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HomeMy WebLinkAboutProcession - DTSB - Holiday Light ParadeIL All " � ^ r .-'.'. Lj APPLICATION FOR USE OF ` , If; W PACK Y.'f j PUBLIC RIGHT-OF-WAY FOR PROCESSIONS r .r The Board of Public Works must have FOUR (4) weeks prior notice of the event " 1865 Sponsor: Downtown South Bend, Inc. Submitted By: Kylie Carter Address: 217 S. Michigan St. City: South Bend State: IN Zip: 46601 Phone: (574) 282-1110 Sponsor may use the public right-of-way described as (describe route and attach map) Start at 7:00 p.m, at Wayne and Michigan, continue north to the Morris, going through the circle and turning right on MLK. Head south on MLK to Washington, head west on Washington, then south on Michigan to Wayne. Staging will take place starting at 5:30 p.m, on Michigan between Western and Wayne, and on Wayne between Main and the Wayne Street garage. .................................. PLEASE NOTE: THE SOUTH BEND POLICE DEPARTMENT RESERVES THE RIGHT TO i1 j CHANGE YOUR ROUTE FOR SAFETY PURPOSES Event name: 'i��ll{=Ys1�, U0' '% ® The Board of Public Wot4E� must havYFOUR (4) weeks prior notice before 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 be held on DECEMBER9 , 2017 and no other date ❑ Registration time for the event starts at a.m./p.m. ® Starting time of the procession is 7 a.m.M Estimated completion time is 8 a.m Ip.rn This event involves the use of the following roadways ® This event involves City streets ❑ This event involves County roads ❑ This event involves State highways ® 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 trust stay on the sidewalk and obey all traffic laws. ® This event is a local/regional/national event (Please circle the appropriate event type) This event will be coordinated with the property owner/business where staging will take place Updated 6/25/ 12 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 rearrest 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 V-P)),kC�xf�c Titles etS C r -iS OF P LIC WORKS APPROVAL Member Member _UL/4r7 Member Date RETURN FORM To: 2 Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Send, IN 46601 Plione: (574) 235-9251 a Fax: (574) 235-9171 s E-Mail: publiewks@southbendin.gov 201.7 Hotiday Light.Parade r ® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIWYY) 7/25/2017 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 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 CONTACT CT Stephen Swihart NAMGibson PHONE a (800) 814-2122 A/C Na; FAX (800)636-2122 Insurance .Agency, Inc. ADDRESS: sswihart@gibsonins. cam 130 S. Main St, Ste 400 INSURERS AFFORDING COVERAGE NAIC # PO Box 11177 INSURERA:Cincinnati Ins Co 10677 South Bend IN 46601-0177 INSURED INSURERB:Cincinnati Ind Co 23280 iNSURERC: Downtown South Bend, Inc. INSURERD: 217 S Michigan St INSURER E : PO Box 930 INSURERF: South Bend IN 46624-0930 COVERAGES CERTIFICATE NUMBER:17/18 Liab 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 SUBR POLICY NUMBER MMIDDY /YYYY MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 500,000 MED EXP (Any one person) $ 5,000 EPP0031054 8/2/2017 8/2/2018 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 % POLICY PRO- JECT ❑ LOG PRODUCTS - COMPIOP AGG $ 2,000,000 Employee Benefits $ 1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED % HIRED AUTOS R AUTOS EPP0031054 8/2/20I7 8/2/201B BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident _$ X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 A EXCESS LIAR CLAIMS -MADE DED I % I RETENTION$ 0 $ RPP0031054 8/2/2017 8/2/2018 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PROPRIFTORIPARTNERIEXECUTIVE �{ 8TATUTE FIRANY E.L. EACH ACCIDENT $ 100 000 B OFFICERfMEMBER EXCLUDED? ❑ (Mandatary in NH) NIA EWCO257774 8/2/2016 8/2/2017 F.L. DISEASE - EA EMPLOYE $ 100 000 E.L. DISEASE - POLICY LIMIT $ 500,000 If as, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may he attached If more space is required) City of South Bend is additional insured with respect to General Liability regarding events hosted by Downtown South Bend, Inc. rFRTIFIrATP Hrll nPIP CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of South Bend 227 W. Jefferson THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. South Bend, IN 46601 AUTHORIZED REPRESENTATIVE �f G Ins Agency/STSWTH ACORD 25 (2014101) 1 NS026 001 ant r ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD