HomeMy WebLinkAboutLicense - Renewal for Public Parking Facility - 133 N Main St & 220 W. Colfax - Smart Parking1316 COUNTY -CITY BUILDING
227 W. JEFFERSON BOULEVARD
SOUTH BEND, INDIANA 46601-1830
PHONE 574/235-9251
FAx 574/235-9171
CITY OF SOUTH BEND TAMES MUELLER, MAYOR
BOARD OF PUBLIC WORKS
February 27, 2024
Mr. Kevin & Mrs. Connie Koak
Smart Parking Inc.
133 N. Main St.
South Bend IN 46601
rizzmartparkingka, email. com
RE: Renewal of Public Parking Facility License
Dear Mr. & Mrs. Koak:
At its February 27, 2024 meeting, the Board of Public Works approved the above
referenced public parking facility license renewal.
Kindly update the current sinne with your new City license number in
accordance with Municipal Code Section 4-39: The Board has approved this license,
contingent upon this remedy. Should you have any questions, please contact this office at (574)
235-9251.
Sincerely,
/s/ Theresa Heffner
Theresa Heffner, Clerk
Enclosures
TH/lh
ELIZABETH A. MARADIK JOSEPH R. MOLNAR GARY A. GILOT MURRAY L. MILLER BRIANA N. MIcou
INTEROFFICE MEMORANDUM
BOARD OF PUBLIC WORKS
DATE: 01/22/2024
TO: Jim Wood, Neighborhood Services and Enforcement
Chris Dressel, Community Investment
Gerald Ellis, Fire Department
Kyle Ludlow, Engineering
FROM: Theresa Heffner, Clerk
SUBJECT: Annual License Application for Public Parking Facility
LOCATION: Smart Parking, Inc.
133 N. Main St. & 220 W. Colfax Ave.
Public Parking Facilities are regulated by municipal code section 4-39. (Copy attached).
Please review the attached public parking license application and provide your
recommendations in the spaces below.
NEIGHBORHOOD SERVICES AND ENFORCEMENT: Favorable
COMMUNITY INVESTMENT: Favorable
FIRE: Section 4-39(k) Favorable
ENGINEERING: Section 4-39(b) Favorable
Sec. 4-39. - Public parking facility.
(a) Definition. Public parking facility shall mean any plot, piece or parcel of land or any building or structure
used for the purpose of storing motor vehicles where the owners or persons storing such vehicles are
charged a fee and which are open to the public.
(b) Signs required:
(1) Each licensee under this section shall maintain at each entrance to the licensed public parking
facility a permanently affixed sign suitable to apprise persons using the public parking facility of
the name of the licensee, the hours of the day or night during which such places are open for
storing motor vehicles, the rates charged and the closing hours of such lot.
(2) When more than one rate is charged for parking, the figures of each rate shall be of the same
size and dimensions. The figures shall measure not less than eight (8) inches in height. The letters
and figures indicating the closing hours shall not be less than four (4) inches in height.
(3) The sign shall give the number of the City license under which the lot is operated.
(4) Where the licensee operates a receiving lot in which cars are accepted with the understanding
that such cars may be removed to another lot, the licensee shall post on such sign, in letters not
less than four (4) inches in height, the following information: "Receiving Lot —Cars Parked Here
May Be Moved To No. Street," (giving the address to which such cars are moved).
(5) All signs shall be subject to the approval of the Building Commissioner of the City.
(6) Where separate rates or charges are made for day parking and for night parking, notice shall be
posted on the signs described in subsection (b)(1) of this section.
(c) License required. No person shall maintain or conduct a public parking facility within the City without
first having obtained the approval from the Board of Public Works and a license issued by the
Controller.
(d) Application:
(1) Applications for licenses for public parking facilities shall be made by the person intending to
operate a public parking facility.
