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HomeMy WebLinkAboutProcession - National MS Society1.31E COUNTY-0 FY BUILDING 227 W. JEFFERSON BOUI.F?i+r* R D S01JT1I BENDS INDIANA 46601-1830 CITY OF Sourti BEND PETE BUTTIGIEG, MAYOR 1*4,1'6701 OF PUBLIC WaRKK-- April 24, 2018 Jill Bennett National MS Society 3500 DePauw Blvd., Suite 1040 Indianapolis, IN 46268 RE: Event: Walk MS: South Bend Date: May 5. 2018 Dear Ms, Bennett: PHONE 574/235-9251 FAX 574/ 235-9171 The Board of Public Works, at its meeting held on April 24, 2018, approved your request to conduct the above referenced event on May 5. 2018, from 8:00 a.m. to 12:00 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 GA1 Y A. 1I,o"C" SUZANNA M. FR11%BF R(i Et,17,A131 'rH A. MARAD1K JAMF:s A. 11JJI1J1:LLER THF,RF'SE J, DORAU APPLICATION FOR USE OF 39 PUBLIC RIGHT-OF-WAY FOR PROCESSIONS The Board of Public Works must have FOUR (4) weeks prior notice of the event,* Sponsor: Z"_&&&1 644 Submitted By: P, tie Address: .3=g, jj)3e_ Ti? 14d. s4v. 1()q(D City: State: zip: Phone: Email: 4, 1 ( - �e haf,*1 a 619 r - 0 Sponsor may use the public right-of-way described uu�f � Event name: a The I (describe route and attach map) RESERVES THE RIGHT TO CHANGE YOUR ROUTE FOR SAFETY PURPOSES L M5 I %CVL -of Public Works must have FOUR (4) weeks prior 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 2— The event shall be held on 20� and no other date Registration time for the event starts at __LE1mVp.m. Starting time of the procession is 07 4ap.m. Estimated completion time is 1 Z- a.m.(n9 This event involves the use of the following roadways This event involves closure of City residential streets El This event involves County roads D This event involves State highways El This event involves use of a park (Must obtain permission from Park Board) , 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 4��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 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. 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. S. 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 TURN FORM To; 3 Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, IN 46601 Phone: (574) 235-9251 • Fax: (574) 235-9171 Printed Name Title. C"", 9AR. °OF P BLIC WOWKS APPROVAL � µ y President Member Member Member Member It;IaL'I`U N FORM TO: Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, IN 46601 Phone: (574) 235-9251 a Far: (574) 235-9171 �_/jl (--d )-C 1) ( -9 Jute I G' U-1 F m Q m x� 71 V A t L15IH jt4l! 4 cn . g .. Sf at l�J cn m CD . 3S 7�agIj n 19 rb ` n G �r -ter fl .ra M L, co '. .. jo D ( n 1 CL � , G � -� R5 H -- Es 03 Y� 00 rrE mud Z� a yn r z 2 � CO nC W �O c �c z z M m Do n n o n 3: 0 z tA C Gl a M m OZ z OW Q to _ -v O Z G) mm >> �o z� Mho MinLA �M l ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM)D➢NYYY) 12126f2017 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), AUTHOR12ED 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 endorsement(s). PRODUCER MARSH USA, INC. 445 SOUTH STREET CONTACT NAME: AIC N Ext : AIC No : E-MAIL ADDRESS: MORRISTOWN, NJ 01960-6454 Attn: Morristown.CertRequest@marsh.com Fax: 212-948-0979 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Federal Insurance Company 20281 INDIAN INSURED NATIONAL MULTIPLE SCLEROSIS SOCIETY INSURER B : ACE Property and Casually Insurance Com an 20699 INDIANA STATE CHAPTER INSURER C : INSURER D : 3500 DEPAUW BLVD, SUITE 1040 INDIANAPOLIS, IN 4626E INSURERE: INSURERF: COVERAGES CERTIFICATE NUMBER: NYC-009896976-16 REVISION NUMBER: 2 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 I TYPE OF INSURANCE POLICYNUMBER MMIDONYYY MMIDDfYYYY LIMITS A X COMM ERCIALGENERAL LIABILITY CLAIMS -MADE M OCCUR 358333-49 12131/2017 112012018 EACHOCCURRENCE S 1,000,000 PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL& ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ JECT PRO � LOC OTHER: GENERAL AGGREGATE g 2,000,000 PRODUCTS-COMP/OPAGG S 1,000,➢00 S A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY 7353-02-37 1213112011 12131/2018 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident S Comp/Coll Deductible S 1,000 B X UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE M00552835 007 1213112017 1213112018 EACH OCCURRENCE g 5,000,000 N AGGREGATE g 5,000,000 DED I X RETENTION $10 000 S A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y l N ANYPROPRIETORIPARTNE1)!EXECUTIVE OFFICERWEMBEREXCLUDED? � {Mandatory in NH) Byes, describe under DESCRIPTION OF OPERATIONS below NIA 71763467 12/31/2017 12/3112018 X P PER STATUTE OTH- ER E.L. EACH ACCIDENT S 1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 E.L. DISEASE- POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CITY OF SOUTH BEND AND BOARD OF PARK COMMISSIONERS ARE ADDED AS ADDITIONAL INSURED EXCLUDING WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY POLICY AS REQUIRED BY WRITTEN CONTRACT BUT LIMITED TO THE OPERATIONS OF THE INSURED UNDER SAID CONTRACT, AND ALWAYS SUBJECT TO THE POLICY TERMS, CONDITIONS AND EXCLUSIONS.