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HomeMy WebLinkAboutNon Res Block Party - Unity Gardens Inc1316 COUNTY-C ri, Y BuILDING 227 W. JF.1+TRS0N Bout.EVARD Soui,ti BENI.). INDIANA 46601-1830 CITY OF SOUTH BEND PETS BUTTIGIEG, MAYOR BOARD OFTUBLIC WORKS July I O, 20 18 Sara Stewart Unity Gardens Inc. PO Box 10022 South Bend, IN 46680 RE: Event Name: Unity Gardens ACF Westside BBQ + Craft Festival Street Closure: Prast Blvd. from Success Acaderny to Ardmore Tr, Date: July 29, 2018 Dear Ms. Stewart: PHONE 574/235-9251 FAX 574/ 235-9171 The Board of Public Works, at its meeting held on July 10, 2018, approved your request to close the ,above referenced street for your event scheduled for July 29, 2018 from 8:30 a.m. to 4:00 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) 235-9251 . Sincerely, Linda M. Mai -tin, Clerk Enclosure GAR Y A. Gii.o'r SLJZANNA M. FRITZBERG EjJZABETi-i A. MARADIK JAMEs A. MUELLER TI 1E R ESE J. DOR AU R M.WME . IMULK-1 01 1, 1 11,WAMjMiW W1#1jD1 TM., N-jEly, j I JrJL -JE-9-111- 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. F1 Fee Paid Applicant Name: bv)"Av \(`kl Address: (`)0\, City: o,5,,-:," State: N Zip: Phone: Email: 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 V 6 G (­ r dll, (Describe Area/Route) Street Closure Name of Street From 'S h C.(,k N, To tfl'Qry\OLk�, Date of Event '�IUAII 20 a. M. a.m. V� 9p.m. a.m. End Time: Registration/Setup E] p... Start P.M, Approximate Number of Attendees 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 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 Form 990 of Form 990-EZ are included with this application, and 0 Yes No additionally filed with the Office of the City Clerk, 4 1h Floor, County_ City Building, 227 W. Jefferson Blvd., South Bend, Indiana. c. Certificate of Insurance d. Maps, drawings and setup plan of the area El Yes El No c. A copy of a flyer or door hanger that has been distributed to all Ej Yes R No affected property owners. 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 812017 d. This event involves the use of the sidewalk ❑ Yes *�p No e. This event is a oca regional/national event (Please circle the ❑ Yes ❑ No appropriate even e) 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 ❑ 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 Qualls, Customer Service Manager, 235-5939 to organize meeting). Yes ❑ No EV IF ALCOHOL IS TO BE SERVED OR SOLD $4W will be s rved Alcoholic bevera es wi l sold Alcoholic beverages e �, g 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) 2344315 for more information. • Application cannot be processed without a copy of this license. SCCGL) rt� y GLJ-r615" 15,19. , 0I 15 11 �11Lt -�1d aril �5'-Jq D.10,t �5r.1 q City of South Bend, Indiana 9 Board of Public Works PERMIT AND AGREEMENT FOR THE USE OF 1 ' 8 THE RIGHT -OF -WAY FOR NON-RESIDENTLALL 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. 8. 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 $400.00 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, 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 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 day ofGw 20 APPLICANT Signature Printed Name OF PUBLIC WORKS APPROVAL 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 IM ,///,) /"-)- 0 / �, maru C-) I'll-) c 08 Cr ilndayjuly 29t Noon UnU14:00RM Proceedsgo to atippor Unityardens wwwoth""quardensool 5121/2018 3701 Prast Blvd - Google Maps 3701 Prast Blvd 3701 Prast 131vif, A't this location unity gardens 43 A), * kc * ,i), i I Imagery @2018 Google, Map data 02018 Google 50 ft C I vd ,om�nunity �3 /01 31 ht(ps;//www.google,com/maps/place/3701 +Prast+Bivd,+SOL]th+Bend,+IN+466281@41.6869548,-86.2997488,195m/datam!3ml!1 e3!4m5!3m4!1 sOx881 1 3263dabd9z BEER I WME At k RITY I TYPE 118 State Form &rA94 (R8 111 111- 5) 5) .w Approved ty state Board of is, 201 5 jNSTRUr,Tjopjs- 1. Applicant must complete all requested info"36017* Z Please type arprint cleady- 3, subroft application and Payment to Me kwaf excise distdct office. Send, deliver, or mail to: DISTRICT 1 52422 county Road 17 Bristol, IN 46507 Telephone: (574) 264940 DISTRICT 2 1353 sot& Govemom Drive Columbia City, IN 46725 TetephGw. (260) 244-4296 DISTRICT 3 279 West 300 North Crawfordsville, IN 47933 Telephone. (765) 362-81115 DISTRICT 4 651 S. Commerce Dr. Seymour, IN 47274 Telephone: (612) 523-8314 DISTRICT 5 3650 south Us Hwy 41 Vincennes, IN 47591 Telephone: t812) 892-1292 DISTRICT 6 6400 East 301h Street Ind-tanapoUs. IN 46219 Tolephane: (317) 641-4100 STEP 1. GENERAL tNFORMAMON -ym Permit number (issued by ATC) Name 10[f applicantappyng for permit (organizatiN4 dub, corporation, individuaO PermItnumbr(' wed " ATC' address ad EE N%+', Gaa" `Ac— E-mail address A of pUcant (nmtherandstreet cffY.,F�ft and ZfPcOde) do w ro 0\-& 00 LtD Af --I mtdlu co -be' Fax number Emergency contact telephone number Name of person MAking application .p gjej�.tact contact telephone .6crei, S-ftWV4 Printed narW of contact person 01 event STEP 2. EVENT INFORMATION Ending date ("th, day, year) Beginning day wknllil/ Beoning date (MOnth, dag YeO Ending day 14'�djt, 110 Time of event 9 El I'm End time E] AM PNI start time Type or desclipti0fl 01"even'., WYV C&A Exact address of event (Vber and t c* estate, and ZZJJPPI 0069 jV q L I k Vd STEP & FLOOR PLAN (See S'hP4- N"Ther 2' -------------- .. . . ....... Page i of 2 r ZNTERIVILL RJR 831MCB DRPARTMM OF THE TRWWURY P. O. BOX 2508 CngCIMMTI, Q8 45201 Employer Identification Number: --- Date: FEB 1.6 2010 27-0901122 DI.R: 170S3342393009 UpIT'!i amDws nic Contact Person: PO BOX 10022 JOAN C MWER U* 31217 3a'DTH BEKD, ':XN 46680 Contact Telephone Pu ker: (977) 829-5500 Accounting Period finding: December 31 Public Charity status: 170(b) (1) (A) (vi) Fo= 990 Required: Yee 8ffective Date of Exemption: July 27, 2009 Contribution Deductibility: Addendum Applies: -� NO =ear Atrplicant. we z=e pleased to inform you that upon review of your application for tax ex-_,::;; : status *a have detemined that you acre -exeupt from Federal income tax • dez sez,,irn 501(c) (3) of the Internal Revenue Code. Contributions to you are dLed'::==i!;'!e I—] section 170 of the code. You are also qualified to receive =ax beg4ests, devises, transfers or gifts wader section 2055, 2106 �. w- 2,4iZ c`_ a Cbde. Because this .letter could help resolve any questions exe--vt status, you should creep it in your pezmanent records. a^;3__.,_- exe. �: tun: section 501(c) (3) of the Code are farther C-l"Gi-tied a= et:- w.ii.: c::_!-. =es or private foundations. We dete=iulmd that You are =t1i= �s_ty -= de= the Code sectianis) ],fisted in the heading Of this ;e=er. Please see enclosed Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, for some helpful information about your responsibilities an an co�zc� 1 ® ,aCERTIFICATE OF LIABILITY INSURANCE ��. DATE (MMIDWYYYY) 05/30/2018 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 Aldridge Insurance 1323 North Ironwood CONTACT Nora Grimm NAME: __-...... --- 1 PHONEFAX nloa: 5742328232 ...__ _....... ADDRES& INSURER{S1 AFFORDING COVERAGE, NAIC # INSURER A : Surplus Insurance Brokers ­ 000000 South Bendm IN 46615 _ _ INSURED _ INSURER B :. Erie Insurance Exchange - 26271 - C : Unity Gardens Inc. _INSURER INSURER D: P O Box 10022 INSURER E: INSURER F: South Bend IN 46680 C:C)VFRAGFS 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 ADDL SUBR POLICY NUMBER POLICYEFF MMIDDIYYYY POLICY EXP MMlDDNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000000 CLAIMS -MADE OCCUR X DAMAGE TO RENTED PREMISES,,, Ea occurrence $ 100000 WED EXP (Any one person) $ 5000 - - PERSONAL a ADV INJURY $ 1000000 ' A N N CS02223417-06 05/30/2017 05/30/2018 _ AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000000 I GEN'L I POLICY ElPRO 1-1 LOC JECT PRODUCTS - COMPIOP AGG $ 2000000 -� $ OTHER: ' AUTOMOBILE LfAGILITY COMBINED SINGLE LIMIT $ 1000000 - -- -. -- ANY AUTO BODILY INJURY (Per person) $ BODILY INJURY IPer accident) $ OWNED SCHEDULED X, AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY r N N Q02-1531021 02/15/2018 02/15/2019 PROPERTYDAMAGE er Paccident -- _- $ x UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4000000 AGGREGATE $ 4000000 A EXCESS LIAR CLAIMS -MADE N N CXS0010847 05/30/2018 05/30/2019 € DED RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? n (Mandatory in NH) N f A N 087-0103598 03/01/2018 03/01/2019 I PER STATUTE �RH IATQT' E.L. EACH ACCIDENT - $ 500000 E.L. DISEASE - EA EMPLOYE - -- $ 500000 E-L- DISEASE - POLICY LIMIT $ 500000 yescer_-- Ifes, dribe und ID ESCRIPTION OF OPERATIONS below I DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Addiliatal Remarks Schedule, may be attached if more space is required) .....I CERTI City of South Bend ATTN: Marcia Qualid 731 S. Lafayette Blvd SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE South Bend Fax; (574)235-9171 ACORD 25 (2016103) ail: ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD