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APPLICATION FOR USE OF •
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PUBLIC RIGHT-OF-WAY FOR EVENT
The following special event has been approved by the Special Events Committee. " 1865
Submitted by: Denise Miller
Event name: CWLL Opening Day Parade
Event Date: May 29 2023
Street Closure: Wilber to Portage, loop around cemetery, continue on Portage,
end at Little League Park on Riverside.
Closure Times: lam to 8:45 am
Sidewalk Closure: ❑ Yes ❑■ No
Comments: Opening Day Procession beginning at Holy Cross School,
continuing to Chet Waggoner Memorial and concluding at Chet
Waggoner Little League Park
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
Elizabeth A. Maradik, President
Gary A. Gilot, Member
Murray L. Miller, Member
Joseph R. Molnar, Vice President
Jordan V. Gathers, Member
1 "/1—
Attest: Theresa M. Heffner, Clerk
Date: February 28, 2023
1
02/13/2023
T;,Bf,, City of South Bend Special Event Application
,fit. 4�•
r. o 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 - Aoolicant Information
2/3/2023 Chet Waggoner Little League
Date of Application: _______ Organization Name:__________
Applicant (Contact) Name:
Kevin Ridenour
---------------------_—__--------------------
574-400-3056 RIDENOURKEVIN2@GMAIL.COM
Applicant (Contact) Phone: Contact Email: —_—
Address: 2126 Parkview PI _-- City/state/ZIP: South Bend, IN 46616
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
Opennin DayParade Parade
Event Name: ___ 9 -- Event Type: (Festival, Race, Parade, Other):___--_
Event Classification: IN 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.)
Participants will form up ar Holy Cross Grade School between 7:00-8:00am Depart to
8:00am on attached Route to arrive at Chet Waggoner Little Leage between 8:30 and 8:45
Date of Event Setup [mm/dd/yy]:04/29/2023
Begin Date of Event [mm/dd/yy]: 4/29/2023
End Date of Event [mm/dd/yy]: 4/29/2023
Event Cleanup Completion [mm/dd/yy]:
Total anticipated attendance: 400
Time: 7AM
Time: 8AM
Time: 8_45AM
Time:
The proposed event will require the closing of: M Streets ❑ Sidewalks
02/13/2023
Is the event ticketed or include fees? ❑ Yes ® 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:
Is this a returning special event or part of a series of special events? 8 Yes ❑ No
If yes, provide the date, location, and attendance of past special events and/or future planned events in the
series:
This has occured annually for over 40years
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? 300
Describe any sound equipment that will be used in the parade/race:
02/13/2023
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 - Equipment. Set-up. and Logistics
Are you hiring a company to provide entertainment, games or inflatables? ❑ Yes 8 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
c 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:
02/13/2023
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
Are you having food at your event (food vendors, caterers, food trucks, etc.)? ❑ Yes ® 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.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 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.
c 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.
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).
02/13/2023
(a)
Company Name: --------------------- _-------_ Contact Name:
Contact Phone: Email:
Address: ...... — ........... _—_---.............. City/State/ZIP: _--
(b)
Name: —_ --___ 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.
• Proposed Cleanup Plan - This plan should include, but is not limited to:
o Measures in place to collect and remove trash, litter and recyclables.
02/13/2023
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 Man
For parades, races and other processional events:
Are you selecting one of South Bend Police Department's (SBPD) pre -approved race routes? ❑ Yes M 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
02/13/2023
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 - Mitieation 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.
02/13/2023
Section K - Indemnity & Hold Harmless Agreement
Date:
Event Name:
Organization:
Applicant (Contact) Name: ____
Applicant (Contact) Phone: ......
Email:
Address:
Event Location (Please describe):
Length of Event (Dates/Times):
City of South Bend Special Events Committee
Indemnity & Hold Harmless Agreement
Event Date:
Alt. Phone:
City/State/ZIP:
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: _ ----- _____---------------- _-------- --------- 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
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Authorized Organizer Signature
l")'\I)ckbM—
Printed Name and Title
'(�CpSIUQn-1- C�-k �Ua�yv� LC.. —
02/13/2023
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 polity 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: 2/3/2023
Applicant Signature:
Printed Name: Kevin Ridenour
SPECIAL EVENTS COMMITTEE APPROVAL
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CERTIFICATE OF LIABILITY INSURANCE J `INxN ray,
01/31/23
Keystone Risk Managers, LLC CERTIFICATE #: 1141106-2023-1 1 1414
1995 Point Township Drive
Northumberland, PA 17867 INSURERS AFFORDING COVERAGE:
ADDITIONAL NAMED INSURED:
CHET WAGGONER LL
2126 Parkview
South Bend, IN 46616
INSURER C:
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
AJl THE TERMS, EXCLUSIONS AND COMMONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
- SUBJECT TO $5.000.000 AGGREGATE SUBLIMTT OF UABILRY FOR ALL LEAGUES, COMBINED. UNDER THE MASTER D&C POUCY. FOR ALL LOSS ARISING FROM ALL CLASS ACTION CLAIMS AND COMMON
LEAGUE CLAIMS. AS MORE FULLY DESCRIBED IN ENDORSEMENTVPI OF THE MASTER DSO POLICY.
SUBJECT TO $5.0011Q00 AGGREGATE SUBLIMIT OF LIABILITY FOR ALL LEAGUES. COMBINED. UNDER THE MASTER CYBER POLICY. FOR SPECIFIED DEFENSE COSTS. AS MORE FULLY DESCRIBED IN
ENDORSEMENT AU OF THE MASTER CYBER POLICY.
INSR
ADD-L
NAMED
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
LIMITS
LTR
INSRD
DATE(MMMONYYY)
DAM(MMATDNYYY)
$1,000,000
GENERAL LIABILITY
EACH OCCURRENCE
011405746
01/07/2023
01/01/2024
X
$2,000,000
A
X
OCCURRENCE
GENERAL AGGREGATE
INCL PARTICIPANTS
Proparty Damage Deductible: $250
PRODUCTSICOMP OPSAGGREGATE
$1,000,000
Sexual Abuse
$1,000,000
X
SEXUALASUSE
OCCURRENCE
Sexual Arose
$1,000.000
AGGREGATE
MEDICAL PAYMENTS
Any One Person
EACH LOSS
$1,000,000'
C
X
DIRECTORS&OFFICERS
015454400
01/01/2023
01/01/2024
AGGREGATE
$1,000,000
C
X
CYBER LIABILITY COVERAGE
015440383
01/01/2023
I
01/01/2024
I
LIMIT OLIABILITY
$100,000 PER
CLAIMS MADE
LEAGUE AGGREGATE
S&P
SECURITY AND PRIVACY LIABILITY
$100,000 PER LEAGUE SUBLIMIT OF LIABILITY ••
RETROACTIVE DATE
CONTINUITY DATE
INSURANCE
$1,000 PER LEAGUE RETENTION
POLICY INCEPTION
POLICY INCEPTION
REGULATORY ACTION SUBLIMIT OF
$100,000 PER LEAGUE SUBLIMIT OF LIABILITY
LIABILITY
$1,000 PER LEAGUE RETENTION
EM
$100,000 PER LEAGUE SUBLIMIT OF LIABILITY ••
NOT APPLICABLE
POLICY INCEPTION
EVENT MANAGEMENT INSURANCE
$1,000 PER LEAGUE RETENTION
EACH LOSS
$35,000
CRIME COVERAGE
Crime Deductible: $250 Property/$1,000 Money
AGGREGATE
NONE
As in Master Policy:
As in Master Policy
1:3
B
X
X
SPORTS EXCESS ACCIDENT
SRG9105434 01/01/2023 01/01/2024
Med. Max. $100,000
Excess
Deductible $50
SCOMERAGESI SELECTED FORADDITIONAL
NAMED INSURED
ADDITIONAL INSURED
Who is an Insured (SECTION II) of the General Liability policy is amended to include as an insured the person or organization shown in the schedule, but only with respect to
liability arising out of the above named Little League'a maintenance or use of ball fields, or other promises loaned, donated, or Tamed to that Little League by such person or
organizations and subject to the following additional exclusions:
1. Structural alienations. new construction, maintenance, repair or demolition operations perfomed by or on behad of the person or organization designated in the Schedule and/or
performed by the above named Little League: and
2. That part of the ball field or other premises not being used by the above named Little League.
NAME AND ADDRESS OF PERSON OR ORGANIZATION:
INSURED
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE
Little League Baseball Risk Purchasing Group, Incorporated
WITH THE POLICY PRO
539 U.S.RT. 15 Highway
South Williamsport, PA 17702
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AUTHORIZED PRESENTATIVE
IMPORTANT
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or after the coverage afforded by the policies listed thereon.
CHET WAGGONER LITTLE LEAGUE
50611 LILAC RD.
SOUTH BEND, IN 46628
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