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HomeMy WebLinkAboutSpecial Event - Bacon Around the Bend 5K - June 22APPLICATION FOR USE OF PUBLIC RIGHT-OF-WAY FOR EVENT s The following special event has been approved by the Special Events Committee. �` 4865 Submitted by: Denise Miller Event name: Bacon Around the Bend 5K Event Date: 6/22/24 Street Closure: N on Niles; R on Pokagon; R on Lawrence; R on Napoleon; L on St Louis; L on Peashway; R on Lawrence, L on Pokagon: L on Niles to Corby's Tavern Closure Times: 6:00 am to 12:00 pm Sidewalk Closure: ❑ Yes 0 No Comments: Annual 5K sponsored by the Family Justice Center of St Joseph County. CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Gary A. Gilot, Member Murray L. Miller, Member M� Joseph R. Molnar, Vice President Breana N. Micou, Member Attest: Laura D. Hensley, Acting Clerk Date: March 26, 2024 L City of South Bend Special Event Application • (�j d'l City and Regional Event $50 application fee if filed 60 days or greater (up to 360 days) in advance of event $100 expedited application fee if filed 30-59 days in advance of event Please Brine Completed Application and Payment to: Public Works Service Center, 731 S. Lafayette Blvd., South Bend, IN Review the Instructions on the Special Events page before completing the application. City and Regional Special Event applications must be submitted more than 30 days in advance of the event date or the application will not be accepted. Date of Application: 3/5/2024 Organization Name, Family Justice Center of St. Joseph County Applicant (Contact) Name: Amy Stewart -Brown Applicant (Contact) Phone: 574-234-6soo Contact Email: astewartbrown(a fiicsic.ora Address: 533 N Niles Ave City/State/ZIP: South Bend. IN 46617 List any professional event organizer, event service provider or commercial fundraiser that is authorized to work on your behalf to plan, produce and/or manage your event. Organization Name: Contact Phone: Contact Name: Contact Email: • Address: City/State/ZIP: e•t� t• Event Name: Bacon Around the Bend 5K Event Type: (Festival, Race. Parade, Other): 5K Race Event Classification: ® Non -Profit* ❑ For -Profit ❑ City (Civic) Sponsored ❑ Other (If Other, please describe): 'The Special Events Committee may request proof of non-profit status. Provide a brief description and timeline of event (Note: A detailed map plan is required in Section H of this application. The description should be a summary overview.) Date of Event Setup [mm/dd/yyl: 6/22/2024 Time: 6:00 AM Begin Date of Event [mm/dd/yy]: 6/22/2024 Time: 6:00AM End Date of Event [mm/dd/yy): 6/22/2024 Time: 11:00 AM Event Cleanup Completion [mm/dd/yy]: 6122/2024 Time: 12:00 PM • Total anticipated attendance: 500 The proposed event will require the closing of: 0 Streets ❑ Sidewalks Is the event ticketed or include fees? ® Yes ❑ No If yes, list fees and fee groups below: isAdults - S40$ Students 25 Children - $10 Does the event have any partnered sponsorships? ® Yes ❑ No If yes, list the number of sponsors at each level of partnered sponsorship: Gurley Leep - Presenting Sponsor Abtrex - Gold Carleton, Inc. - Gold More TBD Is this a returning special event or part of a series of special events? ® Yes ❑ No If yes, provide the date, location, and attendance of past special events and/or future planned events in the series: This is the seventh year for the event. 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? Describe any sound equipment that will be used in the parade/race: NA • C � J • 0 Does the event have participant categories? For example, a run that has different race divisions or a parade with separate walking/marching groups. ❑ Yes ® No If yes, list categories and anticipated participants per category. 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 - Eouioment. Set-uo. and Loeistics Are you hiring a company to provide entertainment, games or inflatables? ❑ Yes ® 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 ® 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 ® No Depending on the potential fire risk, applicants may need to receive approval of the South Bend Fire Department (process facilitated by event coordinator). Describe the event's proposed fire -related entertainment: Will there be any musical entertainment features at the event? ❑ Yes ® 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: Countybridges: Michael Hurt Andy Hayes 219-235-7528, Mhurti@indot.in.gov 574-235-9626, ahayes@co.st-joseph.in.us Section E - Food Are you having food at your event (food vendors, caterers, food trucks, etc.)? ® Yes ❑ No If yes, the event coordinator must apply for and receive a St Joseph County Health Department Temporary Event Permit. 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. All applications and guidelines can be found at the St. Joseph County Health Department Food Service website: sichd.orp-/food-service. Please select food sales types: ❑ Food Vendor ❑ Caterer ❑ Food Truck ❑ Other: Corby's Idsh Pub is providing the food. • 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 apply for 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 Name: Contact Name: Contact Phone: Email: 01 Name: Name: Qualifications: City/State/ZIP: Contact Phone: Contact Contact Phone: • 5ection 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. We will be coordinating with our on -site law enforcement partners to provide security. • Proposed Cleanup Plan - This plan should include, but is not limited to: o Measures in place to collect and remove trash, litter and recyclables. Volunteers will clean up trash and remove signs from the route as soon the final runner has passed their station. 