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HomeMy WebLinkAboutLicense - Transient Merchant - St. Joseph County 4-H FairINTER -OFFICE MEMORANDUM BOARD OF PUBLIC WORKS DATE: 04/18/2023 TO: Chris Dressel, Community Investment Gerald Ellis, Fire Department Brad Rohrscheib, Police Department FROM: Theresa Heffner, Clerk theffner@southbendin.gov SUBJECT: TRANSIENT MERCHANT LICENSE RENEWAL RECOMMENDATION APPLICANT LOCATION: DATE OF EVENT: St. Joseah Countv 4-H Fair 5117 Ironwood South Bend, IN 46614 June 30. 2023 — July 8. 2023 PLEASE INSERT YOUR RECOMMENDATION IN THE APPROPROIATE FIELD BELOW, BASED ON THE ORDINANCE CRITERIA (sec. 4-60): Community Investment: Recommended for approval. Police: Favorable recommendation Fire: Favorable For all municipal business license questions, contact: City of South Bend • bepartment of Community Investment 227 Westkfterson Blvd • Suite 1400 5 -south Bend, Indiana 46601. 574.235.5912 • F; $74,235.9021 c� �i is �5.� LICENSE APPLICATION FOR - TRANSIENT MERCHANT MUNICIPAL CODE SECTION - 4-60 I. APPLICATION TYPE Check One: New Renewal X It. BUSINESS DATA A. Name of Event: St. Joseph Countv Fair 8. Business Name- St. Joseph County 4-H Fair, Inc. C. Business Address: 5117 S. Ironwood city: South Bend _state: IN zip: 46614 D. Mailing Address (if differs): City: state; Zip: E. Business Telephone Number: 5574-291-4870 F. Business Fax Number: NIA G. E-Mail Address. _manager 4hfair.com H. Indiana state Retailer License number: 0003136284000 I. Proposed location where business will be conducted: total grounds J. Description of building or premises to be used: total -grounds K. Proposed bates of operation: June 30-July$ L. Proposed Hours of Operation: 7am-11 prn daily M. Types of goods to be sold: fair food,crafts.carnival rides N. Scales will be used in business transactions: Yes No X If yes, please attach certificate from the Sealer of Weights and Measures. G. Food will be served in ready -to -eat condition: Yes X No P. Description of nature of proposed advertising: Radio, Internet,TV, Newspaper For Office Use Only Application Filed APR 1 8 2023 Public Works Approval Application Fee Paid APR 1 8 2W License Fee Paid APR 1 202,1 Sent to Dept. APR 1 License Number MM;AON5--0 Not Approved Reason CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS - oI4 Elizabeth A. Maradik, President I-_' QO%tdc Gary A. Gilot, Member Murray L. Miller, Member I/ Joseph R. Molnar, Vice President 810 Jorrh�m V. Gathers, Member 1_'`4 Attest: Theresa M. Heffner, Clerk Date: May 23, 2023 For all municipal business license questions, mmam Cry of South Bend • Department of community Investment 227 WestAsfferson Blvd • suite 1400 S •South Bend, Indiana 46WI • 574,235,5912 • F: 576.23SM21 LICENSE APPLICATION FOR -TRANSIENT MERCHANT MUNICIPAL CODE SECTION -4-60 II. BUSINESS DATA (Continued) Q. Contact person to be responsible for customer complaints and available at least sixty(60) days following last date of business: Contact's Legal Name: Kristen SII(orsld-Conklin Residential Address: city: South Bend State: IN z;p: Telephone Number: III. PERSONAL DATA (Applicant) A. Applicant's Legal Name:Kristen Slkorskl-Conklin B. Residential Address: city: South Bend State:IN zip: C. Residential Telephone Number: NSA D. Cellphone Number: E. Position with business: Fair Board President F. Social Securit Number: - G. Gender: H. Date of birth: I. Race= IV. PERSONAL DATA (Owner, if differs) A. Owner's Legal Name: B. Residential Address: City: State: Zip: C. Residential Telephone Number: D. Cellphone Number: E. Position with business: F. Social Security Number: G. Gender- H. Date of birth: I. Race: 2 For all municipal Business Ilcense questions, contact: CM1v, of SoutB Bend • Department of community Investment 229 West Jefferson Blvd • Suite 14W S -South Bend, InGlana 46601 • 574135.5912 • F. 514.235.9021 LICENSE APPLICATION FOR -TRANSIENT MERCHANT MUNICIPAL CODE SECTION -4-60 V. PERSONAL DATA (Additional Owner, if applicable) A. Owners Legal Name:. B. Residential Address: C. Residential Telephone Number: D. Celephone Number: E. Position with business: F. Social Security Number: G. Gender: H. Date of birth: VI. INCLUDE $5.00 PROCESSING FEE WITHAPPLICATION VII. INCLUDE NAMES, ADDRESSES, AND TELEPHONE NUMBERS OF ALL GROUP EVENT PARTICIPANTS. Vill. INCLUDE A CURRENT CERTIFICATE OF LIABILITY INSURANCE WITH THE CITY OF SOUTH BEND LISTED AS THE CERTIFICATE HOLDER. IX. 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 understand that the completed application must be filed no later than thirty days before the planned event is to begin. I have read and understand the regulations of the Transient Merchant license found in the City of South Bend Municipal Cade, Section 4-60. L� 4 3 23 Signature Date .4CORa'a CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIVYM 0411112023 THIS CERTIFICATE 13 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 poiicy(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(*). PRODUCER NAM£: NTAGT Jessica Roush PHaRE . (574) 231-6574 IrAX NC p (574) 25MI77 Synergy LLC ED"DRE roush s nor insuran. oDREss• 3 L Y 9Y oBgroup,com 13800 Jackson Road INSURER 8 AFFORDING COVERAGE NAIL/ INSURER A. K& K INSURANCE Mishawaka IN 46544 INSURED INSURER D: INDIANA FARMERS MUTUAL INS Co 22624 St. Joseph County 4-H Fair, Inc. INSURER INSURERD: 5117 Ironwood Road INSURER E: South Bend IN 46614 INSURER COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NA ALD A30VF 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 DE9CRIHFD HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM'S. POLICY E:XP I LTR TYPEorINSURANCE JNSD WVDBURR! ICYNUMBER - pwn�E JIM'DDYYYY LIMITS X COrrE41ERCIALCENERALLIABR•ITY CLAIMS -MADE FRI OCCUR EACHOCCURRENGE SE 0 RENTED a occurren $ 1,000,000 $ tX},aQt} MED EXP Any one perwin) $ 10,000 A _ KKO0000026396700 3/1912023 311912024 PER80NAL&ADV INJURY 3 1.000,000 CEN'LAGGREGATELIMITAPPLIESPER, X POLICY L0C GENERAL AGGREGATE PRODUCTS PRODUCTS-COMProP AGO $ 5.000,000 $ 5,000,000 OTNER: $ AUTOMOBILE LIABILITY GVMBINED SINGLE LIMIT jEa accident] $ 1 ��•OD� X _ BODILY INJURY [Per person] AW AUTO $ B OWNED AU_0S.1LED ALITOSONLY AV-05 CAP1012112 3/19/2023 311912024 BODILY INJURY Per accldent) � $ FRO TYDAMAGE $ HIRED NON-U I,'dNED ALrrOSONLY AUTOS ON LY UMBRELLALL4B OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE S 5,000,000 A EXCESS LIAR CLAIPAS-MADE XK00000025396900 3/1912023 311912024 DEU RETENTION $ $ g WORKERSCOMPENSATION AND EMPLOYERS' LIABILITY &NYFRCPaIETORrARTNER;EXECUTIVE YIN r.FFICERWE.MBEREXCLUDED9 (Mandatory in NH) NIA WCP1008824 3/1912023 311912024 � STA STATUTE ER E.L. EACH ACCIDENT $ 50o,000 E-L. DISEASE - EA EMPLOYEE $ 500,000 I If yes, nescribe under DESCRIPTION DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additi01lal RB111anc9 Schedu 10, may Be attached it more Space is required) L.CISIIr7L.fLIC NVLUCK %HJANk. CLLAI I IUN S H O U L D AN Y O F TN E ABOVE DESC RIB ED POLICIES BE CAN CELLE D H E FO R E THE= EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of South Bend ACCORDANCE: WITH THE POLICY PROVISIONS. 227 West Jefferson BIVd. AUTHORIZEDREPRESENTATIVE South Bend IN 46601 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks ofACORD African Creations Attn: Linda Kipkorir 18400 Madrin Court South Bend, IN 46637 Phone: 574- 709-4236 Author Stephanie Scott 509 5 Byrkit St. Mishawaka. IN 46544 Phone: 574-208-8898 ❑r Vegetable Joshua Nicholson P.U. Box 528 Valparaiso IN 46383 Phone: 219-464-3123 Bruce's Concessions Jeffrey W. Bruce 802 South Church Street Hastings MI 49058 Phone: 269-838-5731 Bobcat of Michiana/Hull Lift Truck Attn: Caitlyn Wenger, Bobcat Sales Coordinator 29747 Old US Hwy 33 Elkhart IN 46516 Phone: 574-584-7590 Wakarusa Ag Attn: Dwayne Martin 711 East Waterford Street Wakarusa IN 46573-9573 Norwex Kay Crum 613 Misty Harbor Court Mishawaka IN 46544 Mak Foods, LLc dba Porky's Kurt Miller 5401 South 900 East Lafayette IN 47905 Lakeville Lions Jim P.O. Box 506 Lakeville IN 46536 Phone: 574-862-1163 Phone: 574-259-7356 Cell: 574-514-4344 Phone: 765-532-3332 Phone: 574-3fi0-5705 C & C Concessions, Inc. Jason Colglazier P.O. Box 309 New Carlisle IN 46552 Coalbush United Methodist Churcb Michelle Wells 15977 Jackson Rd Mishawaka IN 46544 Fire N The Hole Wood Fired Pizzas Stacy Reed 5389 E 1000 5 Claypool IN 46510 Gideons International Jeffrey McWhirt PO Box 1643 Mishawaka IN 46546 Everdry Waterproofing Attn: Julie A. Escalante 4647 W. Cleveland Road South Send IN 46628 Clara Ross "Bubbles The Clown" 726 Cushing Street South Bend IN 46628 Food Court Concessions Bob Powell 11319 Iris Court Plymouth IN 46563 Kenay Arts Jairo C Harlan 3159 N Springfield Chicago IL 60618 Jake's Foods, LLC Jay G Rounds 1607 Springbrook Ct Goshen IN 46528 Horneworks Investments Zachary Lewis 1920 Ridgedale South Bend IN 46614 Phone: 574-654-8751 Phone: 574-259-4136 Phone: 574-268-8306 Phone: 574-259-SE91 Phone. 574-272-3788 Phone: 574-520-0397 Phone: 574-780-0038 Phone: 773-803-9187 Phone. 574-238-3295 Trade/Midway Phone: 574-876-3065 Lalepa's Island Snow Inc Henna Art Design Ralph Pieniazkiewicz Jayshree Patel 61488 Fellows Street 52076 Myrtle Ave South Bend IN 46614 Phone: 574-299-1539 South Bend, In 46637 Phone: 574-273-8708 Gloria Schrock Forte Enterprises (Tupperware) McGrothe Foods 22250 Ireland Road Brad McGrotha South Bend IN 46614 Phone: 574- 305 Charnie Drive Thomasville GA 31792 Phone. 229-221-5399 AP Concessions, Inc. Aaron/Kristen Pacifico McKinney Food Service 18660 River Estates Lane Shawn McKinney Alva, Florida 33920 Phone: 239-851-3397 3290 FM 161 N Hughes Springs TK 75656 Phone: 903-237-9863 Joseph A. Lewis, MSgt, IN ANG Recruiting & Retention Manager 122 F5S/FPiR 5nowba Indiana Air National Guard Steven Towers 3005 W. Ferguson Road 12482 Shearwater Run Fort Wayne ANGB, IN 46809-D122 Phone: 260-478-3247 Fort Wayne IN 46845 Phone: 574-274-4416 Cell: 260-403-1354 Michiana Lawn Equipment Indiana National Guard Ron Holderbaum Sgt. Kyle Stethem 919 East Mishawaka Road 1023 West Edison Elkhart IN 46517 Phone: 574-295-5555 Mishawaka IN 46544 Phone: 574-323-365O Penn Township 4-H Booth Richard Ramirez Joyce Schultz Navajo Horse Hair Pottery 2809 Northwood 24250 Roosevelt Road Mishawaka IN 46545 Phone: 574476-6721 South Bend IN 46614 Phone: 574-289-4179 Parnell Foods Brett Rubert Planned Parenthood of Indiana 1101 North Ave April Lid insky Belvidere IL 61008 Phone: 815-222-1142 3005 Grape Road, Suite B Mishawaka IN 46545 Phone: 574-287-3808 Michiana Facepainting Rhonda Wilson MJSS Enterprise 24135 Himebaugh Avenue Chaudhry 5attar Elkhart IN 46516 Phone. 574-747-2263 19634 Rolling Acres Drive South Bend IN 46614 Phone: 574-329-1855 Castle Windows Rodney & Lisa Ltd, LLC Attn: Steven Thompson Rodney Albers 1943 Lakeview Drive P.O. Box 1435 Fort Wayne IN 46808 Phone: 419-551-0267 Newcastle OK 73065 Phone: 405-387-3886 Pence Concessions Nedderman Concessions Mike Pence Craig Nedderman 1OO10 us 6 17111 Jackson Rd Bryan ❑H 43506 Phone: 419-636-0888 South Bend, IN 46614 Phone: 574-286-4689 Francisco Rivera Puerto Vallarta Express 415 North Hickory Road South Bend, Indiana 46615 Phone: Luis Espinosa, 574-322-1624 Natalie Hume Quick Draw Caricatures, LLC. 2700 Poinsettia Avenue Middleburg FL 32068 Phone: 419-217-6759 Indiana Health Centers Miranda Buena 1901 Western Avenue, Suite B South Bend, Indiana 46619 Phone: 574-234-9033 St. Joseph County Democratic Party Mary Jo Sullivan 135 South Lafayette Boulevard South Bend IN 46601 Phone: 574-229-6426 Nelson's Port -A -Pit Tad Gungwer 607 Nelson's Parkway Wakarusa IN 46573 Phone. 574-862-2184 Pat Dykes Yoder Buildings, LLC 551 South Washington Street Valoaraiso IN 46383 St. Joseph County Dairy Association Becky Freeman 13800 New Road Mishawaka IN 46544 The Donut Family Todd Hawkins 445 Lake Ave 5t Paul WIN 55110 Phone: 219-405-5284 Phone: 574-514-7069 Phone: 651-398-SS27 St. Joseph County Republican Party Christi 5trycker Tastefully Simple Box 245 29375 Quinn Road South Bend IN 46624 Phone: 574-299-1388 North Liberty IN 46554 Phone: 574-910-2151 Star Martial Arts Michelle Mayer Melanie Birky Sir Horne Improvements 123 N. Elkhart Ave 12849 North U.S. 131 Highway Elkhart IN 46516 Phone: 74-522-5425 5choolcraft MI 49087 Phone: 269-447-3030 Debra 5. Berndt Lil la Rose Tabitha Caid 63476 Pierson Road Scentsy Cassopolis, Michigan 49031 Phone: Z69-445-3010 305 E. Michigan St Three Oaks MI 491ZS Phone: 269-449-7565 Laura Brewer Newton Park Pink Zebra & Lip5ense c/o Marge Skaggs/Kevin Christy 1100 East Lake Street PO Box 449 Knox, Indiana 46534 Phone: 574-906-8321 Lakeville IN 46536 Phone: 574-274-9502 Doors & Drawers Cutco Brad Botts Attn: Janet "Wiggy" Wiggins Z302 Dierdorff Road Phone: Z60-570-0054 Goshen, Indiana 46526 Phone: 574-533-3509 E-Mail: jwiggins@cutcorep.com Weaver Ag & Lawn Equipment Adam Weaver, Senior Vice President 905 Nelsons Parkway Wakarusa IN 46573-9580 Phone: 574-546-4761 Right to Life Michiana Jay Burke, Program Manager 2004 ironwood Circle, Suite 130 South Bend IN 46635 Phone: 574-232-5433 The Pretzel Wagon Sue Miller 11797 Harder Three Rivers Ml 49093 Phone: 269-625-0966 Courtney Ruh Evolve Chiropractic 5230 Beck Drive, #3 Elkhart IN 46516 Phone: 269-365-2622 Thirty -One Gifts Kim Johnson 7752 N Mohawk Trail PO Box 265 Rolling Prairie IN 46371 Phone: Z19.778-4623 ATouch of Fleece Soni Marchhank 