Loading...
HomeMy WebLinkAboutNew Public Parking Facility - Laz Parking Midwest - 401 E Colfax Ave & 430 E LaSalle Ave1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND, INDIANA 46601-1830 PHONE 574/235-9251 FAx 574/235-9171 CITY OF SOUTH BEND JAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS January 28, 2025 Mr. Alan Lazowski LAZ Parking Midwest 401 E., Colfax Ave. & 430 E. LaSalle Ave. South Bend, IN 46617 compliancemail&lasparking com RE: Approval of Public Parking Facility License — 401 E. Colfax Ave. & 430 E. LaSalle Ave. Dear Lazowski: At its January 28, 2025 meeting, the Board of Public Works approved the above reference public parking facility licenses. Kindly update the current shmne with your new City license numbers in accordance with Municipal Code Section 4-39: 401 E. Colfax Ave. — License #PBP2024-013 430 E. LaSalle Ave.— License #PBP2024-014 If you have any further questions, please call this office at (574) 235-9251. Sincerely, /s/ Theresa Heffner Theresa Heffner, Clerk Enclosures TH/hh ELIZABETH A. MARADIK JOSEPH R. MOLNAR GARY A. GILOT MURRAY L. MILLER BREANA N. MIcou INTEROFFICE MEMORANDUM BOARD OF PUBLIC WORKS DATE: 02/29/2024 TO: Jim Wood, Neighborhood Services and Enforcement Chris Dressel, Community Investment Gerard Ellis, Fire Department Kyle Ludlow, Engineering FROM: Theresa Heffner, Clerk SUBJECT: Annual License Application for Public Parking Facility LOCATION: LAZ Parking Midwest 401 E. Colfax Ave. & 430 E. LaSalle 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: 574,235:9021 01K 9,7M,,� T S 5j LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 I. APPLICATION TYPE Check One: II. BUSINESS DATA New x Renewal A. Business Name: Laz Parking Midwest, LLC B. Business Address: 401 E Colfax Avenue City; South Bend C. Mailing Address (If different from above): City: Hartford _State: IN Zip. 46617 1 Financial Plaza 14th floor D. Business Telephone Number: 860-522-7641 E. Business Fax Number: State: CT Zip: 06103 F. E-Mail Address: compliancemail@lazparking.com G. Maximum Number of Vehicles that can be parked at facility at onetime: 300 H. Total Number of Parking Spaces atfacility: 300 I. Hours during which vehicles may be stored: 2417 H. Premises are (check one): Leased by Applicant x Owned by Applicant If Leased: Owner's Name: David Matthews Owner's Business Address: 401 E Colfax Avenue City: South Bend State: IN Owner's Residential Address: City: Zip: 46617 State: Zip: J. Insurance Carrier and Amount of Liability Insurance OR Bonding Agent and Amount of Bond: Nymn + '(_)-,vuwn cS mA see— cz t+a c h(.cf For Office Use Only Application Filed FEB 2 0 2024 Public Works Approval Application Fee Paid F B 7 License Fee Paid 0 207�, Sent to Dept. F ?, () _ _4 License Number PJ�PUA4-01 Not Approved Reason CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS vl�a Elizabeth A. Maradik, President Gary A. Gilot, Member 7, 2w t 7­114� Murray L. Miller, Member ME, Joseph R. Molnar, Vice President Breana Micou, Member Attest: Theresa M. Heffner, Clerk Date: 1anuary28, 2025 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: Marisol Garcia B. Residential Address: 1 Financial Plaza 14th floor City: Hartford State: CT C. Residential Telephone Number: 860-522-7641 D. Residential Fax Number: E. Cellphone Number: F. Position with Business: Compliance Specialist Zip: 06106 IV. OWNERSHIP A. Type of ownership (check one): I_I_c Sole Proprietorship (If sole proprietorship, proceed to 1). LLc Partnership (if partnership, proceed to 2). LLc 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: Telephone Number: Name #2: Residential Address- City: Telephone Number: 3. Corporation Zip: State: Zip; Legal name of corporation: L.AZ Parking Midwest,LLC Date and state of incorporation: CT -December 8, 2008 2 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 IV. OWNERSHIP (Continued) A. Type of ownership (continued): 3. Corporation (continued) Resident Agent: Name: Corporation Service Company Tltie: Business Address: 251 E Ohio Street, Suite 500 City: Indianapolis State: IN Officers: Name #1: Alan Lazowski Title: CEO Business Address: 1 Financial Plaza, 14th floor City: Hartford State: CT Zip: 46204 Zip: 06103 Residential Address: 170 Scarborough Street City: Hartford State: CT Zip: 06105 Name #2: Michael J. Kuziak Title: COO Business Address: 1 Financial Plaza 14th floor City: Hartford State: CT Zip: 06103 Residential Address: 120 Bashan Road City: East Hampton State: CT Zip: 06103 Name #3: Jeffrey N. Karp Title: President and Secretary Business Address: 3 Coply Place City: Boston Residential Address: 36 Claypit Hill Road City: Wayland St 3 . MA Zip: 02116 . MA Zip: 01778 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 WITH APPLICATION 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. .ACOlL L.�3BNM�G U Signature 2/ 1 /24 Date LAC PRICE BY LENGTH OF STAY FROM TO PERIOD SUN MON TUE WED THU FRI SAT Hrs v $ � �# lam - f � d - �_J s Hrs ,•1D S 1a S la S la S�la S la s 1a Hrs v $�15 Si15 S 15 S 15 $ 15 s ACC CERTIFICATE OF LIABILITY INSURANCE 2;2;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 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 NAME; Frank Griffin FAX Brown & Brown of MA, LLC HOONE Ext: (617)471-1220 AFC. No: 1s171479-514"/ 500 Victory Rd. ADDRESS frank. griffin@bbrown.com Marina Bay INSURER(S) AFFORDING COVERAGE NAIC N North Quincy MA 02171 INSURER A: Liberty Mutual Fire Insurance 23035 INSURED INSURERB:LM Insurance Corporation 33600 Laz Parking Midwest, LLC INSURER c: BerkleyInsurance Company '32603 33 West Monroe Street INSURERD:HDI Specialty Insurance Company 16131 Suite 2010 INSURER E: Federal Insurance Company 20281 Chicago IL 60603 INSURER F: Everest National Insurance Com an 10120 r_nVFRAr;FS r:FRTIFICATF NUMBER- 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. INS; LTR . TYPE OF INSURANCE ADOL U POLICYNUMBER iMOiDIGY£FF EXP MI1WDY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY AMA N PREMI E Ea occurrence $ 1,000,000 MED EXP (Any one Derson) $ EXCLUDED A CLAIMS -MADE ® OCCUR :B2611260451033 7/31/2023 .7/31/2024 PERSONAL &ADV INJURY $ 1,000,000 X Contractual Liability GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: PRODUCTS - COMP/OP AGG $ 2 , 000 , 000 POLrCY X PRC- Fx-1 LOC S AUTOMOBILE LIABILITY COMBINED 51 NGLE LIMIT En acz�iddnkl S 5,000,000 BODILY INJURY (Per person) $ AALL ANYAUTO OWNED SCHEDULED NON -OWNED HIREDAUTOS X AUTOS Ix 'kS2611260451013 7/31/2023 7/31/2024AUTOSAUTOSBODILY INJURY (Per accident) $ PROPERTY DAMAGE Per den $ UMBRELLA LIAB X OCCUR LIST OF EACH OCCURRENCE $ 100,000,000 NX X AGGREGATE $ 100,000,000 EXCESS LIAB CLAIMS -MADE [EEATTACHED OLI CIES /31/2023 7/31/2024 DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE � OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N /A 4A561D260451053 7/31/2023 7/31/2024 X WC STATUS OTH- R R E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below A GARAGEKEEPERS LIABILITY 1.S2611260451013 7/31/2023 7/31/2024 $1,000,000 LIMIT C CRIME/EMPLOYEE DISHONESTY 3CCR4500289226 7/31/2023 7/31/2024 $5,000,000 LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) If agreed upon in a written contract or agreement, City of South Bend, Indiana is included as an additional insured for general liability, but only with respect to the operations of the named insured. L22102: Commerce Center Matthews 1 - 401 E Colfax Ave South Bend, IN 46617. Parking Spaces 300 CERTIFICATE HOLDER GANGELLAIJUN City of South Bend, Indiana Attn: Executive Director Venues Parks & Arts 301 S. St. Louis Blvd South Bend, IN 46617 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 Fallon Carey/FACARE V ACORD 25 (2010/05) (D1yt3tf--lU1U AUUI{U L:UKVUKAI IUIN. All rlgnLs reserveo. INS025 (201005) 01 The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 25084 HOC r: See ACORD 25 Rv �P' ADDITIONAL REMARKS SCHEDULE Paq Of AGENCY NAM ED IN 511RED Amity Insurance A Division of Brown & Brown of MA LLC POLICY NIRdeER See Certificate See ACORD 25 CARRIER NAIC CODE See Certificate _J EFFECTIVE DATE: 7,03112023 AlAll I IUFVAL KtMAKR3 ACORD 101 (2008101) ® 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1:41 1 LI i Soma Pole Studio E COLFAX AVE 7� 0 e by el Id INK0 Pier Park Q Search Maps al 5G ' 0 Oaklawn QRlverwalk E LA ID East Race Market © Ye Olde Ea: AP Raceway N Preventative Pet Health Of Michiana OMerrimanS` Playhouse E COLFAX AVE © Seitz Park Mobi Ventd 45° AQI 38 i _.._ -, 4� y _.._ -, 4� y e --"Nq COMMERC'E�N�TER EON THE EAST I��E PARKING RATES 0.2 Hours FREE 2.4 Hours $5,00 0 4.8 Hours $10,00 8.24 Hours $15.00 For all municipal business license questions, contact: City of South Bend -Department of Community Investment 227 West Jefferson Blvd - Suite 1400 S -South Bend, Indlana 46601 - 574.235.5912 - F:574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 I. APPLICATION TYPE Check One: II. BUSINESS DATA New x Renewal A. Business Name: Laz Parking Midwest, LLC B. Business Address: 430 E Lasalle Avenue City: South Bend State: IN zip: 46617 C. Mailing Address (If different from above): 1 Financial Plaza, 14th floor City; Hartford State: CT Zip: 06103 D. Business Telephone Number: 860-522-7641 E. Business Fax Number: F. E-Mail Address: compliancemail@lazparking.com G. Maximum Number of Vehicles that can be parked at facility at onetime: 25 H. Total Number of Parking Spaces at facility: 25 I. Hours during which vehicles may be stored: 24/7 H. Premises are (check one): Leased by Applicant x Owned by Applicant If Leased: Owner's Name: David Matthews Owner's Business Address: 401 E Colfax Avenue City: South Bend State: IN Owner's Residential Address: City: tate: J. Insurance Carrier and Amount of Liability Insurance OR Bonding For Office Use Only zip; 46617 MR nt and Amount of Bond: Application Filed FEB 2 0 2024 Public Works Approval Application Fee PAEB_ ` 0 2024 License Fee Paid'' Sent to Dept. FEB 0 2024 License Number E' 14-01 q CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS Not Approved , Reason Elizabeth A. Maradik, President �-ti� Gfsliit�! Gary A. Gilot, Member Joseph R. Molnar, Vice President Breana Micou, Member Murray L. Miller, Member Date: January 28, 2025 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: Marisol Garcia B. Residential Address: 1 Financial