual Insurance INSURER B INSURER C : INSURER D : INSURER E : INSURER F : 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. WSR LTR TYPE OF INSURANCE ADDL NSp SUER WLD POLICY NUMBER POLICY EFF rpp POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X A311686 08I0512017 08106l2017 EACH OCCURRENCE $ l oo,o0o DAMAGE TO RENTED PR.(ima occurrence)_..._ MISES. MED EXP (Any one erson} 900,000 _$... .-......... ............. ._ . ........_ $ Excluded PERSONAL& ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY ❑ PJPRO- POLICY F] LOC OTHER: GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMPIOPAGG $ 3,000,000 $ LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS _ AUTOS ONLY AUTOS ONLY MDINED SINGLE LIMIT rAUTOMOBILE accident $ BODILY INJURY Perperson) $ BODILY INJURY Per accident $ PROPERTY DAMAGE UMBRELLALIAB OCCUR EXCESS LIAB CLAIMS -WADE DE D RETENTION $ EACH OCCURRENCE $ AGGREGATE $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFF€CERIMF MRFR EXCLUDED? andatory n NH) If yes, describe under DESCRIPTION OF OPERATIONS below !! f I NIA PER OTH- ,,,_,,,,_ „,P5TATUTE _ __— ER E,L, EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE —- - — - $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schadute, maybe attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of South Bend tY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 227 W. Jefferson South Bend, IN 46601 AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) 9)1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS IS A RELEASE _READ BEFORE SIGNING 1, the undersigned, agree that the Maranatha Missionary Baptist Church, and the city of South Bend, IN and its supporting sponsors shall not be liable or responsible for damage to property or any injury to persons, including myself, during any Maranatha Missionary Baptist Church "Accessibility - Riding for a Lift" activity, even when the damage or injury is caused by negligence. I understand that and agree that all riders, their guest(s), and sponsors participate voluntarily and at their own risk in all activities of "Maranatha Accessibility — Riding for a Lift". I release and hold harmless, Maranatha Missionary Baptist Church, supporting sponsors, and the city of South Bend, IN, for any injury or loss to my person or property which may result there from. I understand that this means that I agree not to sue the Maranatha Missionary Baptist Church, or the supporting sponsors, or the City of South Bend, IN, for any injury or property damage in connection with the Maranatha " Accessibility - Riding for a Lift' activity. I further agree that I am responsible to provide adequate insurance on my motorcycle or any other vehicle I use J operate or am responsible for while participating in a Maranatha Missionary Baptist Church activity to cover liability in case of accident or injury. Participant Name (Print) Participant Signature, Date Guardian Signature (Required if under eighteen years of age) z' L