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Home My WebLink AboutSpecial Event - Classic Car Show - August 19,4 yUi Ty �Fti APPLICATION FOR USE OF PUBLIC RIGHT-OF-WAY FOR EVENT MACE The following special event has been approved by the Special Events Committee. 1865 Submitted by: Denise Miller Event name: Classic Car Show Event Date: August 19 2023 Street Closure: Eddy St between Beyer and Dead End Closure Times: 6:00 am to 3:00 pm Sidewalk Closure: ❑ Yes ® No Comments: Classic Car Show along with music and food. CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS a Elizabeth A. Maradik, President Gary A. Gilot, Member Murray L. Miller, Member tl'15�z ff � Joseph R. Molnar, Vice President Alexandra Dolz-Lane, Member Attest: Theresa M. Heffner, Clerk Date: August 8, 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. i Please Bring 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 Date of Application: Applicant (Contact) Applicant (Contact) Phone: a 3- )0Contact Email: AS i G" jo 4 rj16'-1 z em Address: [ I 0 /1/Af lei , S. J P alLIA City/State/ZIP: 5Du a1-4 Secondary Contact Name: v I Contact Phone(679�c�o - Q -,i Contact Email: Address: A n!� ALOE1P s'd.:e a" City/State/ZIP:- Section B - Event Information Event Name: �ij�� ((�� t ,PI G i Expected Attendance: Requested Street Closure: Ali f0i 'r� ,rl -0- 6 (ylCA[-I (j-' /J"P/- i . n From (Cross Street): To (Cross Street): Provide a brief description of the event: Date of Event Setup [mm/dd/yy]: Begin Date of Event [mm/dd/yy]: End Date of Event [mm/dd/yy]: Event Cleanup Completion [mm/dd/yy]: Time: (0 �Q 0 I , j r / Time: 0/) kn} ) Time: Time: Have all residents on the affected block have been notified and invited? Wes ❑ 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: - U Number of households represented by signatures on attached sheet: -O Will this event have music (live or other)? Yes 0 No 4rnwfl Section C - Alcohol Will alcohol be served or sold? ❑ Yes )(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. 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 thatwill have alcohol sales must provide security. If your eventwill 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, orevent applicant) of three (3) security guards in the fields provided in sub -section (b). (a) Security Company Information Company Contact Phone: 40 (b) Independent Security Information Qualifications: Qualifications: C 1 Contact Name: Email: City/State/ZIP: Contact Phone: Contact Phone: Contact Phone: Section D - Food Will your event have food sales (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 on the St. Joseph County Health Department Food Service website at sichd.ora/food-service. Please select food types:) Food Vendor ❑ Caterer ❑ Food Truck Other. If a Food Truck, please list company name(s): n, n:s � % �S - S ln�i �a�.� cl '0~57 c van F or ire P.4 Please describe how food will be cooked and served: boo& w�l1 \ze- c001L G se(�e� b j c, � 0 b� aSe_ step) Section E - Indemnity & Hold Harmless Agreement • City of South Bend Special Events Committee Indemnity & Hold Harmless Agreement Date: tiQ +a3 Event Organ Applic Applic Email: Addre Event Date: s q icc la Name: C i ization: ant (Contact) Name: ` / tv ant (Contact) Phone: -7 i I a-<:�,a I aSfklt. Phone: LI ss: N City/State/ZIP: 1 6 (S� 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: Authorized Organizer Signature Printed Name and Title ��Y-C Section F - Permit & Agreement 1. Pursuant to Local Ordinance No.10628-18, there is a $25.00 non-refundable fee for applications filed 30 or greater in advance of the event date. Applications filed less than 30 days in advance of the event 10days 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). U 