(2) The application shall set forth the following:
a. The name under which and the place where the open parking lot is to be operated.
b. Whether the applicant is an individual, partnership or corporation. If an individual, the name
and business and residence address of the applicant shall be given; if a partnership, the
name and business and residence address of each partner shall be given; if a corporation,
the name, date and state under which such corporation was organized, and the name and
business address, resident agent, and a certified copy of article of incorporation, if requested
by the Board of Public Works, shall be furnished.
c. Whether the premises are owned or leased by the applicant, and, if leased, the name and
residence and business address of each owner, or part owner thereof.
d. The number of motor vehicles which may, at any one time, be stored upon the premises.
e. The hours during which motor vehicles may be stored.
f. A complete schedule of the rates to be charged for storing motor vehicles and the hours at
which changes in rate take place.
g. Such other information as the Board of Public Works may deem advisable.
(3) The application shall be signed and verified under oath by the applicant, if an individual, or by a
duly authorized agent, if a partnership or corporation.
(e) Public parking facility. A fee of eighty dollars ($80.00) shall be paid for each license issued under this
section.
(f) Bond or property liability insurance:
(1) No license shall be issued pursuant to this section and public parking facility shall be operated
until and unless the licensee under this section has deposited with the Board a bond or property
liability insurance policy in the amount scheduled in this section. The bond or insurance policy
shall be with one or more adequate sureties or a surety company acceptable to the Board and
conditioned that the licensee will pay all final judgments rendered against him for damages arising
during the period such bond or insurance policy is in force from the operation of the motor vehicle
in such public parking facility, or from loss, damage, theft or conversion of any motor vehicle.
(2) Any person who sustains damage by reason of the violation of any provision of such bond or
insurance by a licensee may institute suit upon the same and recover any judgment that may be
obtained by reason of such suit.
(3) The bond or insurance policy shall meet the following requirements:
a. It shall contain a provision that it shall continue in force until ten (10) days after written notice
of cancellation has been delivered to the Board of Public Works or until the license of the
applicant has been revoked.
b. The obligation of the bond or insurance policy shall not exceed the principal amount of the
bond.
c. The bond or insurance policy shall be in the following amounts:
1. Where the licensee conducts one (1) lot, ten thousand dollars ($10,000.00).
2. Where the licensee conducts two (2) lots, fifteen thousand dollars ($15,000.00).
3. Where the licensee conducts three (3) lots, the sum of twenty thousand dollars
($20,000.00).
4. Where the licensee conducts four (4) or more lots, the sum of twenty-five thousand
dollars ($25,000.00).
(g) Investigation of applicants; issuance of license:
(1) If, after investigation, the Board of Public Works determines that the applicant for a license meets
the requirements of the section, the Board shall report the same to the Controller.
(2) The Controller shall issue to the applicant a license for a public parking facility upon payment of
the proper fee.
(h) Claimchecks or tags:
(1) At the time of accepting a motor vehicle for storage or parking in any public parking facility the
person conducting the lot, or his agent, servant or employee, shall furnish to the person parking
his motor vehicle a distinctive check.
(2) The check shall be numbered to correspond to a coupon placed upon such motor vehicle and
contain the name and address of the place and the owner operating such public parking facility.
Upon such check shall be written, printed, cut out or stamped the date, and, if parking is charged
for on an hourly basis, the time of acceptance of such motor vehicle.
(3) The above provision shall not be applied where cars are stored on a monthly fee basis.
(i) Rate changes:
(1) No licensee under this section shall make any charge for storing any motor vehicle in a public
parking facility in excess of that set forth in his application for a license, unless he has:
a. Notified the Board of Public Works in writing of the change.
b. Posted signs showing such change in the same manner as set forth in subsection (b).
0) Claims against lot; reports; liability after hours:
(1) Each licensee under this section shall immediately notify the Controller of any claim over twenty-
five dollars ($25.00) made by reason of any loss, theft or conversion occurring upon his premises
or of any claim for damages arising from the operation of his public parking facility.
(2) The obligation of any person operating or conducting a public parking facility under the terms of
this section to the owner of a motor vehicle parked therein shall not extend beyond the regular
posted hours of attendance, as posted upon the open parking lot and printed upon the regular
receipt check furnished to the motor vehicle owner.
(k) Fire equipment required; cars to be accessible:
(1) Public parking facilities shall be equipped with proper fire extinguishing apparatus subject to the
approval of the Fire Department.
(2) All motor vehicles shall be stored in such a manner that they may be reached readily in case of
fire or other emergencies.
(1) Temporary lots; restrictions:
(1) Nothing contained in this section shall be deemed to require the licensing of temporary lots
operated for the accommodation of motorists attending public functions, such as football games
or circuses, even though a fee may be charged the patrons of such temporary lots. No such
temporary lots, however, shall be operated more than two (2) days in any week.
(2) At the entrances of the temporary lots there shall be placed a sign on which is printed the words,
in letters of sufficient size to be legible to all patrons "Temporary Parking Lot —Not Licensed."
(m) Exemptions. All governmental owned and operated public parking facilities shall be exempt from the
licensing provisions of this chapter.
(Ord. No. 6998-81, § 1; Ord. No. 7723-86, § 2; Ord. No. 9093-00, § XII)
For all municipal business license questions, contact: City of South Bend -Department of Community Investment
227 West Jefferson Blvd - Suite 1400 S -South Bend, Indiana 46601 - 574,235.5912 - F: 574.235,121 ,
c.K 5. 1 &�°1 c�
IcO'LF0 :$
LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY
MUNICIPAL CODE SECTION - 4-39
I. APPLICATION TYPE Check One
II. BUSINESS DATA
New
Renewal 4+�
A. Business Name: -S�,►A-RT P A &i4 x6- Tjue
B. Business Address: 133 ,J- A4 6t, ki A
City: �;_d State: ./V G Zip: L f] 1
C. Mailing Address (If differe tfrom bove): P O 0 f X 1 3.3 Od {, U
City: GC—UA i Stater Zip: '7 l I D I
D. Business Telephone Number: Z 16 ' ,S 7 �1 2
E. Business Fax Number:
F. E-Mail Address: P", ZS
MA L-
G. Maximum Number of Vehicles that can be parked at facility at onetime: 17
H. Total Number of Parking Spaces at facility:
I. Hours during which vehicles may be stored: 7 INN( ZA M 7
H. Premises are (check one): Leased by Applicant Owned by Applicant
If Leased: $10.00 flat rate
Owner's Name
Owner's Business Address: z6613_�_ 60 tdky, GV e5+ G�
City: S o N13eK State: _T/V Zip: "1 2 661zg
Owner's Residential Address: Z66 3�
City:_.O LA_. 3e✓t1, State: -! N Zip: L ��
J. Insurance Carrier and Amount of Liability Insurance OR Bonding Agent and Amount of Bond:
41
For Office Use Only
Application Filed JAN 1 9 2024 Public Works Approval
Application Fee Paid] License Fee Paid JAN 1 9 2024
Sent to Dept. JAN 1 g 2024 License Number P b aVI -0091
CITY OF SOUTH BEND, INDIANA
Not Approved BOARD OF PUBLIC WORKS
Reason _W�(4
Elizabeth A. Maradik, President
Gary A. Gilot, Member
Murray L. Miller, Member
Joseph R. Molnar, Vice President
Briana Micou, Member
Attest: Theresa M. Heffner, Clerk
Date: February 27, 2024
For all municipal business license questions, contact: City of South Bend • Department of Community Investment
227 West Jefferson Blvd • Suite 14005 -South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021
LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY
MUNICIPAL CODE SECTION - 4-39
III. PERSONAL DATA tZd ❑�oi
A. Applicant's Legal Name: 'r �i� 7 i•��+�6Jl%
B. Residential Address: 3 2�b t Z 9 1--L- 5't Vl.h --� 2
City: G State: (3 ff- -1 Zip: q jd
C. Residential Telephone Number: 22
16 —.-% "9M 2
D. Residential Fax Number:
E. Cellphone Number: Z �rr S1 --' Z
F. Position with Business:
IV. OWNERSHIP
A. Type of ownership (check one):
Sole Proprietorship (If sole proprietorship, proceed to 1).
Partnership (If partnership, proceed to 2).
1/11- Corporation (If corporation, proceed to 3).
