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HomeMy WebLinkAboutNon Res Block Party - Kite Realty - Cars and Coffee1316 COUNTY—C rry Buia.r ING 227 W. JEFFERSON BOULEVARD SOUTI 113E ND, INDIANA 46601-1830 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD i RKS June 26, 2018 Taryn Ford Kite Realty Group 30 S. Meridian Street, Suite 1100 Indianapolis, 146204 RE: Event Narne: Cars & Coffee Street Closure: Eddy Street from Angela Blvd. to Napoleon Street Date: July 1.4, 2018 Dear Ms. Ford: PHONE 574/2.35-925 FAX 574/235-9171 The Board of Public Works, at its meeting held on June 26, 2018,approved your request to close the above referenced street for your event scheduled for July 14, 2018 from 6:00 a.m. until 1:00 p.m. For your information, the South Bend Police Department will monitor this event. Enclosed please find a copy of your approved permit. You will be responsible for the placement of the barricades and removal at the conclusion of the event. PIease 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. If you have any further questions regarding this matter, please call this office at (574) 235- 9251. Sincerely,. Linda M. Martin, Clerk APPLICATION FOR USE OF, AND BLOCKING OF ACCESS TO, THETUBLIC 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 Applicant Name: TM VIA ki t �d Address: •City] NState. Zip: Lo evidlan 0 O Phone: Ernail-. This application is rnade to the City of South Bend, Indiana, Board of Public Works, for the use of the specified public right-of-wayfby Applicant for the holding of tile hereinafter described event: (Ur, 4- Event Name V 5 0�+e e, Location Street Closure Name of Sti-ect From _rH 1 VIVIV, 1) A To "WVy_L Date of Event J(A19 I_t' - 20 V ti. in Time: Registration/Setup El pli Approximate Number of Attendees (Describe Area/Route) V, . M. Start El P-111, End heE] ni. p'.In. Answer the following appropriately: 1. This event will have music (live or other). n/ Yes E] No a. I understand the Noise Ordinance described in the Agreement/Permit Yes E] 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 5 0 1 (c)(3) Internal Revenue Exemption Status Document and a current copy of Form 990 of Form 990-EL are included with this application, and R/ Yes El No additionally filed with the Office of the City Clerk, 4"' Floor, County - City Building, 227 W. Jefferson Blvd., South Bend , Indiana. c. Certificate of Insurance d. Maps, drawings and setup plan of the area V( Yes F] No e. A copy of a flyer or door hanger that has been distributed to all Yes No affected property owners. 3. a,. This event involves City streets Yes [] No ji b. This event involves County roads El Yes No c. This event involves State highways [:] Yes No Updated 8/2017 d. This event involves the use of the sidewalk 1� Yes ❑ No e. This event is a local/regional/national event (Please circle the 10/ Yes ❑ No appropriate event type) f. Affected property/business owners have been notified of this event. V Yes ❑ No g. There is/are 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 El 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 e 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 roust 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 APPLICAN'frnust 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 most 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. 8, The APPLICAN"I'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 Lip upon the conclusion of the event. 10. Barricades will be delivered and picked up at the event location. The APPLICANT is responsible foi- 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 $400.00 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 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, frorn 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 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 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 10 day of M01 � 20 APPLICANT Signature Printed Name Fro-] Z16 w BOARD OF PUBLIC WORK-S APPROVAL 11resident 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 MY141ber Date I 31017B A -1r �® l�('r(✓j=�LJ CERTIFICATE OF LIABILITY INSURANCE DATE1YYYY1 zr27120271zo1a 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 Insurance Services National, Inc. CONTACT Tim Baumann NAME: HO No Ext : 470.875.0517 FAX Noy 610-537-1929 (AJCUSI E-MAIL ADDRESS: tim.baumann@usi.com INSURER(S) AFFORDING COVERAGE NAIC # 3475 Piedmont Road NE, Suite 800 INSURERA: Endurance Assurance Corporation 11551 Atlanta, GA 30305-2886 INSURED INSURER B : Allied World National Assurance Co. 10690 INSURERC: Sompo America Insurance Company 11126 Kite Realty Group Trust 30 S. Meridian St., INSURER O: INSURER E : Suite 1100 INSURER F : Indianapolis, IN 46204 r•nWC0Ar_Cc rFQTIFrr'A-rP wimmr m. 12774275 RFVIStON 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 ISO BURR WVO POLICY NUMBER POLICY EFFm MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR GGR10012604100 o3/01/2018 03/01/2019 EACHOCCURRENCE S 1,000,000 DAMAGOENTED PREMISES (Ea occurrence] , S 1,000,000 MFO EXP (Any one person} $ Excluded PERSONAL&ADVINJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000 PRODUCTS- COMPIOP AGG S 2,000,000 POLICY PRO_ JECT • p LOG f S OTHER: A AUTOMOBILE LIABILITY ACVS100810 03/01/2018 03/01/2019 COarcldepntSINGLE LIMIT S 1,000,000 BODILY INJURY (Per person) S ANY AUTO S OWNED SCHEDULED AUTOS ONLY AUTOS HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY IX BODILY INJURY (Per accident) PROPE"' OAMAGE Pan er a.,dl $ $ B X UMBRELLALIAB X OCCUR 3088008 0310112018 03/01/2019 EACH OCCURRENCE S 25,000,000 AGGREGATE $ 25,000.000 EXCESS LIAB CLAIMS -MADE DED X RETENTION $ 5,000 $ C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANYPROPRIETORIPARTNERIEXECUTIVE j-' OFFICERfMEMSERFXCLUDEO? (Mandatary in NH) N ! A WCNS1015P0 031D1l2018 03101l2019 X STATUTE ER E.L. EACH ACCIDENT $ 1.000,000 E.L. DISEASE - EA EMPLOYFE $ 1,000,000 E.L. DISEASE - POLICY LIMIT S 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) Re: KRG Eddy Street Commons, LLC , Eddy Street Commons 1044-1234 Eddy Street, South Bend, IN 46601 r CaTICIr ATt= Mnl DER r:ANr:FI..I... ATION City Of South Bond SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Department of Public Works, Engineering Division ACCORDANCE WITH THE POLICY PROVISIONS. 227 W Jefferson Blvd., Suite 1316 AUTHORIZED REPRESENTATIVES South Bend, IN 46601 The ACORD name and logo are registered marks of ACORD ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103)