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 anyfalse or incomplete information. Date: —) 1 i,-� U Applicant Signature: Printed Name: President • Member 40 SPECIAL EVENTS COMMITTEE APPROVAL \ 1 Mfimber 1 mber — : ��- W- Member f-/-123 Date ul doors = t imyW ATE IUC AC�ORIO CERTIFICATE OF LIABILITY INSURANCE 07112 zo 31255r' 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 POI ICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(B), AUTHO IIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER IMPORTANT: If tho corli icater holder Is an ADDITIONAL INSURED, the Pollcylioal must have ADDITIONAL INSURED provisions or be end rsed. N SUBROGATION IS WAIVED, subject Do the terms and conditions of the policy, certain policies may require an endorsement A statement on Ibis ceRifioats doss not confer lights to the certificate holder in lieu of such andorssmard al. PRODUCER "ME Hartlesty, Blake H.r.. .15741223-2100 - - — - --iP 230 E 9th St Blake.Hardesty@infarmbumau.cam Rochester. IN 46975 ADOAEac. _ wWtFRA: United Farm Family Mutual lnsuranco Company 152 WARRED IN6UREN6: FARMERS MARKET INC - --'------ --- INRI.RFi55:__ _.'----_----- '-- .__--- I105NORTHSIDEBLVD SOUTH SEND, IN 46615-2926 wwRERP. _ lwwk a-- IN6URERF: COVERAGES CERTIFICATE NIIMRFR- RFulglnu AllI"-FR• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW MANE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY F iRIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERIA OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WVHICI I THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE RMS, EXCLUSIONS ANDCONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY CLAIMS. _PAID MR LM IYPE OFwWRl1NCE _ jiBdC3tIBR,-- Z._ NUMAEA roWYEFFI yIICT EIJ ; �� CONMEACIAt OEIrERALLUIBRITY 1 EACH OCCUNR6NCE a1.Qli CUlM5-NODE X. 000LR . .. OgILL£T6FENTen— PAEk16ESSEasLUPmwi_ rs100.00D— - -__ MEDEXPIAnymevenewn A __. _ _ CPPB166918 D7/1912022 i07/19/2023 PER6[Na.AADY nLSIRY fl.aey.DQq __ gFNEAAI AOORECATE a 2 GCNLAOOREGATCUMTAPPLESPEA I POLICY EEC LOC __._ __ ,OOD.000 PRODUCTS- CONP.OPAGG_1 I200.0,000 : ODE2 AMFOMOeIELWIIrrY GnMBI FPa NGLE 4NlT �AMY ADTD DOO LYNAWYiPerp �L1.DOD.000 A 'AMOS X iw"�i1Ep j CPPB166918 07l19f2022 07/19f2023 WLY ARi09 1 BODILY wXmrlPPracmPll!t - X IFAUTOSI NED ! Ws1E0 RED AUTOS ONLY JAUT090NLY -----' IpPE�RTYNDOMADE It ' X IUNBME LAN IOCCUM: - �EXCESsuA9 EACHOCCURRENCE !6 A 19/2022 '07119/202307/ AawcrE s1.00,000 MO ' RElEAITION00.000J--_— WORNER6COMPENSATIeN 'AMU pT X yTATUTE EMPLOYERS' LIABILITY WIN - RpeRTAEMCxECunY[ i A '07/1912023 E.L. FACM ACCIDENT WrPXNTALMI DFFNZWTAE4BENEXLLUDf:D' .NIA WC 8336J52 p7/14R022 Ixalwatary NNN7 _ EL DISEASE -EA EMPLOYEEI 65DLD00[ 11 ppaL. ObNb t 04' O DESCRIPngx pF OAEAA110Ng Lebn El.OI6FiASE POLICY LIMIL I t SO0.000' I OEBCAIPnONOFOPEMTNmaI LDGmON6f YE19CI.a6 (AOIXIO tat, AaNXIPntlRM10Na acXPdla, mSp M Asacnra M mwe Space N rpNlrwl RE: CAR SHOW ON 8-19-23 CRY OF SOUTH BEND 227 W. JEFFERSON BLVD. SOUTH BENO, W 46601 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES RE CAN THE EXPIRATION DATE THEREOF, NOTICE WILL BE ACCORDANCE WITHTIIEPOLICYPRO4ISIONS. Hardesty, Blake ®1 OBB-2015 ACORD CORPORATION. All rights re ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 0 IN • CITY OF SB SPECIAL EVE 7315 LAFAYETTE BLVD SOUTH BEND, IN 46601 07/14i2023 1414:09 MID: XXXXXXXXXXXX401 TID: XXXXX800 DEBIT CARD DEBIT SALE Card # XXXXX9XXXXX7464 Network: VISA Cho Card: US D A000000098 C: BDI85BF01724E xta: CJ #: UrJOICE Ngoval Code: 909 . r. ky Mema Cho 6 • s)de: Issuer - PIN Bypa< ,ALE AMOUNT I agree to pay above total arr"t accordng to card issuer agreement. (Merchant agreement K Credit Voudw) X_. 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