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HomeMy WebLinkAboutNon Res Block Party - St Joseph Grade School1316 COUNTY-Crry BUILDING 227 W. JEi;'rERSON BOULEVARD Soin,i-i BEND. INDIANA 46601-1830 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS May 22, 2018 Kathleen Kovach St, Joseph Grade School 216 N Hill Street South Bend, IN 46617 RE: Event Name: St. Joseph Grade School Field Day Street Closure: St. Louis St. from LaSalle Ave. to Colfax Ave. Dear Ms. Kovach: PHONE 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 6, 2018 from 8:15 a.m. until 2.45 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) 23 5-925 1. Sincerely, Linda M. Martin, Clerk Enclosure c: Gene Eyster, Police Department Ed Gleckler, Traffic & Lighting GAizy A. GILOT SUZANNA M. FRi,rZBEM ELIZABErij A. MARADIK JAMF,,,s A, MIJE1.1,ER TiIERESE J. DORM INTER -OFFICE MEMORANDUM BOARD OF PUBLIC WORKS DATE SENT 5/16/2018 TO: XEd Gleckler, Traffic & Lighting X�Brad Rohrscheib, Police Department �KMatt Longfellow, Engineering Chris Dressel, Community Investment Vederico Rodriguez, Fire Department Marcia Qualls, Engineering Aackie Appleman, Park Department fill Sciccitano, Downtown South Bend FROM: Linda M. Martin, Clerk Urw" SUBJECT: Non- Residential Block Party -St. Joseph Grade School Field Day Street Closure: St. Louis Blvd. from Lasalle Ave. to Colfax AMA e,- LOCATION: DATE AND TIME: June 6, 2018 7:15 a.m. to 2:45 p.m. SPONSOR: St. Joseph Grade School DATE DUE: May 0, 2018 FAX OR E-MAIL TO: 235-9171 1 Imartin6l southbendin.gov 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. Paid � ; Applicant Name: J 0 ePk (lid-luI ,L, -0b Address:�� �',i t ( �4� • City:. State: Zip: �((Q Phone: Email: I' VQ n 6 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 Location (Describe Area/Route) Street Closure Name of Street From To Date of Event ( (p 20 ❑ a.m. ED a.m. ❑ a.m. Time: Registration/Setup ❑ p.m. Start ) ❑ p.m. End I,, q j R P.M. Approximate Number of Attendees_ Answer the following appropriately: 1. This event will have music (live or other). a. I understand the Noise Ordinance described in the Agreement/Permit 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 Form 990 of Form 990-EZ are included with this application, and additionally filed with the Office of the City Clerk, 4'h Floor, County - City Building, 227 W. Jefferson Blvd., South Bend, Indiana. c. Certificate of Insurance d. Maps, drawings and setup plan of the area e. A copy of a flyer or door hanger that has been distributed to all affected property owners. 3. Yes ❑ No Yes ❑ No Yes ❑ No r Yes E No ❑ Yes ❑ No a. This event involves City streets 0 Yes ❑ b. This event involves County roads ❑ Yes [1 c. This event involves State highways ❑ Yes ✓Q' Updated 8/2017 No No No 1 d. This event involves the use of the sidewalk El Yes ❑ No e. This event is a (oc 1/regional/national event (Please circle the 0 Yes El No appropriate even type) f. Affected property/business owners have been notified of this event. Yes ❑ No g. There is/arc resident(s) affected by the event that may need ADA yes ❑ No transportation assistance to their residence. h. I understand that I must arrange a meeting with all affected governmental agencies to organize the above event (Call Marcia yes ❑ No Qualls, Customer Service Manager, 235-5939 to organize meeting). 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 (e.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. ❑ • Call the Alcohol & Tobacco Commission at (317) 234-4315 for more information. • Application cannot be processed without a copy of this license. City of South Bend, Indiana • Board of Public Works PERMIT AND AGREEMENT FOR THE USE OF THE RIGHT-OF-WAY FOR NON-RESIDENTIAL BLOCK PARTIES The Non-residential Block Party will be permitted to take place under the following terms and conditions: I. 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 hanger 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 form, 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 at the 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.m. 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 Bend Police Department. 13. IF ALCOHOL IS TO BE SERVED OR SOLD a Certified Check or Money Order for $400.0�0 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 after the event, and provided there is no damage to the area. Names, phone numbers, and qualifications (e.g. Off -duty police officer, professional security guard, or event APPLICANT) of THREE security guards to monitor underage drinking, must 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 Civil City of South Bend, Indiana, from any liability, 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 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. ight-of-Way for Special Events" 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 day of 20 . . .. . ...... APPLICANT Signature Printed Name BOARD OF PUBLIC WORKS APPROVAL President Member Member Member Member RE, TURN FORM TO: Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, IN 46601 Phone: (574) 235-9251 Date Date. 5/11/2018 Certificate of Coverage Certificate Holder This Certificate is issued as a matter of information only and The Diocese of Fort Wayne -South Bend, Inc. confers no rights upon the holder of this certificate. This certificate Chancery Office does not amend, extend or alter the coverage afforded below. P0Box 390 Company Affording Coverage Fort Wayne, IN 46801 THE CATHOLIC MUTUAL RELIEF SOCIETY OF AMERICA 10843 OLD MILL RD Covered Location St. Joseph Grade School OMAHA, NE 68154 216 North Hill South Bend, IN 46617 Coverages This is to certify that the coverages listed below have been issued to the certificate holder named above for the certificate 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 coverage afforded described herein is subject to all the terms, exclusions and conditions of such coverage. Limits shown may have been reduced by paid claims. Type of Coverage Certificate Number Coverage Effective Date Coverage Expiration Date Limits Property Real & Personal Property D. General Liability Each Occurrence 300,000 General Aggregate 2,000,000 Occurrence ® Claims Made 8679 10! I12017 10/1/2018 Products-Comp/OP Agg Personal & Adv Injury Fire Damage (Any one fire) Med Exp (Any one person) Excess Liability 8679 10/1/2017 10/1/2018 Each Occurrence Annual Aggregrate 3,000,000 Other Each Occurrence Claims Made Annual Aggregrate rLimitlCoverage Description of Opera tions/LocationsfVehicles/Special Items (the following language supersedes any other language in this endorsement or the Certificate in conflict with this language) Coverage only extends for claims arising out of St. Joseph Grade School's field day in which St. Louis Street will be closed from Colfax to LaSalle on June 6, 2018. Holder of Certificate Cancellation Additional Protected Person(s) Should any of the above described coverages he cancelled before the expiration date thereof, the issuing company will City of South Bend, IN 227 West Jefferson Blvd South Bend, IN 46601 endeavor to mail 30 days written notice to the holder of certificate named to the left, but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives. 0067003365 Authorized Representative G C-11 Q1 If A .. ........ µ _ cn ENDORSEMENT (TO BE ATTACHED TO CERTIFICATE) Effective Date of Endorsement: 6/6/2018 Cancellation Date of Endorsement: 617l2018 Certificate Holder: The Diocese of Fort Wayne -South Bend, Inc. Chancery Office P O Box 390 Fort Wayne, IN 46801 Location: St. Joseph Grade School 216 North Hill South Bend, IN 46617 Certificate No. 8679 of The Catholic Mutual Relief Society of America is amended as follows: SECTION II -ADDITIONAL_ PROTECTED PERSON(S) It is understood and agreed that Section II -Liability (only with respect to Coverage D - General Liability), is amended to include as an Additional Protected Person(s) members of the organizations shown in the schedule, but only with respect to their liability for the Protected Person(s) activities or activities they perform on behalf of the Protected Person(s). It is further understood and agreed that coverage extended under this endorsement is limited to and applies only with respect to liability assumed by contract or agreement; and this extension of coverage shall not enlarge the scope of coverage provided under this certificate or increase the limit of liability thereunder. Unless otherwise agreed by contract or agreement, coverage extended under this endorsement to the Additional Protected Person(s) will not precede the effective date of this certificate of coverage endorsement or extend beyond the cancellation date. Schedule - ADDITIONAL PROTECTED PERSON(S) City of South Bend, IN 227 West Jefferson Blvd South Bend, IN 46601 Remarks (the following language supersedes any other language in this endorsement or the Certificate in conflict with this language): Coverage only extends for claims arising out of St. Joseph Grade School's field day in which St. Louis Street will be closed from Colfax to LaSalle on June 6, 2018. .< 1, itit Authoriz Represev.e PKS-122(1 o- 11) internal lt1e vemitio SeirvIce Cinciinn af6, QH 46201 natoo- junr-� ,12, 2013 United States Conference of Catholic Bishops 3211 4t" Street, NE Washington, DC 20017-1194 Dear Sir/Madam: no- Pairtment't 09 the, Irtronstovy iR erso" to contarAa Roger Meyer IN 0110429 Tealif Firee ` ellepha"O Humber: 877-629-5600 Employer Hdontificatsarri W"611her: 53-0196617 GrOfAP Exeniptio'n Nuuir+lbewl 0928 This rosponds to your .tune 5, 2013, request for information regarding the status of your group tax exemption. our records indicate that you Warn Issued a determination letter In March 1946, that you are currently exempt frorn federal income tax under section 501(c)(3) of the I eternal Revenue Cods, and are M1ot a private fOLtndation within the meaning of section 509(a) of the Code because you are described in sections 509(a)(1) and 170(b)(1)(A)(I). With your request, you provided a copy of the Official C49th0irc D11-00tory for 2013, which includes the names and addresses of the agencies and instrurnentalltles and the educational, charitable, and religious institutions operated by the Boman Catholic Church in the United States, its territories, and possessions that are subordinate organizations under your group tax exelaaption. Your request indicated that each subordinate organization is a nonprofit organization, that no part of the net earnings thereof inures to tine benefit of any individual, and that no substantial part of their activities is for promotion of legislation. You have further represented that none of your subordinate organizations is a private foundation Linder section 509(a), although all subordinates do not all share the same sub -classification under section 509(a). Based on your representations, the subordinate organizations In the Official Catholic Oirectory for 2013 are recognized 05 exempt Linder section 501(c)(3) of the Code under ol^N 0928, Donors may doduct contributions to you and your subordinate organizations as provided in section 170 of the Code, t3equests, legacies, devises, transfers, or gifts to them or for their use are deductible for federal estate and gifts tax purposes if they meet the appilo able provisions of section 2055, 2-106, and 2522 of the Code, Subordinate organizations under a group exertaptian do not receive Individual exemption letters. Most subordinate organizations are not separately listed in PLIbifcation 78 or the Eo lousiness Master tile, Donors may verify that a subordinate organization is Included (N�Ot. Joseph Grade School Field Day May 31, 2017 8:30 AM - 2:45 PM At both St. Joseph School and Ackles Center Parking Lot Asldng city to allaw us to block off St, Louis, between Colfax and LaSalle for children crossing street between School and Ackles Canter, All activities held on Parish grounds — street to be closed for crossing of children