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HomeMy WebLinkAboutSpecial Event - Fallen Heroes Ride - June 25� Spl' FH gF �O APPLICATION FOR USE OF •� PPAVE PUBLIC RIGHT-OF-WAY FOR EVENT s ,z The following special event has been approved by the Special Events Committee. . 1865 Submitted by: Denise Miller Event name: Fallen Heroes Ride Event Date: June 25 2023 Street Closure: Brief traffic interruptions as riders leave Walmart on Ireland. Closure Times: 8:00 am to 1:00 pm Sidewalk Closure: ❑ Yes ❑■ No Comments: Annual ride to benefit families of military and fallen heroes in Northern Indiana who need financial assistance. CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Gary A. Gilot, Member po"�. a y�� Murray L. Miller, Member Joseph R. Molnar, Vice President I: Jordan V. Gathers, Member Attest: Theresa M. Heffner, Clerk Date: May 9, 2023 1 Ll 1L J 11 City of South Bend Special Event Application Motorcycle Ride $50 application fee if filed 60 days or greater (up to 360 days) in advance of event Review the Instructions on the Special Events page before completing the application. City and Regional Motorcycle Event applications must be submitted more than 60 days in advance of the event date or the application will not be accepted. Section A - Applicant Information Date of Application: g 3 Z - Jcx.s Organization Name/QHj4kiCk)a _%�� I0� Applicant (Contact) Name:l>- r3 d._v_'i __q___�Ay�7 �_�Z______________ Applicant (Contact) Phone: ^_ S� �/ _ �J O_�S�Contact Email:-," Address:_( 0E_1p�.(� ______ City/State/ZIP:_t2Zsi.w.kl� 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 Event Name Wit___ - L Dr'___ Event Type: Motorcycle Event Classification: Er 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/yy]:,tzA __j5 10 3Time: '�LI Qi ________________________ Begin Date of Event [mm/dd/yy]��y_�O Time: End Date of Event [mm/dd/yy]: _1%u1�1E_ .207.E Time: Event Cleanup Completion [mm/dd/yy]:______________________ Time: Total anticipated attendance: A_______________ The proposed event will require the closing of: JX Streets ❑ Sidewalks Is the event ticketed or include fees? Cg Yes ❑ No If yes, list fees and fee groups below: i- IL Does the event have any partnered sponsorships? ❑ Yes Q9 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? % Yes ❑ No If yes, provide the date, location, and attendance of past special events and/or future planned events in the series: /4� • 40 • 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. ,64- har- A4n • Proposed Cleanup Plan - This plan should include, but is not limited to: o Measures in place to collect and remove trash, litter and recyclables. • 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. n U Section H - Site Plan / Route Map • 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. ,Ceu a A"011ty 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. C� Section K - Indemnity & Hold Harmless Agreement City of South Bend Special Events Committee • Indemnity & Hold Harmless Agreement Date: LI-12 -;2 3 Event Date: 22- 7 — Event Name: t_tg1lsL-----LLQ��_ yt3r�1�.�L—_1LiQe ......... — ----- Organization: ns2%s—_!`1te! Applicant (Contact) Applicant(Contact)Phone: �__�Ol t- �iS 073 _AIt.Phone: Email: Al 1jZpL rrL"_ _ Address: Gos !�P._Aj- c , _ ........ City/State/ZIP: _ / 51f q w.� Event Location (Please describe): WAS- M140-- 3Z11ru*?'0 RD. So. 8 ")40 Length of Event (Dates/Times): _-aIVF R.4. — 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: GR-� c ri — �, E r; i� r J —�j ------ 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: Authorized Organizer Signature • -�1'y %� _ -1�t�L.�-------------------------------- - - - -- - ----- - --------- 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 motorcycle rides applications filed 60 or greater 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: Printed Name: /7fqZ__4_Ii A ----A -------------------------------------------------- 40 ----------------------- r sident - 4 -- - -- M ber SPECIAL EVENTS COMMITTEE APPROVAL /Member Member Me ---- 5��1---------------- Date ACC I® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 04/06/2023 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 Gateway City Insurors LLC d/b/a Gateway Insurance CONTACT Brad & Christina Beineke NAMAJCE: PHONE Bad. 314-631-5111 ac Not: 314-631-5115 ao0 brad@gatewaycanhelp.00m &/or chrisOna@gatewaycanhelp.com 9302 Gravois Rd INSUIRI AFFORDING COVERAGE NAIC0 St Louis MO 63123 INSURERA: U.S. Insurance Company of America WSURED INSURER B: First Comp insurance Company INSURERC: American Legion Post #308Inc INSURER O: PO Box 36 INSURER E : 122 LlncolDWay E 1 INSURER F: Osceola IN 46561 COVERAGES CERTIFICATE NUMBER: 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 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 LTR TYPE OF INSURANCE AWLUM POLICY NUMBER POLICY EFF POLICY EXP Lam A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR 7 US-2021-156 01/28/2023 01/28/2024 EACH OCCURRENCE E 1,000,000 PREMISES Ea oxurrerlw E 50,000 MED EXP (Any are Parker) E EXCLUDED I PERSONAL B ADV INJURY S 1,000,000 GENL X AGGREGATE LIMIT APPLIES PER POLICY JECT F7LOC OTHER: GENERAL AGGREGATE E 2,000,000 PRODUCTS-COMP/OPAGG E 2.000,0W E AUTOMOBILE LIABILITY ANYAUTO AUTNED OS ONLY AUTOSULED HIRED NON -OWNED AUTOS ONLY AUTOS ONLY No Coverage COMBINED SINGLE LIMIT Ea agodenl E BODILY INJURY (Per perl E BODILY INJURY (Pat solaced) E PROPERTY DAMAGE Per accident) E f UMBRELLA LIAR EXCESS UAB OCCUR CLAIMS -MADE NO Coverage EACH OCCURRENCE E AGGREGATE $ DED RETENTION S S B WORKERSCOMPENSATNRI ANDEMPLOYERS' LABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN OFFICE ITINH MREXCLUDEDT ❑Y (Mandatory ) N yes, descdba under DESCRIPTION OF OPERATIONStal. NIA WCO204196 01/28/2023 01/28/2024 PER OTH- X STATUTE Eft E.L. EACH ACCIDENT E 100,000 E.L DISEASE -EA EMPLOYEE E 100,000 E.L DISEASE -POLICY LIMB E $LID 6 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may as attached N mom apace Is required) A Veterans Fraternal, civic, non-profit organization philanthropically fund raising for the benevolence of Veterans and the Community. The Auxiliary and other groups associated in the Post are additional insured's. The property coverages may be viewed in the policy which will be mailed to the insured. City of Osceola 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 Brad W. Beineke itl © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Fallen Heroes Family Ride Leave Walmart on Ireland Road at 11:00 am. Take Ireland Road to State Road 23, State Road 23 to State Road 41 State Road 4 to US 31 ,North on US 31 to New Road, New Road to Miami Road , Miami to Kern Road , Kern Road to Beech Road , Beech Road to Lincoln Way, Lincoln Way to Post 308 1PALLEN HEROES The Randy Gwynn Chapter of the American Legion Riders Osceola #308 is requesting your help to put on a benefit for the families of Northern Indiana's fallen heroes, who have paid the ultimate price for our freedom and safety. This ride is scheduled for Sunday, June 25th, 2023. All proceeds from the ride will be donated to the families of Northern Indiana's fallen heroes and military families in need of financial assistance. Participating riders will receive a t-shirt illustrating the ride on the front and the ride sponsors on the back. T-shirts will be given out while supplies last. The ride starts at Wal-Mart on Ireland Rd, South Bend and ends at the American Legion post 308 in Osceola, IN. There will be food, refreshments, and entertainment for all. Your support with a donation of $100.00 will get your name or business name on the back of this year's t-shirt. We are also looking for monetary donations, services, or merchandise to be used as prizes. Sponsors will receive t-shirts if any remain after the ride. I would like to express, in advance, our gratitude to you for your generosity. The cutoff date is June 1st, 2023, so the shirts can be printed and on hand for the ride. There is only room for 40 sponsors to be printed, so the first 40 received will be on the shirts. Please include the name as you would like it printed on the shirt. Thank you, Make checks payable to: Marvin Walters Fallen Heroes Ride Contact: Marvin (574) 315-0735 P O Box 452 • Hank (574) 855-0444 Osceola, IN 46561 American Legion Riders Post 308 ,-FALLEN HEROES FAMILY RIDE JUNE 259 2023 Support the families of Northern Indiana Military who have �-. G1VEN THEM= JUIVES For our FREEDOM* Sign up from 8:00 AM - 10:45 AM in the Wal-Mart parking lot on Ireland Rd in South Bend Kickstands up at 11:00 AM for a 60-mile ride ending at the American Legion post 308 in Osceola Cost for riders: Admission for non -riders: $15 per bike $5/person $10 for 2nd up $15/person with t-shirt(while supplies last) Join us after the ride for GREAT FOOD and ENTERTAINMENT Contact: Marvin Walters 574-315-0735 or mwalters0@yahoo.com Hank Widelski 574-855-0444 or henrywidelski@yahoo.com Find us on Facebook at American Legion Riders Post 308 *Proceeds will be donated to families of fallen military personnel and military families in need of financial assistance 0 AMERICAN LEGION RIDERS FALLEN HERO FAMILY RIDE PH. 574-33'M575 PO BOX 452 OSCEOLA, IN 46561 Bo Box 160E SWIH BEND, INDIANA 71-1212/712 DATEI 13-207-3 1113 $�jxkk --8 MEMO & __qAd _ _—__� •