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HomeMy WebLinkAboutSpecial Event - St. Joseph County Crop Walk - September 24APPLICATION 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 Joseph County Crop Walk Event Date: September 24 2023 Street Closure: Participants remain on the sidewalk Closure Times: 1:00 prn to 5:00 pm Sidewalk Closure: ❑ Yes x❑ No Comments: Walkers will begin at Zion UCC and walk along the East Race to Broadway Christian Parish and back. 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 A:�*� aq;;�k Alexandra Dolz-Lane, Member Attest: Theresa M. Heffner, Clerk Date: September 12, 2023 1 ",, City of South Bend Special Event Application d City and Regional Event rD • ("= Sit ->`a= $50 application fee if filed 60 days or greater (up to 360 days) in advance of event ' iws ' $100 expedited application fee if filed 30-59 days in advance of event Please Brim 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. City and Regional Special Event applications must be submitted more than 30 days in advance of the event date or the application will not be accepted. Date of Application: 8/15/2023 Applicant (Contact) Name: Tom Whipkey Organization Name: St Joseph County Crop Walk Applicant (Contact) Phone: 574485-9245 Contact Email: twNpkeyftatt.net Address: 1139 MinerSt City/State/ZIP: 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: Event Name: St Joseph County Crop Walk Event Type: (Festival, Race, Parade, Other): Walk Event Classification: ® 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.) Set up begins Saturday morning with marking the routes with sidewalk chalk. Participants begin arriving Sunday at 1 pm. The walk begins at 2pm and concludes no later than 5pm. Date of Event Setup [mm/dd/yy]: 09/24/2023 Time: 7:00 am Begin Date of Event [mm/dd/yy]: 09/24/2023 Time: 1:00 pm End Date of Event [mm/dd/yy]: 09/24/2023 Time: 5:00 pm Event Cleanup Completion [mm/dd/yy]: 09/2412023 Time: 40 Total anticipated attendance: 150 The proposed event will require the closing of: ❑ Streets ❑ Sidewalks Is the event ticketed or include fees? ❑ Yes ❑x No If yes, list fees and fee groups below: • Does the event have any partnered sponsorships? © Yes ❑ No If yes, list the number of sponsors at each level of partnered sponsorship: Church World Services Is this a returning special event or part of a series of special events? Q Yes ❑ No If yes, provide the date, location, and attendance of past special events and/or future planned events in the series: The last Sunday in September for the last 40 years at Howard Park and Zion UCC. Average attendance is 200. r L J If your event is a parade, race, or other processional -type event, please complete Section C.Otherwise, continue to Section D. What is the estimated number of parade/race spectators on the proposed route? 0 Describe any sound equipment that will be used in the parade/race: A small sound system will be used prior to the start of the walk at Zion UCC. L� • Does the event have participant categories? For example, a run that has different race divisions or a parade with separate walking/marching groups. CO Yes ❑ No If yes, list categories and anticipated participants per category. A long walk along the river to Broadway Christian Parish and back. A short walk along the river to the Farmers Market and back. If your event is a parade, what is the approximate number and type(s) of animals, vehicles, and floats participating in the parade? (Note: If using animals in a parade, event organizers are responsible for cleaning up animal waste left on the parade route.) Describe parade participants below: Section D - Eauioment Set-up, and Logistics Are you hiring a company to provide entertainment, games or inflatables? ❑ Yes ❑x No o If yes, you must submit proof of insurance for all stage and entertainment companies three (3) weeks before the event. Describe any hired entertainment: Will you be staking any tents, inflatables, portable restrooms or any other anchorings? ❑ Yes 0 No o If yes, you must provide proof of locates (locate number) two (2) weeks prior to your event. Locates can be found by calling 811. Does your event include the use of fireworks, rockets, lasers, or other pyrotechnics? ❑ Yes [D No o Depending on the potential fire risk, applicants may need to receive approval of the South Bend Fire Department (process facilitated by event coordinator). o Describe the event's proposed fire -related entertainment: Will there be any musical entertainment features at the event? 0 Yes ❑ No o If yes, describe the type of music, schedule of sound check/performances, and the names of any artists • performing. Charlie Pellitier will perform folk music from 1 PM until 2PIM For stage inspections, contact the Department of Homeland Security at 317-232-2222. If your route crosses over a state road or abridge please contact the following for permission: State, IN DOT: Countybridges: Michael Hurt Andy Hayes 219-235-7528, Mhurtl@indot.in.gov 574-235-9626, ahayes@co.st-joseph.in.us Are you having food at your event (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. 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 at the St. Joseph County Health Department Food Service website: sichd.ore/food-service. Please select food sales types: ❑ Food Vendor ❑ Caterer ❑ Food Truck ❑ Other: • If a Food Truck, please list company name: Describe how food will be cooked and served: Section F - Alcohol Will alcohol be served or sold? ❑ Yes ® No If no, please continue to Section G - Contingency and Strategic Planning If yes: o The applicant must applyfor and receive a temporary liquor license from the Alcohol & Tobacco Commission. Indiana ATC forms are located at in.gov/atc/2409.htm. (Temporary Permits are near the bottom of the form list.) Forms must be filed with the district ATC office five (5) days prior to the requested event date. 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. Deposit will be returned upon inspection of event area by the Board of Public Works. • o Events with 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) Company Contact Name: is Contact Phone: Email: (b) Name: Name: Qualifications: Name: Qualifications: City/State/ZIP: Contact Phone: Contact Phone: Contact 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. Walkers will be advised to call 911 in case of emergency. Walkers will be advised to call the Zion UGC office for non emergency needs. A vehicle will circulate along the long walk route to provide assistance if needed. Proposed Cleanup Plan - This plan should include, but is not limited to: o Measures in place to collect and remove trash, litter and recyclables. Designated walkers will carry trash bags to pick up litter along the routes. Trash will be disposed of in the Zion UCC dumpster. U • Inclement Weather Plan -This plan should include, but is not limited to: o Safety measures that will betaken in the event of a tornado warning, tornado watch, thunderstorm, and extreme temperatures. • Walkers will shelter inside Zion UCC. Walk could be canceled. • Proposed Lost and Found Plan - This plan should include, but is not limited to: o A description of the use of signage, announcements on public address systems or pre -event handouts. Lost and found will be in the Zion UCC office. FE ., L- A 3 11", 107MuET.' • For parades, races and other processional events: Are you selecting one of South Bend Police Department's (SBPD) pre -approved race routes? ❑ Yes ® No You must select from SBPD's pre -approved race routes (see links on application site) or provide sufficient evidence of event participation if the applicant is proposing a different route through South Bend. If your event will not be using a pre -approved race route, the proposed event map should include a route plan clearly identifying the timing and locations of proposed street closures, and the direction of parade movement. If your event will not be using a pre -approved race route, please explain: There were no links to routes. We are not planning any right of way closures. 0 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. • Location of fencing, barriers, and/or barricades. Indicate any removable fencing and exit locations for emergency purposes. • Location of all stages, platforms, bleachers, grandstands, tents, booths, cooking areas, vehicles, trailers, and other temporary structures. Applicants should also clearly mark locations of food and alcohol serving or sales, if applicable. • The location(s) and number of all portable toilets and wash stations. • The location(s) and number of all trash and recycling containers, including dumpsters. • The location of generators or any source of electricity. • Traffic plan and map, including proposed loading/drop off areas, barricades, secured areas, vehicle and bicycle parking areas, and considerations for TRANSPO bus route changes. 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. • j=�mv=L -.0 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. 0 • City of South Bend Special Events Committee Indemnity & Hold Harmless Agreement Date: 8/15/2023 Event Date: 9/24/2023 Event Name: St Joseph County Crop Walk Organization: Church World Services Applicant (Contact) Name: Tom Whipke Applicant (Contact) Phone: 574485-9245 Alt. Phone: Email: twhjpkey(&att_net Address: 11390Miner St City/State/ZIP: South Bend IN 46617 Event Location (Please describe): Starting at Zion UCC walkers will walk along the East Race and/or to Broadway Christian Parish and back. Length of Event (Dates/Times): 09/24/2023 1pm-5pm 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: St Joseph County Crop Walk 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: 8/15/2023 Authorized Organizer Signature Thomas W Whipkey • Printed Name and Title 1. Section L - Permit & Agreement Pursuant to Local Ordinance No. 10628-18, there is a $50.00 non-refundable fee for Tier II and III event • applications filed 60 or greater days in advance of the event, or a $100 non-refundable expedited fee for applications filed between 30and 59 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 anyfalse or incomplete information. Date: 8/15/2023 Applicant Signature: Printed Name: Member SPECIAL EVENTS COMMITTEE APPROVAL ember c 1 - W Me ber Member q/'5/.;2 3 Date m 2 m c m m 'o (D v W n. < D m � is Iloue ^ is e!gwnlo� nolla3 is is ellaPeW m w 0 m V ale0 m m 2 JD n • � D m M m Leer St 0 W J is ue6lyolW S iS ue6l4olyq $ IS ue614olvj S a o m m L? J T m ° y 3cn m m �y 1) 0 3 is Iloueo K o �P S� D co — � 1S mgwnlo3 L N m -� 4sn2f m °c �agOC a o ID�IS 1 `o. r N IS eliauevq 7 / m c � d u =r 1S saoue.i_I 5 3 0 t„e� 0 50 r�IS is APP3 S m O C j C �o W 3 m �` 0 is asmol Q �f 3 �o oy� m o. is sijagoa v 9� S Sunnysideq,,e r� u C� • THKW" W. WMPKEY 1139 EAST MINER SOUTH BEND, IN 4WI7 K�9 tcunet.c/om g/ I: 27 i29 18261: 0033447411' 6084 6084 �� ]4918L2112 n ACORO® CERTIFICATE OF LIABILITY INSURANCE `/ DAM(MMIDDNYYY) 1 8/24/2023 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 endomement(s). PRODUCER Waldorf Risk Solutions, LLC PO Box 590 Huntington NY 11743 CONTACT NAME` PHONE . 831423-9500 uc NII: 631-424.3610 ADDRESS: Info rsl928.com INSURERSAFFORDINGCOVERAGE NAICS INSURER A: Certain Underwriters at Uo da, London-AA7122000 INSURED CHUWRL Church World Service Inc. INSURERS: 28606 Phillips St, PO Box 968 INSURERC: _ INSURERD: Elkhart IN 46515 NSURER E: NSURER F: COVERAGES CERTIFICATE NUMBER: 47484907 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 Tp 'ADOL SUBR. TYPE OF INSURANCE POUCY NUNBER POLICY EFF MM,DOIYYYY POLICY SKIP MMNOIYYYY LIMITS A X ! COMMERCIAL GENERAL LIABILITY Y Y 23W1777 4/7/2023 477/2024 EACH OCCURRENCE $1.000.000 MAGE TO RENTED CLAIMS -MADE � OCCUR PREMISES IEs occurrence) E MED EXP(Any we person) S15.000 PERSONAL B ADV INJURY S GENL AGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE S2,000,000 X _ POLICY JE8r LOC . PRODUCTS - COMP/OP AGG E OTHER: $ AUTOMOBILELIABILITY CCMBIN IN L LIMIT$ Ea acciden BODILY INJURY IPer person) ANYAUTO $ OWNED SCHEDULED AUTOS ONLY AUTOS - _. BODILY INJURY (Per accident)$ HIRED NONOWNED AUTOS ONLY AUTOS ONLY pROPERTV DAMAGE Per accident $ E UMBRELLALIAS OCCUR EACH OCCURRENCE $ AGGREGATE EXCESS LIAR CLAIMS -MADE $ S DIED RETENTIONS WORKERS COMPENSATION ANDEMPLOYERS' UABILITY YIN ANYPROPRIETORIPARTNERJEXECUTIVE ER TH- STATUTE ER E.L. EA CH ACCIIEN $ OFFICERAIEMBEREXCLUDED? NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEEI $ If es. deaRibe under DESCRIPTION OF OPERATIONS helmv E.L. DISEASE -POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule. may be attached If more apace Is reeuired) Coverage certified above extends to include the Certificate Holder as Additional Insured but only with respect to liability arising out of the CROP Walk. RE: St. Joseph County Crop Walk on 9/24/2023 South Bend 731 S Lafayette South Bend IN 46601 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 5 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD • • POLICY NUMBER:23W1777 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): South Bend 731 S Lafayette South Bend IN 46601 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1