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HomeMy WebLinkAboutProcession - University of Notre DameINTER -OFFICE MEMORANDUM BOARD OF PUBLIC WORKS TO: t,-E// DATE SENT: 8/1/2017 d Gleckler, Traffic &Lighting ederico Rodriguez, Fire Department Matt Longfellow, Engineering Kara Wood, Park Department Lt. Gene Eyster, Police Department 4'11 Sciccitano, Downtown South Bend arcia Qualls, Streets Legal Department FROM: Linda M. Martin, Clerk SUBJECT: PROCESSION RECOMMENDATION -Notre Dame Trail SPONSOR: UniversitV of Notre Dame DATE OF EVENT: Au ust 26 2017 6:00am-12:00 m DATE DUE: August 1 2017 FAX OR E-MAIL TO: 235-9171 I (martin south bend in.clov RECOMMENDATIONS AND COMMENTS: By Date ; I= I = PERMIT/AGRE, IGMCNT 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 hatmless 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. Notyleadon of approval/denial of this request will be issued by relarn of this form, rrpon signed authorization by the Board ofPublia Works I understand the above rules and regulations and that this application may be denied based on, any false or incomplete inforint Sponsor Signature PrintedName Matthew Klawitter Title Program Director, Notre Dame Trail B ARD Or,PUB lC WO S APPROVAL VII (. _ ..— President Member Member A0� J Member Member Date ItEl TURN FORM TO: 2 Board oi: Pub1Jc Works 1316 County -City Building 227 West 3'effemo Boulevard South Bend, iN 46601 Phone: (574) 23"251 o Pax: (574) 235-9171 o d Mail: publiawks@southbaudin,gov 0 QA 1 7 ■ "I nr ili II -b"tiwi i eh IS 1 II . . . . . . . . . . . . . . . . . . . . . . . . . 1 A am— MOM — T 1 ■ I e I ,I 11 I d, • . s irn_ I� S A i 4 `% "" CERTIFICATE OF LIABILITY INSURANCE DAT7/251DD/YYYY) 7I25l2017 THIS CERTIFICATE !S 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 OF A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND T14E CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) 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 endorsements . PRODUCER CONTACT " Aon Risk Services Central, Inc. Chicago IL Office Ra�N°„„ e q ; (866) 203-7i 22 xo.: (800) 385 -0105 E-MAIL ADDRESS: 200 East Randolph Chicago, IL 60601 USA PRODUCER $700D0001890 CUSTOMERIDN; INSUREAS AFFORDING COVERAGE NAIL # INSURED INSURERA, Notre Dome 0aneralUablllyTrust NIA INSURER e: United Edacatora Ins, a Roolprocel RRG 10020 University of Notre Dame Risk Management & Safety 036 Grace Hall Notre Dame; IN 46556,5612 INSURER C:. .... INSURER D: INSURER C: INSURER F, rnVOF2Ancs r:FRTmeATA NHMRER' REVISION NUMBER: THIS is TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED RAMED -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. THL INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT To ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limns shown are as requested wan LIR - - TYPE OF INSURANCE AOD'L Blinn Mn MD POLICY NUMBER PouaYl" YYhoFYY PODCY657 LIMITSuWon A OENERALLIAINUTY IiI COMMERCIAL GENERAL LIABILITY 13 CLAIMS MADE M OCCUR W LIDUOR LIAD CITY 10 CONTRACr€rAEL1ADILITV GEN'L AGGREGATE LIMITAPPLIES PEP: POLICY 13 PRO- 13 LOC JECT 0210117-30 711I2017 7/112018 ERE 000 PSOEAREMIS (FA DWRae) $1,600,000 MED W(P An am man) NIA PERSONAL ADV INJURY 100 000 OENERALAGGREGATE 110001000 PRODUCT. -COMA OP AGO 1 OOO 000 AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL, OWNED AUTOS ❑ SCHEDULED AUTOS © HIRED AUTOS ❑ NON-OWNEDAUTO ❑ COMBINED SINGLE LIMIT (Eaaccidanl) BODILY INJURY (Par Penton) BODILY INJURY (Pat eeddanq PROPERTY DAMAGE (Peraarrdenl) B UMBRELLA LIAO 11OCCUR ® EXCESS LIAR ❑ CLAIMS MADE H22.78Y 71112017 7/112018 EACH OCCURRENCE $10,1)00,000 AGGREGATE $10,000 000 DEDUCTIBLE ❑ RETENTION WORKERS COMPENSATION AND EMPLOYERW LIABILITY YIN NiYPRdPRmTdPA,ARm RAmcui Ne ElE,L. OFFICFRMF1re1RL11CW0W? (Mandatory In Nil) 11 YYes dearfihe undor DESCRIPTION OFOPEAATIONS I.). ❑ WCBTATU• TORYLR€ITS ❑ OTH -ER , EACH ACCIDENT 151. DISEASE -EA EMPLOYEE E.L. DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS ILOCATIONSI VEHICLES I (Attach ACORD 101, Addlltomit Remarks Schedule, It more space to required) The City of South Bend is Included as additional Insured for the use of facllilies On August 25 to August 26,201 T. Board of Public Works City of South Band 227 West Jefferson 1316 County -City Building South Bend, IN 46601 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE AUTHORIZED REPRESENTATIVE AOL&I T�CServices C'.&d' /.. ACORD 25 (2009109) 0 19882009ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD