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HomeMy WebLinkAboutNon Res Block Party - Urban Adventure Games Inc1316 COLINTY-CITY BIJILDING 227 W. JEFFERSON BOULEVARD Soun i BEND. INDIANA 46601-1830 OTY OF SOUTH BEND PETF� BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS July 10, 2018 Jennifer Stephens Urban Adventure Games, Inc. PO Box 11463 South Bend, IN 4663,4 RE: Event Name: Urban Adventure Games, Inc. Street Closure: Wayne St. fi-om MLK Jr. Blvd. to Michigan St. Date: July 28, 2018 Dear Ms. Stephens: 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 28, 2018 from 5:00 a.m. to 3:00 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 darnaged 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 (3ARY A. GiLOT SOZANNA M, FRITZBERo DAZABETi-i A. MARADIK JAMEs A. MUE'lLER THE RE J. DORAU 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 Applicant Name: Urban Adventure Games, Inc. / Jennifer Stephens Address: PO Box 11463 City: South Bend State: IN Zip: 46634 Phone: 574-703-2535 Email: —jennifer@urbanadventuregames.com 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 2018 Urban Adventure Games Location Wayne Street Garage - 121 E Wayne St, South Bend, IN 46601 (Describe Area/Route) Street Closure Name of Street Wayne St From MLK Jr Blvd To Michigan St Date of Event Juiy 28 20 18 N a, m. 0 a.m. El a.m. Time: Registration/Setup 5:00 n p.m. Start 8:00 E] p.m. End 3:00 P.M, Approximate Number of Attendees 600 Answer the following appropriately: 1. This event will have music (live or other). [X-1 Yes, n No a. I understand the Noise Ordinance described in the Agreement/Permit FX-1 Yes El 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-EZ are included with this application, and Yes F-1 No additionally filed with the Office of the City Clerk, 41h Floor, County - City Building, 227 W. Jefferson Blvd., South Bend, Indiana. c. Certificate of Insurance d. Maps, drawings and setup plan of the area Yes No c. 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 X Yes No b. This event involves County roads ❑ Yes No c. This event involves State highways Yes No Updated 8/2017 d. This event involves the use of the sidewalk ® yes ❑ No e. This event is a oca re iona ational event (Please circle the ® yes ❑ No appropriate event type) 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 ® 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 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 trust 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 farce 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. 1.1. The APPLICANT will follow the City of South Bend Noise Ordinance, which is in effect at all hours. Between the hours of 1.1:00 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 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 THRFE 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 1 5th day of APPLICANT Signature A Printed Name Jennifer Stephens 20 18 BOARD OF PUBLIC WORKS APPROVAL Presi nt Member Member ­/ / � ') �, )_ 0 mefri&iv V 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 , , � � ~`. \� \�/ /»�}S: y Form NP-- I State Form 5106.5 (4--03 ) Indiana Department of Revenue Indiana Government Center North Indianapolis, Indiana 46204 Indiana Nonprofit Sales Tax Exemption Certificate (This certificate may not be used to collect sales tax) 1800150461902 I II I III lll� l�l l l l ll llll I I@ I llll fall 18111 H111111f #Il l llll Illl llll IIII IIII URBAN ADVENTURE GAMES INCORPORATED PO BOX 11463 SOUTH BEND, IN 46634-0463 TID: 0158427769 LOC: 000 Corresp ID: I800.150461902 Issued: 04/30/20I 8 Organization is only exempt from payment of sales tax on purchases for which the organization is granted exemption, I(Detach Here) Qualifying for sales tax exemption requires the completion and filing of an application form prescribed by the Indiana Department of Revenue. The Taxpayer Identification Number (TID) above mast he provided to the retailer if purchases are to be exempt from sales tax. In addition, to qualify for sales tax exemption, such purchases must be used for purposes described in Information Bulletin #10. The TID must be used on Sales Tax Exemption Certificates (ST-105) when making qualified purchases. The fact that an organization is granted exemption from income tax by the federal government, or that it at one time was granted such an exemption by the State of Indiana, does not neccessarily mean that a purchase made by a nonprofit organization is exempt from sales tax. Requirements for Sales Tax Exeuipt Purchases by Nouprofif Organizations: A. Purchases by a Nonprofit Organization for its Own Use: I _ In order to qualify for sales tax exemption on purchases, a nonprofit organization must satisfy the following conditions., (a) The organization must be named or described in IC 6-2.5-5-21(b). Organizations named or described in this Code section are organized and operated exclusively for one or more of the following purposes: Civic Charitable Educational Fraternal Litcnary Religious Scientific (b) Included in the above general organizational categories are the following specifically named types of nonprofit organizations: Business Leagues Churches Convents Fraternities Labor Unions Licensed Hospitals Monasteries Parochial Schools Pension Trusts Shared Hospital Services Sororities Student Cooperative Housing 2. In order to qualify for sales tax exemption, purchases must be used for the same purposes for which the nonprofit organization is granted exemption. 3. Purchases for the private bent flt of any member, director, or q f facer of the nonprofit organization, or for• any other individual are not eligible for-ea'elrrption. Purchases used far social purposes are never exempt, B, Purchases by Nonprofit Organization for Resale: Purchases of tangible personal property purchased for resale by nonprofit organizations are eligible for sales tax exemption. i D® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY) 0611512 01 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 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 CNAME:O TACT Michelle Wasoski Gibson Insurance Agency, Inc. PHONE (800) 814 2122 FAX A!C No El No : (800) 8362122 130 S Main St, Ste 400 E-MAIL mwasoski@gibsonins.com ADDRESS, INSURER(S) AFFORDING COVERAGE NAIL $ PO Box 11177 INSURERA: Cincinnati Specialty Underwriter 13037 South Bend IN 46601-0177 INSURED INSURER B : Urban Adventure Games, Inc, INSURER C : PO BOX 11463 INSURER D : INSURER E: INSURERF: South Bend IN 46634 COVERAGES CERTIFICATE NUMBER: 7128118 - 7129118 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. LTR TYPE OF INSURANCE AULIL INSD WVO POLICY NUMBER MMIfIDIYYYY (MMUMOnfYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS.MADE x OCCUR DAMAG PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ 1,00D,000 A CSU0101718 07/28/2018 07/29/2018 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY 0jE7 LOG PRODUCTS -COMPIOPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per arx'ldent $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAR OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAR DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN 8TRTUTE ER " E.L. EACH ACCIDENT $ ANY PROPRIETORIPARTNERIFXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ NIA E.L. DISEASE- EA EMPLOYEE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space Is required) Certificate holder is additional insured with respect to general liability coverages as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of South Bend, Indiana ACCORDANCE WITH THE POLICY PROVISIONS. 227 W. Jefferson Blvd AUTHORIZED REPRESENTATIVE South Bend IN 46601 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Street Closure 1 message Jennifer Stephens <jennifer@urbanadventuregames.,com> To: blarneystone05@gmaii.com To Whom It May Concern: Jennifer Stephens <jennifer@urbanadventuregames.,com> Thu. Jun 14, 2018 at 5:37 PM I am writing to inform you that Urban Adventure Games will be taking place in the Wayne Street Parking Garage (121 E Wayne St) on Saturday, July 28, 2018. We are requesting Wayne Street, from MLK Jr Blvd to Michigan St, be closed to traffic from 5:00am unfil 100pm. We are required to notify all affected businesses, We are sorry for any inconvenience this may cause. If we can answer any questions or help in any way, please feel free to reach out to me. Please respond with a confirmation that you received this email. Best regards, Jennifer Jennifer Stephens 88A Treasurer / Board Member Main: 574.703.2535 A Mobi'le: 574.404.8220 www,Urbai,iAdventureGanies,cotii The Adventure Begins July 28th, 2018! Dear Potential Sponsor, On behalf of the Board of Directors, we invite you to join us in celebrating the 100, race of the Urban Adventure Games. This year the annual race will take, place on July 28, 2018 throughout the cities of South Bend, Mishawaka, and Notre Dame. Each year the games bring in an average of 750 racers and 300 volunteers to participate in a "thrilling, zany, action -packed exploratory race". Established in 2009, the mission of the Urban Adventure Games has been to expose hundreds of racers to the wonderful surrounding communities. Racers compete in a scavenger hunt type event and visit checkpoints to complete challenges and win points. In addition to being a unique event, each year we give back to the community in a variety of ways, from direct financial contributions to complimentary race entries. We feel this race is significant for its impact on businesses and racers. Racers have told us that during the race they have visited areas and businesses that they've never seen before ­ and they keep visiting them after the race! One racer told us: "I'd never been to the Kroc Center before jumping into the pool during the challenge — now I take exercise classes regularly!" Other racers have talked about the personal meaning of competing in challenges they never thought they could complete. "Rappelling down a six story building was never something I thought I could do. After doing that, with the help of the fire department, I have been more motivated to try other athletic events!" In order to create this awesome event, we need help from sponsors like you. On the following page, you will see the perks and advertising opportunities given to our sponsors. Please consider partnering with us to create the biggest and best race yet. We're accepting cash donations, as well as in -kind donations of goods and services. If' you are ready to make a donation, please return the Sponsor Agreement., One of our representatives will be in contact with you for details. Have a question before donating? Just email us at info@urbanadventuregames.com or call us at (574)703-2535 and we will get right back to you. Thank you in advance for considering this request. Sincerely, The Board of Directors Kim McInerney, Board President Jennifer Stephens, Board Treasurer Bethany Cockburn, Sponsorship Coordinator Testa Hardesty Marketing Coordinator Bob Wolosin, Community Relations Coordinator Jonathan Jones, Race Director Urban Adventure Games PO Box 1'146,1, SoAh Berid, ��11 46634 (574) 703-2535