HomeMy WebLinkAboutSpecial Event - Livestrong at the YMCA 5K - August 7501`, TH R�
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APPLICATION FOR USE OF x
PUBLIC RIGHT-OF-WAY FOR EVENT = rt� Z.
The following special events have been approved by the Special Events Committee.
Submitted by: Denise Miller
Event name: LIVESTRONG at the YMCA 5K and 1 Mile Family Fun Run
Event Date: 817121
Street Closure: Start on Wall St East of Greenlawn, East on Wall St then left into Zoo
parking lot, Left onto S Greenlawn Ave, Right on Wall St, continue West
along Wall St, cross over Twyckenham, Right onto Sunnyside Ave, follow
to Wayne St and turn right, follow loop around Wayne St and turn right
back onto Sunnyside Ave, follow back to Wall St and turn Left to finish
just past Wall St.
Closure Times: 5:30 am to 12:00
Sidewalk Closure: ❑ Yes ❑ X No
Comments: Well-being program designed to help adult cancer survivors reclaim their
total health and no cost to the participant.
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
C�
Elizabeth A. Maradik, President
Gary A. Gilot, Member
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Joseph R. Molnar, Member
Jordan V. Gathers, Member
Murray L. Miller, Member
Attest: Anne Fuchs, Clerk
City of South Bend Special Event Application
46
City and Regional Event
$50 application fee if filed 60 days or greater (up to 360 days) in advance of event
$100 expedited application fee if filed 30-59 days in advance of event
Review the Instructions on the Special Events page before completing the application. City and Regional Special
Event applications must be submitted more than 30 days in advance of the event date or the application will not
be accepted.
Section A - Applicant Information
Date of Application: 3_30_21
Applicant (Contact) Name:Crystal Jodarski
Applicant (Contact) Phone:574-233-7760,
Address: 321 East Walter St.
Organization Name:__—_ YMCA of Greater Mkhiana (OBnen Centen YMCA Partnership
cjodarski mca
Contact Email: ym.or 9 g _
City/State/ZIP: South Bend, IN 46614
List any professional event organizer, event service provider or commercial fundraiser that is authorized to work
on your behalf to plan, produce and/or manage your event.
Organization Name:
Contact Phone:
Address:
Contact Name:
Contact Email:
City/State/ZIP:
Section B - Event Information
LIVESTRONG at the YMCA Sk and 1 Mile Family Fun Run Race
Event Name: Event Type: (Festival, Race, Parade, Other):______—______
Event Classification: E Non -Profit" ❑ For -Profit
❑ City (Civic) Sponsored ❑ Other (If Other, please describe):
"The Special Events Committee may request proof of non-profit status.
Provide a brief description and timeline of event (Note: A detailed map plan is required in Section H of this
application. The description should be a summary overview.)
Set up: 5:30am
Packet Pick-up: 6:30am
5K Start: 8:00am (If staggared start is needed start time will be 7:30am.)
1 Mile Family Fun Run: 8:45am
Date of Event Setup [mm/dd/yy]:$=7 =2 Time: 5_30am
Begin Date of Event [mm/dd/yy]: $_7-21 --- -- -------- —__ Time: 8:00am
End Date of Event [mm/dd/yy]: 8-7=21 .......... —__.... Time: 1 1 _00am
Event Cleanup Completion [mm/dd/yy]: 8-7-21 ___ 12:00_
Pm
—---------Time:-------—
Total anticipated attendance: 200
The proposed event will require the closing of: ® Streets 11 Sidewalks
Is the event ticketed or include fees? ® Yes
Regular Registration - 41112021 - 7/1812021
$25 per person
$20 per person for housandtls of 2.8 participants
Late Regiatratlon - 7/1912021 - 81712021
$30 par person
Virtual participant Option - 4/1/2021 - 81712021
$25 per person
❑ No If yes, list fees and fee groups below:
Does the event have any partnered sponsorships? ® Yes ❑ No
If yes, list the number of sponsors at each level of partnered sponsorship:
We haven't secured our sponsors at this time but plan to have the following levels:
Platinum - $5,000 - limit 2
Gold - $2500
Bib - $1500 - limit 1
Silver - $1000
Bronze - $750
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:
This is a new event, although in previous years, the YMCA has held the 3 for 3 Triathlon
Event to benefit The LIVESTRONG at the YMCA program. This new event will take the
place of the Triathlon event moving forward.
If your event is a parade, race, or other processional -type event, please complete Section C. Otherwise,
continue to Section D.
