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HomeMy WebLinkAboutLicense - Renewal for Public Parking Facility - 100 W. Navarre St., 621 Memorial Dr., 707 N. Michigan St.1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND, INDIANA 46601-1830 PHONE 574/235-9251 FAx 574/235-9171 CITY OF SOUTH BEND TAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS February 14, 2023 Mr. Anthony Shane Galloway Memorial Hospital / Beacon Health System 100 Navarre Place, Suite 6645 South Bend, IN 46601 s gallowaykbeaconhealthsystem. org RE: Renewal of Three (3) Public Parking Facility Licenses Dear Mr. Galloway: Thank you for submitting your renewal applications for three (3) Parking Facilities: Navarre Parking Garage, Lafayette Parking Garage, and Bartlett Parking Garage. The Board has approved these licenses at its February 14, 2023 meeting. Should you have any questions, please contact this office at (574) 235-9251. Sincerely, /s/ Theresa Heffner Theresa Heffner, Clerk Enclosures TH/lh ELIZABETH A. MARADIK JOSEPH R. MOLNAR GARY A. GILOT JORDAN V. GATHERS MURRAY L. MILLER INTEROFFICE MEMORANDUM BOARD OF PUBLIC WORKS DATE: 01 /11 /2023 TO: Jim Wood, Code Enforcement Chris Dressel, Community Investment Gerard Ellis, Fire Department Matt Longfellow, Engineering FROM: Theresa Heffner, Clerk theffner south bend in.gov SUBJECT: Annual License Application for Public Parking Facility Memorial Hospital of South Bend/ Beacon Health System LOCATION: 707 N. Michigan St. (Bartlett Parking Garage); 100 W. Navarre St. (Navarre Parking Garage); 621 Memorial Dr. (Lafayette Parking Garage) Public Parking Facilities are regulated by municipal code section 4-39. (Copy attached). Please review the attached public parking license application and provide your recommendations in the spaces below. CODE ENFORCEMENT: Favorable recommendation COMMUNITY INVESTMENT: Favorable Recommendation FIRE: Section 4-39(k) Favorable ENGINEERING: Section 4-39(b) Favorable - All three locations have signs in compliance with 4-39(b) Sec. 4-39. - Public parking facility. (a) Definition. Public parking facility shall mean any plot, piece or parcel of land or any building or structure used for the purpose of storing motor vehicles where the owners or persons storing such vehicles are charged a fee and which are open to the public. (b) Signs required: (1) Each licensee under this section shall maintain at each entrance to the licensed public parking facility a permanently affixed sign suitable to apprise persons using the public parking facility of the name of the licensee, the hours of the day or night during which such places are open for storing motor vehicles, the rates charged and the closing hours of such lot. (2) When more than one rate is charged for parking, the figures of each rate shall be of the same size and dimensions. The figures shall measure not less than eight (8) inches in height. The letters and figures indicating the closing hours shall not be less than four (4) inches in height. (3) The sign shall give the number of the City license under which the lot is operated. (4) Where the licensee operates a receiving lot in which cars are accepted with the understanding that such cars may be removed to another lot, the licensee shall post on such sign, in letters not less than four (4) inches in height, the following information: "Receiving Lot —Cars Parked Here May Be Moved To No. Street," (giving the address to which such cars are moved). (5) All signs shall be subject to the approval of the Building Commissioner of the City. (6) Where separate rates or charges are made for day parking and for night parking, notice shall be posted on the signs described in subsection (b)(1) of this section. (c) License required. No person shall maintain or conduct a public parking facility within the City without first having obtained the approval from the Board of Public Works and a license issued by the Controller. (d) Application: (1) Applications for licenses for public parking facilities shall be made by the person intending to operate a public parking facility. (2) The application shall set forth the following: a. The name under which and the place where the open parking lot is to be operated. b. Whether the applicant is an individual, partnership or corporation. If an individual, the name and business and residence address of the applicant shall be given; if a partnership, the name and business and residence address of each partner shall be given; if a corporation, the name, date and state under which such corporation was organized, and the name and business address, resident agent, and a certified copy of article of incorporation, if requested by the Board of Public Works, shall be furnished. c. Whether the premises are owned or leased by the applicant, and, if leased, the name and residence and business address of each owner, or part owner thereof. d. The number of motor vehicles which may, at any one time, be stored upon the premises. e. The hours during which motor vehicles may be stored. f. A complete schedule of the rates to be charged for storing motor vehicles and the hours at which changes in rate take place. g. Such other information as the Board of Public Works may deem advisable. (3) The application shall be signed and verified under oath by the applicant, if an individual, or by a duly authorized agent, if a partnership or corporation. (e) Public parking facility. A fee of eighty dollars ($80.00) shall be paid for each license issued under this section. (f) Bond or property liability insurance: (1) No license shall be issued pursuant to this section and public parking facility shall be operated until and unless the licensee under this section has deposited with the Board a bond or property liability insurance policy in the amount scheduled in this section. The bond or insurance policy shall be with one or more adequate sureties or a surety company acceptable to the Board and conditioned that the licensee will pay all final judgments rendered against him for damages arising during the period such bond or insurance policy is in force from the operation of the motor vehicle in such public parking facility, or from loss, damage, theft or conversion of any motor vehicle. (2) Any person who sustains damage by reason of the violation of any provision of such bond or insurance by a licensee may institute suit upon the same and recover any judgment that may be obtained by reason of such suit. (3) The bond or insurance policy shall meet the following requirements: a. It shall contain a provision that it shall continue in force until ten (10) days after written notice of cancellation has been delivered to the Board of Public Works or until the license of the applicant has been revoked. b. The obligation of the bond or insurance policy shall not exceed the principal amount of the bond. c. The bond or insurance policy shall be in the following amounts: 1. Where the licensee conducts one (1) lot, ten thousand dollars ($10,000.00). 2. Where the licensee conducts two (2) lots, fifteen thousand dollars ($15,000.00). 3. Where the licensee conducts three (3) lots, the sum of twenty thousand dollars ($20,000.00). 4. Where the licensee conducts four (4) or more lots, the sum of twenty-five thousand dollars ($25,000.00). (g) Investigation of applicants; issuance of license: (1) If, after investigation, the Board of Public Works determines that the applicant for a license meets the requirements of the section, the Board shall report the same to the Controller. (2) The Controller shall issue to the applicant a license for a public parking facility upon payment of the proper fee. (h) Claimchecks or tags: (1) At the time of accepting a motor vehicle for storage or parking in any public parking facility the person conducting the lot, or his agent, servant or employee, shall furnish to the person parking his motor vehicle a distinctive check. (2) The check shall be numbered to correspond to a coupon placed upon such motor vehicle and contain the name and address of the place and the owner operating such public parking facility. Upon such check shall be written, printed, cut out or stamped the date, and, if parking is charged for on an hourly basis, the time of acceptance of such motor vehicle. (3) The above provision shall not be applied where cars are stored on a monthly fee basis. (i) Rate changes: (1) No licensee under this section shall make any charge for storing any motor vehicle in a public parking facility in excess of that set forth in his application for a license, unless he has: a. Notified the Board of Public Works in writing of the change. b. Posted signs showing such change in the same manner as set forth in subsection (b). Q) Claims against lot; reports; liability after hours: (1) Each licensee under this section shall immediately notify the Controller of any claim over twenty- five dollars ($25.00) made by reason of any loss, theft or conversion occurring upon his premises or of any claim for damages arising from the operation of his public parking facility. (2) The obligation of any person operating or conducting a public parking facility under the terms of this section to the owner of a motor vehicle parked therein shall not extend beyond the regular posted hours of attendance, as posted upon the open parking lot and printed upon the regular receipt check furnished to the motor vehicle owner. (k) Fire equipment required; cars to be accessible: (1) Public parking facilities shall be equipped with proper fire extinguishing apparatus subject to the approval of the Fire Department. (2) All motor vehicles shall be stored in such a manner that they may be reached readily in case of fire or other emergencies. (1) Temporary lots; restrictions: (1) Nothing contained in this section shall be deemed to require the licensing of temporary lots operated for the accommodation of motorists attending public functions, such as football games or circuses, even though a fee may be charged the patrons of such temporary lots. No such temporary lots, however, shall be operated more than two (2) days in any week. (2) At the entrances of the temporary lots there shall be placed a sign on which is printed the words, in letters of sufficient size to be legible to all patrons "Temporary Parking Lot —Not Licensed." (m) Exemptions. All governmental owned and operated public parking facilities shall be exempt from the licensing provisions of this chapter. (Ord. No. 6998-81, § 1; Ord. No. 7723-86, § 2; Ord. No. 9093-00, § XII) For all municipal business license questions, contact: City of South Bend -Department of Community Investment 227 West Jefferson Blvd -Suite 1400 S -South Bend, Indiana 46601 - 574.235.5912 - F: 574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 I. APPLICATION TYPE Check One II. BUSINESS DATA New Renewal $5.00 Public Portal A. Business Name: MEMORIAL HOSPITAL OF SOUTH BEND / BEACON HEALTH SYSTEM B. Business Address: 707 N MICHIGAN ST / BARTLETT PARKING GARAGE City: SOUTH BEND State: IN Zip: 46601 C. Mailing Address (If different from above): 615 N. MICHIGAN ST. - PROPERTIES DEPT. City: SOUTH BEND State: IN Zip: 46601 D. Business Telephone Number: 574-647-1471 E. Business Fax Number: 574-647-1473 F. E-Mail Address: PLEDA@BEACON HEALTH SYSTEM. ORG G. Maximum Number of Vehicles that can be parked at facility at onetime: 468 H. Total Number of Parking Spaces at facility: 468 I. Hours during which vehicles may be stored: 7 DAYS / 24 HOURS H. Premises are (check one): Leased by Applicant Owned by Applicant X If Leased: Owner's Name: Owner's Business Address: City: Owner's Residential Address: City: ate: Zip: State: Zip: J. Insurance Carrier and Amount of Liability Insurance OR Bonding Agent and Amount of Bond: THE HORTON GROUP (ATTACHED) For Office Use Only BALANCE DUE - $80.00 Application Filed JANUARY 6, 2023 Public Works Approval Application Fee Paid JANUARY 6, 2023 License Fee Paid Sent to Dept. License Number PBP2023-002 CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS Not Approved -WA4 1:_1z Reason Elizabeth A. Maradik, President Joseph R. Molnar, Vice President � a A lye 0- Murray L. Miller, Member Jorrddan//V. Gathers, Member I 11 ~ Attest: Theresa M. Heffner, Clerk Date: February 14, 2023 Continue to page 2 For all municipal business license questions, contact: City of South Bend • Department of Community Investment 227 West Jefferson Blvd • Suite 1400 S •South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 III. PERSONAL DATA A. Applicant's Legal Name: Patricia Leda B. Residential Address: 615 N. Michigan St. - Properties Dept. City: SOUTH BEND State: IN Zip: 46601 C. Residential Telephone Number: WORK: 574-647-1471 D. Residential Fax Number: E. Cellphone Number: 574-647-1472 F. Position with Business: IV. OWNERSHIP A. Type of ownership (check one): Sole Proprietorship (If sole proprietorship, proceed to I) - Partnership (If partnership, proceed to 2). I'. X Corporation (If corporation, proceed to 3). f 1. Sole Proprietor Name: Residential Address: City: Telephone Number:, 2. Partnership (List at least two (2) partners) Name #1: Residential Address: City: Telephone Number: Name #2: Residential Address: City: Telephone Number: .Zip: State: Lip: State: 3. Corporation Legal name of corporation: MEMORIAL HOSPITAL OF SOUTH BEND INC. Date and state of incorporation: OCTOBER 31, 1985 2 For all municipal business license questions, contact: City of South Bend • Department of Community Investment 227 West Jefferson Blvd • Suite 1400 S -South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 IV. OWNERSHIP (Continued) A. Type of ownership (continued): 3. Corporation (continued) Resident Agent: Name: ANTHONY SHANE GALLOWAY Title: DIRECTOR, BEACON PROPERTIES ADMINISTRATION Business Address: 100 NAVARRE PLACE, SUITE 6645 City: SOUTH BEND State: IN Zip: 46601 Officers: Name #1: LARRY TRACY Title: PRESIDENT, MEMORIAL HOSPITAL OF SOUTH BEND Business Address: 615 N. MICHIGAN ST. City: SOUTH BEND State: IN Zip: 46601 Residential Address: City: State: Zip: Name #2: Title: Business Address: City: State: Zip: Residential Address: City: State: Zip: Name #3: Title: Business Address: City: Residential Address: City:. _ 3 State: e: Zip:. p: For all municipal business license questions, contact: City of South Bend -Department of Community Investment 227 West Jefferson Blvd - Suite 1400 S -South Bend, Indiana 46601 - 574.235.5912 - F: 574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 V. INCLUDE COMPLETE RATE AND HOUR SCHEDULE WITH APPLICATION VI. INCLUDE A CURRENT CERTIFICATE OF LIABILITY INSURANCE WITH THE CITY OF SOUTH BEND LISTED AS THE CERTIFICATE HOLDER VII. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION Vill. AFFIRMATION I, hereby, certify and affirm that all of the information I have given in this application is true and accurate to the best of my knowledge. I further certify that I have in no way attempted to mislead the City in this application by omitting facts known to me. I have read and understand the regulations of the Public Parking Facility license found in the City of South Bend Municipal Code, Section 4-39. Signature ONLINE RENEWAL JANUARY 6, 2023 Date Garage Rates Monday - Friday i ( \ 0-1 hours 1-3 hours 3-6 hours 8-8 hours 8-�'4 hours $1.00 $2.00 $4.00 $6.00 �C� 0 DATE (MM/DDIYYYY) `f CERTIFICATE OF LIABILITY INSURANCE 9i30i2022 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 The Horton Group PHONE FAX 10320 Orland Parkway pvc 708-845-3000 JC, No): Orland Park IL 60467 ADDRESS- eertiflcgtesMthehortonaroumoom INSURED BE, Beacon Health System, Inc; Beacon Medical Group Memorial Hospital of South Bend, Inc.; Elkhart General Hospital Community Hospital of Bremen 615 N Michigan Street South Bend IN 46601 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Medical Protective 11843 INSURER B : Selective Insurance ComDanv of America 12572 INSURER F : COVERAGES CERTIFICATE NUMRFR- 147R7RS115 RFVI-RlnN MIIMRFR- 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, INSR E)OLr'iS 1t3R POLICY EFF POLICY EXP LTR TYPE OF INSURANCE@10.,POLICY NUMBER DDfYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR l-- -. � Y Y H002223 10/1/2022 .1MIyI1DD1YYYYl 10/1/2023 EACH OCCURRENCE $ 1 000,000 PPREM SES Ea occurrence $ 100 000 X MED EXP (Any one person) $ 5,000 1,000 _ PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3.000,000 GGEEN'L AGGREGATE LIMIT APPLIES PER: ^ POLICY1:1a jECOT E LOC PRODUCTS - COMP/OPAGG $3.000,000 $ OTHER: B AUTOMOBILE LIABILITY Y Y S 2547491 8/13/2022 I 8/1312023 COMBINEDSINGLE LIMIT ..{Ea atiC.dent) $ 1,000,000 $ ANY AUTO BODILY INJURY (Per person) OWNED X SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE P0� a, cldent $ A UMBRELLA LIAB OCCUR HX E002223 10/l/2022 10/1/2023 EACH OCCURRENCE $15,000,000 X EXCESS LIAB CLAIMS -MADE AGGREGATE $ 15,000,000 DED X RETENTIONS9,,nnn S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE ER EL. EACH ACCIDENT $ ANYPROPRIETOR/PARTNER/ EXECUTIVE OFFICER/MEMBEREXCLUDED? ❑ N/A EL. DISEASE- EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCR.PT10N OF OPERATIONS below EL. DISEASE - POLICY LIMIT I $ A Medical Malpractice Shared Limits H002223 10/1/2022 10/1/2023 Incident 500.000 A Mad Malpractice Separate Limits H002223 10/1/2022 10/1/2023 I n99degate UAggregate 00 15,0,0 0500,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Annual Parking Garage License: CMS, Bartlett and Navarre Garages. CERTIFICATE HOLDER CANCELLATION City of South Bend 227 W. Jefferson Blvd. Suite 1400 South South Bend IN 46601 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD For all municipal business license questions, contact: City of South Bend -Department of Community Investment 227 West Jefferson Blvd - Suite 1400 S -South Bend, Indiana 46601 - 574.235.5912 - F: 574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 I. APPLICATION TYPE Check One: New Renewal $5.00 Public Portal II. BUSINESS DATA A. Business Name: MEMORIAL HOSPITAL OF SOUTH BEND / BEACON HEALTH SYSTEM B. Business Address: 100 W NAVARRE ST / NAVARRE PARKING GARAGE City: SOUTH BEND State: IN Zip: 46601 C. Mailing Address (If different from above): 615 N. MICHIGAN ST. - PROPERTIES DEPT. City: SOUTH BEND State: IN Zip: 46601 D. Business Telephone Number: 574-647-1471 E. Business Fax Number: 574-647-1473 F. E-Mail Address: PLEDA@BEACONHEALTHSYSTEM.ORG G. Maximum Number of Vehicles that can be parked at facility at onetime: 591 H. Total Number of Parking Spaces at facility: 591 I. Hours during which vehicles may be stored: 7 DAYS / 24 HOURS H. Premises are (check one): Leased by Applicant Owned by Applicant X If Leased: Owner's Name: Owner's Business Address: City: Owner's Residential Address: ate: Zip: City: State: Zip: J. Insurance Carrier and Amount of Liability Insurance OR Bonding Agent and Amount of Bond: THE HORTON GROUP (ATTACHED) For Office Use Only Application Filed JANUARY 6, 2023 Public Works Approval Application Fee Paid JANUARY 6, 2023 License Fee Paid Sent to Dept. License Number PBP2023-001 CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS Not Approved WA4 Reason Elizabeth A. Maradik, President Gary A. Gilm, Member pe. y A Murray L. Miller, Member M/ Joseph R. Molnar, Vice President JordanV. Gathers, Member Attest: Theresa M. Heffner, Clerk Date: February 14, 2023 BALANCE DUE - $80,00 Continue to page 2 For all municipal business license questions, contact: City of South Bend • Department of Community Investment 227 West Jefferson Blvd • Suite 1400 S -South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 III. PERSONAL DATA A. Applicant's Legal Name: Patricia Loda B. Residential Address: 615 N. Michigan St. - Properties Dept. City: SOUTH BEND State: IN C. Residential Telephone Number: WORK: 574-647-1471 D. Residential Fax Number: E. Cellphone Number: 574-647-1472 F. Position with Business: Zip: 46601 IV. OWNERSHIP A. Type of ownership (check one): Sole Proprietorship (If sole proprietorship, proceed to 1). Partnership (If partnership, proceed to 2). _X Corporation (If corporation, proceed to 3). 1. Sole Proprietor Name: Residential Address: City: Telephone Number: 2. Partnership (List at least two (2) partners) Name #1: Residential Address: City: Telephone Number: Name #2: Residential Address: City: Telephone Number: State: State: State: Zip: Zip: Zip: 3. Corporation Legal name of corporation: MEMORIAL HOSPITAL OF SOUTH BEND INC. Date and state of incorporation: OCTOBER 31, 1985 F] For all municipal business license questions, contact: City of South Bend -Department of Community Investment 227 West Jefferson Blvd - Suite 1400 S -South Bend, Indiana 46601 - 574.235.5912 - F: 574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 IV. OWNERSHIP (Continued) A. Type of ownership (continued): 3. Corporation (continued) Resident Agent: Name: ANTHONY SHANE GALLOWAY Title: DIRECTOR, BEACON PROPERTIES ADMINISTRATION Business Address: 100 NAVARRE PLACE, SUITE 6645 City: SOUTH BEND State: IN Zip: 46601 Officers: Name #1: LARRY TRACY Title: PRESIDENT, MEMORIAL HOSPITAL OF SOUTH BEND Business Address: 615 N. MICHIGAN ST. City: SOUTH BEND State: IN Zip: 46601 Residential Address: City: State: Zip: Name #2: Title: Business Address: City. Residential Address: City: Name #3: Title: Business Address: City: Residential Address: City:- 3 State: Zip: Zip: State:_ .Zip: State: Zip: For all municipal business license questions, contact: City of South Bend • Department of Community Investment 227 West Jefferson Blvd • Suite 1400 S •South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 V. INCLUDE COMPLETE RATE AND HOUR SCHEDULE WITH APPLICATION VI. INCLUDE A CURRENT CERTIFICATE OF LIABILITY INSURANCE WITH THE CITY OF SOUTH BEND LISTED AS THE CERTIFICATE HOLDER VII. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION Vill. AFFIRMATION I, hereby, certify and affirm that all of the information I have given in this application is true and accurate to the best of my knowledge. I further certify that I have in no way attempted to mislead the City in this application by omitting facts known to me. I have read and understand the regulations of the Public Parking Facility license found in the City of South Bend Municipal Code, Section 4-39. Signature ONLINE RENEWAL JANUARY 6, 2023 Date Garage_ Elates Monday - rriday 0-1 hours 1-3 hours 3-6 hours 5--8 hours 8-?�4 hours $1.00 $2.00 $4.00 $6.00 AcnRna, CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) �%� 1 9/30/2022 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 The Horton Group 10320 Orland Parkway Orland Park IL 60467 INSURED t31u Beacon Health System, Inc; Beacon Medical Group Memorial Hospital of South Bend, Inc.; Elkhart General Hospital Community Hospital of Bremen 615 N Michigan Street South Bend IN 46601 COVERAGES CERTIFICATE NUMBER: 1476296115 NAME: 708-845-3000 INSURERA: Medical Protective INSURER B : Selective Insurance INSURER C : INSURER F,. FAX IA/D. No) M19-up.cDm tDING COVERAGE :ompany of America REVISION NUMBER: NAIC # I 12572 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, INS SUB,TYPE OF INSURANCE 06L POLICY NUMBER POLICY EFF MM/DDIYPOLICY YY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y H002223 10/1/2022 10/1/2023 EACH OCCURRENCE $1,000,000 CLAIMS -MADE t - - t OCCUR l0f'A'E� IETI7ED PREMISES7Ea occurrence)$ 100,000 MED EXP (Apy. one person) $ 5,000 X 1,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY El I Ll LOC PRODUCTS - COMP/OP AGG $ 3 000 000 $ OTHER: B AUTOMOBILE LIABILITY Y Y S 2547491 8/13/2022 8/13/2023 00MBINED LIMIT accidrm!) $ 1,000,000 $ ANY AUTO BODILY INJURY (Per person) OWNED SCHEDULE AUTOS ONLY AUTOSBODILY INJURY (Per accident) $ X HIRED NON -OWNED AUTOS ONLY AUTOS ONLY rX PRpPRT%DAMAGE ft accident $ A UMBRELLA LIAR OCCUR E002223 10/1/2022 10/1/2023 EACH OCCURRENCE $15,000,000 X EXCESS LIAB X CLAIMS -MADE AGGREGATE $ 15,000,000 DED X RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN TATUTE ER E,L EACH ACCIDENT $ ANYPROPRI ETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? ❑ N/A E,L. DISEASE - EA EMPLOYEE $ (Mandatoryin NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Medical Malpractice Shared Limits A Med Malpractice Separate Limits H002223 10/1/2022 H002223 10/1/2022 10/1/2023 10/1/2023 Incident Aggregate Incident/Aggregate 500,000 15,000,000 500,000/ 1,500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Annual Parking Garage License: CMS, Bartlett and Navarre Garages. VCRI Iri%,mia n%JLUCK City of South Bend 227 W. Jefferson Blvd. Suite 1400 South South Bend IN 46601 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD )us iness license questions, contact: City of South Bend - Department of Community Investment fferson Blvd - Suite 1400 S -South Bend, Indiana 46601 - 574.235.5912 - F: 574.235.9021 =NSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 I. APPLICATION TYPE Check One New Renewal $5.00 Public Portal II. BUSINESS DATA A. Business Name: MEMORIAL HOSPITAL OF SOUTH BEND / BEACON HEALTH SYSTEM B. Business Address: 621 MEMORIAL DR / LAFAYETTE PARKING GARAGE City: SOUTH BEND State: IN Zip: 46601 C. Mailing Address (If different from above): 615 N. MICHIGAN ST. - PROPERTIES DEPT. City: SOUTH BEND _ ,State: IN Zip: 46601 D. Business Telephone Number: 574-647-1471 E. Business Fax Number: 574-647-1473 F. E-Mail Address: PLEDA@BEACONHEALTHSYSTEM.ORG G. Maximum Number of Vehicles that can be parked at facility at onetime: 599 H. Total Number of Parking Spaces at facility: 599 I. Hours during which vehicles may be stored: 7 DAYS / 24 HOURS H. Premises are (check one): Leased by Applicant Owned by Applicant X If Leased: Owner's Name: Owner's Business Address: City: State: Zip: Owner's Residential Address: City: State: Zip: J. Insurance Carrier and Amount of Liability Insurance OR Bonding Agent and Amount of Bond: THE HORTON GROUP (ATTACHED) For Office Use Only BALANCE DUE - $80.00 Application Filed JANUARY 6, 2023 Public Works Approval _ Application Fee Paid JANUARY 6, 2023 License Fee Paid Sent to Dept. License Number PBP2023-003 Not Approved Reason CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS jw�4 11/,;_1(a Elizabeth A. Maradik, President Joseph R. Molnar, Vice President Gary A. Gilot, Member 772 vy C Murray L. Miller, Member Jordan V. Gathers, Member l�14 Attest: Theresa M. Heffner, Clerk Date: Febmary 14, 2023 Continue to page 2 For all municipal business license questions, contact: City of South Bend • Department of Community Investment 227 West Jefferson Blvd • Suite 1400 S -South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 III. PERSONAL DATA A. Applicant's Legal Name: Patricia Leda B. Residential Address: 615 N. Michigan St. - Properties Dept. City: SOUTH BEND State: IN Zip: 46601 C. Residential Telephone Number: WORK: 574-647-1471 D. Residential Fax Number: E. Cellphone Number: 574-647-1472 F. Position with Business: IV. OWNERSHIP A. Type of ownership (check one): Sole Proprietorship (If sole proprietorship, proceed to 1). Partnership (If partnership, proceed to 2). X Corporation (If corporation, proceed to 3). 1. Sole Proprietor Name: Residential Address: City: Telephone Number: 2. Partnership (List at least two (2) partners) Name #1: Residential Address: City: Telephone Number: Name #2. Residential Address: City: Telephone Number. State: State: State: .Zip _ .Zip:_ X3 3. Corporation Legal name of corporation: MEMORIAL HOSPITAL OF SOUTH BEND INC. Date and state of incorporation: OCTOBER 31, 1985 2 For all municipal business license questions, contact: City of South Bend • Department of Community Investment 227 West Jefferson Blvd • Suite 1400 S •South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 IV. OWNERSHIP (Continued) A. Type of ownership (continued): 3. Corporation (continued) Resident Agent. Name: ANTHONY SHANE GALLOWAY Title: DIRECTOR, BEACON PROPERTIES ADMINISTRATION I Business Address: 100 NAVARRE PLACE, SUITE 6645 City: SOUTH BEND State: IN Zip: 46601 Officers: Name #1: LARRY TRACY Title: PRESIDENT, MEMORIAL HOSPITAL OF SOUTH BEND Business Address: 615 N. MICHIGAN ST. City: SOUTH BEND State: IN Zip: 46601 Residential Address: City: State: Zip: Name #2: Title: Business Address: City: State: Zip: Residential Address: City: State: Zip: Name #3: Title: Business Address: City:_ _ Residential Address: City: State: Zip: For all municipal business license questions, contact: City of South Bend • Department of Community Investment 227 West Jefferson Blvd • Suite 1400 5 -South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 V. INCLUDE COMPLETE RATE AND HOUR SCHEDULE WITH APPLICATION VI. INCLUDE A CURRENT CERTIFICATE OF LIABILITY INSURANCE WITH THE CITY OF SOUTH BEND LISTED AS THE CERTIFICATE HOLDER VII. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION VIII. AFFIRMATION I, hereby, certify and affirm that all of the information I have given in this application is true and accurate to the best of my knowledge. I further certify that I have in no way attempted to mislead the City in this application by omitting facts known to me. I have read and understand the regulations of the Public Parking Facility license found in the City of South Bend Municipal Code, Section 4-39. Signature 4 ONLINE RENEWAL JANUARY 6, 2023 Date a y Garaqe Rates Monday - Friday 0-1 hours 1-3 hours 3-6 hours S-8 hours 8-914 hours $1.00 $2.00 $4.00 $6.00 C �e DATE (MM/DDIYYYY) `� CERTIFICATE OF LIABILITY INSURANCE 9/30/2022 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 The Horton Group PHONE FAx 10320 Orland Parkway (� G..No E<sf; 708 845 3000 TAlC,H,1: Orland Park IL 60467 EA pRess: certificates ehortv rou .com INSURER(S) AFFORDING COVERAGE NAIC # INSURED BE, Beacon Health System, Inc; Beacon Medical Group Memorial Hospital of South Bend, Inc.; Elkhart General Hospital Community Hospital of Bremen 615 N Michigan Street South Bend IN 46601 INSURERA: Medical Protective 11843 INSURER B : Selective Insurance Company of America 12572 INSURER C D: COVERAGES CERTIFICATE NIIMRFR-1d7R7QA11R RFVISInN NIIMRFR- 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. y R TYPE OF INSURANCE iADDL SUBR POLICY NUMBER POLLIICY EFF POLICY EXP . LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y H002223 10/1/2022 10/1/2023 EACH OCCURRENCE $1,000,000 CLAIMS -MADE I X J OCCUR P E SE ac L $ 100 000 MED EXP (Any one person) $ 5,000 X 1.000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY PRO ❑ LOC X JECT PRODUCTS-COMP/OPAGG $3,000,000 $ MER: B AUTOMOBILE LIABILITY ANY AUTO Y Y S 2547491 8/13/2022 8/13/2023 COMBINEDCEatSINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ OWNED X SCHEDULED AUTOS ONLY AUTOS tid Per accident) BODILY INJURY ( ) $ X I HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAMAGE PAr $ $ A UMBRELLA LIAB 1 OCCUR E002223 10/1/2022 10/1/2023 EACH OCCURRENCE $ 15,000,000 X EXCESS LIAB X yl CLAIMS -MADE AGGREGATE $ 15,000,000 DED X RETENTION $ $ WORKERS COMPENSATION PER - AND EMPLOYERS' LIABILITY Y i N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? NIA STATUTE J ER E.L. EACH ACCIDENT $ EL DISEASE - EA EMPLOYE (Mandatoryin NH) $ If yes, describe under DESCRIPTION OF OPERATIONS below $ E.L. DISEASE - POLICY LIMIT A A Medical Malpractice Shared Limits Med Malpractice Separate Limits H002223 10/1/2022 H002223 10/1/2022 10/1/2023 10/1/2023 Inddent Aggregate Incident/Aggregate 500,000 15,000,000 500,000/ 1,500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Annual Parking Garage License: CMS, Bartlett and Navarre Garages. CERTIFICATE HOLDER CANCELLATION City of South Bend 227 W. Jefferson Blvd. Suite 1400 South South Bend IN 46601 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD