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Home My WebLink AboutProcession - Family Justice Center1316 COUNTY -CITY BUILDING 227 W. JF!Flml RSON BOULEVARD SOUTIi B NI"). INDIANA 46601-1830 SOUTHCITY OF BuTTiGIF.G, MAYOR BOARD OF PUBLIC June 12, 2018 Amy Stewart -Brown Family Justice Center 533 N Niles Avenue South Bend, IN 46617 RE: went: Bacon Around the Bend 5k Date:, June 23, 2018 Dear Ms. Steward -Brown: 1'IlONIl ", 574/ 235-9251 FAX 57 41235-'9171 The Board of Public Works, at its meeting held on June 12, 2018, approved your request to conduct the above referenced event on June 23, 2018, from 7:00 a.m. to 12:00 p.m., on the designated route as submitted. Enclosed please find copy of your approved permit. The Police Department asks that runners may use the road, and all walkers must use the sidewalks. further, the Police Department recommends that the walk start fifteen minutes after the run so the two can be differentiated for security purposes. All participants should obey all traffic laws. Police and volunteers will furnish an escort and traffic control. If l 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, "I'raffic & Lighting GARY A. Gii,o'r ` UZANNA M„ FRITZ i'ERG E1..I/.ABE'I'11 A. Mr\RADIK JA v Es k MUELLER T1IERESE I DORAU APPLICATION FOR USE OF , PUBLIC RIGHT-OF-WAY FOR PROCESSIONS The Board of Public Works must have FOUR (4) weeks prior notice of the Sponsor: '(Ami A Lv,.,kj:f y- Submitted By: Address: City: e State: Zip: t Phone: c Email:�Ak\(-4v, vy rk6) Sponsor may use the public right-of-way described as (descry e route and attach map) PLEASE NOTE: THE SOUTH BEND POLICE DEPARTMENT RESERVES THE RIGHT TO CHANGE YOUR ROUTE FOR SAFETY PURPOSES Event name : ❑ The Board of Public Works must have FOUR (4) weeks prior notice before event occurs F-1 All certificates of insurance, pyre -paid costs, maps, and any other applicable information requested or required by the Board of Public Works have been provided with this application F-1 "jThe event shall be held on ,Tyr &j 20'i and no other date F-1 Registration time for the event starts at a.m./ m, Stai -ting time of the procession is p.m. F] Estimated completion time is a. rn, (ED -1 This event involves the use of the following roadways This event involves closure of City residential streets F-1 This event involves County roads ']'his 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 Qualls, Customer Service Manager, 235-5939 to organize meeting) This event involves the use of the sidewalk ,— Nmadq P-n d�d4a,10W E� Participants must stay on the sidewalk and obey all traffic laws. /' 4 0 d A This event isa egional/national event (Please circle the appropriate event type) (0=�A/r, This event will be coordinated with the property owner/business where staging will take place Updated 08/2017 2 wa PERM IT/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. 4If 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 RETURN FORM TO: Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, IN 4660t Phone: (574) 235-9251 e Fax: (574) 235-9171 Printed Name ME, President— Member Member Member V'E Gwku- TPROVAL) RE TURN FORM TO. Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, IN 46601 Phoj= (574) 235-9251 • Fax: (574) 235-9171 Member Date FAMILY JUSTICE CENTER ST. JOSEPH COUNTY Bacon Around the Bend 5K Route Information Date: Saturday, June 23, 2018 Race start time: 8:00am Expected end time: 11:30am Number of runners expected: 100-150 Starting at Family Justice Center 533 N. Niles Ave, South on Miles to Madison Street, West on Madison to the East Race Bank Trail, North on the East Race Bank crossing Howard onto the foot bridge to Pokagon Street, West on Pokagon to Hillcrest, South on Hillcrest to Parkovash, West on Parkovash to Lafayette, South on Lafayette to Tonti, East on Tonti to Hillcrest, North on Hillcrest to Pokagon and back down the foot bridge to the East Race Bank Trail, East on East Race Bank Trail South of Niles Ave. dog park to Niles Ave, South on Niles to Corby's Irish Pub 441 E. LaSalle Ave Family Justice Center and Corby's Irish Pub grant permission to be the starting and ending points for the route. Respectfully submitted by: Amy Stewart -Brown, Executive Director 574-234-6900 astewartbrown@fjcsjc.org Inn Away Ai Avc, Tom Aw- Nokonds Park VAR01" W `oj is tl le 44 I hw,"'Jkd °�A v.m d S ! t vwwr Po I* Loppei FOO rx"t, P14 I n &Y'denc v hui h y job, 1" Mae Mns"e Log AS" Miaff�ott so Ll h Bepid: Janws MOM Pbmml CeMel CO P MeWW MORO Ml Rmim! Ic 6r� FRED A The PAW al SL Jowph co W Lasalle Avc- WX Aw, F I woe �%ve saifl' 111, oseph ("'hurch F I Kh CERTIFICATE OF LIABILITY INSURANCE DATE{ 5116t201 YYYY) 6I201 a 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 GIBSON INSURANCE AGENCY, INC. (SOUTH BEND, IN) 130 S. Ma€n St., Suite 400 South Bond, IN 46601 CONTACT NAME Angel Karbataeali PHONE (AIC No, Ext): (574) 245-3547 FAX (AIC No): (574) 236-6399 EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Family Justice Center of St. Joseph County INSURER A: Mount Vernon Fire Insurance Company 26522 INSUREB B: INSURER C: INSURER D: INSURER E: INSURER F: (:nVPRAGFR 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 AObL INSR SUBR WVD POLICY NUMBER POLICY EFF (MMIDOIYYYY) POLICY EXP (MMrDONYYY) LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1,k] OCCUR CL 2730397 6/23/2018 6/2512018 EACH OCCURENCE $1,000.000 pppp ENTED PR IS a occurrence) $100,000 MED EXP (Any one parson) S1,000 PERSONAL & AOV INJURY $1,000.000 GENERAL AGGREGATE $3.000,000 PRODUCTS-COMP/OP AGG See L-535 GEN'L AGGREGATE LIMIT APPLIES PER: nX POLIGY Fj PRO- LUC t$ AUTOMOBILIE LIABILITY ANY AUTO AU,SYNED R�y6RULED HIRED AUTOS MMWNLD W. eBcIN1F.01 INGLE LIMIT $ BODILY INJURY (Per person) $ INJURY (Per accident $ pBgODILY (PerT.'5enly]pAMAGE $ S UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE S AGGREGATE $ b5D I I RETENTION; S WORKERS COMPENSASION AND EMPLOYERS' LIABILITY ANY CCPROPRIhEIT6ORIPARTNERIEXECUTIVE Y!❑N Wa Ida iMV, N r EXCLUDED? �f �h �d UKIIIRR �F 9PERATIONS batow NIA C TORY L�ITS Oi E.L. EACH ACCIDENT S E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (See attached Acord 101 for addltlonal IlablIty limits) Additional Insured - City of Soulh Bend f.1-H I11-ICAII- KIIIA -K C.HN[1CLLA1I0IV City of South Bend SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 227 W. Jefferson Blvd. EXPIRATION DATE THEREOF. NOTICE Wil_ . BE DELIVERED IN ACCORDANCE WITH THE South Bend, IN 46601 POLICY PROVISIONS. AUTHORIZED REPRESEIVTATIV�k� JJ� ACORD 25 (2010/05) Copyright 1988-2010 ACORD CORPORATIOV rights reserved, The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 4579 plc �rrr:�" ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY INSURED GIBSON INSURANCE AGENCY, INC. (SOUTH BEND, IN) Family Justice Center of St, Joseph County POLICY NUMBER CL 2730397 CARRIER NAIC CODE EFFECTIVE DATE: 6/2312018 Mount Vernon Fire Insurance Company 26522 ADDITIONAL REMARKS 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 ProductslCompleled Operations Aggregate Limit See L-535 General Aggregate Limit $3,000,000 ACORD 101 (2008/01) Copyright 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD