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Home My WebLink AboutProcession - South Bend Riley High School Homecoming Parade1316 COUNTY-Crry BijILDING 227 W. JEFFERSON BouLEVARD `°y'01 )TH 131',ND. INMANA 46601 - 1830 CITY OF Sou-nii BEND PETE BUTTIGIEG, MAYOR BOARD OF PU13LIC WORKS July 10, 2018 Kathy Johnson South Bend Riley High School 1902 S. Fellows St, South Bend, T.N 46614 RE: Parade: South Bend Riley Homecoming Parade Dear Ms, Johnson: PHONE 574/235-92511 FAX 574/ 235-9171 The Board of Public Works, at its meeting held on July 10, 2018, approved your request to conduct your parade on September 21,2018, from 5:00 p.m. until 6.00 p.m,, on the designated route as submitted. Enclosed please find a copy of your approved permit. The South Bend Police and Traffic and Lighting Departments will supply traffic control. Participants are to, follow all traffic regulations. In addition, throwing candy is prohibited. If you have any further questions regarding this matter, please call this office at (574) 235- 9251. Sincerely, yy( Linda M. Mai -tin, Clerk Enclosure GARY A. Git,o'r SUZANNA M. FRITZBEm, ELIZABETH A. MARADIK JAMEs A. MUELLEiz TiiERESE J. 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: Submitted By:c/ Address: 19 o a City: & t"Cm -� State: f1i Zip: ( [ i Phonc: 3 `% 3 -5/a,3 Emai l: d�� ors S Sponsor may use the public right-of-way described as (describe route and attach map) PLEASE NOTE: THE SOUTH BEND POLICE DEPARTMENT RESERVES THE RIGHT TO CHANGE YOUR ROUTE FOR SAFETY PURPOSES Event name: 5of t' ire _ no f .E y��C r�-crier Pc��a_ Ig The Board of Public Works must have (4) weeks priorYotice before event occurs All certificates of insurance, pre -paid costs, maps, and any other applicable information requested or required by the Board of Public Works have been provided with this application (}�c The event shall be held on 6�Wt- c,) I , 20 1 S and no other date Registration time for the event starts at a.m p.m. [ Starting time of the procession is ,® Estimated completion time is 6 a.m p.m. This event involves the use of the following roadways This event involves closure of City residential streets ❑ This event involves County roads ❑ This event involves State highways ❑ This event involves use of a park (Must obtain permission from Park Board) zF& 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 ❑ Participants must stay on the sidewalk and obey all traffic laws. I el This event is 41'locaj_�regional/national event (Please circle the appropriate event type) This event will be coordinated with the property owner/business where staging will take place Updated 08/2017 PERMITIAGREEMENT FOR A PROCESSION 1. Sponsor shall reimburse the Board for the actual cost to the City for the event, if deemed necessary. 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. 4. If 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. Sponsor acknowledges that the Police Department reserves the right to change this route for safety purposes. 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 httl_,dv*RETURN F"oRM T : 3 Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, IN 46601 Phone: (574) 235-9251 • Fax: (574) 235-9171 4"-c-0, 1 �e<, pi _J�) b 11 ��e) ki Printed. Name � �'t � � � r C ce , 60 Title OARD OF P BT 1c WORKS APPROVAL, Presid nt` MenYber Member / ! 0 et er 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 9 Pax: (574) 235-9171 Parade Route for September 21, 2018 Christian Center on Ireland Rd. to Miami street turn Right and then to Jackson Rd. to soccer field to dismiss floats and particpants. TaCL-s1)1) A� t A �7-1 0 CERTIFICATE OF LIABILITY INSURANCE DATE (MM 1YYYY) os113/2012aie 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(les) 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 ondorsement(s). PRODUCER CONTACT Susan Thompson NAME: Laven Insurance Agency Inc. aye No Ext ; (574) 291-5510 FAX.,,): (574) 291-8505 E-MAIL suet@Iaveninsurance.com ADDRESS: R O. Box 2379 INSURERIS) AFFORDING COVERAGE NAIC N SOUTH BEND IN 46680 INSURERA: Peerless 24198 INSURED INSURER B : Indiana Insurance 22659 South Bend Community School Corporation INSURER C : INSURER D : 215 S. Dr. Martin Luther King Jr. Blvd. INSURER E : INSURER F : South Bend IN 46601 COVPRAGES CERTIFICATE NUMBER: 18-19 Master 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 MAYBE 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, ILTR TYPE OF INSURANCE tNgp yyyp POLICYNUMBER POLICY EFF MMfODlYYYY POLICY EXP MM1ODfYYYY LIMITS X COMMERCIALGENERALLIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR DAMAGE T PREMISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 15,000 PERSONAL BADVINJURY $ 1,000,000 A Y CBP9381640 03/13/2018 03/13/2019 GEN'LAGGREGATE LIMIT APPLIES PEW GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ JECT PRO- ❑ LOC PRODUCTS - COMP/OP AGO $ 2,000,000 I Employee Benefit Liability $ 1,000,000 OTHER; I AUTOMOBILE LIABILITY CEa OMBacidanlNwc;2NNGLELIMIT a $ 1,000,000 BODILY INJURY (Per person) $ ANYAUTO A OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED NON -OWNED AUTOS ONLY IXAUTOS ONLY BA9143886 03/13/201 B 0311312019 BODILY INJURY (Per acciden[) $ PROPERTY DAMAGE Per accident S X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 10,000,000 B EXCESS LIPS CLAIM&MADE CU9719162 03/13/2018 03/13/2019 M AGGREGATE $ 10,000,000 X DED RETENTION $ 101000 $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE ER STATUTE ER E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ NIA {Mandatory in NH) E.L. DISEASE- EA EMPLOYEE $ E,L, DISEASE- POLICY LIMIT $ ifyes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Event: Homecoming Parade September 21, 2018-Riley High School Certificate holder and the City of South Bend are named as additional insureds. ��warLa.I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Board of Public Works ACCORDANCE WITH THE POLICY PROVISIONS. 227 West Jefferson Blvd AUTHORIZED REPRESENTATIVE 1316 County City Building South Bend IN 46601 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD