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Home My WebLink AboutPublic Parking Facility - LAZ Parking Midwest LLCINTER -OFFICE MEMORANDUM BOARD OF PUBLIC WORKS tit v&&cL,„ ter DATE SENT: TO: R W+Iketsoft Code Enforcement Federico Rodriguez, Fire Department , Matt Longfellow, Engineering Chris Dressel, Community Investment Y,Larry Magliozzi, Area Plan -/.Angela Smith, Area Plan, FROM: Linda M. Martin, Clerk SUBJECT: License Application foil Public Parking Facility LOCATION: LAZ Parking Midwest, LLC 1228 N. Eddy Street DATE DUE: February 6, 2018 FAX OR E-MAIL TO: 235-9171 I lmartin@southbondin.gov RECOMMENDATIONS AND COMMENTS: By Date 1 /23/2018 For all rnunlc�pa I business license questions, contact: City of South Bend Department of CornMUnity Mvestment 227 West Jefferson Blvd - Sulte 1400 S -South Bend, Indiana 46601 574.235.5912 - F: 4,23&,90ZI 7n -7 Oa -7 WWWRINATSIURVATROU M*H�� Imai!l�i�'l,irlilzLi'i�t,"?,-Tg-ff an MUNICIPAL CODE SECTION - 4-39 1, APPLICATION TYPE Check One: New ' Renewal x 11. BUSINESS DATA A. Business Name: LAZ Parking Midwest, LLC B, Business Address: 1228 N. Eddy Street City: South Bend State: -Indiana — ZIP: 46617 C. Mailing Address (If different from above): c/o Heather Mortimer 15 Lewis Street City: Hartford State: CT D. Business Telephone Number: 860.5223641 x7793 E. Business Fax Number: 8,60.524.8249 Zip: 06103 F. E-Mail Address: hmortimer@lazparking.com G. Maximum Number of Vehicles that can be parked at facility at one time: 1200 H. Total Number of Parking Spaces at facility, 1200 1. Hours during which vehicles may be stored: 24 Hours H, Premises are (check one): Leased by Applicant x Owned by Applicant If Leased: Owner's Name: Kite Reality Eddy Street Garage Owner's Business Address: 1234 N. Eddy Street, Suite 115 City: South Bend State: Indiana Zip: 46617 Owner's Residential Address: City: State: J. Insurance Carrier and Amount of Liability Insurance OR Bonding Agent and Amount of Bond: Broker: Amity Insurance Agency/ Lexington Insurance Company For Office Use Only Application Filed JAN 2 2 2018 Public Works Approval AN 2 2 2918 Application Fee Paid JAN 2 2 2013 License Fee Paid Sent to Dept JAN 2 2 2013 License Number AiTW vka Ment-d of Pi or Not Approved Reason 1 For all municipal business license questions, contact: city of South Bend Department of Community Investment 227 West Jefferson Blvd o Suite 1400 S -South Send, Indiana 466g1 574,235,5912 e F: 574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 Ill. PERSONAL DATA A. Applicant's Legal Name: Heather P. Nollez B. Residential Address: 15 Lewis Street City: Hartford State: CT Zip: 06103 C. Residential Telephone Number: 860.522.7641 x7793 D. Residential Fax Number: E. Cellphone Number: F. Position with Business: Corporate Compliance Officer IV. OWNERSHIP A. Type of ownership (check one): Limited Liability Sole Proprietorship (If sole proprietorship, proceed to 1). Company Partnership (If partnership, proceed to 2). Corporation (if corporation, proceed to 3). 1. Sole Proprietor Name: Residential Address: City: 2. Partnership (List at least two (2) partners) Name #1: Residential Address: City: Name #2: Residential Address: City: State: Zip: State: Zip: State: Zip: 3. Corporation Legal name of corporation: LAZ Parking Midwest, LLC Date and state of incorporation: Connecticut -Dec 08, 2008 2 For all municipal business license questions, contact: City of South Bend -Department of Community Investment 227 west Jefferson Blvd a Suite 1400 S -South Bend, Indiana 46601 0 574.235.5912 m F: 574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 IV. OWNERSHIP (Continued) A. Type of ownership (continued): 3. Corporation (continued) Resident Agent: Name: Corporation Service Company Title: Business Address: 251 East Ohio Street Suite 500 City: Indianapolis State: IN Officers: Name #1: Alan Lazowski Title: CEO Zip: 46204 Business Address: 15 Lewis Street City: Hartford State: CT Zip: 06103 Residential Address: 170 Scarborough Street City: Hartford State: CT Zip: 06103 Name #2: Michael J. Kuziak Title: COO Business Address: 15 Lewis Street City: Hartford State: CT Zip: 06103 Residential Address: 120 Bashan Road City: East Haddam Name #3: Jeffrey N, Karp State: CT Zip: 06423 Title: President & Secretary Business Address: 3 Copley Place City: Boston State: MA Zip: 02116 Residential Address: 36 Claypit Hill Road City: Wayland State: MA Zip: 01778 3 For all municipal business license questions, contact: City of South Bend -Department of Community Investment W West.lef€erson Blvd - Suite 1400 S -South Bend, Indiana 46601 - 574.235.5912 - F: 574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 V. INCLUDE COMPLETE RATE AND HOUR SCHEDULE WITH APPLICATION VI. INCLUDE COPY OF CURRENT INSURANCE POLICY OR BOND WITH APPLICATION VII. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION Vlll. AFFIRMATION I, hereby, certify and affirm that all of the information I have given in this application is true and accurate to the best of my knowledge. I further certify that I have in no way attempted to mislead the City in this application by omitting facts known tome. I have read and understand Ahe'regulations of the Public Parking Facility license found in the City of South Bend Municipal ' Code, Section 4-3%-" F 1/11/2018 Signature Date i 4 AC"R" CERT`IFICA TE LIABILITY IN U NCE �� ATE D/23/ )DDlY7 723/201 THIS CERTIFICATE 15 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 13Y THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), 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 Amity Insurance Agency, Inc. 500 Victory Rd. Marina Bay North Quincy MA 02171 CONTACT Frank Griffin NAME: PHONE (617) 471-122U FAfc No: (617)479-5137 A➢oRlEss:fgxaffxnQamxtyins.com INSURERS AFFORDING COVERAGE NAIL # INSURERA:Lexin ton Insurance Com an INSURED - LAZ Parking Midwest, LLC 33 West Monroe Street Suite 270 Chicago IL. 60603 INSURER B:Liberty Mutual Fire Insurance INSURERC:Federal insurance Com an INSURER D:Liberty Insurance Corporation INSURERE:American Guarantee & Liability INSURERFIThe Ohio Casualty Company COVERAGES CERTIFICATE NUMBER:17-18 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 BF 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 ADUL INSR SUER WVO POLICY NUMBER POLICY EFF MMIDD)YYYY POLICY EXP MMI➢D)YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIA131LITY DAMAGE TO PREMISES (ES a occu ence) $ 11000,000 MED EXP (Any one person) $ EXCLUDED A 7 CLAIMS -MADE WOCCUR 013135971 /31/2017 /31/2018 PERSONAL & ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2,000,000 $ POLICY PRO X LOC AUTOMOBILE LIABILITY E� aaadenDtSINGLE LIMIT $ 11 000100 0 BODILY INJURY (Per parson) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X AUTOS NON-OWNED S2611260451017 /31/2017 /31/2018 BODILY INJURY (Per accident) $ Perr a cidentPOrDAMAGE $ * UMBRELLA LIAR X OCCUR SEE ATTACHED EACH OCCURRENCE $ 100,000,000 * AGGREGATE $ 100, 000, 000 EXCESS LIAR CLAIMS-MADELIST OF EXCESS POLICIES /31/2017 /31/2018 DED RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE � OFFICERIMEMBEREXCLUDED? (Mandatory In NH} NIA A561D260451027 /31/2017 J31/2018 � WC STATU- OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 11000,000 E.L. DISEASE - POLICY LIMIT $ 11000,000 If yes, describe under DESCRIPTION OF OPERATIONS belav A GARAGEKEEPERS LIABILITY 013135971 /31/2017 /31/2010 $1,0DO,000LIMIT C CRIME/EMPLOYEE DISHONESTY 82224802 /31/2017 /31/2018 $1.000,000LIMIT DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space is required) If agreed upon in a written contract or agreement, City of South Bend is included as an additional insured for general liability per CGL Form #LX9466, but only with respect to the operations of the named insured. Re: 100903 - Eddy Street Commons at Notre Dame UL:K I H-16A I r PIULUrK 4HIVl.rGL.LN 1 IUIV City of South Bend Attn: Michelle Adams 227 W. Jefferson. Boulevard Suite 1400 S 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 Griffin/FG ��-.� ACORD 25 (2010105) I NS025 (201005).01 (01988-2010 ACORD CORPORATION: All rights reserved. The ACORD name and logo are registered marks of ACORD