Section C - Parades. Races, and other Processional Events
What is the estimated number of parade/race spectators on the proposed route? 100
Describe any sound equipment that will be used in the parade/race:
Our timing compnay will have the ability to have sound.
Does the event have participant categories? For example, a run that has different race divisions or a parade with
separate walking/marching groups.
❑ Yes ® No
If yes, list categories and anticipated participants per category.
If your event is a parade, what is the approximate number and type(s) of animals, vehicles, and floats participating
in the parade? (Note: If using animals in a parade, event organizers are responsible for cleaning up animal waste
left on the parade route.) Describe parade participants below:
Section D - Eauioment Set-up, and Logistics
Are you hiring a company to provide entertainment, games or inflatables? ❑ Yes 0 No
If yes, you must submit proof of insurance for all stage and entertainment companies three (3) weeks
before the event.
Describe any hired entertainment:
Will you be staking any tents, inflatables, portable restrooms or any other anchorings? ❑ Yes R No
o If yes, you must provide proof of locates (locate number) two (2) weeks prior to your event. Locates can
be found by calling 811.
Does your event include the use of fireworks, rockets, lasers, or other pyrotechnics? ❑ Yes M No
o Depending on the potential fire risk, applicants may need to receive approval of the South Bend Fire
Department (process facilitated by event coordinator).
o Describe the event's proposed fire -related entertainment:
Will there be any musical entertainment features at the event? ❑ Yes ® No
If yes, describe the type of music, schedule of sound check/performances, and the names of any artists
performing:
For stage inspections, contact the Department of Homeland Security at 317-232-2222.
If your route crosses over a state road or a bridge please contact the following for permission:
State, INDOT: County bridges:
Michael Hurt Andy Hayes
219-235-7528, Mhurtl@indot.in.gov 574-235-9626, ahayes@co.st-joseph.in.us
Section E - Food
Are you having food at your event (food vendors, caterers, food trucks, etc.)? ❑ Yes 0 No
o If yes, the event coordinator must apply for and receive a St Joseph County Health Department
Temporary Event Permit.
o Vendor(s) must also apply for and receive a St. Joseph County Health permit. Health Permits must be
filed with the county 30 days prior to the proposed event. Each vendor must obtain necessary permits to
serve on-site and display these permits at the event.
o All applications and guidelines can be found at the St. Joseph County Health Department Food Service
website: sichd.ora/food-service.
Please select food sales types: ❑ Food Vendor ❑ Caterer ❑ Food Truck ❑ Other:
If a Food Truck, please list company name:
Describe how food will be cooked and served:
Section F - Alcohol
Will alcohol be served or sold? ❑ Yes 0 No
If no, please continue to Section G - Contingency and Strategic Planning
If yes:
The applicant must apply for and receive a temporary liquor license from the Alcohol & Tobacco
Commission. Indiana ATC forms are located at in.gov/atc/2409.htm. (Temporary Permits are near the
bottom of the form list.) Forms must be filed with the district ATC office five (5) days prior to the
requested event date.
o Application cannot be processed without a copy of this license.
A refundable $400.00 deposit paid by card or check (made to City of South Bend) must be submitted
with application.
c Application cannot be processed without deposit. Deposit will be returned upon inspection of
event area by the Board of Public Works.
o Events with have alcohol sales must provide security. If your event will be hiring a security company,
please provide its contact information in sub -section (a) below. Otherwise, please list the names, phone
numbers, and qualifications (e.g. off-duty police officer, professional security guard, or event applicant) of
three (3) security guards in the fields provided in sub -section (b).
(a)
Company Nam(
Contact Phone:
Contact Name:
Email:
Address: —------------ — ----- ----------------------- City/State/ZIP:
(b)
Name:
Contact Phone:
Qualifications: . . . ........... . .... . .... . .................. . .............
Name:
ualifications:---------------------------------------------------------
Name: Contact Phone:
Qualifications: --___ ---------- ___— --- —_— ----- —
Name: Contact Phone:__—___
Qualifications: __-- _
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.
In the event of an emergency, the YMCA will have a communication system on site to be able
to communicate to key individuals. We also will make sure all volunteers have key phone
numbers to report any incidences.
• Proposed Cleanup Plan - This plan should include, but is not limited to:
o Measures in place to collect and remove trash, litter and recyclables.
The YMCA team and volunteers will be responsbile for all clean up efforts. We have a course
team prepared to clean up route after our last racer.
• 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.
In the event of inclement weather, the YMCA will follow the guidance of local experts to help
us make event day decisions and follow all city recommenations. We would make sure
participants and news outlets had key infomation about any cancellions prior to race event.
• Proposed Lost and Found Plan - This plan should include, but is not limited to:
o A description of the use of signage, announcements on public address systems or pre -event
handouts.
In the event of lost and found, we will have an area for participants to claim their belongs. We
will also have announcements to make sure people are aware. If things are left, we will make
sure people know that they can find their belongings at the O'Brien Center after the event has
concluded.
Section H - Site Plan / Route Mau
For parades, races and other processional events:
Are you selecting one of South Bend Police Department's (SBPD) pre -approved race routes? ® Yes ❑ No
You must select from SBPD's pre -approved race routes (see links on application site) or provide sufficient
evidence of event participation if the applicant is proposing a different route through South Bend.
If your event will not be using a pre -approved race route, the proposed event map should include a route plan
clearly identifying the timing and locations of proposed street closures, and the direction of parade
movement.
If your event will not be using a pre -approved race route, please explain:
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.
• Location of fencing, barriers, and/or barricades. Indicate any removable fencing and exit locations for
emergency purposes.
• Location of all stages, platforms, bleachers, grandstands, tents, booths, cooking areas, vehicles, trailers,
and other temporary structures. Applicants should also clearly mark locations of food and alcohol
serving or sales, if applicable.
• The location(s) and number of all portable toilets and wash stations.
• The location(s) and number of all trash and recycling containers, including dumpsters.
• The location of generators or any source of electricity.
• Traffic plan and map, including proposed loading/drop off areas, barricades, secured areas, vehicle and
bicycle parking areas, and considerations for TRANSPO bus route changes.
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:
c 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.
Date: 3/30/2021
Section K - Indemnity & Hold Harmless Agreement
City of South Bend Special Events Committee
Indemnity & Hold Harmless Agreement
Event Date: 08/7/2021
Event Name: LIVESTRONG at the YMCA 5K and 1 Mile Family Fun Run
Organization: YMCA of Greater Michiana_O'Brien Center/YMCA Partnership
Applicant(Contact)Name: Crystal Jodarskl__
Applicant (Contact) Phone: 574-233-7760_ at Phone: 920-495-1123
Email cjodarski@ymcagm.org
City/State/ZIP
Address: : _
321 East Walter Str. South Bend IN 46614
Event Location (Please describe):
Potawatomi Park; Mishawaka Ave. at Greenlawn Ave.
Length of Event (DatesTSam - 1lam,
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.
agrees to indemnify. Organization Name: The YMCA of Greater Michiana — _----_ __—_ B fy, 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: 3/30/2021
Signature
I Jodarski - 3/30/2021
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 Tier II and III event
applications filed 60 or greater days in advance of the event, or a $100 non-refundable expedited fee for
applications filed between 30 and 59 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.
I 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.
Date:
03/30/2021
Applicant Signature:
Printed Name: Crystal Jodarsk
SPECIAL EVENTS COMMITTEE APPROVAL
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LIVESTRONG® at the YMCA 5K will be
passing through your neighborhood
on Saturday, August 71.
LIVESTRONG® at
the
YMCA 5K begins at
8:00 AM
and a 1 Mile
Fun
Run follows at 9:00
AM.
Roads will be closed from approximately 7:00 AM -10:00 AM.
What is LIVESTRONGID at the YMCA?
LIVESTRONGo at the YMCA is a 12 -week,
research -based physical activity and well-being
program designed to help adult cancer survivors
reclaim their total health at no cost to the
participant.
-6
the
VQ
L I V E S T R 0 N G
LIVESTRONG® at the YMCA 5K will be
passing through your neighborhood
on Saturday, August 71.
LIVESTRONG® at
the
YMCA 5K begins at
8:00 AM
and a 1 Mile
Fun
Run follows at 9:00
AM.
Roads will be closed from approximately 7:00 AM -10:00 AM.
What is LIVESTRONG® at the YMCA?
LIVESTRONG" at the YMCA is a 12 -week,
research -based physical activity and well-being
program designed to help adult cancer survivors
reclaim their total health at no cost to the
participant.
they
L I V E S T R 0 N G
YMCA OF GREATER MICHIANA INC.
3665 HOLLYWOOD RD.
SAINT JOSEPH, MI 490859581
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800162-2800
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1:2 7 24848 5 21:000 10088 200 bull 1047
$ 50.00