1. Sole Proprietor
Name:
Residential Address:
City: State: Zip:
Telephone Number:
2. Partnership (List at least two (2) partners)
Name #1:
Residential Address:
City: State: Zip:
Telephone Number:
Name #2:
Residential Address:
City: State: Zip:
Telephone Number:
3. Corporation C �}
Legal name of corporation: /�U'✓�� l���' 2l -�-�C
Date and state of incorporation:
2
For all municipal business license questions, contact: City of South Bend -Department of Community Investment
227 West Jefferson Blvd - Suite 14005 -South Bend, Indiana 46601 - 574.235.5912 - F: 574.235.9021
LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY
MUNICIPAL CODE SECTION - 4-39
IV. OWNERSHIP (Continued)
A. Type of ownership (continued):
3. Corporation (continued)
Resident Agent:
\ I,
Name: Ztj
Title: P (` ` -
Business Address: 2 0
lei, Z
:FL-- _
City: Stater Zip: y y l
Officers: ` /I
Name #1: / - 1 f, OOLC
Title: _-Gry+�a>r
Business Address: 0 Z7-�s )�
City: State:
Residential Address: G i 2 £'
City: b d ►r f_-j; State:
Name #2:
Title:
Business Address:
City
Residential Address:
City:
Name #3:
Title:
Business Address:
City:
Residential Address:
City:
3
/Xl=
__zip:
Zip:
State: Zip:
State: Zip:
State:
Zip:
State: Zip:
For all municipal business license questions, contact: City of South Bend • Department of Community Investment
227 West Jefferson Blvd • Suite 1400 S -South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021
LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY
MUNICIPAL CODE SECTION - 4-39
V. INCLUDE COMPLETE RATE AND HOUR SCHEDULE WITHAPPLICATION
VI. INCLUDE A CURRENT INSURANCE POLICY OR BOND
VII. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION
VIII. 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 have read and understand
the regulations of the Public Parking Facility license found in the City of South Bend Municipal
Code, Section 4-39.
� r
Signature
4
I -/o
— Zo z y
Date
r� DATE (MM/DD/YYYY)
�caR� CERTIFICATE OF LIABILITY INSURANCE
01/09/2024
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 endorsement(s).
PRODUCER CONTACT
NAME:
Liberty Mutual Insurance PHONN Ext. 800-962-7132 NC No: 800-845-3666
PO BOX 188065 a DRESS: BusinessService@LlbertyMutual.com
INSURERS AFFORDING COVERAGE NAIC#
Fairfield OH 45018 INSURER A: Ohio Security Insurance Company 24082
INSURED INSURER B:
SMART PARK INC INSURERC:
Po Box 44951 INSURER D;
INSURER E :
Detroit MI 48244 INSURER F;
nn"rcoAr_ec d%CGTICIr`ATC nu1MRCR• nnn6G.5A16F RFVISION NUMBER: 2016-03
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.
INSRPOLICY EFF POLICY EXP
LTA TYPE OF INSURANCE INSD SWVD UER POLICY NUMBER MMIDDfY YY) (MWDDNYYVI LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
S 1,000,000
CLAIMS -MADE X OCCUR
PREMISES fEa occurrence
$ 300,000
MED EXP (Any one person)
$ 15,000
PERSONAL & ADV INJURY
$ 1,000,000
A
X
X BLS62567338
01/04/2024
01/04/2025
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS -COMP/OP AGG
$ 2,000,000
qPOLICY JPIT 71 LOC
`
$
OTHER;
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident)
$
BODILY INJURY (Per person)
$
ANY AUTO
BODILY INJURY (Per accident)
$
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPEfiTYDAMAGE
Per a ld
$
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
LIAR
CLAIMS -MADE
4EXCESS
DED RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N
OFFICER/MEMBEREXCLUC E
(Mandatory in NH)
N/A
TATUTE I It ER
EL EACH ACCIDENT
$
EL. DISEASE- EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: For location 133 N Main St South Bend, IN 46601 City of South Bend is Additional Insured if required by written contract or written agreement subject to
General Liability Blanket Additional Insured Provision.
rrartmj,A-rc ur►r nco f'_Alklf't-t I ❑TION
City of South Bend
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
227 W Jefferson Blvd
AUTHORIZED REPRESENTATIVE
South Bend IN 46601
Curtis Luken
U-]!JUU-ZUI0 AGUKLJ L UKrUrIR l IUIV. Au ngnts reserveu.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
d,
11
For all municipal business license questions, contact: City of South Bend • Department of Community Investment
227 West Jefferson Blvd • Suite 1400 S -South Bend, Indiana 46601 • 574.235.5912 • F: 574.23 .9021
LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY
MUNICIPAL CODE SECTION - 4-39
I. APPLICATION TYPE Check One: New Renewal
II. BUSINESS DATA
A. Business Name: SM A f�!- PA)2 Ki vc _TVC
B. Business Address: 7-2-0 W-
LJP-
V
City: 5_6 e,, State: Zip: gdKpI
C. Mailing Address (if different from above): LC�3�'7( 32
City: etke(a r[ State: _D zip: �� 0
D. Business Telephone Number:
E. Business Fax Number:
F. E-Mail Address:
G. Maximum Number of Vehicles that can be parked at facility at onetime:
60"7
H. Total Number of Parking Spaces at facility:
I. Hours during which vehicles may bestored ALI, bpv 5wi E uN, E 1'�0V 4 hr, e7, 30(1/4 -tp
H. Premises are (check one): Leased by Applicant tZ Owned by Applicant M,
If Leased: $10.00 flat rate
Owner's Name: Z_ I' a LLG
Owner's Business Address: 1 2,,6 G(AecbALA 4i'tL ,ay
City: F Or-b I. OLVA(O, _ State: _✓V zip:
Owner's Residential Address: 26 GL.e tw` IF
"� L pitt j
City: r—o rf L ja State:.L✓y zip:
U
J. Insurance Carrier and Amount of Liafbility Insurance OR Bonding Agent and Amoun of�rond:
L_ s,ilkt? Y J "I u.�UA_L— �I Z,r. W► I l ro9 � l.Ca,V
For Office Use Only
Application Filed J AN 1 9 2024 Public Works Approval
Application Fee Paid JAN_1 9 2024 License Fee Paid JAN I q 9094
Sent to Dept. >I nib{ 1 n 2024 License Number
Not Approved
Reason
I
For all municipal business license questions, contact: City of South Bend • Department of Community Investment
227 West Jefferson Blvd • Suite 1400 S -South Bend, Indiana 46601 • 574.235,5912 • F: 574.235.9021
LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY
MUNICIPAL CODE SECTION - 4-39
III. PERSONAL DATA
A. Applicant's Legal Name:
B. Residential Address: � 3
City: G� tl unt,( I State: 0 Zip: 0111
C. Residential Telephone Number:
D. Residential Fax Number:
E. Cellphone Number: 2
F. Position with Business: pyres
LI)• ) Z� �_ LAy `b .Z
IV. OWNERSHIP
A. Type of ownership (check one):
Sole Proprietorship (If sole proprietorship, proceed to 1).
Partnership (If partnership, proceed to 2).
V Corporation (If corporation, proceed to 3).
1. Sole Proprietor
Name:
Residential Address:
Citv:
Telephone Number:
2. Partnership (List at least two (2) partners)
Name #1:
Residential Address:
State:
11
City: State: zip:
Telephone Number:
Name #2:
Residential Address:
City:
Telephone Number:
State:
3. Corporation
Legal name of corporation: 0,00 5-ruy--� pry rkl' JNG
Date and state of incorporation: Zo/-�, — d H l D
K
WM
For all municipal business license questions, contact: City of South Bend • Department of Community Investment
227 West J effe rso n Blvd • Suite 1400 S •South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021
LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY
MUNICIPAL CODE SECTION - 4-39
IV. OWNERSHIP (Continued)
A. Type of ownership (continued):
3. Corporation (continued)
Resident Agent: ((��
Name: I Zwa vl
I� (�
Title: 1' r4S4 �-b
Business Address:
City: G l -e'u �L
V I`Y,\IL,
7,30 LAJ. t 9_z'k (kv),,.� 7-
-State: n/� Zip: V L////
Officers: M / /'
Name #1: ` �� ��l t-1 �Qe4
Title:_ "ery)fo (' v
Business Address: 3 0276 Fe r�-
city: State: /-I—T— Zip: Y 31 73
Residential Address: Z Ueli �'6�lA '� 3
City:n
_ ��.r,6mya d,kh�- stater Zip: qJ7
Name #2:
Title:
Business Address:
Citv:
Residential Address:
City:
Name #3:
Title:
Business Address:
Citv:
Residential Address:
City:
3
State:
State:
State:
Zip:
P:
Zip:
For all municipal business license questions, contact: City of South Bend • Department of Community Investment
227 West Jefferson Blvd • Suite 1400 S -South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021
LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY
MUNICIPAL CODE SECTION - 4-39
V. INCLUDE COMPLETE RATE AND HOUR SCHEDULE WITHAPPLICATION
VI. INCLUDE A CURRENT INSURANCE POLICY OR BOND
VII. INCLUDE $5.00 PROCESSING FEE WITHAPPLICATION
VIII. 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 have read and understand
the regulations of the Public Parking Facility license found in the City of South Bend Municipal
Code, Section 4-39.
Signature
4
/ �_ Z0Z
Date
� 0 DATE (MM/DD/YYYY)
�cv►zo CERTIFICATE OF LIABILITY INSURANCE
01 /09/2024
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 endorsement(s).
PRODUCER ON
NAONRIE:TACT
Liberty Mutual Insurance PHONN Exlk 800-962-7132 ac Nn 800-845-3666
PO BOX 188065 a nREss: BusinessServiceQLibertyMutual.cam
INSURERS AFFORDING COVERAGE NAIC #
Fairfield OH 45018 INSURER A: Ohio Security Insurance Company 24082
INSURED INSURER B:
SMART PARK INC INSURERC:
Po Box 44951 INSURER D:
INSURER E :
Detroit MI 48244 INSURER F:
/+AVC�A rGC rcoTlcIrnTc rulnnP=o. nn199F7ARR RFVISInN NUMBER-- 2016-03
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
LTR
I TYPE OF INSURANCE
D
UB
POLICYNUMBER
MM/DDIYYYY
tA1D MD YYY
LIMITS
)(
COMMERCIALGENERALLIABILITY
EACH OCCURRENCE
$ 1,000,000
FZ7,
CLAIMS -MADE OCCUR
DAMAGE o RE
PREMISES Ea oc a
$ 300,000
MED EXP (Any one person)
$ 15,000
PERSONAL & ADV INJURY
$ 1,000,000
A
X
J X BLS62567338 01/04/2024
01/04/2025
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
S 2,000,000
1
PRODUCTS - COMP/OP AGG
$ 2,000,000
X POLICY E',&- LOC
$
OTHER:
AUTOMOBILE LIABILITY
j
COMBINED SENGLE LIMIT
Ea CCldenl
$
BODILY INJURY (Per person)
$
ANY AUTO
BODILY INJURY (Per accident)
$
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
P OPERTY DAMAGE
r cciden
$
UMBRELLA LIAB
OCCUR
EACHOCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
❑ED I I RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBEREXCLUDED? F`N]
(Mandatory in NH)
N/A
PER I I OTH-
STATUTE I IER
E.L. EACH ACCIDENT
$
E.L. DISEASE- EA EMPLOYE
$
E.L. DISEASE - POLICY LIMIT
$
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
RE: For location 220 W Colfax Ave, South Bend, IN 46601 City of South Bend is Additional Insured if required by written contract or written agreement subject
to General Liability Blanket Additional Insured Provision.
r-PQTIG1r"ATF i4n1 nPR CANCELLAI IUN
City of South Bend SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
227 W Jefferson Blvd
AUTHORIZED REPRESENTATIVE
South Bend IN 46601 Curtis Luken
01988-2015 AGOHD GUHPUHA I IUN. Au rignTs reservea.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD