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Home My WebLink AboutSpecial Event - Living Stations of the Cross - April 704 til1L APPLICATION FOR USE OF •� PUBLIC RIGHT-OF-WAY FOR EVENT A> The following special event has been approved by the Special Events Committee. Submitted by: Denise Miller Event name: Living Stations of the Cross Event Date: April 7 2023 Street Closure: Chapin to W Dubail, W Dubail to Kemble Ave, Kemble Ave to W Donald, Donald to Chapin -Rolling Closures Closure Times: 3:30 pm to 6:30 pm Sidewalk Closure: ❑ Yes ❑■ No Comments: Re-enactment of the 14 Stations of the Cross of Jesus in the neighborhood surrounding Our Lady of Hungary Church in the Rum Village neighborhood. CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Gary A. Gilot, Member Murray L. Miller, Member ��Z m Joseph R. Molnar, Vice President �A& Jordan V. Gathers, Member Attest: Theresa M. Heffner, Clerk Date: March 28, 2023 1 City of South Bend Special Event Application Neighborhood Event $25 application fee if filed 30 days or greater (up to 180 days) in advance of event. Please Brine Completed Application and Payment to: Public Works Service Center, 731 S. Lafayette Blvd., South Bend, IN Review the Instructions on the Special Events page before completing the application. Neighborhood 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 /n / Date of Application: - cw"" Organization Name: L�( IV, `44, 1 C� I r� Applicant (Contact) Name: c[ [� 1-a ZCC�.� / 0 J Applicant(Contact)Phone:�7iU�� 1��- 0gUContactEmail• It`L71'��1112( O1hSA.C)cq. �� Address: 231 to �G'\IQ✓f Sj. CitVState/ZIP: 5,,,E , P— 11U -fWk3 Secondary Contact Name: 3(eV _ jjj j I LIX t l V K2 Q Contact Phone: 514I a&] I 00 Contact Email: Address: f) Cc, ki Pi / S 1 - City/State/ZIP: �5lY Pi%1 Lk Ql da _ _ ' ^ SSe�ction B - Event Information �}' (� /� Event Name: L0ryi- . STI(h(,�J M Q�� Expected Attendance: I JV -r�oo Requested Street Closure: From (Cross To (Cross Street): Provide a brief description of the event: 4&w1w,c4cy AehcnS ci e (Itvss °q J,03uS ►n bu✓ rwt�hho✓G1wci Su�VUw,oi�� Guy �u,� a� ""-1y C/�u i In 4iq urn qlt I 10'9e iu 1gVtb0VrhL-"d . n t' Date of Event Setup [mm/dd/yy]: Ave 1 1 � `'Q 3 Time: *T"Y br✓1 Begin Date of Event [mm/dd/yy]: �r, 1 ,20;�3 Time: p n/�'1 End Date of Event [mm/dd/yy]: � i I oZl7a3 a Time: �. s.'ny, Event Cleanup Completion [mm/dd/yy]: �nr1 17 �� l Time: .( i�24f' Have all residents on the affected block have been notified and invited? ❑ Yes ®No Please attach a copy of the door hanger or letter used to notify residents in addition to signature attachment. Number of households fronting the proposed street closure: Number of households represented by signatures on attached sheet: Section C - Alcohol Will alcohol be served or sold? ❑ Yes q No If Yes: o The applicant must apply for and receive a temporary liquor license from the Alcohol & Tobacco Commission. 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. Application cannot be processed without deposit. Deposit will be returned upon inspection of event area by the Board of Public Works. o The applicant must submit a map or drawing of: o Fencing around serving area o Trash receptacles o Events that will 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) Security Company Information Company Contact Phone: (b) Independent Security Information Contact Name: Email: City/State/ZIP: Name: Contact Phone: Qualifications: Name: Contact Phone: Qualifications: Name: Contact Phone: Qualifications: Will your event have food sales (food vendors, caterers, food trucks, etc.)? ❑ Yes J4 No If yes, the event coordinator must apply for and receive a St Joseph County Health Department Temporary Event Permit. Vendors) 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 on the St. Joseph County Health Department Food Service website at Please select food types: ❑ Food Vendor ❑ Caterer ❑ Food Truck ❑ Other: If a Food Truck, please list company name(s): Please describe how food will be cooked and served: Section E - Indemnity & Hold Harmless Agreement City of South Bend Special Events Committee //�� Indemnity & Hold (Harmless Agreement Date: Vo2-a a3 Event Date: -Agial -7 90 ) Event Name: Organization Applicant (Cc Applicant (Contact) Phone: " )2Qa —?4 o O Alt Phone: [574) -QM W Addre! Event Location (Please describe): Length of Event (Dates/Times): APPLICANT 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, 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: 0-9-a I - ,3 Authorized Organizer Signature Printed Name and Title 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 Printed Name: i President Member SPECIAL EVENTS COMMITTEE APPROVAL Member Gtvimca 0k(Vidual) Member 3 -31-33 Date 3/13/2014 httpSJAn .google.eonJmai%/embed?tb--!1MI011 m81 trr3!1d2981.O926405334553!26-86.2595092411584713d41.653740379475BM3rn211i10241276814r1... tkagnlana Y000 Mart 6 View on Google Maps V W Dubail Sl<- <- <- <- <- <- W Oubail St IF, a 0 o I 0 o _. V 0 M _ Q 3 o I m to < , ro V Bruce St At Brune St Out Lady of ,rAt t n � tHnPanParish ZahoranFuneral Home - ?I�n ^ c Spool — TTJ Clothing Ac x — a v .rt St W Calvert St ;to US Marine Corps 1 ,1p nA Reserve Units A, r v � t A Sherrill St eb I rn D A N � b 1 % '» p to W Donald St t, > -> W Donald St > > l Concept Home •� r Remodeling • W Donald _ Music Go Round T rp 71 zj � y to ,fl m T W Transportation'.` V Ewing Ave W Ewing Ave _ _ W Ewing Ave W Ewi! GuOgl€ Map i Reporta map error Vs:/ANwugoogie.ci:n*ropsArrbedI`pI:i=I 1mIO! IrrO. *0 Id2981.OG264C63345&v 2d-66.2595M 11594T, 1fi447eria�ge�var Certificate of Coverage Date` 2/21,12023 Certificate Holder This Certificate is issued as a matter of information only and The Diocese of Fort Wayne -South Bend. Inc. confers no rights upon the holder of this certificate. This certificate Chancery Office P O Box 390 does not amend, extend or alter the coverage afforded below. Fort Wayne, IN 46801 Company Affording Coverage THE CATHOLIC MUTUAL RELIEF SOCIETY OF AMERICA 10843 OLD MILL RD Covered Location OUR LADY OF HUNGARY CHURCH OMAHA, NE 68154 829 W CALVERT ST SOUTH BEND, IN 46613-0000 Coverages This is to certify that the coverages listed below have been issued to the certificate holder named above for the certificate 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 coverage afforded described herein is subject to all the terms, exclusions and conditions of such coverage. Limits shown may have been reduced by paid claims. Type of ('overage Certificate Number ('overage Effective Dale Coverage Expiration Dale Limits Property Real & Personal Proper" D. General Liability Each Occurrence 1,000.000 General Aggregate ElOccurrence Products-Comp/OP Agg ❑ Claims %lade 8679 10/1/2022 10/1/2023 Personal & Ad, Injury Fire Damage (any one fire) \led Exit (:Inv one person) Excess Liability Each Occurrence annual Aggregrate Other Each Occurrence Claims )lade Annual Aggregrate Limit/('overage Description of Operations/Locations/1'ehicles/Special Items (the following language supersedes any other language in this endorsement or the Certificate in conflict with this language) Coverage is verified for claims arising out of Our Lady of Hungary Church during their Living Stations of the Cross on April 07, 2023. Holder of Certificate Cancellation Should any of the above described coverages be cancelled before the expiration date thereof, the issuing company will City of South Bend, IN endeavor to mail 30 days written notice to the holder of certificate named to the left, but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives. Authorized Representativea / 0067004840 /'/ r :� N�eq uo sl!e1s0'aeiNasl A!�naeg C ��•�•� ;0 ti M L-�7 Z Lh �A cc �- z iL m_ z 04 �VJ g- o M °` o � Ir � 'o �- o >WWRoo a�6 s Ir 0 0 cc ti 0 0 o- 0 0