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HomeMy WebLinkAboutNon Res Block Party - Kite Realty - Trick or Treat11, 316 COUNTY-Crry BuILDING 227 W. JETFERSON BOULEVARD SOU'l 11 BF.M). INDIANA 46601-1830 CITY OF SOUTH BEND PETE Bui'TiGIEG, MAYOR BOARD OF PUBLIC WORKS October 9, 2018 Taryn Ford Kite Realty Group 30 S. Meridian St. Indianapolis, IN 46204 RE: Event Name: Trick -or -'Treat Street Closure: Eddy St. from Angela Blvd. to Napoleon Blvd, Dear Ms. Ford: PHONF 574/235-9251 FAX 574/ 235-9171 The Board of Public Works, at its meeting held on October 9, 2018, approved your request to close the above referenced street for your event scheduled for October 23, 2018 from 1:0�O p.m. until 8:00 p.m. For your information, the South Bend Police Department will monitor this event. Enclosed please find a copy of your approved permit. You will be responsible for the placement and removal of barricades for the closure of the street. 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. If you have any further questions regarding this matter, please call this office at (574) 235- 9251. Sincerely, Linda M. Martin, Clerk Enclosure GARY A. Gii,oi' SUZANNA M. FlUTZBERo ELIZABE,119 A. MARADIK JAMEs, A. M U UIJ, ER TiffiRESE 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 -RE FUNDABLE APPLICATION FEE OF $125.00, IN THE FORM OF A CERTIFIED CHECK OR MONEY ORDER, PAYABLE TO THE CITY OF SOUTH BEND, MUS­ INCLUDED WITH APPLICATION. [V,47c c Paid ✓ dG, T( Applicant Name: VL4 V1 rOl Address: q n §hzity: wdiAMOD I (� State: -1 Zip: 104- Phone: �11-6100-�i wo Email: +-foydftft�vel�- �M� 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 -�- I o�-' - a - Tye 0 � Location edh S-k mmws (Describe Area/Route) Street Closure Eddu Name of Street eM C To rIFrom N(4%0 (e Q n Date of Event 20 M F-11 a.m. F-1 m .m� Time: Registration/Setup MP.M. Stall El a.m. End 16 N?rp.t. 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 D 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 50 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 ❑� No additionally filed with the Office of the City Clerk, 4,h 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. a. This event involves City streets Yes ❑ No b. This event involves County roads El Yes No c. This event involves State highways E] Yes No Updated 8/2017 1 d. This event involves the use of the sidewalk [� Yes ❑ No e. This event is a local/regional/national 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 e Board of Public Works The Non-residential Block Party will be permitted to take place under the following terms and conditions: 1. Pursuant to Local Ordinance No. 10224-13, there is a $125,00 non-refundable fee for non- residential Block Patties. 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 TOO 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 $400.0O 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 of 20 Tg,j 71 APPLICANT Signature Printed Name I —B9ARD OF PUBLIC UX APPROVAL President Member Member 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 EDDY STREET COMMONS TRICKAREAT Radio Remote Crafts Pumpkins Magiic Face Painting Home Depot Pidgeon and Hen Kite 10 Soccer Shot Balloons Fire Safety 13 Porta Potties Trick -or -Treat Napoleon Blvd. 31017B 0 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYYI 2/27/2018 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(€es) 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 Lines - (404) 923 3700 Commercial L USI Insurance Services National, Inc. 3475 Piedmont Road NE, Suite 800 Atlanta, GA 30305-2886 coNTACT Tim Baumann NAIVE: "ONE FAX :0610 537 1929 EMAIL tim.baumann@usi.com anDREss; INSURER(S) AFFORDING COVERAGE , NAIC 4 INSURERA: Endurance Assurance Corporation 11551 INSURED Kite Realty Group Trust 30 S. Meridian St., Suite 1100 Indianapolis, IN 46204 INSURER e : Allied World National Assurance Co, 10690 INSURER_ C : Sompo America Insurance Company _ _ INSURER O : 11126 INSURER E ; INSURER F ; i,r_nwr+cr+ e-CDTIRt!'_A-rr: MHMME-0- 1277427"b REVISION NUM$EK: oee DeroW 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 ❑1=SCRIBED 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 A SD WVO POLICY NUMBER MM nD YYY MMIDDIOL'ryYYYYe'p LIMITS A X COMM&RCIALGENERAL LIABILITY CLAIMS -MADE X OCCUR GGR10012604100 031011201E 03/01/2019 EAC"OCCURRENCE S 1,1300,000 -71 PREMISES Ea occu nce}� S 1,0001000 MEO EXP (Any one person) S Excluded PERSONAL &AOV INJURY 5 1.000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERNLAOGREGATE S 2,000,000 PRODUCTS -COMPIOPAGG $ 21000,000 POLICY ❑ L_"J LOC 5 ,fop A OTHER: AUTOMOBILE LIABILITY ACVS100BIO 0310f12018 03/01/2019 EOMacelde tswyLELIMIT S 1,000,000 BODILY INJURY (Per person) ANYAUTO BODILY INJURY (per eccldnntl S OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY PROPERTYOAh1AGE Per accidan€ $ $ B TXU1MBRE1kL-ALJAB"TIOx CESS LIAR OCCUR3088008 CLAIMS -MADE 03/01/2018 03/01/2019 EACHOCCURRENCE S 25,000,000 AGGREGATEE $O X RETNS WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIMEMSEREXCLUDEO? C IMandatory in NH) If es, Jest ibe undo€ D>�SCRIPTION UO OPERATIONS below X1 STA E ERH NIA WCN81015P0 03/0112018 03/01/2019 E.L. EACH ACCIDENT S 1,y00,0g0 E.L. DISEASE - EA EMPLOYEE $ i'000,000 E.L. DISEASE - POLICY HMiT S 1,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES (ACORD 101, Additional Remarks Schedule, maybe alfached If more space Is required) Re: KRG Eddy Street Commons, LLC , Eddy Street Commons 1044-1234 Eddy Street, South Bend, IN 46601 r�r: Ft f-awr:F1 I l I111N City of South Bend Department of Public Works, Engineering Division SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION BATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 227 W Jefferson Blvd„ Suite 1316 AUTHORIZEDREPRESENTATIVE South Bend, IN 46601 The ACORD name and logo are registered marks of AGUKu lyt3ti-zV15 H�vreu �,�rcrvrcra I rely, ntI I1y€1w Iearlvcu, ACORN 25 (2016103)