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Home My WebLink AboutProcession - Fraternal Order of Police #36 - Fallen Officer Scholarship Ride1316 COUNTY -CITY BUILDING 227 W. JEFFE-ASON BOULEVARL) SOUTH REND. INDIANA 46601-11930 CITY OFSOUTH BEND FETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS July 24, 2018 fiery Mullins Fraternal Order of Police #36 701 W. Sample Street South Bend, IN 46601 RE: Event Name: Fallen Officer Scholarship Ride Date: August 11, 2018 Dear Mr. Mullins: PHONi-,' 574/235-9251 FAX 574/ 235-9171 The Board of Public Works, at its meeting held on July 24, 2018, approved your request to conduct your motorcycle procession on August 11, 2018, beginning at 12:00 p.m. and ending at approximately 5:00 p.m. on the designated route as submitted. Enclosed please find copy of your approved permit. Participants must obey all traffic laws. Please coordinate your event with Lieutenant Eugene Eyster of the Police Department, If you have any further questions regarding this matter, please call this office at (574) 235- 9251. Sincerely, b/( Linda M. Martin, Clerk Enclosure , GARY A. Gii,oi' SUZANNA M. I"RITZBER(i ELIZABF" ri I A. MARADIK JAW's A. Mtjrt,I,F,'It THER[�'L.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: Fraternal Order Of Police #36 Submitted By: Gery Mullins Address: 701 West Sample Street City: South Bend State: Indiana Zip: 46601 Phone: 574-276-2027' Email: gmullins@so,uthbendun.gov Sponsor may use the public right-of-way described as (describe route and attach map) 1 1 1 1 F11 1 1 11,115K. l!".1 01111 � i I i 1� 111,1101" WL1111 ta Im fil U11 n &L I jciffl��M Event name: Fallen Officer Scholarship Ride The Board of Public Works must have FOUR (4) weeks prior notice 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 [R The event shall be held on August'llth 2018 and no, other date Registration time for the event starts at 12:00 a.m= Starting time of the procession is 2:00 a,m= FX_1 Estimated completion time is uo a.mM This event involves the use of the following roadways This event involves closure of City residential streets This event involves County roads nX � This event involves State highways This event involves use of a park (Must obtain permission from Park Board) 1 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) F-1 This event involves the use of the sidewalk F-1 Participants must stay on the sidewalk and obey all traffic laws. LR This event is aoca ' egional/national event (Please circle the appropriate event type) [R This event will be coordinated with the property owner/business where staging will take place Updated 08/2017 2 PERMI UAGREEMENT FOR A PROCESSION 1. 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. 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. 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 V RETURN FORM TO: Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, IN 46601 Phone: (574) 235-9251 + Fax: (574) 235-9171 Printed Name Title j�v rt- r Cn (Ll)1 n/ OARD OF PUBLIC WORKS APPROVAL GC. President Member Me J 7L� (-/Ida Member 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 • Fax: (574) 235-9171 SPECIAL EVENTS GUIDELINES SIGNATURE FORM Prior to the Commissioners approval of the Fallen Officer's Scholarshi Ride (event) on Saturday, August 11 th, 2018 , (day & date) your request needs to be approved by the appropriate departments affected by the designated route. Emer enc Management —1222 S. Michigan Street 46601 574 235-9378 Email — elainesjcema@ have been contacted regarding this event and give my approval of the event as stated. John Antonucci, Director Date St. Joseph County Sheriff- 401 W. Sam le 46601 - 574 245-6540 Fax- 574 245-6574 I have been contacted regarding this event and give my approval of the event as stated. Michael Grzegorek, County Sheriff Date St. Joseph Coun En ineerin - 227 W. Jefferson Rm, 732 46601 - 574 235-9626 Fax -- (574) 235-5057 I have been contacted regarding this event and give my approval of the event as stated. Jessica J. Clark, P.E., County Engineer Date South Bend Dot. of Public Works - 227 W. Jefferson Rm. 1316 - 574 235-9251 Fax — (574) 235-9171 I have been contacted regarding this event and give my approval of the event as stated, t KI Sara 4.Boyles, h.D.4y.E. City Engineer Date India a Dept. of Transportation —12209 N 1206 W Monticello IN 47960 - 219 851-142 Fax — (219) 325-7516 I have been contacted regarding this event and give my approval of the event as stated. Mike Hurt, Plymouth District Date _Mishawaka Engineerina Department — 600 E. 3 ld St., Mishawaka 46544 - 574 2558-1619 Fax- (574) 258-1776 I have been contracted -regarding this event and give my approval of the event as stated. Chris Jamrose, P.E., Mishawaka Engineer Date d.,Iv, Lot!, ii M1 Ak ar I When: August Ilya 2018 Registration from Noon to 1:45 pm Ride starts at 2:00 pm with two stops along route Ride ends at FOP 36 Corn & Sausage Roast with food, drink, and entertainment Where: South Bend Police Dept 701 W Sample St, South Bend Why: This is an FOP 36 Scholarship fund raiser for local high school seniors. The Thomas J. DeRuc Sr. Memorial Scholarship honors our fallen South Bend Police Officers. Fees: $20 rider & $10 for passengers Each Rider/passenger will receive an event T-shirt, half year associate membership with FOP 36, all you can cat Corn and Sausage, one drink ticket, & entertainment. All are welcome to ride and celebrate the lives of our fallen heroes, and the future of our children. This is a full day of entertainment at the cost of a normal ride. Even ifyou don't wide a motorcycle you can still come out to support the event —A, $10 adtiaission gets the all,)�ou can eat corn, sausage and evening entertainment. Visit and like us on Facebook at: FOP 36 Fallen Officer SchL)larshij) Ride Or visit: tLoj).16. co M South Bend Police Department West on Sample Right on Mayflower Road Left on Western Avenue Right on County Line Road Right on US 20 (Lincoln Hwy) Left on Marvel Lane (Turns into Timothy Road) Right on Chicago Trail Right on Redwood Road Left on Brush Trail (Turns into Adams Road) Right on Orange Road Left on Brick Road Left on 31 Bypass, South Exit at Ironwood Road South Right on Jackson Road Left on York Road Right to Hamilton School Parking lot Hamilton School Left on York Road Right on Jackson Road Right on Elm Road Right on Kern Road Left on Shirley Avenue Right to Southlawn Cemetery Southlawn Cemetery Left on 931 Right on Pierce Road (Turns into Center Street) Right on Main Street (Also Hwy 23/Liberty Hwy) Left to FOP #36 FOP'#136 l8n I M, (Jr'�--111;,) -IYC Aj MAW ME A� �® CERTIFICATE OF LIABILITY INSURANCE DATE (MM10IYYYY) 06,13,201E 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 CONTACT Chuck Kennedy NAME: STAR Insurance - Huntington Office AHCNN Ext . (260) 356-3313 Arc No : (260) 356-3764 E-MAIL angela.altzroth@stafflnancial.com ADDRESS: sta�nancial.com 400 Frontage Rd INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Scottsdale Insurance Company Huntington IN 40750 INSURED INSURER S : INSURER C : Fraternal Order Of Police, South Bend Lodge 36 INSURER D : PO Box 299 INSURER E : INSURER F : South Bend IN 46624 COVERAGES CERTIFICATE NUMBER: 2018 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 CONTRACTOR 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. INSR LTR TYPE OF INSURANCE I 4WD POLICY NUMBER POLICY EFF MMfDDIYYYY POLICY EXP MMIDDfYYYY LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP {Any one person) $ 5,000 PERSONAL & ADV INJURY S 1,000,000 A CPS2766873 011071201E 01/0712019 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE g 2,000,000 POUCY ❑ PRO- JEGT LAC 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 accident $AUTOS HIRED NON -OWNED ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEO I RETENTION $ $ 1 1 WORKERS COMPENSATION AND EMPLOYERS' LIAABILITY Y 1 N PER OTH- STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? NIA E.L.EACHACCIDENT $ (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT S DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) For the Fallen Offers Ride being held August 11, 2018 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of South Bend ACCORDANCE WITH THE POLICY PROVISIONS. 227 W Jefferson St AUTHORIZED REPRESENTATIVE South Bend IN 46601 O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2018103) The ACORD name and logo are registered marks of ACORD