HomeMy WebLinkAboutSpecial Event - St. Nick 6 - December 2 - Revised Routey O
APPLICATION FOR USE OF u o
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PUBLIC RIGHT-OF-WAY FOR EVENT sr ,-", ,2
The following special event has been approved by the Special Events Committee. teas
Submitted by: Denise Miller
Event name: St Nick 6
Event Date: December 2 2023
Street Clo ure: Brief closures at intersections starting at St Joseph Parish,
East Race North to Holy Cross College, back to St Joseph Parish
Closure Times: 8:00 am to 12:00 pm
Sidewalk Closure:
❑ Ye x❑ o
Comments: Annual run/walk event to support the parish.
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
VIL a
Elizabeth A. Maradik, President
Gary A. Gilot, Member
Murray L. Miller, Member
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Joseph R. Molnar, Vice President
Briana Micou, Member
Attest: Theresa M. Heffiier, Clerk
Date: November 28.2023
•
City of South Bend Special Event Application
City and Regional Event
$50 application fee if filed 60 days or greater (up to 360 days) in advance of event
$100 expedited application fee if filed 30-59 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. 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.
Section A - Applicant Information
Date of Application: q 1 :1" 1-L4 Organization Name: -f . j-Ofev f ke ISl.
Applicant(Contact)Name: rA+-k^A fl+i�f
Applicant (Contact)Phone:4-T.3 -'fZ8 Contact Email:V1vf3,200 q'9Ai I.Co-k
Address: Z 6 N. q-, II 54. City/State/ZIP: SO V+L Sella N Y661
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
Contact Email:
City/State/ZIP:
Section B - Event Information
Event Name: 5r4% N t c L ` Event Type: (Festival, Race, Parade, Other): lv h W i
Event Classification: x 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 Hof this
application. The description should be a summary overview.)
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Date of Event Setup [mm/dd/yy]: I Z 1 1 `Z 3 Time:
Begin Date of Event [mm/dd/yy]: ky 1I L. I 1 q Time:,
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00 x.Q
End Date of Event [mm/dd/yy1: 1 I. 0 'r- 2 Time:
Event Cleanup Completion [mm/dd/yy]: l 't't- ! Z j Z 3 / Time: 00
Total anticipated attendance: OD t v n & I I t (f
The proposed event will require the closing of: KS treets Sidewalks
Is the event ticketed or include fees? I" Yes ❑ No If yes, list fees and fee groups below:
• 3S IrvhNft TPD - o& irrh"er 4or 34
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Does the event have any partnered sponsorships? ❑ Yes % 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? 0 Yes U No
If yes, provide the date, location, and attendance of past special events and/or future planned events in the
series:
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If your event is a parade, race, or other processional -type event, please complete Section C.Otherwise,
continue to Section D.
Section C - Parades Races, and other Processional Events
What is the estimated number of parade/race spectators on the proposed route? t{ 0 0 .Cx
Describe any sound equipment thatwillbe used in the parade/race: 1 I
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Does the event have participant categories? For example, a run that has different race divisions or a parade with
separate walking/marching groups.
04 Yes ❑ No
If yes, list categories and anticipated participants per category.
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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:
hIA
Section D - Eauioment. Set-uo. and Logistics
Are you hiring a company to provide entertainment, games or inflatables? ❑ Yes (N No
., 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? Cl Yes 06 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 60 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? ❑ Yes r No
. o If yes, describe the type of music, schedule of sound check/performances, and the names of any artists
performing:
For stage inspections, contact the Department of Homeland Security at 317-232-2222.
If your route crosses over a state road or a bridge please contact the following for permission:
State, INDOT: County bridges:
Michael Hurt Andy Hayes
219-235-7526, Mhurt1@indot.in.gov 574-235-9626. ahayes@cost-joseph.in.us
Section E - Food
Are you having food at your event (food vendors, caterers, food trucks, etc)? ❑ Yes 00 No
If yes, the event coordinator must apply for and receive a St Joseph County Health Department
Temporary Event Permit.
Vendors) 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.
All applications and guidelines can be found at the St. Joseph County Health Department Food Service
website:
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 PQ No
If no, please continue to Section G - Contingency and Strategic Planning
If yes:
The applicant must apply for and receive a temporary liquor license from the Alcohol & Tobacco
Commission. Indiana ATC forms are located at . (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)
\J
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:
c The number of Indiana Law Enforcement Academy certified officers, fire, ano emergency
medical personnel, and the need to use any of the City's public safety or emergency response
services.
If hiring a security service, provide contact information and the number of hired event personnel.
Proposed internal communications systems appd public address systems.
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Proposed Cleanup Plan - This plan should include, but is not limited to:
c Measures in place to collect and remove trash, fitter and recyclables.
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• Inclement Weather Plan -This plan should include, but is not limited to:
Safety measures that will be taken in the event of a tornado warning, tornado watch,
thunderstorm, and extreme temperatures.
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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.
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Section H - Site Plan / Route Mao
For parades, races and other processional events:
Are you selecting one of South Bend Police Department's (SBPD) pre -approved race routes? ❑ Yes X 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:
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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:
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 artd time.
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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
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10
Section K - Indemnity & Hold Harmless ALereement
. City of South Bend Special Events Committee
Indemnity & Hold Harmless Agreement
Date: �� Z 3 Event Date: TI z 3
Event NameCL 6
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Organization: S -t -Jvferk Vkili
Applicant (Contact) Name: /(K
Applicant (Contact) Phone: 111 - 1 %
Email: Vl rAl11 11 i O f ?i 2 D D (v A
Address:
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Alt. Phone:
City/State/ZIP: S 0 V'{ � b el,'J , 1 N '{ 6 61:—
Event l,ocation (Please describe): I
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Length of Event (Dates/Times):
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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: s�. -)—yS eP L r K.(1 S L agrees to indemnify, defend
and hold harmless the Civil City of South Bend, In Tana, 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: I I ;;' I 2;
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Authorized Organizer Signature
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Printed Name and Title
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• 1. 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 30 and 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.
a. 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.
1 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: �44 41I,'- I -z 3
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Applicant Signature: Q PS
Printed Name:
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=CIAL EVENTS COMMITTEE APPROVAL
Member
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•
•
Certificate of Coverage Date:8/30/2023
Certificate Holder
This Certificate is issued as a matter of information only and
The Diocese of Fort Wayne -South Bend, Inc.
confers no rights upon the holder of this certificate. This certificate
Chancery Office
P O Box 390
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
Covered Location
ST JOSEPH SCHOOL
OMAHA, NE 68154
216 N. HILL ST
SOUTH BEND, IN 46617
('overag.
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 anv 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
Cmerage Expiration
Date
Limits
Property
Real & Personal Property
D. General Liability
Each Occurrence
700,000
General Aggregate
1,000,000
Occurrence
Products-Comp/OP Agg
® Claims Made
N079
10/1/2023
10: 1 '2024
Personal & Adv Injury
Fire Damage (Anv one fire)
Med Elp (An, one person)
Excess Liability
Each Occurrence
:Annual Aggregrate
Other
Each Occurrence
Claims Made
Annual Aggregrale
Limit/Coverage
Description of Operations/Loca rioncNehides/Special Items phe following language supersedes anv other language in this endorsement or the Certificate in
conflict with this language)
City of South Bend, Special Events Committee, and Board of Public Works are named additional protected person(s) but only for claims
arising out of St. Joseph School's St. Nick 6k and 3k Annual Run/Walk Event on December 2, 2023.
Holder of Certificate ('ancellation
Additional Protected erson s
Should any of the above described coverages be cancelled
before the expiration date thereof, the issuing company will
The City of South Bend
endeavor to mail 30 days written notice to the holder of
Public Works Service Center
certificate named to the left, but failure to mail such notice shall
731 S. Lafayette Blvd.
impose no obligation or liability of any kind upon the company,
South Bend IN
its agents or representatives.
oe
.Authorized Representative
'All /�/
r
0067005097
ENDORSEMENT
(TO BE ATTACHED TO CERTIFICATE)
• Effective Date of Endorsement: 12/2/2023
Cancellation Date of Endorsement: 12/3/2023
Certificate Holder: The Diocese of Fort Wayne -South Bend. Inc.
Chancery Office
P O Box 390
Fort Wayne, IN 46801
Location: ST JOSEPH SCHOOL
216 N. HILL ST
SOUTH BEND, IN 46617
Certificate No. 8679 of The Catholic Mutual Relief Society of America is amended as follows:
SECTION II - ADDITIONAL PROTECTED PERSON(S)
It is understood and agreed that Section II - Liability (only with respect to Coverage D - General
Liability), is amended to include as an Additional Protected Person(s) members of the organizations shown
in the schedule, but only with respect to their liability for the Protected Person(s) activities or
activities they perform on behalf of the Protected Person(s).
It is further understood and agreed that coverage extended under this endorsement is limited to and
applies only with respect to liability assumed by contract or agreement: and this extension of
coverage shall not enlarge the scope of coverage provided under this certificate or increase the limit
of liability thereunder. Unless otherwise agreed by contract or agreement, coverage extended under
• this endorsement to the Additional Protected Person(s) will not precede the effective date of this
certificate of coverage endorsement or extend beyond the cancellation date.
Schedule - ADDITIONAL PROTECTED PERSON(S)
The City of South Bend
Public Works Service Center
731 S. Lafayette Blvd.
South Bend IN
Remarks (the following language supersedes any other language in this endorsement or the Certificate in
conflict with this language):
City of South Bend, Special Events Committee, and Board of Public Works are named additional
protected person(s) but only for claims arising out of St. Joseph School's St. Nick 6k and 3k Annual
Run/Walk Event on December 2, 2023.
4Au
PKS-122(10.11)
Denise Miller
From: Nathan Phillips <nphillips3200@gmail.com>
Sent: Thursday, September 7, 2023 8:37 PM
To: Denise Miller
Cc: Chris Martin
Subject: St. Nick 6K - City Application Email
Attachments: Race Route Notification for Neighbors.pdf, No Parking Request for Neighors.pdf,
Certificate-514743-0067005097.pdf, SN6 2023 3K Course Map.pdf, SN6 2023 6K Course
Map.pdf, St Nick 6 Race Application Packet 12-2-2023.pdf
Hello!
Attached is our completed application for the St. Nick 6K event on December 2, 2023. This is an event we have done
annually for over 10 years now. Please let us know if there is anything else needed. We are planning the same event
with the same course, but with an increase in our estimate for attendees. We have included the application form,
insurance documentation, the race maps, and notifications for neighbors on the race route and the no parking request.
Also please let us know when the city counsel meeting is planning to be held.
Thank you!
Nathan Phillips
aphillips3200@gmail.com
49
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