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HomeMy WebLinkAboutSpecial Event - Fallen Heroes Family Ride - June 27_ J APPLICATION FOR USE OF vi � i0 PUBLIC RIGHT-OF-WAY FOR EVENT The following special events have been approved by the Special Events Committee. isbs Submitted by: Denise Miller Event name: Event Date: Street Closure: Closure Times: Fallen Heroes F 6/27/21 Intermittent cros Ride at intersections, Sidewalk Closure: ❑ Yes ❑ X No Comments: American Legion Riders Post 308 motorcycle ride with an anticipated attendance of 200. Proceeds to support the families of fallen Northern Indiana Military personnel and their families. CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Gary A. Gilot, Member Joseph R. Molnar, Member Jordan V. Gathers, Member Murray L. Miller, Member Attest: Anne Fuchs, Clerk 1 City of South Bend Special Event Application J r rQ'IirST Motorcycle Ride ---- _ f SG o Zr $50 application fee if filed 60 days or greater (up to 360 days) in advance of event Review the Instructions on the Special Events page before completing the application. City and Regional Motorcycle Event applications must be submitted more than 60 days in advance of the event date or the application will not be accepted. Section_A - Applicant Information Date of Application: 7 __a� I Organization Name:1�_I Applicant (Contact) Name:17�j�i Applicant (Contact) Phone: I.__,S7Y - 3j. 7J Contact Email: coy Address: � ,{Z n, City/State/ZIP: /'! 1� J Z& List any professional event organizer, event service provider or commercial fundraiser that is authorized to work on your behalf to plan, produce and/or manage your event. Organization Name: --------------------------------- Contact Name: Contact Phone: __.._ Contact Email: Address: _ ________ City/State/ZIP: Section B - Event Information Event Name : Awr, �� �! Mo event Type torcycle Event Classification: PF( Non -Profit* ❑ For -Profit ❑ City (Civic) Sponsored ❑ Other (If Other, please describe): —__— T________ -- *The Special Events Committee may request proof of non-profit status. Provide a brief description and timeline of event (Note: A detailed map plan is required in Section H of this application. The description should be a summary overview.) Date of Event Setup [mm/dd/yy]: QCTime: Begin Date of Event [mm/dd/yy]: OVL,L [_-- Time: _[�'r� Av— - 2 so r'1 End Date of Event [mm/dd/yy]: 1* Time: _U_L17 _LA"_ Event Cleanup Completion [mm/dd/yy]: -0-6Z.01-41------ Time: __ Total anticipated attendance: _af,7_0 The proposed event will require the closing of: © Streets ❑ Sidewalks Is the event ticketed or include fees? dyes ❑ No If yes, list fees and fee groups below: Does the event have any partnered sponsorships? ❑ Yes 2r' No If yes, list the number of sponsors at each level of partnered sponsorship: Is this a returning special event or part of a series of special events? ® Yes ❑ No If yes, provide the date, location, and attendance of past special events and/or future planned events in the series: Section G - Contingency and Strategic Planning For each of the following, please provide detailed descriptions. If you run out of space, attach a response to this application submission. Emergency Safety Plan - This plan should include, but is not limited to: o The number of Indiana Law Enforcement Academy certified officers, fire, and emergency medical personnel, and the need to use any of the City's public safety or emergency response services. o If hiring a security service, provide contact information and the number of hired event personnel. o Proposed internal communications systems and public address systems. Proposed Cleanup Plan - This plan should include, but is not limited to: o Measures in place to collect and remove trash, litter and recyclables. Inclement Weather Plan - This plan should include, but is not limited to: o Safety measures that will be taken in the event of a tornado warning, tornado watch, thunderstorm, and extreme temperatures. Section H - Site Plan / Route Ma Site Plan / Route Map - For All Events: Provide an attached map with the geographic locations of all event items listed below. • Outline of entire event venue including the names of all affected streets and areas. Clear markings for street closures and a schedule for each. Section I - Mitigation of Impact If you are using and/or closing public sidewalks or streets, you are required to notify area business owners and residents. You must: o Present your event concept to the surrounding stakeholders (residents, businesses, and neighborhood groups) that represent the venue area. Attach a copy of the brochure or door hanger distributed to all affected residents/businesses/neighborhood groups describing the event purpose, date and time. Section J - Insurance A Certificate of Insurance (copy) confirming the existence of a liability policy (General Liability and Automobile Liability) of not less than $700,000 per occurrence and $1,000,000 aggregate, which specifically names the City of South Bend, IN as an additionally insured for the event must be submitted. Copy of Certificate of Insurance must be submitted two (2) weeks prior to the date of the event. Section K - Indemnity & Hold Harmless Agreement City of South Bend Special Events Committee Indemnity & Hold Harmless Agreement Date:, ��! � ���Event Date:_ --------------- Event Name: _ £�: -6Y2 ..rkj(�%v`�G� Organization: -mss l! ,�_. tQ2 l_ Z a'2f Applicant (Contact) Name:�'i2W��i L�)� LT�Rj�__ Applicant (Contact) Phone: _L-,o,o Y. iS- C 915-- Alt. Phone: Email: k 1 LT�k5� CrC -�------- --- --- Address: _ -�cy,� sf_- '7 --___-- —_T City/State/ZIP: �lc7l� q-+-��i �Y-V Event Location (Please describe): Length of Event (Dates/Times): _ -", - T-- ,) j/ Qa__Pg��"^ Insurance Amount: This event is insured for no less than $700,000 per occurrence and $1,000,000 in aggregate, and the certificate of insurance includes a rider naming City of South Bend, Special Events Committee, and Board of Public Works as additionally insured for the event. Organization Name: � 1 C&iJ �rl 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, Indiana, may suffer or incur as a result of any claims or actions which may be made against the City, its agents, employees, or subdivisions by any person, including a participant in the activity, arising out of the approval of this request by the Civil City of South Bend, Indiana, through the Board of Public Works, to close a portion of the public right-of-way for the event described above, or for any harm or damage alleged to have occurred because of the holding of the special event. The undersigned certifies that he/she is authorized to bind the APPLICANT to these terms. Signed on this Date: --------------- Authorized Organizer Signature Printed Name and Title Section L - Permit & Agreement 1. Pursuant to Local Ordinance No. 10628-18, there is a $50.00 non-refundable fee for motorcycle rides applications filed 60 or greater days in advance of the event. 2. The APPLICANT must comply with all terms and conditions of this Permit and Agreement. 3. The APPLICANT must obtain signatures from and/or make 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, time and contact information must be included with the attachments to this application. The applicant is responsible for providing affected residents and business owners with transportation to their property. 4. The APPLICANT shall reimburse the Board for the actual cost to the City for the event, if deemed necessary. 5. Notification of approval/denial of this request will be issued by return of this form, upon signed authorization by the Special Events Committee. 6. The APPLICANT shall provide to the Board a Certificate of Insurance showing a liability policy in full force and effect with limits of $700,000.00 per occurrence and $1,000,000.00 aggregate and the City of South Bend, Special Events Committee, and Board of Public Works listed as an additional named insured for this event. 7. 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. 8. 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. 9. 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 7:00 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). 10. 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. have read the Application and the Permit and Agreement for this Special Event and I affirm the truth of the information provided by me to the best of my knowledge. I understand and agree to the above rules and regulations, and any applicable state and federal laws. I also understand that this application may be denied based on any false or incomplete information. Datej__n_j=_IZU_ ------ Applicant Signature: Printed Name: SPECIAL EVENTS COMMITTEE APPROVAL President Mleber Membd_ Member Member Date American Legion Riders Post 308 FALLEN HEROES FAMILY RIDE June 27, 2021 Support the families of Northern Indiana Military who have GIVEN THEIR LIVES For our FREEDOM* Sign up from 8:00 AM — 10:45 AM in the Wal-Mart parking lot on Portage Ave in South Bend Kickstands up at 11:00 AM for a 60 -mile ride ending at American Legion Post 308 in Osceola Cost for riders: Admission for non -riders: $15 per bike $5/person $10 for 2ad up $15/person with t -shirt (while supplies last) Join us after the ride for GREAT FOOD and ENTERTAINMENT Contact: Marvin Walters 574-315-0735 or mwalters4 vahoo.eom Hank Widelski 574-855-0444 or he 'dels1d ahoo.com Find us on Facebook at American Legion Riders Post 308 *Proceeds will be donated to families of fallen military personnel and military families in need of financial assistance 3/L4/LUL I 3/u I ror[age /we, aouin bens, IIV 400zo Lo Army Klaers, ILL Llncolnway t, l/sceola, Iry 4*ou-i - uoogle ivlaps Maps 3701 Portage Ave, South Bend, IN 46628 to Drive 80.4 miles, 1 hr 50 min Army Riders, 122 Lincolnway E, Osceola, IN 46561 F)1 hr 50 min miles M Beawn Qra:pa:naral . 11C al h Sntrlh El End -- Rond f„ .I New RoadmC11t Nvnh Liberty ,t 001 North r Ir Vari,Go gle Mkhlpan Strael. via N Bendix Dr 1 hr 50 min 1 hr 50 min without traffic 80.4 miles Explore Army Riders 0 0 Restaurants Hotels Gas stations Parking Lots More .WW Army Riders I Township Map data ©2021 Google 2 mi i_ hff--/hen•n•r n nnnl c-/mons/,lir/37!11+Onhonn+A.i Q+ ifh+Rena+IAI+ARR7f2/Re.n-I/•I AMERICAN LEGION RIDERS FALLEN HERO FAMILY RIDE PH. 574-339-1575 PO BOX 452 OSCEOLA, IN 46561 PAY TO THE DE r 71-1212/712 10 n 6 DATE q -p DOLLa[t Ce. ank, INDIANA SOUTH BEND, INDIANA 46634 n_rr.\I1- - �J 1:0712121281: 874 rrrm Ills log C3 (t Reply all gJ Delete & Junk Block RE: Motorcycle Rides Toy Villa Ie 3/30 /202' ?.30 pp%I To: Brad Rohrscheib; Special Event Committee Cc: Eric Crittendon Brad: I appreciate the update. Regards, Toy 6 t 0-) __> From: Brad Rohrscheib <brohrsch@southbendin.gov> Sent: Tuesday, March 30, 20211:32 PM To: Special Event Committee<SpecialEventCommittee@southbendin2.onmicrosoft.com> Cc: Eric Crittendon <ecritten@south bendin.gov> Subject: Motorcycle Rides Special Event Committee Members, St. Joseph County Police, Mishawaka Police, and South Bend Police just had a joint meeting to discuss motorcycle rides. It was decided that there will be new standards effective immediately for a ride to be police escorted. The ride must stay within St. Joseph County. The ride organizer must show proof of at least 100 participants pre -registered 2 weeks prior to the event date, otherwise it must be a "poker run" style ride that is not escorted. A waiver form will also be prepared for the organizer and possibly each participant to sign with regards to liability. I will work with IT to make sure these items get added to the city website in the section under Motorcycle Rides. The application submission process remains the same as far as dates and fees etc. Thank you. Sgt. Brad Rohrscheib Traffic & Special Events South Bend Police Department 701 W. Sample St. South Bend, IN 46601 (574) 235-9817 Reply Reply all Forward hHnr//ni rtlnnL nfFiro nnmlmoil/rioonlin L9nnnni d��7-'I A.vcrcinn-'Jn71 nZ99nnA nA 1 /1 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 04/05/2021 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 Brad & Christina Beineke NAME' _ Gateway City Insurers LLC d,b.Ia Gateway Insurance PHONE q ExU 314-631-5111 (FAX No) 314-631-5115 9302 travois RdA ADDRESS bradgatewaycanhelp com &/or christina@gatewaycanhelp con-, INSURER(S) AFFORDING COVERAGE NAIC # Sl Louis MO 63123 INSURER A National Casually Insurance Company INSURED INSURER D First Comp Insurance Company American Legion Post 4308. Inc INSURER C P O Box 36 INSURER D 122 Lincolnway E INSURER E Osceola IN 46561 INSURER r1r1%1=0Ar_GC PGDTILIC_A.TF N111MRF17• RFVISIfIN NIIMRFR• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LIS -ED 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 AFFORCED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMIT:, SHOIAIN MAY HAVE BEEN REDUCED BY PAID CLAIMS LIR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER Mh1 pO.YYYY 'gam- LIMITS X COMMERCIAL GENERAL LIABILITY _ •-:_ �I . r •::h� •t - S 1.000,000 CLAM'S -MAD' X L'CCUR •- _ ._..-. - r S 50,000 5.000 - - - A KKO 0000008692.4 01128.12021 01/2812022 PERSONAL s ACV IN:JRY S 1.000,000 GEN L AGGREGATE LIMIT APPLIES -'__R GENERAL AGGLREG,Y; E c 2.000,000 X POLICY PRO- PRODUCTS-CCOaRO, AGG s 2;000.000 JECTPRO_ O T htE�. AUTOMOBILE LIABILITY FOM!1IN D SiNG-E LII.'IT ANY AUTO ECDILY IN. URY !Per p emarj _ OWNED SGi=DULE? UDILY IN.JRY fPer acacent; S AUTOS ONLY AJTOS HIRED NcN.Ui'%E: PROPERTY DAVAGE AUTOS 0Ni Y AUTOS ONLY LPs• ac:rfc'E; . UMBRELLA LIAB EACH OCCURRENCE EXCESS LIAB f Ci AL'.1S-N+an=. AGGREGATE D_D RET ENr1ONS .5 WORKf RS COMPENSATION PERTIS. AND EMPLOYERS' LIABILITY 57.:.t I;TL ER _ Y ANYPROPRIETOR'PARTNER EXE(':,'-, YIN N f A \NCO204196 01!28,'2021 01/28/2022 `- _ EACH ACCIDENT _ S 100,000 B OFFICER'NIEI.IB'_RExCLJDEC•� �, PL G 100-000 (Mandatory in NH) `J F DISEASE - EA =NI. CYE_ desaloe Lr)- y i_i...F,- - :,;1, yy = L DISEASE-POLIS_Y LIMIT c 500.000 DESCRIPTION OF OPERATIONS I LOCATIONS) VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) A Veterans Fraternal, civic, non-profit organization philanthropically fund raising for the benevolence of Veterans and the Community The Auxiliary and other groups associated in the Post are additional insured's The properiv coverages may be viewed in the policy which will be mailed to the insured Fallen Heroes Family Ride on June 27, 2021 CERTIFICATE HOLDER CANCELLATION 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 I O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD