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HomeMy WebLinkAboutProcession - Buffalo Soldiers MC South Bend1316 COUNTY-Cin BuiLDING 227 W.JFFFERSON Bot-ILEVARD S01TH I BEND. INDIANA 46601-1830 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS William Lottic Buffalo Soldiers MC South Bend 914 Lincolnway West South Bend, IN 46616 RE: Event Name: 111V Prevention Motorcycle Ride Date: June 23, 2018 Dear Mr. Lottie: PFK)NF 574/235-9251 FAx 574/ 235-9 171 The Board of Public Works, at its meeting held on May 8, 2018, approved your request to conduct your motorcycle procession on June 23, 2018, beginning at 9:00 a.m. and ending at approximately 3:3 0 p.m. on the revised route beginning at Charles Martin Center progressing up Riverside Drive to Cleveland Road. Enclosed please find copy of your approved permit. Participants must obey all traffic laws. Please note the Police Department will not provide any escort service upon your return to the City. Also, please coordinate your route with Pfc. Rohrscheib of the South Bend Police Department. If you have any further questions regarding this matter, please call this office at (574) 235- 9251. Since ely, Linda M. Martin, Clerk Enclosure c: Pfc. Rohrscheib, Police Department Ed Gleckler, Traffic & Lighting Federico Rodriguez, Fire Department GARY A. Gii...o'r StJZANNA M. FRITZ111-Rc, Ei,IZA13Ei'ij A. MARADIK JAMLs A. M(xi'lER TH[�'RESE J. DORAU INTER -OFFICE MEMORANDUM BOARD OF PUBLIC WORKS DATE SENT: 4/5/2018 TO: Ed Gleckler, Traffic & Lighting Federico Rodriguez, Fire Department Matt Longfellow, Engineering KIKara Wood, Park Department Lt. Gene Eyster, Police Department Jill Sciccitano, Downtown South Benc Marcia Qualls, Streets Legal Department FROM: Linda M. Martin, Clerk SUBJECT: PROCESSION RECO �MENDATIOWHIV Prevention Motorcvcle Ride SPONSOR: Buffalo Soldiers MC South Bend DATE OF EVENT: June 23 2018 9:00 a.m. to 3:30 p.m. DATE DUE: April 17, 2018 FAX OR E-MAIL TO: 235-9171 1 lmartin southbendin, ov RECOMMENDATIONS AND COMMENTS: By Date APPLICATION FOR USE PUBLIC RIGHT-OF-WAY FOR PR+ The Board of Public Works must have FOUR (4) we( sponsor: �� SubmittedBy: p t, f y: Address: City:Kil;„: �yttie d� State: Gip: �' Phone: µ `' , 1,�µ , / Email: �; „ w.�. , a r5l j c (,.,) Nix" Sponsor may use the public right-of-way described as (describe route and attach snap) PLEASE NOTE: THE SOUTH BENDS POLICE DEPARTMENT RESERVES THE RIGHT TO HAN E YOUR ROUTE FOR SAFETY PURPOSES Event name: VA IG �� �C �.. - ❑ The Board of Public Works must have FOUR (4) weeks prior notice before event occurs LZ All certificates of insurance, pre -paid costs, amps, and any other applicable information requested or required by the Board of Public Works have been provided with this application ❑'i The event shall be held on z'o 1 + 1. , 20 and no other date ❑ Registration time for the event starts at ''p.m. ❑ Starting time of the procession is ) X 0 6 a.m. m. ❑ Estimated completion time is :310a.m. " .m This event involves the use of the following roadways ❑ This event involves closure of City residential streets R This event involves County roads This event involves State highways ❑ This event involves use of a park (Must obtain permission from Park Board) KI I understand that I must arrange a meeting with all affected governmental agencies to organize the above event (Call Marcia (walls, Customer Service Manager, 235-599 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 oca regional/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. 5. 1f 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 a , TURN Fb T : Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, IN 46601 Phone: (574) 235-9251 e Fax: (574) 235-9171 Lo-I Printed Name I Title RE S't�oQN. 04I�JF io Sz4hj(.RS, r016 OARD OF PUBLIC WORKS APPROVAL A_ -I / f�" X-jx)� d'�q_d President M mber Member Member 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 �5-&�`��� Date CERTIFICATE OF' LI ILI ' INSURANCE DATE (MMIDDOYYYY) 4/2/ p18 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOE'S NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE IPOLICIES 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(iesp must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditionsof 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 CONTACT" NAME Angel Karbalaeali GIBSON INSURANCE AGENCY, INC. (SOUTH BEND, IN) PHONE (AIC No, Ext): (574) 245-3547 FAX (A/C No): (574) 236-6399 130 S. Malin St., Suite 400 EMAIL ADDRESS: South Bend„ IN 46601 INSURER(S) AFFORDING COVERAGE NAIL # INSURED INSURER A: Mount Vernon Fire Insurance Company 26522 INSURER B: Imani & Unidad Inc. 914 Lincoln Way W INSURER C., South Bend„ IN 46616 INSURER D: 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, NSR LTR TYPE OF INSURANCE ADDL INSR SUBR WWVD POLICY NUMBER POLICY EFF IMMIDDNYYY) POLICY IFXP (MMJDD✓YYYY) LIMITS GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE r OCCUR X CI.. 27,2787�B 6123120/8 612512t118 PEACH OCCURENCE Pa. Q sENTErrence) ... ��tER $1,000,000 - $100.;000 MED EXP (Any one person) $1,00D PERSONAL BADVINJURY $1,000,000 GENERAL AGGREGATE $3,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY PRO,- LOC PRODUCTS-COMPIOP' AGG, 'See See L-535 $ AUTOMOBILIE LIABILITY ANY AUTO ZI.. OU4NF.D SSHEr7ULED HIRED AUTOS ANp%Cl$W1RdE0POare (E g�NEDt1 INGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ c,d nl?AfNAGE $ $ UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSASION AND EMPLOYERS„ LIABILITY ANY PROPRIETORIPARTNERlEXECUTIVEY/N (WanSERJM�n NIir EXCLUDED? atory D fl5Ra�PAeFUPERATdON,helow NIA T(}Tt LIhAITS O E.L.EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE-POL(CYLIMf7 $ ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (See attached Acord' 101 for addlllonal liability Limits) ;ity of South wend is an additional insured per CG 2011 04 13. ER11FICNIE HOLDER CANCELLATION ity if South Bend 27 West Jefferson Boulevard oath' Bend', IN 46601 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION'... DATE THEREOF„ NOTICE WILL BE DELIVERED IN ACCORDANCE WWITH THE. POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 25 (2010/05) Copyright 1988-2010 ACORD The ACORD name and logo are registered marks of ACORD reserved. AGENCY CUSTOMER ID: 4579 LOG : All Fat 11111"[01 IL F-1 W 114-J F,1 ZIII 1*1.1�I AGENCY GIBSON INSURANCE AGENCY„ INC. (SOUTH BEND, IN) POLICY NUMBER CL 2727878 CARRIER Mount Vernon Fire Insurance Company INSURED Imani & Unidad Inc. 914 Lincoln Way W South Bend, IN 46616 NAIL CODE 26522 EFFECTIVE DATE: 6/23/2018 Page 1 of 1 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE COVERAGE PART LIMITS Commercial Liability Each, Occurrence Limit $1,000,000 Personal & Advertising Injury Limit (Any One Person/Organization) $1,000,000 Medical Expense Limit (Any One Person) $1,000 Damages To Premises Rented To You (Any One Premises) $100,000 Products/Completed Operations Aggregate Limit See See L-535 General Aggregate Limit $3,000,000 ACORD 101 (2008/01) Copyright 2008 ACORD CORPORATION. Ali rights reserved. South Bend Chapter Buffalo Soldiers MC Proposed Route through South Bend, IN HIV Prevention Benefit Ride .tune 23, 2018 12:00 pm Leave Charles Martin Youth Center 802 Lincolnway West West on Lincolnway West to Diamond Avenue Right on Diamond Avenue to roundabout exiting on Riverside Drive Continue on Riverside Drive to Cleveland Right onto Cleveland turning onto Old Cleveland Road to County Line Road ur. LU � sir. � : -•� 3s ' • ,- k uZE L�lJG! St LIJ tg FrOr i p R 1� r 3 1 A Y Y Y A A■ V � hY c Fiibbb rr�pp}�l �■r; F w �j 0 a (1 s fn U7 U3 - ra L) +I + [] 111 A� m i^ CtiJ tY? '{I' Ln ko I — a q E� 0? a bR w # ti. L. L. f - CL N +:� ` is i ......