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HomeMy WebLinkAboutProcession - St Margarets House - Winter Walk 20191316 CouNTY—CITY BUILDING 227 W.JEFFERSON BOULEVARD S011TH BEND. INDIANA 46601-1830 ^s 4 1865 CITY OF • BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC December 20, 2018 Angelica Healy St. Margaret's House 117 N. Lafayette Blvd. South Bend, IN 46601 RE: Event: Winter Walk 2019 Date: February 17, 2019 Dear Ms. Healy: PHONE 574/235-9251 FAx 574/235-9171 The Board of Public Works, at its meeting held on December 20, 2018, approved your request to conduct the above referenced event on February 17, 2019, from 1:30 p.m. to 3:30 p.m. on the designated route as submitted. Enclosed please find copy of your approved permit. Please note that participants must stay on the sidewalks and obey all traffic laws. If I can be of any further assistance to you in this matter, please call me at (574) 235-9251. Sincerely, Linda M. Martin, Clerk Enclosure GARY A. G1LOT 5UZANNA . FRITZBERG ELIZABETH A. MARADIK JAMEs A. MUELLER THERESE J. DoRAu APPLICATION FOR USE OF '1 ONCE PUBLIC RIGHT-OF-WAY FOR PROCESSIONS" The Board of Public Works must have FOUR (4) weeks prior notice of the event,,', 1865 Sponsor: � , Y� -i " ��� " Submitted By: 1 CGS C����. p Address: 1 City: State: Zip: 4IOI,PO \ Phone: 7 - 2 "4 .-j WS Email: avi v 1C U oy- 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: V� a1k 20\9 Fr 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 [� The event shall be held on I& A-7 , 20 19 and no other date [V� Registration time for the event starts at 1 3b a.rn, la.nr Starting time of the procession is 2 , �)Q a.m. p.m Estimated completion time is 3 50 a.m.r . This event involves the use of the following roadways This event involves closure of City residential streets This event involves County roads F] This event involves State highways 0 This event involves use of a park (Must obtain permission from Park Board) Rf 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. This event is local regional/national event (Please circle the appropriate event type) Rf This event will be coordinated with the property owner/business where staging will take place Updated 08/2017 2 INSTRUCTIONS PROCESSIONS r n w � 1. Complete application a. Your application must have the following: i. Map or drawing of the Route ii. Beginning and end times iii. Whether you will be using or closing a residential street or sidewalk 2. A Certificate of Insurance naming the City of South Bend as an additional insured must be attached to your application 3. Applications MUST be received at least FOUR (4) WEEKS in advance 4. Signature and contact information is required 5. Please make the business/agency/property of where you will be meeting to start your event is aware of your event. 6. Return Application to: Board of Public Works 227 West Jefferson 1316 County -City Building South Bend, Indiana 46601 Phone: (574) 235-9251 Fax: (574) 235-9171 Updated 08/2017 1 PERMIT/AGREEMENT 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 sighting, 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 RETURN FORM TO: 3 Board of Public Works 1316 County -City Bt6ldin 227 West Jefferson Boulevard South Bend, IN 46601 Phone: (574) 235-9251 0 Fax: (574) 235-9171 Hw:.5e Printed Name Title BOARD mOF PUBLIC WORKS At P OVAL 1°ei dent 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 # Fax: (574) 235-9171 � MaV 'f7 V1G� St. liar aret"s House Winter Walk Route February 17th 2019, 2:30-3:30pm SMHQ/0'0 117 Lafayette, Z 26 cu LaSallle v c rw e�tto�' •. Colfax Avo. T t� 6 CCB QWN?ONN Washington $te y, I Jefferson t u 4 WN-Wayne St _ � W " l� py e apt is V YY WeG'l ebP r' ASS lore ,u :r Start at the County City Building (CCB - 227 W. Jefferson Blvd.) Proceed NORTH on Lafayette Blvd. walking on the east side of the street to LaSalle Ave. Turn EAST (right) walking on the south side of the street to Main St. Turn SOUTH (right) walking on the west side of the street to Western Ave. Turn WEST (right) walking on the north side of the street to Lafayette Blvd. Turn NORTH (right) walking on the east side of the street to the north side of Washington St. Cross Lafayette to the west side of the street and head north to end the walk @ St. Margaret's House (SMH - 117 N. Lafayette Blvd.) 0 STMARGA-01 LeA -» DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 1 1 r2/rt1 lt 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. ..... .._W ..... 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 The Healy Group„ Inc. 17535 Generations Drive South Bend, IN 46635 741271-6000 243-3214 INSURERA:SelectI've In surance Group Inc ......... ......... .... 112572 INSURED St Margaret's House Inc !NSURERc; 117 N. LaFayette Blvd. INSURER D South Bend, IN 46601 INSURER. E INSURER F .......... ..... ...... ...... ._.ITIT m _..._._._._ COVERAGES ... __ ...._..._.. _C C I � I�IUIMB_ R-. _.- 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. TYPE OF INSURANCE POLICY INNSR AM_....._._,....__.._._.. ___ 'ADDbfSUBR' 1 NUMBER f POLICY EFF POLICY EXP LIMITS .�A�t/R0�..1�1M(N�RLYXxyt. I A X COMMERCIAL GENERAL LIABILITY 1,000,000 �. CLAIMS -MADE � X� X DAMAGE e _ :$ .1, EACH OCCURRENCE OCCUR $ 2238806 08/0112018 08/01/2019 ERENTED - 20,000 MED EXP ,Any oneperspnl ! $ 1,000 000 PERSONAL "&,ADV INJURY 1$ 1,000,000 E,N°d AGGREGATE L APPLIES PER ,GENERAL AGGREGATE $ 3,000 000 POLICY %e LOC PRODUCTS COMPIOPAOG $ 000,000 ,��aDThIE'...... ..............._---........_...........__WWW__W_._ g AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY (Per person) $ �w OWNED SCHEDULED - A RFbD NO,�-tJN P OPER rY� RY (Par accident) $ . AUTOS ONLY AUTOS BODILY INJURY DAMAGE !JT S ONLY A O ' O d QEeR arrldpn, i ,,,,,,,, ,, $ __-. . . ._.................. ... - A X UMBRELLA LIAR 1l OCCUR I . EACH C RRENCE $ 1,000,000 EXCESS LIAB CLAIMS -MADE X S 2238806 08I01/2018 08/01/2019 1 000 000 CU DED f RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y I N �,,,,,,, H STATUTE. � , """"""� ER IETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT ANY PROPRI rpN°FRRUI MBER EXCLUDED? �IN I F` E.L DISEASE - EA EMPLOYEE $ Jftaaudatory�n NH) a- .. If yes, describe under, OESGRIPTI0 OF OPERATIONS below € E.L. DISEASE -POLICY LIMIT , 1 D of South Bend is IONS I LOCATIONS N 9I VEHICLES Insured _... (ACORD ..... ___........_.u._ ......uu DESCRIPTION OF OPERATIONS I LOCATNONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) City SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of South Bend THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 125 S. Lafayette Blvd Suite 100 ._................ ._ _..... ....... .. .. South Bend, IN 46601 AUTHORIZED REPRESENTATIVE _ _._..__..............................w...........�....—......... ........... _........ _._ _.............. ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD