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HomeMy WebLinkAboutPublic Parking Facility - MC Investments LLCINTER -OFFICE MEMORANDUM BOARD OF PUBLIC WORKS DATE SENT: 215I2018 TO: 4Randy Wilkerson, Code Enforcement ederico Rodriguez, Fire Department Matt Longfellow, Engineering Chris Dressel, Community Investment Larry Magliozzi, Area Plan Angela Smith, Area Pla FROM: Linda M. Martin, Clerk SUBJECT: License Application for Public Parking Facility -Renewal MC Investments LLC LOCATION: 123 N. Main St DATE DUE: 02/06/2018 FAX OR E-MAIL TO: 235-9171 1 lmartin@southbendin.gov RECOMMENDATIONS AND COMMENTS: By Date For all municipal business license questions, contact: City of South Bend Department of Community Investment 227 West Jefferson 13M - Suite 1400 S -South Bend, Indiana 46601 0 574.235.5912 . F: 574,235,9021 339 L)- LICENSE APPLICATIION'FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION 1. APPLICATION TYPE Check One: New 11. BUSINESS DATA A. Business Name: MC Investments LLC Renewal X B, Business Address: 123 N. Main Street City: South Bend State: IN' C. Mailing Address (if different from above): 1428 Hamilton Avenue City: Cleveland State: OH D. Business Telephone Number: 2168570262 E, Business Fax Number: 2167811960 F. E-Mail Address: mfclpa@aol.com 0,10=1 G. Maximum Number of Vehicles that can be parked at facility at one time: 55 H. Total Number of Parking Spaces at facility: 55 I. Hours during which vehicles may be stored: H. Premises are (check one): Leased by Applicant _ Owned by Applicant X If Leased: Owner's Name: Owner's Business Address: City: Owner"s Residential Address., City: State: . Zip: State* Zip: J. Insurance Carrier and Amount of Liability insurance OR Bonding Agent and Amount of Bond: Attached For Office use Only Application Filed JAN 3 1 nm Public Works Approval Application Fee P;a17d1l I License Fee Paid Sent to Dept. JAN R I 2nip -License Number Not Approved Reason 11 al=lm mw� For all municipal business license questions, contact: City ofSouth Bend - Department of Community Investment 227 West efferson Blvd a Suite 1400S -South Bend, Indiana 46601 - 574.235.5912 - F: 574.235.9021 LICENSE APPLICATION FOR PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION 4-39 111. PERSONAL DATA A. Applicant's Legal Name: Michael Coyne B. Residential Address, 1428 Hamilton Avenue city: Cleveland State: OH zip: 44114 C. Residential Telephone Number.. 2168570262 D. Residential Fax Number: E. Cellphone Number: j F. Position with Business: Manager IV, OWNERSHIP A. Type of ownership (check one): -Sole Proprietorship (If sole proprietorship, proceed to 1). Partnership (if partnership, proceed to 2). X Corporation (if corporation, proceed to 3). 1. Sole Proprietor Name: Residential Address: City: State: Zip: Telephone Number: 2. Partnership (List at least two (2) partners) Name #1: Residential Address: City: State: Zip: Telephone Number: Name #2: Residential Address: City: State: Zip: Telephone Number: 3. Corporation Legal name of corporation: Mary Coyne Investments LLC Date and state of incorporation- 1998 Ohio 2 .............. .. ....... .. .. .. . For all Municipal business license questions, contact: City of South Bend a Department of Community Investment 227 West Jefferson 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 IV. OWNERSHIP (Continued) A. Type of ownership (continued): 3. Corporation (continued) Resident Agent: Name: Jackie Stevenson Title. Manager Business Address: 514 S. West Street city: South Bend State: IN zip: 46544 Officers: Name #1: Mary Coyne Title: Member Business Address: 1428 Hamilton Avenue City: Cleveland State: OH Zip: 44114 Residential Address: City: State: Zip: Name #2: Title: Business Address: City: State: Zip: Residential Address: City: State: Zip: Name #3: Title: Business Address: City: State. Zip: Residential Address. City: State: Zip-, For all municipal business license questions, contact: City of South Bend • Department of Community Investment 227 West Jefferson 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 A CURRENT INSURANCE POLICY OR BOND VII. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION Vill. 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 to me, I have read and understand the regulations of the Public Parking Facility license found in the City of South Bend Municipal Code, Section 4-39. Signature Date 4 Michael F. Coyne Attorney and Counsellor at Law 1428 Hamilton Avenue Cleveland, Ohio 44114 USA 216.857.0262 January 24, 2018 Michelle Adams Business License Administrator City of South Bend 227 W. Jefferson Blvd. South Bend, Indiana 46601 Re: License Renewals Dear Michelle: Enclosed please find two license renewals for our two lots and two checks to cover application fees and license fees. Thanks! Very truly yours,. r Michael F. Coyne Enclosures COYNIF-3 OP ID: MG r - ���1� CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDDIYYYYI 01/31/2018 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 440-461-1101 Todd Associates, Inc. 23825 Commerce Park, Suite A Beachwood, OH 44122 Randy J. Cumley NC RAP CT Randy J. Cumley PHONE 440-461-1101 FAX 440-446-0192 (A/C, No, Ext): IArC, No): ADaRIESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Valley Forge Ins. Co. 20508 INSURED Mary Coyne Investments, LLC Coyne Investments Ltd. 1428 Hamilton Ave INSURERB:American Casualty Co.ICNA 20427 INSURER G:CNA Financial Corp. 20443 Cleveland, OH 44114 INSURERD: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER' 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�TYPE LTR OF INSURANCE DDL INSD UDR WVD POLICY NUMBER POLICY EFF MMIDD POLICY EXP IDDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR 6045941880 02/14/2017 02114/2018 _ EACH OCCURRENCE 1,000,DOD $ PREMISES DAMAGE T�oNcT1EDnCe $ 500,000 GEN'L MED EXP An ane Verson 000 $ 15,— PERSONAL&ADVINJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO-LOG OTHER:13 GENERAL AGGREGATE 2,000,000 PRODUCTS-COMPIOPAGG 2,000,000 $ AUTOMOBILE LIABILITY X ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS RffiD ONLY AUOP611WN OY 6045941894 02114/2017 02114/2018 COMBINEDSINGLE LIMIT Ea accident 1,000,000 $ BODILY INJURY Per person)$ BODILY INJURY Per accident $ �OaP CRIYt AMAGE Pe as $ $ C X UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE GUE6045941913 02/14/2017 02114/2018 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DFD TX RETENTION$ 10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETORIPARTNERIEXECUTIVE ❑ ({J anda(ory In NH) PXGLUDED7 If yes, describe under DESCRIPTION OF OPERATIONS below NIA SER TE OTH- E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ _T I CJIP{f111i(°Iaft01P A JOU 161§AenON)LVE�S (ACORD 101, Additional Remarks Schedule, may 6a attached If more space is required) .1123 N Main St, JSiouJthUBtf"ient3d, IN 46601 1 CITY -SOB SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of South Bend ACCORDANCE WITH THE POLICY PROVISIONS. Michelle Adams Business License Administrator 227 W. Jefferson Blvd. AUTHORIZED REPRESENTATIVE South Bend, IN 46601 (rf I � ACORD 25 (2016/03) ©1988-2015 AGORD CORPORA I ION. All rignts reservec[. The ACORD name and logo are registered marks of ACORD