0 • Inclement Weather Plan - This plan should include, but is not limited to: o Safety measures that will be taken in the event of a tornado warning, tornado watch, • thunderstorm, and extreme temperatures. We have the ability to email all participants updates regarding weather. • 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. 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 ® No You must selectfrom 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: We will be using the same route as we have the past 3 years. Map is attached. 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. • 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. U Section K - Indemnity & Hold Harmless Agreement • City of South Bend Special Events Committee Indemnity & Hold Harmless Agreement Date: 3/5/2024 Event Date: 6/22/2024 Event Name: Bacon Around the Bend 5K Organization: Family Justice Center of St. Joseph County Applicant (Contact) Name: Amy Stewart -Brown Applicant (Contact) Phone: 574-234-6900 Alt. Phone: 317-E90-8840 (Amy's Cell) Email: astewartbrownrd)ficsic.oro Address: 533 N Niles Ave City/State/ZIP: South Bend, IN 46617 Event Location (Please describe): Starting at FJC and finishing at Corby's Irish Pub, see attached map Length of Event (Dates/Times): 4 hours 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: Family Justice Center of St. Joseph County 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: 3/5/2024 Authorized Organizer Signature Amy Stewart -Brown Executive Director 40 Printed Name and Title 71e •r wwmiu--u-i • 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. 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 0 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 any false or incomplete information. Date: 3/5/2024 Applicant Signature: Printed Name: Amy Stewart -Brown Member SPECIAL EVENTS COMMITTEE APPROVAL Member Member Member Date Cl 0 W Angela Blvd E Angela Blvd z 3 - LORE LE ' North Shpre Or Park el HARTEI 5 HEIGHTS y� J� S,: �litl �•, t N,.acn S: O ial Hospital© - A J, W Madison st E Lasalle Ave Z Q m �-0 Irish.( z Howard St t Y 9 Lmpy F31V0 n Ka�nrama St o Pie NORTHEAS Z SOUTH BED = r b North on Niles from Cedar Right on Pokagon Right on Lawrence Right on Napoleon Left on St Louis Left on Peashway Right on Lawrence Left on Pokagon Left on Niles (its Leeper Ave here and turns into Niles) to Corby's A�Ro® CERTIFICATE OF LIABILITY INSURANCE DATE (sIWD zD) 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 endorsements . PRODUCER Gibson Insurance Agency Inc 202 South Michigan St., Suite 1400io South Bend IN 46601 CONTACT Kim Parsons NAME:PHONE . 574245.3500 FAX xo:574236-B389 n IESS: liparsonsUthegibsonedge.com INSURIERS AFFORDING COVERAGE NAIC0 INSURER A: Mount Vernon Fire Insurance Company 26522 INSURED FAMUIIS-01 Family Justice Center of St Joseph County, Inc. 533 North Niles Avenue INSURER S: INSURERC: South Bend IN 46617-1919 INSURERD: NSURER E: INSURER F: CERTIFICATE 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 L TYPE OFINSURANCE ADDL SUBR POUCY NUMBER POLICY OFF MMIDDIYYYY POLICY EXP MMID LIMITS A X COMMERCIAL GENERAL LIABILITY SE2022234 6/22/2024 6/23/2024 EACH OCCURRENCE S 1.000,1)00 PREMISES Me o%cumi $100,000 CLAIMS -MADE OCCUR MED EXP Any one person) $1,000 PERSONAL S ADV INJURY $1.000,000 AGGREGATE LIMIT APPLIES PER: POLICY JECOTD LOC GENERAL AGGREGATE S2,000,000 GEN'L PRODUCTS-COMPIOPAGG $ $ OTHER: AUTOMOSILELMBILF. M BIN ND SINGLE LIMIT a sMent f ANY AUTO BODILY INJURY (Per person) S OWNED SCHEDULED AUTOS ONLY AUTO$ BODILY INJURY (Per accident) $ HIRED NON-0WNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per ac9dent S s , UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS�MADE AGGREGATE f I $ DED RETENTIONS WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNEWEXECUTIVE OFFICEPoNIEMBER EXCLUDED? ❑ NIA PE O STATUTE ER E.L. EACH ACCIDENT S E.L. DISEASE- EA EMPLOYEE S (Mandatory in NH) If yes, 1,egbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101, AddNional Remarks Schedule, may a atlached H mom apace is rK usmj) Certificate holder is additional insured with respect to general liability coverages as required by written contract. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. The City of South Bend AUTHORIZED REPRESENTATIVE &thsai, nwrawar lyc�i�1r ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Denise Miller 'mN rom: Amy Stewart -Brown <astewartbrown@fjcsjc.org> Sent: Wednesday, March 6, 2024 8:39 AM To: Denise Miller Subject: Bacon Around the Bend 5K Permit Application (June 22, 2024) Attachments: 2024 BATB route.pdf; 2024 Bacon Around the Bend SB permit application.pdf; Certificate.pdf Good morning, Attached to this message is our application, certificate of liability insurance, and the map of the route. I will put the check in the mail today for the permit fee. Please let me know if you need any additional information. Thankyou, Amy Amy Stewart -Brown, MPA Executive Director Family Justice Center of St. Joseph County 4133 N. Niles Ave. outh Bend, IN 46617 574-234-6900 ext. 6807 24-hour SOS Crisis Hotline: 574-289-HELP Sign up forourmailing list here 40 fA111t ,IISMSCINT¢¢ a.geox cauxry 0 0 Family Justice Center of St. Joseph County 533 N. Niles Ave. South Bend, IN 46617 574-234-6900 3260 eon 2n12 CAT! CoILLAM in c 11@0032600 4071212128C 144 3421113P