Plaza 14th floor City: Hartford State: CT Zip: 06106 C. Residential Telephone Number: 860-522-7641 D. Residential Fax Number: E. Cellphone Number: F. Position with Business: Compliance Specialist IV. OWNERSHIP A. Type of ownership (check one): I_I-c Sole Proprietorship (If sole proprietorship, proceed to 1). LLc Partnership (If partnership, proceed to 2). LLc 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 Legal name of corporation: LAZ Parking Midwest,LLC Date and state of incorporation: CT -December 8, 2008 2 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 IV. OWNERSHIP (Continued) A. Type of ownership (continued): 3. Corporation (continued) Resident Agent: Name: Corporation Service Company Title: Business Address: 251 E Ohio Street, Suite 500 City: Indianapolis state: IN Officers: Name #1: Alan Lazowski Title: CEO Zip: 46204 Business Address: 1 Financial Plaza, 14th floor City: Hartford State: CT Zip: 06103 Residential Address: 170 Scarborough Street City: Hartford State: CT Zip: 06105 Name #2: Michael J. Kuziak Title: COO Business Address: 1 Financial Plaza 14th floor City: Hartford State: CT zip. 06103 Residential Address: 120 Bashan Road City: East Hampton Name #3: Jeffrey N. Karp Title: President and Secretary Business Address: 3 Coply Place City: Boston Residential Address: 36 Claypit Hill Road City: Wayland St 3 CT zip: 06103 . MA Zip: 02116 . MA Zip: 01778 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 WITH APPLICATION VI. INCLUDE A CURRENT INSURANCE POLICY OR BOND VII. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION Vill. 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 2/ 1 /24 Date LAZ CE BY LENGTH OF STAY FROM TO 24 PERIOD SUN MON TUE WED THU FRI SAT Hrs v $�� $l" — S S�� i $ $� s� Hrs v $l10 -^I $l10Slla S 10 $ la� S 10 Hrs v $ 15 $ 15 S 15 S 15 $ 15 $�15 S�15 ACQ 2/2/2024 V CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) ��. 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 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 M NA Frank Griffin Brown & Brown of MA, LLC PHONN (617)471-1220 FlaNo, (617)479-5147 M. 500 Victory Rd. ADDRESS: frank. griffin@bbrown.com Marina Bay INSURER(S) AFFORDING COVERAGE NAIC # North Quincy MA 02171 INSURER A: Liberty Mutual Fire Insurance 23035 INSURED INSURER B: LM Insurance Corporation 33600 Laz Parking Midwest, LLC INSURER C: BerkleyInsurance Company 32603 33 West Monroe Street INSURERD:HDI Sp2CililtY Insurance Company 16131 Suite 2010 INSURER E: Federal Insurance Company 20281 Chicago IL 60603 INSURER F: Everest National Insurance Company 10120 rnlioonr_cc rCDTICIrATF wIMRFR• REVISION NUMBER: THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW SAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. IINSR ADDLISUBRI POLICY FfF LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMLODYM'YY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY T PREMISES Ea rren $ 1,000,000 MED EXP (Any one person) $ EXCLUDED A CLAIMS -MADE FX] OCCUR 3B2611260451033 7/31/2023 7/31/2024 PERSONAL &ADV INJURY $ 1,000,000 % Contractual Liability GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 $ 06LI Y X FARO- X LOC JECTCOMBINED AUTOMOBILE LIABILITY SINGLE LIMIT Ea acci n $ 5,000,000 BODILY INJURY (Per person) $ X A ANYAUTO INJURY (Per accident) $ ALL OWNED SCHEDULED 15 2611260451013 7/31/2023 7/31/2024 AUTOS AUTOS X X NON -OWNED PROPERTY Peac TY DAMAGE E$ HIRED AUTOS AUTOS X UMBRELLA LIAR X OCCUR 3EE ATTACHED LIST OF EACH OCCURRENCE $ 100,000,000 X AGGREGATE $ 100, 000, 000 EXCESS LIAR CLAIMS -MADE ?OLICIES 7/31/2023 7/31/2024 DED RETENTION $ B WORKERS COMPENSATION R WC S7ATLI- OTH- TORY LIMITS AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE jet I E.L, EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? I`� I (Mandatory in NH) NIA �A561D260951053 d/31/2023 7/31/2024 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 11000,000 If yes, describe under DESCRIPTION OF OPERATIONS below A GARAGEKEEPERS LIABILITY 1S2611260451013 d/31/2023 7/31/2024 $1,000,000 LIMIT C CRIME/EMPLOYEE DISHONESTY 3CCR4500289226 7/31/2023 7/31/2024 $5,000,000 LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) If agreed upon in a written contract or agreement, Ciyt of South Bend, Indiana is included as an additional insured for general liability, but only with respect to the operations of the named insured. L22124: Corby's Lot Matthews 2 - 430 E Lasalle Ave South Bend, IN 46617. Parking Spaces 25 /�G OTI CIf�ATC -^I mom UAIUUl 1 A1111N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Ciyt of South Bend, Indiana Attn: Executive Director Venues AUTHORIZED REPRESENTATIVE Parks & Arts 301 S. St. Louis Blvd South I Bend, IN 46617 Fallon Carey/FACARE ACORD 25 (2010/05) W tsnn-tU IU 711,%JMU PV-1 U. INS025 (201005)01 The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 25084 LOC 9: See ACORD 25 %--- ADDITIONAL REMARKS SCHEDULE Pa a of AGENCY mAM ED IN S URED Amity Insurance A Division of Brown & Brown of MA LLC POUCYNOMaER See Certificate See ACORD 25 CARUIDER NAIL CODE See Certificate EFFECTIVE DATE: 7I3472 23 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURERS) AFFORDING COVERAGE NAIC # INSURER G: American Guarantee & Liability,Insurance Company 26247 INSURER H: Westfield Specialty Insurance Company 16992 INSURER I: Great American Assurance Company 26344 INSURER J: ADDITIONAL POLICIES 1I a pollcy below does not include Amit information, refef to the corresponding policy on the ACORD certificate form for pDlloy limits INSR LTR —EOFINSURANCE AODL INSD SUER WVD POLICY NUMBER POLICY EFFECTIVE DATE (mm/dd/yyy) POLICY EXPIRATION DATE (mm/ddtyyy) LIMITS D EXCESS GENERAL LIABILITY XLXD6109900S 7/31/2023 7/31/2024 AGGREGATE $4,000,000 E UMBRELLA LIABILITY 79863543 7/31/2023 7/31=24 AGGREGATE $25,000,000 F EXCESS LIABILITY XC9EX00286231 7/31/2023 7/31/2024 AGGREGATE $15.000.000 G EXCESS LIABILITY AEC011173109 7/31/2023 7/31/2024 AGGREGATE $15,000.000 " EXCESS LIABILITY XSL345214K00 7/31/2023 7/31/2024 AGGREGATE $10,000,000 I EXCESS LIABILITY EXC5125913 7/31/2023 7/31/2024 AGGREGATE $10,000.000 E EXCESS LIABILITY 78187246 7/31/2023 7/31/2024 AGGREGATE $25,000.000 — .„' I.... —/ ® 2008 ACORD CORPORATION. All dgh[s reserved. The ACORD name and logo are registered marks of ACORD ��� _---� --- ������ PRIVRiEPaBNING , � � ;, ��� -. �arnwiuvvw[i[t V — — .� — _ i.� ��� ioww ��ontni arv�a _ _ x:�iw � ��TT � � � �—,_mil- m�V' - ---� �, �_ - Fes'- �� ::.'� �T- �� � , --� �. a i .AA -- sin '►*1 a rZi IL , Y� fit a rim { .tip t' 37, rl lei* I1i+ifTTil� L Pay ere Authorized Parking Only Monday - Friday 9am - 5pm Public Parking Pay Here Monday - Friday 5pm or later Saturday & Sunday Pay All Day rs •i � G � �'��'a, y . .0 mppeolldl�mhl _ .. h - 1•�_ �-�-�-' t �.� - - *F .J� ti • E •yam • * . l� +[j * Acmmr . ` - �, ..� ...fir i� i r-y~S rsk r •Y - 1 y� ti :r _.� ..-