HomeMy WebLinkAboutSpecial Event - 2021 Urban Adventure Games - July 31APPLICATION FOR USE OF
PUBLIC RIGHT-OF-WAY FOR EVENT
The following special events have been approved by the Special Events Committee.
Submitted by: Denise Miller
Event name: 2021 Urban Adventure Games
Event Date: 7/31/21
Street Closure: St Louis from the South side of Jefferson to St Peter.
Closure Times: 5:00 am to 10:00 am
Sidewalk Closure: ❑ Yes ❑ X No
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Comments: Participants pair up in teams of two to embark in a race around the City.
Participants will run, bike, slide, climb and swim on their way to a number
of checkpoints spread across the South Bend area. Closure times are only
necessary for the start of the race.
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
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
1
„THBf__ City of South Bend Special Event Application
o City and Regional Event
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$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: July 8, 2021Urban Adventure Games, Inc. Organization Name: ____
Applicant (Contact) Name: Urban Adventure Games, Inc./ Emily Sims
Applicant (Contact) Phone:
312-718-4769 Contact Email:racedirector@urbanadventuregames.com
—_----------------
Address: PO Box 11463 ____ City/state/ZIP: South Bend, IN 46634
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
2021 Urban Adventure Games Race
Event Name: Event Type: (Festival, Race, Parade, Other):__--_
Event Classification: ® Non -Profit' ❑ For -Profit
El City & In-kind sponsors 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.)
The Urban Adventure Games is a thrilling, zany, action -packed exploratory race.
Participants pair up in teams of two to embark on an "Amazing Race” in a day. Racing
around the city, participants will run, bike, slide, climb, swim and do so much more on their
way to a number of checkpoints spread across the South Bend area. Race is from 8am-3pm
on July 31, 2021.
Date of Event Setup [mm/dd/yy]: 07/31 /21
Begin Date of Event [mm/dd/yy]: 07/31 /21 07/31 /21 ---
End Date of Event [mm/dd/yy]: ---_
Event Cleanup Completion [mm/dd/yy]: 07/31/21
Total anticipated attendance: 500
Time: 5:00am
---- ----------------------
Time: 8:00am
-----------------
Time: 3:00pm
-------------------------
Time: 3_OOpm
The proposed event will require the closing of: 0 Streets ❑ Sidewalks
Is the event ticketed or include fees? ® Yes ❑ No If yes, list fees and fee groups below:
Elite Division: $200; Open Division: $180; Fun Division: $160
Does the event have any partnered sponsorships? ® Yes ❑ No
If yes, list the number of sponsors at each level of partnered sponsorship:
South Bend Venues Park & Arts
Athletico
Let's Spoon
Eco Owl
U93
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:
July 28, 2018, Downtown South Bend - 600 participants
July 29, 2017, Four Winds Field - 600 participants
July 30, 2016, Four Winds Field - 600 participants
July 25, 2015
Annually: July, 2009 - July 2014 (specifics unknown)
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? 500
Describe any sound equipment that will be used in the parade/race:
We will have a wireless speaker system at Howard Park.
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.
Elite Division: 52; Open Division: 268; Fun Division: 180
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-uo, and Logistics
Are you hiring a company to provide entertainment, games or inflatables? ❑ Yes ® No
c 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 ® 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 ® 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
o If yes, describe the type of music, schedule of sound check/performances, and the names of any artists
performing:
U93 will be there to DJ
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: Countybridges:
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 ❑ No
c 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.ore/food-service.
Please select food sales types: ❑ Food Vendor ❑ Caterer 0 Food Truck ❑ Other:
If a Food Truck, please list company name:
Real Grille Food Truck, Kona Ice Truck, Let's Spoon, Rico Sauve Group, Smokin D's BBQ
Describe how food will be cooked and served:
Food will be cooked and served at each individual truck.
Section F - Alcohol
Will alcohol be served or sold? Eyes ❑ 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.
o A refundable $400.00 deposit paid by card or check (made to City of South Bend) must be submitted
with application.
o Application cannot be processed without deposit. Deposit will be returned upon inspection of
event area by the Board of Public Works.
