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HomeMy WebLinkAboutSpecial Event - St. Joe Grade School Field Day - June 5APPLICATION FOR USE OF PUBLIC RIGHT-OF-WAY FOR EVENT The following special event has been approved by the Special Events Committee. Submitted by: Denise Miller Event name: St Joe Grade School Field Da Event Date: June 5 2023 Street Closure: St Louis St between LaSalle & Colfax Ave Closure Times: 6:30 am to 3:00 pm Sidewalk Closure: ❑ Yes 0 No Comments. Annual Field Day behind St Joseph Grade School. 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 IV Jordan V. Gathers, Member Attest: Theresa M. Heffner, Clerk Date: May 9> 2023 1 • P b' „ Tx City of South Bend Special Event Application y Neighborhood Event s„ )z $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 accented. Section A - Applicant Information Date of Application: April 25, 2023 Organization Name: St. Joseph Grade School and Parish Applicant (Contact) Name: Karey Circosta Applicant(Contact)Phone: 574-298-1171 Contact Email: kcircostagnd.edu Address: 216 N. Hill Street City/State/ZIP: South Bend, IN 46617 Secondary Contact Name: Nic Circosta Contact Phone: 574-234-3134 Contact Email: ncircosta@stioenarish.com Address: 216 N. Hill St City/State/ZIP: South Bend, IN 46617 Section B - Event Information Event Name: St. Toe Grade School Field Day Expected Attendance: 400 Requested Street Closure: St. Louis Street From (Cross Street): LaSalle Street To (Cross Street): Colfax Ave Provide a brief description of the event: We are having our annual Field Day and want to close St. Louis Street behind our parish and school so we can use that area for activities and to make sure kids can run to all the stations safely. Date of Event Setup [mm/dd/yy]: 6/5/23 Time: 6:30am Begin Date of Event [mm/dd/yy]: 6/5/23 Time: B:OOam End Date of Event [mm/dd/yy]: 6/5/23 Time: 2:301m Event Cleanup Completion[mm/dd/yy]: 6/5/23 Time: 3:OO12m 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: Will this event have music (live or other)? ® Yes ❑ No �I • Will alcohol be served or sold? ❑ Yes © No If Yes: c 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. 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. o 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). la) Security Company Information Company Contact Phone: • (b) Independent Security Information Name: Qualifications: Name: Qualifications: Name: Qualifications: 0 Contact Name: City/State/ZIP: Contact Phone: Contact Contact i • Will your event have food sales (food vendors, caterers, food trucks, etc.)? []Yes ❑x No o If yes, the event coordinator must apply for and receive a St Joseph County Health Department Temporary Event Permit. c 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. c All applications and guidelines can be found on the St. Joseph County Health Department Food Service website at sichd.org/food-service. 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: • 0 Section E - Indemnity & Hold Harmless Agreement • City of South Bend Special Events Committee Indemnity & Hold Harmless Agreement Date: 4/25/23 Event Date: 6/5/23 Event Name: St. Joseph Grade School Field Day Organization: St. Applicant (Contact) Name: Applicant (Contact) Phone: Grade School and Parish kcircosta@nd.edu Address: 214 N. Hill St Circosta 574-298-1171 Event Location (Please describe): Length of Event (Dates/Times): 6/5/23 = Alt. Phone: City/State/ZIP: 574-234-3132 South Bend, IN 46619 • 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: 4/25/23 �a�t.¢.y �zceattL Authorized Organizer Signature Karey Circosta, Field Day Chair Printed Name and Title 0 Section F - Permit & Aereement • 1. Pursuant to Local Ordinance No. 10628-18,there isa$25.00non-refundable fee for applications filed 30 days or greater in advance of the event date. Applications filed less than 30 days in advance of the event date will not be accepted. 2. All residents within the affected area must be notified of this event. The APPLICANT must obtain signatures from at least 10 residents that reside along the closed right-of-way and make an attempt to notify all other affected residents. APPLICANTS must include a copy of a brochure or letter of invitation distributed to all affected neighbors describing the event purpose, date, and time. 3. The APPLICANT is responsible, prior to the event, for determining if there are any affected residents that need assistance accessing their residence. The APPLICANT is responsible for providing said resident(s) access or transportation to their property. 