25434 Grant Rd South Bend. IN 46619 Phone: 574-274-0669 H B Royalty Victor Berinstany 58025 County Rd 9 Elkhart, IN 46517 Phone:574-265-9742 Lemonade N More Grant Ryals PO Box 2339 Riverview, FL 33568 R C Sales & Leasing Rick 23247 U5 33 Elkhart, IN 46517 Slushie Station Blake Ryals PO Box 2339 Riverview, FI 33569 Phone:813-460-1033 Phone:574-2G6-5153 Phone:813-460-2264 Withers Concessions Ron Withers 3048 W 1500 N Macy IN 46951 Phone: 574-382-2347 Tom's Tasty Taters Wayne Smith 808 Pearl 5t Plymouth IN 46563 Phone: 574-936-9672 WonderPax Jennifer Gant -Brush PO Box 55061 Norfolk VA 23505 Phone: 757-646-1073 LeafFilter North of Michigan, LLC 1595 Georgetown Road Hudson OH 44236 Phone: 80D-726-7703 Ext. 1305 Alegria Campestre Maria Gonzalez 13577 Juniper Rd Argos, IN 46563 Phone: 574-281-2255 Dizon's Foods Erasmo Dixon 2699 McKelvey Rd Maryland Heights 5t. Louis. MO 63043 Phone:314-680-0595 Native Spirit 5talon Lema 3310 N Hamilton Ave. Chicago, IL 60619 Phone:872-600-6288 Our Melt Bar Amy Shea ker 19 West Blagrove 5t. Richmond, Ohio 43344 Your Make Up Dealer Sylvia Wilson 1814 Lenninger Ave. Elkhart, IN 46517 Phone:937-243-4320 Phone:574-747-2263 Purdue Polytechnic High School/Paramount Schools of Excellence 5teph Ebersol 635 5 Lafayettee Blvd. South Bend, IN 46614 Phone: 574-241-1392 Landers Crafters Georgia Landers 3402 Felician Street Fort Wavne.IN 46803 Xicee' Cosmetics Tatiana Edwards 4510 Hickory Road, Apt 3B Mishawaka, IN 46545 Child Evangelism Crystal King PO Box 54 Argos, IN 46501 Jubilee's Boutique 30335 Tower Rd. Elkhart, IN 46516 Phone:260-710-6008 Phon e:574-404-4468 Phone:574-315-8746 Phone:574-386-2404 Kitchen Craft Johna Metcalf 2511 Dora Ave. Tavares, FI 32778 Phone: 352-720-075 Mary Kay Trudy Jackson 51520 James Lawrence Parkway Granger, IN 46530 Phone:574-261-7708 Minix By. De, LLC De' Aviana Holman 4425 Irish Hills Dr. 36 South Bend, IN 46614 Rustic Fisher Creations Elizabeth Fisher 67679 Sycamore Rd. North Liberty, IN 46554 Sleep and Spas Joshua Hughes 46 Marion Ave. Saratoga Springs, NY 12866 Phone:574-575-1055 Phone: 574-279-S754 Phone: 561-358-9187 Love Lock Boutique 1225 South 291" 5treet South Bend, IN 46615 Twisted Craft Junkies Amanda Pennington 402 Park Ave. Mishawaka, IN 46545 Color Street 404 E Center St. Bourbon, IN 46504 Glaxxer Flora Cale 1710 N Brookfield 5t. South Bend, IN 46628 Lori K Bath Annette Williams 551 Franklin Street Valparaiso, IN 46383 Lularo Koren Williams 324 N. 2nd St. Cassopolis, IN 49031 Patriotic Merchandise Patty Framak 56730 Via Pisa Elkhart, IN 46516 Potter's Alley Gifts Nicolette Potter 1316 Sunwood Dr. South Bend, IN 46628 The Arty People Samara Dulik 3924 Miami Street South Bend, IN 46614 The Window Source Andrea Strickland 1329 West North Street Bremen, In 46506 Phone: 574-350-4845 Phone: 574-303-9362 Phone:574-341-2258 Phone: 574-217-1538 Phone: 708-850-6889 Phone: 269-228-0172 Phane:S74-361-4330 Phone:269-830-4Z68 Phone:574-301-9744 Phone: 574-215-4357 Thirty One Gifts Kim Johnson 7752 N Mohawk Trail Rolling Praire, IN 46371 Underthe Sea Mermaids Robyn Fereh 1018 Huey St. South Bend, IN 46628 Phone: 219-778-4623 Phone: 574-315-2155 Legions of Mary Sandy Walker 522 Lowell Wood South Mishawaka, IN 46544 Bomb Party Jewelry Karissa Ameling 2455 F. State Rd. 2 Rolling Prairie, IN 46371 Phone: 574-z59-6215 Phone:219-326-1669