HomeMy WebLinkAboutSpecial Event - South Bend Riley Homecoming Parade - October 8f4yOL�NeF .
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APPLICATION FOR USE OF •
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PUBLIC RIGHT-OF-WAY FOR EVENT �•.� �a
The following special event has been approved by the Special Events Committee. ". 1865
Submitted by: Denise Miller
Event name: South Bend Riley Homecoming Parade
Event Date: 10/8/21
Street Closure: Leave Christian Center on Ireland Rd to Miami, turn Right
to Jackson Field
Closure Times: 6:00 pm_ to 7:00 pm
Sidewalk Closure: ❑ Yes ❑ No
Comments: Annual South Bend Riley Homecoming Parade.
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS Imo/
Elizabeth A. Maradik, President
Gary A. Gilot, Member
Joseph R. Molnar, Member
Jordan V. Gathers, Member
Murray L. Miller/, Member
Attest: Anne Fuchs, Clerk
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City of South Bend Special Event Application
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.
I, Section A - Applicant Information /� e
Date of Application: _—U_7' q / / _Ri ------- —_ Organization
Applicant (Contact) Name: --ire_ — ---- -------------------
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Applicant (Contact) Phone: M3 - 5/c23 --------- Contact Email: }%ptin5Oyt 1`� SbCSC KI�_�a ,
Address: 19o-1 S. JC46W $-XAJ -41bIJIS ----
City/State/ZIP: _5��—�'1`�'_
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
�mannaag.ejyour event.
Organization Name: I1�1J](!/__LIji t-____ Contact Name:
Contact Phone: -------------------------------/Contact Email:------------------------------------
Address:---------------------------------
City/State/ZIP:
—
Section B - Event Information
Event Name : 1____--____--'`� —Event Type: (Festival, Race, Parade, Other): -----------
Event Classification: 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.)
Date of Event Setup [mm/dd/yyl: AQI
Begin Date of Event [mm/dd/yy]: _ Jn
End Date of Event [mm/dd/yyl: ----- L4
Event Cleanup Completion [mm/dd/yyl:
Time: -.0-
__4_'
--------------
Time: p�-Q-6-------------------------
Time: fY s—.1 -------------------------
Time: —LJ_ - -----------------------
Total anticipated attendance: —_—L ele—_—_________ p
The proposed event will require the closing of: )0 Streets 0 Sidewalks 1'a1 �IGILQ
us
Is the event ticketed or include fees? ❑ Yes '54 No If yes, list fees and fee groups below:
Does the event have any partnered sponsorships? ❑ Yes 'A 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? A Yes ❑ No
If yes, provide the date, location, and attendance of past special events and/or future planned events in the
series:
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?----. a Q.
Describe any sound equipment that will be used in the parade/race:
Does the event have participant categories? For example, a run that has different race divisions or a parade with
separate walking/marching groups.
AYes ❑ 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 - Equipment Set-up and Logistics
Are you hiring a company to provide entertainment, games or inflatables?
❑ Ye
o 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? ElYes ANO
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? Cl Yes
Depending on the potential fire risk, applicants may need to receive approval of the South Bend Fire
Department (process facilitated by event coordinator).
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:
Section E - Food �. J
Are you having food at your event (food vendors, caterers, food trucks, etc.)? 11Yes L� No
If yes, the event coordinator must apply for and receive a St Joseph County Health Department
Temporary Event Permit.
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.
All applications and guidelines can be found at the St. Joseph County Health Department Food Service
website: s'chd.org/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 '�*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 t� Qoy/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.
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 Name: --_— ------- —_— ------------ —_--- Contact Name:,
Contact Phone: ------ — ---- —----- --------- -- Email: -----___.
AA.Ara«. ____—----- City/State/ZIP:
(b)
Name: —----------------------------------------- ---- Contact Phone:
Name:----------------------------------------------------- Contact
Qualifications: -----------------------------------------------
Name: --__—--- Contact Phone: ------- ---------------- -----
Qualifications:----------------------------------------------------------------
---------------
Section G - Contin enc and Strategic Plannin
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.
Section K - Indemnity & Hold Harmless Agreement
City of South Bend Special Events Committee
Indemnity & Hold Harmless Agreement
Date: _JZ ��C..... 7��Q Event/gate:
Event Name:
Organization:
Applicant (Contact) Name: _1��-I__/_1 _LSL_/1Cl�Li[I_C----------------------------------------------------
Applicant (Contact) Phone: _ _
ls7 _1 �7----------------- Alt. Phone: _ L_--��-----------
Email:
2.fn.
J --I-----,, - [�
Address: ___110''0_U)_5_t ------ City/State/ZIP:
Event Location (Please describe):
Length of Event (Dates/Times): __[ Y/- l ------ ! _-vo?%m- -�= �- ""--"--"-
////----
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 �e L __ - ➢t t%'1�� 1_ agrees to indemnify, defend
1J -----------
and hold harmless the Civil City of South Bend, Indian ,from y 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:
Organizer Signature
ha
Printed Name and Title
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.
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.
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:
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: -------------------
Applicant Signature:-- ----- ---- --- ------ — --------- — ------------------
PrintedName:—� �_1J -�-_____1!_�—niil�iQ/-------------------
SPECIAL EVE COMMITTEE APPROVAL
President ---- Member Member
___ ----- -------------------
Member Member Date
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:
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.
Approved by State Board of Accounts PURCHASE ORDER -PAYMENT VOUCHER R1 40281
PAID BY Chao No. EXTRA -CURRICULAR ACTIVITIES REPORT
AMOUNT C0 RILEY HIGH SCHOOL Date 7 - o�/-off ,20
ONE WILDCAT WAY
n 1902 S. FELLOWS STREET
/
Date 20�/ /1 _ , SOUTH BE , 1'46613 ..
PURCHASED OF /�--(y�(.h (iii- /,��d,,,/1'Of/( j
ADDRESS
DELIVER TO
SEND INVOICE TO
TO THE TREASURER: The following expense is incurred, payable from theme - r VUU WLX>w T -O? I (,p Account. 0"'WIll
NO payment is to be made unless this form is on file with the Treasurer, properly approved and items or service have been received. 'W
\
QUANTITY DESCRIPTION UNIT PRICE TOTAL
a. .
l• L/ �XX�
It
TAX EXEMPT 740281-03
The So nd Community School Co p. is q political subdivision of the State of Indiana, and is, therefore, not subject to any excise taxes imposed
by the edera Government or Sal Tal by the State of Indian .
SIGN
F CTIVITIES
CLAIMANTS
SIGNATURE
ACTIVITY SPO R OR OFFICIAL
P PAL DATE
Items priced and rece ve K except as noted
DATE , 20 TITLE
Form No. SA -1 B
VENDOR PURCHASE ORDER NOT AUTHORIZED UNLESS SIGNED AS PRESCRIBED ABOVE
FORM APPROVEDOARD OF ACCOUNTS
IST BANK
No030321
THIS WARRANT VOID TWO YRS
SSUEA�cR
FOR SOUTH SEND COMMUNITYBSCHOOLL CORPORATION
SOUTH BEND.ENDANn
DEC, 31 OF THE RZOF
SCHOOL EXTRACURRICULAR ACCOUNT
71-1212
JAMES WHITCOMB RILEY HIGH SCHOOL
Tate:
07/23/21
ONE WILDCAT WAY. 1902 S. FELLOWS ST., SOUTH BEND, IN 56613
PO #:
040281
030321
Claim:
987
Fund:
Student Activit
Homecoming
Invoice:
Purpose:
Parade Permit
FIFTY AND 00/100
********50.00
PAY TO: CITY OF SOUTH BEND
731 S. LAFAYETTE
SOUTH BEND IN 46601
111 30 3 2 1118 1:0 7 1 2 1 2 1 281: 208
JAMES WHITCOMB RILEY HIGH SCHOOL EXTRA -CURRICULAR ACCOUNT 030321 030321
CONTROL# PO# INVOICE# DESCRIPTION DATE AMOUNT
002677-987 40281 Parade Permit -7-7-2-372-1 50.00
CITY OF SOUTH BEND 50.00
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ACOROP" CERTIFICATE OF LIABILITY INSURANCE
DAT71/3M��YI
THIS CERTIFICATE IS ISSUED ASA 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: N the certificate holder is an ADDITIONAL INSURED, the policy(Nes) 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
NAME CT Stephen SvAhart
Gibson Insurance Agency, Inc.
ac w Err . (BCC) 814-2122 INC Nap (800) 836-2122
202 S Michigan SL Suite 1400
q ueess: sswihart@thegibsonedge.com
INSURERISAFFORDING COVERAGE NAICR
South Bend IN 46601
INSURER A: Peerless ins Co 24198
INSURED
INSURER B: Indiana Ins CO 22659
South Bend Community School Corporation
INSURER C: Safety National Cas Co 15105
215 S Dr. Martin Luther King Jr Blvd
INSURER 0:
INSURER E :
South Bend IN 46601
INSURER F:
COVERAGES CERTIFICATE NUMBER: 20/21 Liab REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER OD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INIRR
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CLAIMSAIADE l OCCUR
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PREMISES Ea occu,,em=1 S 500,000
MED EXP (Any one Person) S 15,000
PERSONAL&ADV INJURY 5 1.000,000
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CBP8493461
12/01/2020
121012021
GENI.AGGREGATE LIMIT APPLIES PER.
PRO
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GENERALAGGREGV,TE 5 2.000,000
PRODUCTS-COMPIOP AGG 5 2.000,000
OTHER:
Employee Benefits S 1.000.000
AUTOMOBILE
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COMBINED SINGLE LIMIT 5 1.000,000
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AUTOS ONLY AUTOS
BA8493457
12/01/2020
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BODILY INJURY (Per aciden) 3
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The CTy of South Bend
227 W Jefferson St.
South Bend
IN 46601
SHOULD ANY OF THEASOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
YV IMV HILEV HEPHESENIATNE
1988-2015 ACORD CORPORATION, All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDDIYYYY)
11f302020
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 endomement(s).
PRODUCER
CONTACT Stephen SWihart
NAME:
Gibson Insurance Agency, Inc.PSIDNE
(800) 814-2122 AN.No: (800) 836-2122
202 S Michigan S1, Suite 1400
ADDREss: sswihartQthegibsonedge.com
INSURERS) AFFORDING COVERAGE NAIC0
South Bend IN 46601
INSURER A: Peerless Ins Co 24'98
INSURED
INSURER B Indiana Ins CO 22659
South Bend Community School Corporation
INSURER C Safety National Cas CO 15105
215 S Dr. Martin Luther King Jr Blvd
INSURER 0
INSURER E:
South Bend IN 46601
INSURER
COVERAGES CERTIFICATE NUMBER: 20/21 Liab 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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 RECUCED BY PAID CLAIMS.
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DESCRIPTION OF OPERATIONS bebw
V biL KIFnoN OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Addltional Remarks Schaduk. may Be attacked if more space u required)
City of South Bend Venues Parks 8 Arts
219 S. St. Louis BNd
South Bend
IN 46617
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
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