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Home My WebLink AboutProcession - Girls on the Run Michiana1316 COUNTY -CITY BUILDWO' 227 W. JEFFERSON BouLl'iVARD SOLF11 I BEND, INDIANA 46601-1830 %CITYOFSOUTHBEND PETE BUTT] GI EG, MAY'-" BOARD OF PUBLIC February 27, 2018 Samba Payne Girls on the Run Michiana 51160 Bittersweet Road, Suite 202 Granger, fN 46530 RE: Event: Girls on the Run 5K Date: May 12,2018 Dear Ms. Payne: PHONE 574/235-9251 FAx 574/ 235-9171 The Board of Public Works, at its meeting held on February 27, 2018, approved your request to conduct the above referenced event on May 12, 2018, from 7:00 a.m. to 10:00 a.m,, on the revised route approved by Police and 'rraffic & Lighting. Enclosed please find copy of your approved permit. The Police Department asks that runners may use the road, and all walkers must use the sidewalks. Further, the Police Department recommends that the walk start fifteen minutes after the run so the two can be differentiated for security purposes. All participants should obey all traffic laws. Police and volunteers will furnish an escort and traffic control. If I can be of any further assistance to you in this matter, please call me at (574) 23 5-925 1. Sincerely, 1) ft Linda M. Mal -tin, Clirk Enclosure c: Gene Eyster, Police Department Ed Gleckler, Traffic & Lighting GARY A. Gii,or SUZANNA M. FRITZBER(i ELIZABE-rii A. MARADIK JAMEs A. MUELLLR THERFSE, J. DORAIJ INTER -OFFICE MEMORANDUM BOARD OF PUBLIC WORKS DATE SENT: 10/9/2017 TO: d Gleckler, Traffic & Lighting Rodriguez, Fire Department AVederico Blatt Longfellow, Engineering Mara Wood, Park Department Lt. Gene Eyster, Police Department II Sciccitano, Downtown South Bend Marcia Qualls, Streets Legal Department FROM: Linda M. Martin, Clerk SUBJECT: PROCESSION RECOMMENDATION -Girls on the Run 5K SPONSOR: Girls on the Run-Michiana DATE OF EVENT: May 12, 2018 7:00am-10:00am DATE DUE: October 17, 2017 FAX OR E-MAIL TO: 235-9171 1 Imartin(a)_southbendin.gov RECOMMENDATIONS AND COMMENTS: BY Date �plS7liflt , APPLICATION FOR USE OF PUBLIC RIGHT-OF-WAY FOR PROCESSIONS �} The Board of Public Works must have FOUR (4) weeks prior notice of the Sponsor: Girls on the Run-Michiana Submitted By: Samira M. Payne Address: 51160 Bittersweet Rd Ste 202 City: Granger State: IN Zip: 46530 Phone: 574-703-1929 Email: samira.payne@girlsontherun.org Sponsor may use the public right-of-way described as (describe route and attach map) The event will start and end at Four Winds Field. We have received permission from Four Winds Field to host the event at this location. The proposed 5k route is attached PLEASE NOTE: THE SOUTH BEND POLICE DEPARTMENT RESERVES THE RIGHT TO CHANGE YOUR ROUTE FOR SAFETY PURPOSES Event name: Girls on the Run 5k ❑ The Board of Public Works must have FOUR (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 May 12 , 20 18 and no other date ❑ Registration time for the event starts at 7 a.m./p.m. ❑ Starting time of the procession is gam a.m./p.m. ❑ Estimated completion time is 10 am a.m./p.m. This event involves the use of the following roadways ® This event involves closure of City residential 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. ® This event is local/ gional/national event (Please circle the appropriate event type) ® This event will be coordinated with the property owner/business where staging will take place Updated 08/2017 2 PEI RNHT/AGRE E MENT FOR A PROCESSION I. 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. If this event results in closure of a residential street, all residents within the affected area must be notified of this event. The APPLICANT must make a reasonable attempt to notify all residents that reside on the block. A copy of a brochure or letter describing the event purpose, date, and time must be distributed to all affected neighbors and included with the application. 5. If this event results in closure of a residential street, the applicant is responsible, prior to the event, for determining if there are any residents affected that could potentially need assistance in accessing their residence. The applicant is responsible for providing said resident access or transportation to their property. 6, 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, 7. 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. S. Sponsor acknowledges that the Police Department reserves the right to change this route for safety purposes. 9. 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. 10. 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 p RETURN FOR o: 3 Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, IN 46601 Phone; (574) 235-9251 a Pax; (574) 235-9171 Printed Name Title OAR President Member D OF P LIC WORKS APPRC yam- Member I] Member RETURN FORM TO: 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 YZA-11 er Date 1 ® - ��oRD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 112912018 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(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 endorsoment(s). PRODUCER NFP Corporate Services (SE), Inc. 1901 Roxborough Rd., Ste. 300 Charlotte NC 28211 CONTACT NAME; Debbie Chia one PHONE FAX 704 464-4847 Alc No E-MAIL ADDREss: debbie.chiappone@nfi?.com INSURERISI AFFORDING COVERAGE NAIC # INSURER A: Philadelphia Indemnity Ins. Co 18058 INSURED GIRMICH INSURER B : Hartford Accident & Indemnity 223557 Girls on the Run Michiana 51160 Bittersweet Rd., Ste. 202 INSURERC: Granger IN 46530 INSURERD: INSURER E INSURER F r.nVFRerrFC f'512TII='Ir'ATF MIIMFIFR• 1RR7R-.r,7nin 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 MW�anYYY MM1�DYEXP lYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y PHPK1755036 2/1/2018 2/1/2010 EACH OCCURRENCE $1,000,000 CLAIMS -MADE L11 OCCUR DAMAGE TO RENTED PREMISES We occurrence $ 1,000,000 X MED EXP (Any one person) $ 5,000 AbuselMolestalio X Special Events PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP/Op AGG $ 3,000,000 POLICY ❑ PRO- JECT Fx] LOC $ OTHER: I A AUTOMOBILE LIABILITY PHPK1755036 2/112018 21112019 COMBINED SINGLE LIMIT Ea accident $ 000 000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS NON -OWNED X HIRED Ix AUTOS ONLY AUTOS ONLY BODILY INJURY (Per accident) $ PROPERTY DAMAGE PEr accident $ $ A X UMBRELLA LIAR X OCCUR PHUB611999 21f12018 21112019 EACH OCCURRENCE $10,000,000 AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED X RETENTION $ lo.ono $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNER/EXECUTIVE Y❑ 22WECEL3349 12/19/2017 12/19/2018 X I STATUTE I I ERH E.L. EACH ACCIDENT $ 100,000 OFFICERIMEMSER EXCLUDED? {Mandatory in NH) N 1 A E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below A Property; Special Form Replacement Cost PHPK1765M 211/2018 211/2019 Canlenls Limit: Deductible: 100,000 500 DESCRIPTION OF OPERATIONS! LOCATIONS! VEHICLES IACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: GOTR 5k event: Certificate holder and the following are included as additional insured(s) as respects to general liability for the operations of the named insured as required by written agreement or permit: Swing -Batter Swing LLC South Bend Cubs 501 W. South St. South Bend, IN 46601-2724 See Attached... C-FRTHIPWATF i4ni nFR CANCELLATION SHOULD ANY OF THE ABOVE. DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of South Bend, The South Bend Parks & ACCORDANCE WITH THE POLICY PROVISIONS. Recreation Dept. and The Board of Park Commissioners 321 E. Walter St. AUTHORIZED REPRESENTATIVE South Bend IN 46614-2642 1. l 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD