HomeMy WebLinkAboutNon Res Block Party - Kite Realty - Family Fun Day1316 COUNTY -CI Y BuILDING
227 W. JEFFERSON BOULEVARD
Soui-i-i BEND, INDIANA 46601-1830
CITY OF SOUTH BEND PETE BU'I-I'IGIEG, MAYC
BOARD OF PUBLIC WORK I
May 22, 2018
Taryn Ford
Kite Realty Group
30 S. Meridian Street
Indianapolis, IN 46204
RE: Event Name: Family Fun Day
Street Closure: Eddy St. from, Angela Blvd. to Napoleon St.
Dear Ms, Ford:
8 HOM-1, 574/235-9251
FAX 574/ 235-9171
The Board of Public Works, at its meeting held on May 22, 2018, approved your request to close the
above referenced street for your event scheduled for June 9, 2018 from 8:00 a.m. until 2:00 p.m. For
your information, the South Bend Police Department will monitor this event. Enclosed please find a
copy of your approved permit.
The Bureau of Traffic and Lighting will deliver barricades necessary to close the street to the
applicant's address. You will be responsible for their placement .and removal at the conclusion of the
closing of various streets. Please note that a ten foot (10) clear and unobstructed lane must be
maintained at either curb or down the center of the street for emergency purposes and that no fires are
allowed in the street, The Applicant will be liable for the replacement cost of $50.00 per cone as
a result of any missing or damaged cones.
If you have any further questions regarding this matter, please call this office at (574) 235-925 1.
Sincerely,
Linda M. Martin, Clerk
Enclosure
c: Gene Eyster, Police Department
Ed Gleckler, Traffic & Lighting
GARY A. Git,o'j, SUZANNA M. FRITZBERG ELIZABEIE A. MARADIK JAMEs A. Mur,,,i,i,r�R THERESF J. DORAU
INTER -OFFICE MEMORANDUM
BOARD OF PUBLIC WORKS
DATE SENT 5/10/2018
TO: Ed Gleckler, Traffic & Lighting
G"e-Eyster, Police Department ?0 '-ScJ� b
Matt Longfellow, Engineering
Chris Dressel, Community Investment
-dFederico driguez, Fire Department
. a , Engineering
O?dackie Appleman, Park Department
Jill Sciccitano, Downtown South Bend
FROM: Linda M. Martin, Clerk`f
SUBJECT: Non- Residential Block Party -Family Fun Day
Street Closure:Eddy St from Angela Blvd to Na oleon
LOCATION:
DATE AND TIME: June 9, 2018 8:00 a.m. to 2:00 p.m.
SPONSOR: r -Cao � m vuwon�
DATE DUE: May 15, _2018
FAX OR E-MAIL TO: 235-9171 1 Imartin southbendin. ov
RECOMMENDATIONS AND COMMENTS:
By Date
APPLICATION
FOR USE OF AND BLOCKING OF ACCESS TO THE PUBLIC
RIGHT-OF-WAY FOR NON-RESIDENTIAL BLOCK PARTIES
The Board of Public Works must have FOUR (4) weeks prior notice of the event.
A NON-REFUNDABLE APPLICATION FEE OF $125.00, IN THE FORM OF A CERTIFIED
CHECK OR MONEY ORDER, PAYABLE TO THE CITY OF SOUTH BEND, MUST BE
INCLUDED WITH APPLICATION.
Fee Paid d
Applicant Nairte: Fib � /� r/
Address: City: ijsStajte�: p� Zip:"
Phone: �•� �� Email:'' 1 G�QvG4
W
This application is made to the City of South Bend, Indiana, Board of Public Works, for the use of the
specified public right-of-way
+by Applicant for the holding of the hereinafter described event:
Event Name I 1 r l
Location
Street Closure
Udw "(41- OWMA6
w S i (Describe Area/Route)
Name orstreet -�•f
From n G a f'lf
To
Date of Event1...G;_ 20
da.m.
Time: Registration/Setup ❑ p,m
Approximate Number of Attendees
Start El p.m. End �i ❑f
C".i p
.Answer the following appropriately:
1, This event will have music (live or other).
Yes ❑ No
a. I understand the Noise Ordinance described in the Agreement/Permit
[Vl Yes ❑ No
2. Required Information to Accompany Application
a. Certified Check or Money Order in the Amount of $125.00, or:
b. For Certified Nonprofit Organizations: Copies of the 501(c)(3)
Internal Revenue Exemption Status Document and a current copy of
Forth 990 of Form 990-EZ are included with this application, and
❑V Yes ❑ No
additionally filed with the Office of the City Clerk, 4th Floor, County -
City Building, 227 W. Jefferson Blvd., South Bend, Indiana.
c. Certificate of Insurance
`
d. Maps, drawings and setup plan of the area
d Yes ❑ No
e. A copy of a flyer or door hanger that has been distributed to all
affected property owners.
❑� Yes ❑ No
3.
a. This event involves City streets
Yes No
b. This event involves County roads
❑ Yes No
c. This event involves State highways
❑ Yes No
Updated 8/2017
1
d. This event involves the use of the sidewalk
Yes
❑ No
e. This event is a oca /regional/national event (Please circle the
9
appropriate even pe)
Yes
❑ No
f Affected property/business owners have been notified of this event.
[� Yes
❑ No
g. There is/are resident(s) affected by the event that may need ADA
transportation assistance to their residence,
Yes
❑ No
h. I 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).
Yes
❑ No
IF ALCOHOL IS TO BE SERVED OR SOLD
Alcoholic beverages will be served ❑ Alcoholic beverages will be sold ❑
Certified Check or Money Order for $400.00 must be submitted with application. ❑
• Application cannot be processed without deposit.
• Deposit will be returned upon inspection of event area by the Board of Public. Works.
Names and phone numbers of THREE security guards ❑
• To monitor underage drinking.
• Qualifications must be listed (c.g. Off duty police officer, professional security guard, or event
APPLICANT),
A drawing must be submitted showing: ❑
• Fencing around serving area
• Trash receptacles.
o Ample trash receptacles must be provided to ensure proper disposal of refuse.
Temporary liquor license. El® Call the Alcohol & Tobacco Commission at (317) 234-4315 for more information.
• Application cannot be processed without a copy of this [icense.
City of South ]Bend, Indiana a Board of Public Works
PERMIT AND AGREEMENT FOR THE USE OF
THE RIGHT-OF-WAY FOR NON-RESIDENTIAL BLOCS: PARTIES
The Non-residential Block Parry will be permitted to take place under the following terms and
Conditions:
1. Pursuant to Local Ordinance No. 10224-13, there is a $125.00 non-refundable fee for non-
residential Block Parties. Non-profit organizations meeting Section 501(c)(3) of the Internal
Revenue Code are exempt from the fee provided copies of the 501(c)(3) Internal Revenue
Exemption Status Document and a current copy of Form 990 of Form 990-EZ are filed with this
application and with the Office of the City Clerk, 4th Floor, County -City Building, 227 W,
Jefferson Blvd., South Bend, Indiana.
2. The APPLICANT must comply with all terms and conditions of this Permit and Agreement.
3. All residents and businesses within the affected area must be notified of this event. The
APPLICANT must obtain signatures from and/or has made an attempt to notify all residents that
reside on the block. A copy of a brochure or door Danger distributed to all affected
residents/businesses describing the event purpose, date, and time must be included with the
application.
4. The applicant is responsible, prior to the event, for determining if there are any residents or
business owners affected that could potentially need assistance in accessing their property. The
applicant is responsible for providing said resident/business owner transportation to their
property.
5. The APPLICANT shall reimburse the Board for the actual cost to the City for the event, if
deemed necessary.
6. APPLICANT shall include a flyer or letter describing the details of the event.
7. Notification of approval/denial of this request will be issued by return of this fonn, upon signed
authorization by the Board of Public Works.
S. The APPLICANT 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.
9. The APPLICANT assumes full responsibility for providing ample disposal containers for
refuse/recycling and assures the area will be cleaned up upon the conclusion of the event.
10. Barricades will be delivered and picked up atthe event location. The APPLICANT is responsible
for seeing that all cones are maintained and returned undamaged.
11. The APPLICANT will follow the City of South Bend Noise Ordinance, which is in effect at all
hours. Between the hours of 11:00 p.rn. and 7:00 a.m. certain noises are particularly prohibited.
These include operating radio receiving sets, musical instruments, phonographs and other sound
reproduction devices if audible fifty (50) feet away, as well as shouting, yelling, hooting,
whistling, or singing in the streets in a manner to disturb the peace (Municipal Code 13-57).
12. The APPLICANT assures the City that the area will be closed during the times indicated on the
application only. Event end times are pursuant to the recommendations of the South Bond Police
Department,
13. IF ALCOHOL IS TO BE SERVED OR SOLD a Certified Check or Money Order for $400.00
must be submitted with application. The application cannot be processed without a deposit. The
deposit will be returned by the Board of Public Works upon inspection of the event area afterthe
event, and provided there is no damage to the area. blames, phone numbers, and qualifications
(0.9- Off -duty police officer, professional security guard, or event APPLICANT) of THREE
security guards to monitor underage drinking, rnust be submitted with the application. A drawing
Must be submitted showing fencing around serving area, and trash receptacles. For a temporary
liquor license call the Alcohol and Tobacco Commission at (317) 234-4315 for more
information. Application cannot be Processed without a copy of this license,
14. APPLICANT agrees to indemnify, defend and hold harmless the I City it
Indiana, from any liability, Civil Ci Of South Bend,
loss, 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 the activity, arising out of the approval of this
request by the Board of Public Works to close a portion of the public right-of-way for the event
described above.
I have read the Application and Permit and the Agreement for the "Use of Right -of -Way for Special
Eovents" and I understand and agree to the above rules and regulations. I also understand that this
application may be denied based on any false or incomplete information,
Dated this 10- day of Mllt4 20
APPLICANT Signature
Printed Name 100 V1 I h'
77-
0, RTC OF PU LIC WORKS APPROVAL
resident Member
Member ber
Member Date
RETURN FORM TO:
Board of Public Works
1316 County -city Building
227 West Jefferson Boulevard
South Bend, IN 46601
Phone: (574) 235-9251
SIV Ifa
A�COR�® CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDfYYYY)
212712018
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
Commercial Lines - (404) 923-3700
US] Insurance Services National, Inc.
3475 Piedmont Road NE, Suite 800
Atlanta, GA 30305-2886
CONTACT NAME: Tim Baumann
PHONE
AtCo Ext : 470 875 0517 FAX 610 537-1929
AIC ...
ADORE S: tim.baumann@usi.com
INSURER(S) AFFORDING COVERAGE
NAIC#
INSURERA: Endurance Assurance Corporation
11551
INSURED
Kite Realty Group Trust
30 S. Meridian St.,
Suite 1100
Indianapolis, IN 46204
INSURER B : Allied World National Assurance Co,
10690
INSURER C : Sompo America Insurance Company ��—
11126
-
INSURER D 7
INSURER E ;
_
INSURERF;
COVERAGES CERTIFICATE NUMBER: 12774275 REVISION NUMBER: See below
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
MMIDDNYYY
POLICY EXP
MMfDDIYYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE Pfl OCCUR
GGR10012604100
03/01/2018
03/01/2019
EACH OCCURRENCE
S 1,000,000
DAMAG
PREMISES' U(EHaeccurrence
S _ 1,000,000
MED EXP (Any one person)
$ Excluded
PERSONAL &ADV INJURY
S 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
JECTPRO-
POLICY PRO- X LOG
OTHER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMPIOP AGG
$ 2,000,000
_.
5
A
AUTOMOBILE LIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
X HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
ACVS100810
03/01/2018
03/01/2019
EeaccdenntSINGLELIMIT
S 1,000,000
BODILY INJURY (Per person)
S
BODILY INJURY (Per accident)
5
PROPERTY DAMAGE
Per accident
5
s
B
X
UMBRELLALIAB
EXCESS LIAB
X
I OCCUR
CLAIMS -MADE
3088008
03/01/2018
03/01/2019
EACH OCCURRENCE
5 25,000.000
AGGREGATE
$ 25,000,000
DEfa X RETENTION 5,000
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETORIPARTWRIEXFCUTIVE
OFFICERIMEMBEREXCLUDED? C
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N1A
WCN31015PO
03/01/2018
03/01/2019
X STATUTE ET'-
E.L. EACH ACCIDENT
1.000,000
$
E.L. DISEASE - FA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Re: KRG Eddy Street Commons, LLC , Eddy Street Commons 1044-1234 Eddy Street, South Bend, IN 46601
CERTIFICATE HOLDER CANCELLATION
City of South Bend
Department of Public Works, Engineering Division
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
227 W Jefferson Blvd., Suite 1316
AUTHORIZED REPRESENTATIVE
South Bend, IN 46601
The ACORD name and logo are registered marks of ACORD @ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03)
IL 67,
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