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HomeMy WebLinkAboutProcession - Embassy of Rwanda1316 COUNTY -CITY BUILDINU 227 W. JETFERSON BOULEVARD SOUTH BEND. I NMANA 46601-1830 CITY OF SOUTi-i BEND PETE BUTTiGIEG, MAYOR BOARD OF PUBLIC WORKS April 10, 2018 Philbert Mucyo Embassy of Rwanda 3 001 Trenton Court Mishawaka, IN 46545 RE: Event: Walk to Remember Date: April 27, 2018 Dear Mr. Mucyo: PHOM; 574/235-9251 FAX 574/ 235-9171 The Board of Public Works, at its meeting held on April 10, 2018, approved your request to conduct the above referenced event on April 27, 2018, from 4:30 p.m. to 6:00 p.m. on the designated route as submitted. Enclosed please find copy of your approved permit. Please note that participants must stay on the sidewalks and obey all traffic laws. If I can be of any further assistance to you in this matter, please call me at (574) 235-9251. Sincerely, Linda M. Martin, Clerk Enclosure c: Gene Eyster, Police Department Ed Gleckler, Traffic & Lighting Federico Rodriguez, Fire Department GARY A. Gti,o'r SLIZANNAM.FRITZBERG ELIZABETHA.MARADIK JAMEs A. MuF-'LLER THERESE J. DORAU TO: FROM: SUBJECT: SPONSOR: DATE OF EVENT: DATE DUE: FAX OR E-MAIL TO: INTER -OFFICE MEMORANDUM BOARD OF PUBLIC WORKS DATE SENT: 3/23/2018 NEd Gleckler, Traffic & Lighting Federico Rodriguez, Fire Department Matt Longfellow, Engineering Kara Wood, Park Department Lt. Gene Eyster, Police Department Jill Sciccitano, Downtown South Bend Marcia Qualls, Streets Legal Department , Linda M. Martin, Clerk' PROCESSION RECOIVI'ENDATION Embassy of Rwanda April 27, 2018 April 3, 2018 235-9171 1 Imartin6a7southbendin.gov RECOMMENDATIONS AND COMMENTS: By Date APPLICATION FOR USE OF PUBLIC RIGHT-OF-WAY FOR PROCESSIONS The Board of Public Works must have FOUR (4) weeps prior notice of the Sponsor: LAA,j .Q_t K'Alm-o'107 Submitted By: ✓ ,_... mu""' TM ,address: �.CL M.r City: State: Zip: 2_0- ',,��" Phone: L Email: 6' Sponsor may use the public right -of vyay described as (describe route and attach map) PLEASE NOTE: THE SOUTH BENT) POLICE DEPARTMENT RESERVES THE RIGHT TO CHANGE YOUR ROUTE FOR SAFETY PURPOSES Event name: ...;., wr:.. ' :_ \ The Beard of Public Works must have FOUR (4) weeks prior notice before event occurs All certificates of insurance, pre -paid costs, naps, and any other applicable information requested requiredor y Boardthe Works have been provided with this application The event shall lac heldf Pub is r 20-— and no other date ❑ Registration time for the event starts at a.rn. in., ❑ Starting time of the procession is�,a.m. p�u; f.. ❑ Estimated completion time is .. L a.m..mm, 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 (walls, 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 a event (Please circle the appropriate event type) ❑] This event will be coa"'pclinated with the property owner/business where staging will take place Updated. 08/2017 2 PERMIT/AGREEMENT 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. 8. 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 M RETURN FORM TO: 3 Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, 1N 46601 Phone: (574) 235-9251 • Fax: (574) 235-9171 Printed Name Title OARD OF PU LIC WOVS APPR zkpII_I d;�' C& President Member Member tuber O RETURN FORM TO: Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, IN 46601 Phone: (574) 235-9251 • Fax: (574) 235-9171 VAL Date EMBAOFT-03 MCHO ACUR[D� �� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 1/26/2018 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 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 (301) 231-6447 NAME: ONTACT Martens -Johnson Insurance Agency, Inc 6227 Executive Blvd Rockville, MD 20852 PHONE FAX AIC Exl : AIC No IL E-MAIL ADDRESS; INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Philadelphia Insurance Companies 6777 INSURED Embassy of the Republic of Rwanda INSURER B : INSURERC: 1875 Connecticut Ave NW #41$ INSURER D : Washington, DC 20009 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MMIODfYYYY POLICY EXP MMIDDfYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE -DAMAGE $ 1,000,00 CLAIMS -MADE ] OCCUR Y N PHPK1770031 1/3112018 1/31/2019 TO RENTED PREMISES La occurrence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL& ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 X JE PO - POLICY LOC PRODUCTS -COMP/OP AGO $ 2,000,00 $ OTHER: AUTOMOBILE LIABILITY COEa acMBcident INED SINGLE LIMIT $ 300,000 BODILY INJURY (Per person) $ A ANY AUTO N N PHPK1769918 113112018 1131/2019 BODILY INJURY (Per accident) $ ALL OWNED X SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4,000,00 HCLAIMS-MADE AGGREGATE $ 4,000,00 A EXCESS LIAR N N PHUB615959 1/3112018 1/3112019 DE❑ I X I RETENTION $ 10,000 $ WORKERS COMPENSATION EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE PER OTHAND STATUTE ER E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Excess policy is over General Liability policy only. Certificate Holder is listed as Addlitional Insured on the listed General Liability Policy. This is for a 1 day event on April 27, 2018 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Board of Public Works 227 West Jefferson THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1316 County- City Building South Bend, IN 46601-0000 AUTHORIZED REPRESENTATIVE ACORD 26 (2014101) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Ray & Joan Kroe Corps Community Center, South Bend 900 W Western Ave, South Bend, IN 46601 •«w Head east on W. 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