4. The cones will be delivered to the APPLICANT's address. The APPLICANT assumes full responsibility for clean-up and assures the City that all cones will be maintained and returned undamaged. The APPLICANT will be liable for the replacement cost of $50.00 per cone as a result of any missing or damaged cones. 5. Block parties must end by 8:00 p.m. 6. A street will be blocked off from intersection to intersection only. No half -blocks or alleys can be blocked Off. 7. The Special Events Committee reserves the right to deny any block party application based on traffic and speed limit records. No street may be closed with a speed limit over 30 MPH or considered to be a major arterial. 8. The Special Events Committee reserves the right to deny any block party application based on information gathered from the South Bend Police Department or other sources. 9. The APPLICANT agrees to allow residents that live on the above -referenced block access in and out of the restricted area as needed. 10. The APPLICANT agrees to abide by all terms and conditions of the South Bend Municipal Code and Board • of Public Works' policy adopted in Resolution No.10628-18 on December,11, 2018. 11. Notification of approval/denial of this request will be issued by return of this form, upon signed authorization by the Board of Public Works. 12. The City of South Bend Noise Ordinance 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 stereos, speakers, musical instruments, 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). 0 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: 4/25/2023 Applicant Signature:/IQiL¢t� (atlL Printed Name: Karey Circosta SPECIAL EVENTS COMMITTEE APPROVAL i 44 i Pr ent t j Mem er Member Member fin' Me S�e2�.23 Date 11 S • A� s � tJOSEPH � L CATHOLIC CHURCH E. COIFA%AVENUE N W�E 5 MEMO STREET CLOSURE - JUNE 5th To: St. Louis Street Residents From: St. Joseph Grade School Field Day Committee Again this year, St. Joseph Grade School will be holding their annual Field Day end -of -the -school -year celebration for students. This year's event will be on Monday, June 5th. We will be closing St. Louis Street between LaSalle and Colfax from 6:30am until 3:30pm. Please have cars that are parked on St. Louis Street moved before that time. Alley access will still be available as well as parking on Colfax and LaSalle. Thank you for your understanding each year! This allows our school and parish to have a wonderful and safe event for our students. In Christ, St. Joseph Grade School Field Day committee • Certificate of Coverage Date:4/25/2023 Certificate Holder The Diocese of Fort Wayne -South Bend, Inc. Chancery Office P O Box 390 This Certificate is issued as a matter of information only and confers no rights upon the holder of this certificate. This certificate 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 OMAHA, NE 68154 Covered Location St. Joseph Church -South Bend -St. Joseph Grade School 216 N Hill Rd South Bend, IN 46617 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 Coverage Certificate Number Coverage Effective Date Coverage Expiration Date Limits Property Real & Personal Property D. General Liability Each Occurrence 700,000 General Aggregate 1,000,000 ElOccurrence Claims Made 8679 10/1/2022 10/1/2023 Products-Camp/OP Agg Personal & Adv Injury Fire Damage (Any one fire) bled Exp (Any one person) Excess Liability Each Occurrence .annual Aggregrate Other Each Occurrence Claims Made Annual Aggregrate Limit/Coveragc Description of Opera[ions/LocatiomNehicles/Special Items (the following language supersedes any other language in this endorsement or the Certificate in coofiicl with this language) Coverage only extends for claims arising out of St. Joseph Grade School's field day in which St. Louis Street will be closed from Colfax to LaSalle on June 5, 2023. Holder of Ccrtificalc Cancellation Additional Protected Person(s) Should any of the above described coverages be cancelled before the expiration date thereof, the issuing company will City of South Bend, IN 227 West Jefferson Blvd. endeavor to mail 30 days written notice to the holder of certificate named to the left, but failure to mail such notice shall South Bend, IN 46601 impose no obligation or liability of any kind upon the company, its agents or representatives. 0067004866 Authorized Representative zr , -