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Home My WebLink AboutNon Res Block Party - Studebaker National Museum1310 CouN'ry-Cri Y BuiLDING 227 W.JEFFERSON BOULEVARD SOUTH 1314NO. INDIANA 46601-1830 CITY Or SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS August 9, 2018 Ms. Jo McCoy Studebaker National Museum 201 Chapin St. South Bend, IN 46601 RE: Non -Residential Block Party,: Concours d'Elegance at Copshaholm. Location: W. Washington St. from Laurel St. to Chapin St. Dear Ms. McCoy: PHOM- 574/235-9251 FAX 574/235-9171 The Board of Public Works, at its meeting held on August 9, 2018, approved your request to close the above referenced street for your Concourse d'Elegance scheduled for August 11, 2018 from 5:00 a.m. until 5:00 p.m. For your information, the South Bend Police Department will monitor this event. 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 placernent 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 me at (574) 235-925 1, Sincerely, Linda M. Martin, Clerk c: Gene Eyster, Police Department Federico Rodriguez, Fire Department Marcia Qualls, Engineering Ed Gleckler, Traffic & Lighting GAR" A. Git,o,j, SUZANNA M. FRITZKim Et.,iZAtir:Tf i A. MARADIK JAMEs A. MUELLER TiIERESE J. DORAU M 1112113211 n M I M 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. F] Fee Paid Applicant Name: Address: City: 91'pkXg -J�, q4.jtate: zip Phone: Email: Lt C This application is made to the C tyy of South Bend, dia. Boa0d of Public Works, for the use of the specified public right-of-way by Applicant for the ho 6ng of the hereinafter described event: Event Name Location Street Closure Date of Event Time: Registral Approximate Number of Attendees _ 'P Answer the following appropriately: e 1. This event will have music (live or other). El Yes No a. I understand the Noise Ordinance described in the Agreement/Permit VYes 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 HillYes F] No additionally filed with the Office of the City Cleric, 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 IE/ Yes No e. A copy of a flyer or door hanger that has, been distributed to all 51-�Yes No affected property owners, 3. a. This event involves City streets Ej/yes 0 b. This event involves County roads Yes N"�-�T F1 o c. This event involves State highways Yes No Updated 8/2017 1 d, This event involves the use of the sidewalk Yes No e. This event is a local/regionalln�'a-,-i—o !vent (Please circle the Yes ❑ No appropriate event type) f. Affected property/business owners have been notified of this event. EYYes No g. There is/are resident(s) affected by the event that may need ADA El Yes [il"-'No transportation assistance to their residence. li. I understand that I must arrange a meeting with all affected governmental agencies to organize the above event (Call Marcia EI/Yes No Quay stainer Service Manager, 235-593,9 to organize meeting). t U. IF ALCOHOL IS TO BE SERVED OR SOLD Alcoholic beverages will be served El Alcoholic beverages will be soldF-1 Certified Check or Money Order for $400.00 must be submitted with application. EJ • 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. application only. Event end times are pursuant uant to the reconunendations ofthe Solith Bend Police Department, 13. IF ALCOHOL IS TO BE SERVED OR SOLD a Certified Check or Money Order f6r $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 Pertnit 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 dented based on any false or incomplete information. Dated this 420�k day of 20 APPLICANT Signature Printed Narne I OUR President 7N--- Menfier member Member Member RE, TURN FORM TO; Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, IN 46601 Phone: (574) 235-9251 Date' I 07/11/2012 13:19 FAX 574 235 8522 Internal Revenue Service District Director Data; NOV 2 81983 Studebaker Museum, Inc. 227 W. Jefferson South Bend, IN 46601 •, . Doar Appl,ioantt, STUDEBARER^ MUSEUM upol Department of the Treasury F.rnployer identilication Number: 35•-1555535 Accounting Period Ending: Deeember 31 Foundation Status Classification, 509 (a) (2) Advance Ruling Pe ed Ends: December 31, 1984 Person to Contact; Donna Carlisle Contact Telephone Numbers 513-684-3578 Case No..313a76024Eb Based on information supplied, and assuming your operations will be as stated in your application .for recognition of exemption, we have d.et.ersn3.-qod you are exempt from Federal, income tax under seotion 501(o)(3) of the Internal Rev+an,ue Code. Because you axe a newly created organization, we are not now moms a final determindtion of your foundation status under seotion ao9(a) Of the C-040 . However, vie have determined that you can reasonably be expected to be a publicly supported organization described in aeotion 509 (a) (2) . Accordingly, you will be treated as a publicly supported organization, and not as a private foundation, during an advance ruling period. This advance ruling period begins on the date of your inception and ends on the date shown above. Within 90 days after the end of your advance ral.ing period, yolti taut submit to us information needed to determine whether you have met the requirements of the applicable support test during the advanoe ruling period. It you est011s3h that you have been a publicly supported organization, you will be classified as a section 509(a)(1) or 509(a)(2) organization as Long as you continue to Most tho requirements of the appliaable ,support test. If you do not meet the public support ►:equirements during the advance ruling period, you will be.oiasritied as a private tounda•tion for future periods. Also, if you are classified as a private founft-tion, yi>u will be treated as a private fpundati.on from the date of your inoeption for purposes of seotions 507(d) and 4940. Grantors and donors may rely on the determination that you are not a private foundation until 90 days after the end of your advance ruling period. Nt you submit the required information within the 90 daym, grantors and donors may oolitinue to rely on the advance determination until. the Servioe makes a final, dotelrmination of your foundation status. However, if notioe that you will no longer be treated as a seotion 509(a)(2) organization is published in the Internal Revenue Bulletin, grantors and donors may not rely on this determination after the date of such publioation. Also, a grantor or donor may not rely on this determination if he or she was in part responsible for, or was aware of, the act or failure to act that resulted in your loss of section 509(a)(2) status, or acquired knowledge that tho internal. Revenue Servioe had given notice that you would be remove4! From classification as a section 509(a)(2) organization. P.O. sox 2508, Cincinnati, Ohio 452011 tcveq j tw L,,Ater 11145(DO) (6 -77) NATIONAL MUSEUM WHAT: Concou�rs d'Elegance at Copshaholm WHERE: W. Washington Street from Laurel Street to Chapin Street [See atlachedlocaflon map] QATE(s): Saturday, August 11, 2018 TIME(s): Gam, to 14pm WHO: Studebaker National Museum CONTACT: The on -site contact during the event is: Patrick Sl'ebonick, cellnumber (5714) 334-0087 On Saturday, August 1.1, 2018, the Studebaker National Museum will be hosting a special event at the Oliver Mansion, called the Concours d'Elegaince at Copshaholm. The Oliver Mansion has been chosen because of its historical importance, beauty, and exquisite gardens, We are thrilled to be guests in your neighborhood and It's Important to us that we are communicating clearly with you, the neighbors. EVENT DESCRIPTION: ® Event hours are from Gam to 14pm on Saturday, August 11, 2018. • We will leave your neighborhood as we found it: litter and recycling will be handled by the Studebaker National Museum. • During the event hours, we expect between 1,000 to 1,500 attendees. • Street will be closed between Gam and lipm on Saturday, August 11, 2018. Seethe attached map for specifics. We will have amplified sound during the hours of Sam and'ipm: there will be a public address system and pre-recorded background music. We are working closely with the City of South Bend to minimize the impacts of the event. Our ,goal is to create an enjoyable and positive experience in your neighborhood. If you or any of the surrounding residents and businesses have questions or comments about impacts of this event, please email us at: Patrick Slebonick Studebaker National Museum 201 Chapin St, South Bend, IN 146601 pslebonicl(@studebakermuseum.org 201 CHAMN STREET 6"ky,ONE 574 235.971,f TOLL FRSF » E4CMM$.S9M.a600 FAX • 5PE235, C)22 WWV'm"m",STUD&BAKFRMvEMUSEUM ORFu oa f - CX 2 4w p Xt � Ir�1 G:t CD v CL �y uPwvq 110 x: Ia�1� t r .. 15 ua r IN r.a 00 l; 3 l U7 43J a;, CO c A Bp& 6 C, 4,„Y r' m L �r .02 z' fiQQD r wu U Z C3 � a Qx o U z 0 °z °z z z Q r 61 ACOROCERTIFICATE OF LIABILITY INSURANCE 01YYYY) nATE(M91I2018 `,, 0611O 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 endorsement(s). PRODUCER CONTACT Alison Christensen NAME: Gibson Insurance Agency, Inc. PHONE Fxt, (800) 814-2122 aC No : (SDD) 836-2122 130 S Main St, Ste 400 AGDRESs: achristensen®gibsonins.Com PO Box 11177 INSURERS AFFORDING COVERAGE NAIC p South Bend IN 46601-0177 INSURERA : Citlzens Ins Co of the Midwest 10395 INSURED INSURER B: Hanover Insurance Company 22292 Studebaker National Museum INSURERC: 201 Chapin St INSURERD: INSURER E ' South Bend IN 46601 INSURER F: COVERAGES CERTIFICATE NUMBER: 5/1118-19 Liab REVISION N11iVIRPRt 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 AVULISUSK POLICY NUMBER DD CY EFF MMI POLICYP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR Z9WA166436 05/01/2018 05/01/2019 EACH OCCURRENCE 1 000,000 $ � DAMAGE TO RENTE11- PREMISES Ea occurrence $ 100,000 MED EXP Any one Person $ 10,000 pERSONALBADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: POLICY ❑ jECOT- 7 LOC OTHER: GENERALAGGREGATE $ 2,000,000 PRODUCTS •COMPIOPAGO $ 2,000,006 $ A AUTOMOBILE LIABILITY X ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED X NON-0WNEO AUTOS ONLY AUTOS ONLY AWWA165341 05/01/2018 0,910112019 CO MBIND SINGLE LIMIT Ea accl ent $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Peracctdenl $ $ B X UMBRELLALIAB EXCESS LIAR X OCCUR CLAIMS -MADE UHWA166463 05/01/2018 05/01/2019 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 DED RETENTION $ 0 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIMEMBER❑ EXCLUDED? (Mandatory in NH) If yes, describo under DESCRIPTtONOFOPERATIONSbelow NIA WZWA165928 05/01/2018 05/01/2019 X PERTUTE ORTH ST E.L.FACHACCIDENT $ 500 000 E.L. DISEASE -EA EMPLOYEE $ 500,000 E.L. DISEASE -POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) PROOF OF COVERAGE ONLY 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 1b19RR-2015 ACORD CORPORATION. All rinhhe raearvarl ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD