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HomeMy WebLinkAboutStreet Closure - KRG Eddy Street Commons - ND Pep Rallyv I - - ---- - ---- a INTER -OF ICE MEMORANDUM BOARO OF PUBLIC WORKS DATE SENT 8/23/2017 TO: Ed Gleckler, Traffic & Lighting Gene Eyster, Police Department Matt Longfellow, Engineering Chris Dressel, Community Investment Federico Rodriguez, Fire Department Marcia Qualls, Engineering J Kara Wood, Park Department '4 Jill Sciccitano, Downtown §9uth Bend FROM: Linda M. Martin, Clerk 4440-1, SUBJECT: Non- Residential Block Party -Notre Dame Pep Rally Eddy Street Commons LOCATION: Street Closure: Eddy Street from Angela to Napoleon DATE AND TIME: September 29. 2017: Start time: 4:00 a.m. to 8:00 p.m. SPONSOR: Carissa McNeil DATE DUE: September 5, 2017 FAX OR E-MAIL TO: 235-9171 1 ImartinCo).southbendin.gov RECOMMENDATIONS AND COMMENTS: By Date d. This event involves the use of the sidewalk e. This event is iregional/national event (Please circle the appropriate event type) £ Affected property/business owners have been notified of this event. g. There is/are resident(s) affected by the event that may need ADA transportation assistance to their residence. h. 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). MXYes ❑ No U-Yes ElNo D, -'Yes ❑ No L❑ Ycs ❑ No R Yes ❑ No IF ALCOHOL IS TO BE SERVED OR SOLD Alcoholic beverages will be served ❑ Alcoholic beverages will be sold ❑ Certified Check or Money Order for $400.00 must be submitted with application. • Application cannot be processed without deposit. + Deposit will be returned upon inspection of event area by the Board of Public Works. Names and phone numbers of THREE security guards • To monitor underage drinking, Qualifications must be listed (e.g. Off -duty police officer, professional security guard, or event APPLICANT). A drawing must be submitted showing: a Fencing around serving area + Trash receptacles. o Ample trash receptacles must be provided to ensure proper disposal of refuse. Temporary liquor license. + Call the Alcohol & Tobacco Commission at (317) 234-4315 for more information. * Application cannot be processed without a copy of this license. t 11� her MCbMIq a x a x application only. Event end times are pursuant to the recommendations ofthe South Bend Police Department. 13. IF ALCOHOL IS TO 13E 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 returned by the Board of Public Works upon inspection of the 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 information. Application cannot be processed without a copy of this license. 14. APPLICANT agrees to indemnify, defend and hold harmless the Civil City of South Bend, Indiana, from any Iiability, loss, 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 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 _�L day 9f), AW . 1 20 APPLICANT Signature Printed N 4 BOARD OF PU LIC WORKS APPROVAL Presid nt Mem er Member ember M - . Member , Date RETURN FORM TO: Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, IN 46601 Phone: (574) 235-9251 -is L99't "a .84 M IO�' O I LL N Nr4 84;iun�.. / 3 r 4 .p -I • �.y N fL � � LL -Q � �. 1�9 U h Wu . t .L l 8 0 1 ri UA 3s iLh'4 LZO .rr r l/ V.L .O4 � mry Sao r �.. ¢ r � 6 c N � �NA as 5 o a,, 310178 AC ROB CERTIFICATE OF LIABILITY INSURANCE GATE 1lYYYY) 5/912019/2017 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(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 endorsement(s). PRODUCER Commercial Lines - (404) 923-3700 Wells Fargo Insurance Services USA, Inc. CONTACT NAME: KDlli PHONE 404-923-3532 FAX AIG No ; 877-362-9069 A1C o E t : EMAIL kimberlee.m.kolli@wellsfargo.com ADDRESS; o.com Gay g INSURERS AFFORDINGGOVERALiE NAIL# 3475 Piedmont Road NE, Suite 800 INSURERA: LM Insurance Corporation 33600 Atlanta, GA 30305-2888 INSURED INSURER B: Allied World National Assurance Co. 10690 Kite Realty Group Trust INSURER C 30 S. Meridian St., Ste. 1100 INSURER D: INSURER E : INSURER F : Indianapolis IN 46204 COVERAGES CERTIFICATE NUMBER: 11760500 REVISION NUMBER: See below 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 I O SU13R V POLICY NUMBER POLICY EFF MMfDDJYYYY POLICY EXP MWDDIYYYY LIMITS q XCOMMERCIALGENERAL LIABILITY CLAIMS -MADE [�] OCCUR TB5Z91453740077 No Deduc#iblelRetention 03/01/2017 03/01/2018 EACH OCCURRENCE $ 1,000,000 PAM PREM SES Ea oceur, nce $ 500,000 MED EXP (Any one person) $ Excluded Applies t0 GL PERSONAL&ADVINJURY 5 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑ PROJECT LOC PRODUCTS • COMP/OP AGG 5 2.000,000 5 OTHER: I I A AUTOMOBILE LIABILITY AS5Z91453740067 03/01/2017 03/01/2018 E° ac,QeDn€SINGLE LIMIT S 1,000,0o0 BODILY INJURY (Per person) 5 X ANY AUTO No deductible OWNED SCHEDULED AUTOS ONLY AUTOS on Auto Liability y BODILY INJURY (Per accident) 5 X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAMAGE Per accident 5 5 B X UMBRELLALIAB X OCCUR 3088008 03/01/2017 03/01/2018 EACH OCCURRENCE S 25,000,000 AGGREGATE $ 25,000,000 EXCESS LIAR CLAIMS -MADE DED I X RETENTIONS 5.000 $ A AND KERS EMPLOYECOMPENSATION' LIIT AND EMPLOYERS' LIABILITY ANYPROPRtE~TOPJPARTNERfEXECUT€VE Y f N OFFIC6RIMEMBEREXGLUDE07 (Mandatory in NH) NIA WC5Z91453740087 03/01/2017 03101 /2018 X 5 ATPEN UTE FIR E.L. EACH ACCIDENT f,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,0w If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT - 1,ODD,D00 $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 1011, Additional Remarira Schedule, maybe attached if more space Is required) Re: KRG Eddy Street Commons, LLC , Eddy Street Commons 1044-1234 Eddy Street, South Bend, IN 46601 lmMI:41I;1L",\1;in iLai 411121 tlGleL";qAW_\ILei ► City of South Bend Department of Public Works, Engineering Division 227 W Jefferson Blvd., Suite 1316 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 POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) (rhia ce,t1k.te p1 ces cerff.teq 11760495 issued ae M20171