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
Contact Phone:
Contact Name:
Email:
Address: --- _— ---- __ — ---------------------- City/State/ZIP:
(b)
Name: Off -Duty SBPD officers — - Contact Phone:
Name: Contact
Qualifications:--------------------------------------------------
Name:------------------------------------ Contact
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.
There will be (3) off-duty South Bend Police Officers at Howard Park as the event wraps up.
All racers are instructed to call 911 if there is an emergency while they are out on the race
course.
Proposed Cleanup Plan - This plan should include, but is not limited to:
o Measures in place to collect and remove trash, litter and recyclables.
South Bend Venues Parks & Arts will be disposing of trash barrels for the games.
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.
Any inclement warnings/advisories will be given before racers depart. Additional covering if
needed will be at the Howard Park buildings.
• Proposed Lost and Found Plan - This plan should include, but is not limited to:
c A description of the use of signage, announcements on public address systems or pre -event
handouts.
Lost and found items will be announced on the public address system when race participants
return to Howard Park.
Section H - Site Plan / Route Mao
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:
Race participants establish their own route as they claim check -points and explore the South
Bend region.
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.
Section K - Indemnity & Hold Harmless Agreement
City of South Bend Special Events Committee
Indemnity & Hold Harmless Agreement
Date: 07/08/2021 Event Date: 07/31/2021
Event Name: 2021 Urban Adventure Games
Organization:
Urban Adventure Games, Inc.
------------------------------------
Applicant (Contact) Name: _Emil y Sims
Applicant (Contact) Phone: 312718-4769 —_----- Alt. Phone:
Email racedirector@urbanadventuregames.com _------ --- ---------------
Address: PO Box 11463 --- ______City/State/ZIP: South Bend, IN 46634 --
Event Location (Please describe):
Race start/finish at Howard Park
Length of Event (Dates/Times): July 31, 2021_ 8:00am_3.00pm
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:
Urban Adventure Games, Inc ._— 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: 07/11/2021
Digitally signed by Emily Sims
DN: cn=Emily Sims, o, ou, email=esims@cfh.net, c=US
Date: 2021.07.11 14:18:11 -04'00'
Authorized Organizer Signature
Emily Sims, Race Director
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.
B. 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: 7/11/21
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Applicant Signature: ow ma+m+aza_204a0
Printed Name: Emily Sims
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BEER / WINE AUTHORITY I TY3"Iy
\ State Form 35494(R1013�20)
INSTRUCTIONS: �uN L ZOZ�
1. Applicant must complete all requested informal .
2. Please type orprint cralmy.
3. Submit application and payment to the local excise district office.
4. All events are $50 00 per day (905 /AC 1-11.1-1). But ecks and money
orders made payable to the Indiana Alcohol and Tobacco Commission am accepted.
5. Serving past midnight, no later than 3AM, is one (1) day
6. No rain checks on any o1 the listed events.
Visit httoslNnnvin.aov/atrsseol2379 htm for additional information about the districts.
Deliver or mail completed application and payment to:
DISTRICT 1
DISTRICT
52422 County Road 17
651 S. Commerce Drive
Bristol, IN 46507
Seymour, IN 47274
Telephone: (574) 264-9480
Telephone: (812) 523-8314
DISTRICT 2
1353 South Governors Drive
Columbia City, IN 46725
Telephone: (260) 244-4285
DISTRICT 3
41 West 300 North
Crawfordsville, IN 47933
Telephone: (765) 362-8815
DISTRICTS
3650 South US Hwy 41
Vincennes, IN 47591
Telephone: (812) 882-1292
DISTRICT 6
6400 East 30th Street
Indianapolis, IN 46219
Telephone: (317) 541-4100
Page 1 of 2
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STEP 1. GENERAL INFORMATION
Name of applican applying
for permit ( nizaeon, dub, corporation, indMduali
TM Penult number pssuadbyATC)
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E-mail address
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Name of persoamaking application
Fax number
Emergency confect telephone num
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Printed n#me of contact person of event
Emergency contact telephone number
EMIq Sims
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STEP 2. EVENT INFORMATION
Beginning day
Beginning date (monM, day, year)
Ending day
E:I date (month, day, year)
7
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Time d wont
Stan time 11.30
KAM ❑ PM i
Endtime z•3Q
❑ AM tj'PM
Type or description of event
Exact adarbse of nt (nuniberandslinu,4 dry, state, antl Z/Pcode) ��,((��W—y
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STEP 3. FLOOR PLAN (See Step 4, Number2.)
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Page 1 of 2
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STEP 4. ACKNOWLEDGMENT
In order to qualify for this authority to serve beer and wine, the following guidelines must be met:
1. There must be a wall defined premises, i.e. building, lent, enclosure, or fenced -in or designated area.
2. You must have a defined floor plan or diagram. This is to be drawn on Page 1, Step 3 of this application. If minors are to be present, you must have
a defined separation between the bar area and family area. (Must be on floorplan.)
3. There shall be NO carry -out privileges, NO carry -in privileges and NO spirituous beverages allowed.
4. Each applicant must designate an individual to be responsible for the event and such person shall sign the authority.
5. ANY and ALL persons dispensing or accepting payment for alcoholic beverages MUST POSSESS a valid ATC employee permit.
6. The event must meet applicable Indiana State Board of Health requirements, padicularly with regard to restroom facilities.
7. If the event is held in a town park. you must have approval from the town board.
S. Legal Hours of dispensing alcoholic beverages: (Prevalling time)
Monday through Saturday — 7 AM to 3 AM the following day
Sunday -- 7 AM to 3 AM the following day
9. Applicant must file with the district office at which the event will be held at least five (b) days prior to the event.
10. The authority must be posted in the most conspicuous place at the location of the event. An excise officer or commissioner, for good cause, has the
authority to revoke the authority during the event.
STEP S. COMMUNITY CLEARANCE
1. Sign re or h//erilf of ly, or Chief arT Mai of (urisdlGian where the event will be held
Care signed fnbnih, day, year)
V
2. Signature of the mayor tirlhe event is held in F )
Date signed (month, day, year)
Note:
Please post your approved request in a conspicuous place where the alcoholic beverages are being dispensed at the location.
If for any reason this request is denied, you may be notified either in person or by telephone.
I swear or affirm under penalties of perjury that the information is true and accurate.
SignaVtr6af perrPi /agent Signa u aotm that you hem read and wrl abide by the rules and guidelines.)
Dab sigapd mond, Vey. year)
FOR DISTRICT USE ONLY
District number
Dab issued (mon M, day. year)
Reviewed by Exdse PdK Dis ' 1
Approved ❑ Denied
M2
Page 2 of 2
Denise Miller
From: Emily Sims<raced irector@urbanadventuregames.com >
Sent: Wednesday, July 14, 2021 2:28 PM
To: Denise Miller
Subject: security for Urban Adventure Games
Hi Denise!
We intend to hire off-duty SBPD officers for the post party. The officers are:
-Stephanie Northcutt
-Ken Ryan
-Randy McMurry
If you have any additional questions, please let me know.
Thank you!
Emily
Emily Sims
Race Director
Mobile: 312.718.4769
www.UrbanAdventureGames.com
The Adventure Begins July 31 20211
CITY OF SB SPECIAL EVE
731 S LAFAYETTE BLVD
SOUTH BEND, IN 96601
07/14/2021
15:23:59
MID: %1(X%X%k)WO1X401 TID XX 800
CREDIT CARD
VISA SALE
Card #
XXXXXXXXXXXX0913
SEQ a:
2
Batch a:
17
INVOICE
3
Approval Code:
913986
Entry Method:
Manual
Mode:
Cnli e
Tax Amant:
$0.00
Avs Code:
NNN
SALE AMOUNT $4002
I agree to pay above total amount
according to card ower agreement.
(Merdwnt agreement it Credit Voucher)
MERCHANT COPY
CITY OF SB SPECIAL EVE
731 S LAFAYETTE BLVD
SOUTH BEND, IN 96601
01/14/2021
15:20:56
MID: XIW(XXXXXW401 TIC: XXXXX800
CREDIT CARD
VISA SALE
Card u
XXXXXCtXXXX;(0913
SEQ p:
I
Batch q:
17
INVOICE
2
Approval Code:
913381
Entry Metrad:
Manual
Mode:
Online
Tax Amount:
$040
Avs Code:
NNN
SALE AMOUNT $100.0
I agree to pay above total amount
according to cad suer agreement.
(Merdnant agreement A Credit Voucher)
MERCHANT COPY