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HomeMy WebLinkAboutPermit - Public Parking Facility -Laz Parking - 121 S Niles & 1228 N Eddy1316 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 April 8, 2025 Ms. Daniela Alberca LAZ Parking Midwest LLC 121 S. Niles Ave. South Bend, IN 46617 compliancemailklazparking com RE: New Public Parking Facility License Dear Ms. Alberca: Thank you for submitting your application of the Public Parking Facility License for 121 S. Niles Ave. Upon further review by a City Inspector, it came to our attention that the current signage for the parking lot is missing the number of the City license, in accordance with Municipal Code Section 4-39: Kindly update the current signage with your new City license number PBP2025-004. The Board has approved this license, contingent upon this remedy. Should you have any questions, please contact this office at (574) 235-9251. Sincerely, Is/ Theresa Heffner Theresa Heffner, Clerk Enclosures TH/hh ELIZABETH A. MARADIK JOSEPH R. MOLNAR GARY A. GILOT MURRAY L. MILLER BREANA N. MIcou 1316 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 April 8, 2025 Ms. Heather Parker LAZ Parking Midwest LLC 1228 N. Eddy St. South Bend, IN 46617 compliancemailklazparking com RE: Renewal of Public Parking Facility License Dear Ms. Parker: Thank you for submitting your renewal of the Public Parking Facility License for 1228 N. Eddy St. Upon further review by a City Inspector, it came to our attention that the current signage for the parking lot is missing the number of the City license, in accordance with Municipal Code Section 4-39: Kindly update the current signage with your new City license number PBP2025-005. The Board has approved this license, contingent upon this remedy. Should you have any questions, please contact this office at (574) 235-9251. Sincerely, Is/ 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: 1 /16/2025 TO: Jim Wood, Neighborhood Services and Enforcement Chris Dressel, Community Investment Derek Erquhart, Fire Department Kyle Ludlow, Engineering FROM: Theresa Heffner, Clerk SUBJECT: Annual License Application for Public Parking Facility LAZ Parking Midwest, LLC LOCATIONS: 121 S. Niles Ave. 1228 N. Eddy St. 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 recommendation. COMMUNITY INVESTMENT: Favorable recommendation. FIRE: Section 4-39(k): Favorable recommendation ENGINEERING: Section 4-39(b) Posted sign or QR Code Website requires License Number. 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. 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 14005 -South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 Rfc,, p� 1-7bl �'�`� �rll ti� 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: 121 N. Niles Ave.. City: South Bend State: IN C. Mailing Address (If different from above): 1 Financial Plaza FI. 14 City: Hartford State: CT D. Business Telephone Number: 860-522-7641 E. Business Fax Number: F. E-Mail Address: compliancemail@lazparking.com p: 46617 Zip: 06103 G. Maximum Number of Vehicles that can be parked at facility at onetime: 30 H. Total Number of Parking Spaces at facility: 30 I. Hours during which vehicles may be stored: 24/7 H. Premises are (check one): Leased by Applicant Owned by Applicant If Leased: Owner's Name: David Matthews david@matthewsllc.com Owner's Business Address: 401 E. Colfax Ave., Suite 277 City: South Bend State: IN Owner's Residential Address: City: p: 46617 te: Zip: J. Insurance Carrier and Amount of Liability Insurance OR Bonding Agent and Amount of Bond: McGriff Insurance Services LLC 2,000,000 For Office Use Only Application Filed JAN 1 4 2025 Public Works Approval Application Fee PaiIAN 1 4 2 2E License Fee Paid JAN 1 4 20.5 Sent to Dept. 4 A N `} 4A 2 VG 7,: License Number P,S'-QG4 Not Approved Reason CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS ta'aa Elizabeth A. Maradik, President Gary A. Gilot, Member Murray L. Miller, Member Joseph R. Molnar, Vice President Breana Micou, Member ,t /� // I. Attest: Theresa M. Heffner, Clerk Date: April 8, 2025 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 A. Applicant's Legal Name: Daniela Alberca dalberca@lazparking.com B. Residential Address: 79 High Ledge Cr. City: Manchester State: CT C. Residential Telephone Number: 860-990-3684 D. Residential Fax Number: E. Cellphone Number: F. Position with Business: Jr. Compliance Specialist 06040 IV. OWNERSHIP A. Type of ownership (check one): Sole Proprietorship (If sole proprietorship, proceed to 1). Partnership (If partnership, proceed to 2). Corp. Corporation (If corporation, proceed to 3). 1. Sole Proprietor Name: Residential Address. City: Telephone Number: 2. Partnership (List at least two (2) partners) Name#1: Residential Address: City: Telephone Number:_ Name #2: Residential Address: City: Telephone Number:. State: Zip: State: Zip: State: 3. Corporation Legal name of corporation: LAZ Parking Midwest LLC Date and state of incorporation: CT December 8, 2008 2 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 IV. OWNERSHIP (Continued) A. Type of ownership (continued): 3. Corporation (continued) Resident Agent Name: Title: Business Address: City: Officers: Name #1: Heather Parker Title: Director Business Address: 1 Financial Plaza 14th Floor City. Hartford State: CT Residential Address: City. State: — Name #2: Alan Lazowski Zip: Zip: 06103 Zip: Title: CEO 860-522-7641 alazowski@lazparking.com Business Address: City: Sta Residential Address: 170 Scarborough St. City: Hartford State: CT Zip: Name #3: Title: Business Address: Citv: Residential Address: City: 3 State: Zip: p: 11 7For all municipal business license questions, contact: City of South Bend -Department of Community Investment 227 West Jefferson Blvd - Suite 1400 5 -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. Signature Date 0-2 Hours Free 2-4 Hours $5.00 4-8 Hours $10.00 8-24 Hours $15.00 Jackson Lockhart, General Manager, Indiana 350 Massachusetts Ave. Ste. 13, Indianapolis, IN 46204 317-260-1853 jlockhart@lazparking.com Oluwabukola Harrison Idowu, Director of Operations 126 N. Main St., South Bend, IN 46601 WK:574-232-3843 C:574-999-0795 oldowu@lazparking.com Daniela Alberca, Jr. compliance Specialist 1 Financial Plaza, 14th FI. H a rtfo rd, CT 06103 4 DAlberca@lazparking.com DATE (MMIDDIYYYY) .aco�lo CERTIFICATE OF LIABILITY INSURANCE 12/20/2024 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: Susie Guarino McGriff Insurance Services LLC PHONE 150 S. Warner Road, Suite 460 _w(,c • 61D-233-4846 FAX A c, Noi: King Of Prussia PA 19406 ADDRESS: Susan. uarinD m riff.com INSURER A: National Union Fire Ins Co of Pitt. PA 19445 INSURED 151LAZKARP INSURERB: AIU Insurance Company 19399 LAZ Parking Midwest, LLC - Chicago INSURER C : Allianz Global Risks US Insurance Co 35300 33 W. Monroe St., Suite 2010 Chicago IL 60603 INSURERD: INSURER E INSURER F : LI/^A = eu uA000. eno na agc RFVISIAN NIIMRFR- 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. MSR DL:S BR POLICY EFF POLICY P LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDIYYYY A X COMMERCIAL GENERAL LIABILITY Y Y 3609369 7/31/2024 7/31/2025 EACH OCCURRENCE $1,000.000 F-,7 CLAIMS -MADE OCCUR 11AME TO RENTED PREMISES xwrrence $ 1.000,000 IVIED EXP (Any one person) $ 10.000 PERSONAL &ADV INJURY $ 1,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $ 2.00%000 POLICY L jE O LOC $ OTHER: A AUTOMOBILE LIABILITY Y Y 3135689 7/31/2024 7/31/2025 COMBINED SINGLE LIMIT Ea accldmfi $5,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE er ate _ $ $ C X UMBRELLA LABX OCCUR Y Y SEE SCHEDULE 7/31/2024 7/31/2025 EACH OCCURRENCE $100,000.000 X AGGREGATE $ 100,000,000 EXCESS LIAB CLAIMS -MADE DE.D 1 1 .RETENTION $ $ B WORKERS COMPENSATION I AND EMPLOYERS' LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE Y WC014111735 7/31/2024 7/31/2025 XR STATUTEER E.L. EACH ACCIDENT $ 1,000,000 EL, DISEASE - EA EMPLOYE $ 1,000,000 OFFICER/M EMBER EXCLUDED? NJ N /A (Mandatory in NH) E.L. DISEASE - POLICY LIMIT $ 1,000.000 If yes, describe under DESCRIPTION OF OPERATIONS below A Garagekeepers Liability Y Y 3135689 7/31/2024 7/31/2025 11.000.000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 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 with a waiver of subrogation in favor for general liability, but only with respect to the operations of the named insured. RE: L22137 — Emporium Lot —121 N Niles Ave. rco-rivif-ATC Wnt ntcp CANCELLATION City of South Bend 227 W. Jefferson Blvd, Suite 1400 S., South Bend IN 46601 USA 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 V lVtftf-ZUIOAGUKU LoUKrUKP1I Ivry. /All ngnw reaerveU. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 151 LAZKARP LOC #: See COI (Acord 25) ACORO� AnnlTirWA1 QCI►AAll 0t-UCI 11 C AGENCY NAMED INSURED McGriff Insurance Services, LLC POLICY NUMBER See COI (Acord 25) See COI (Acord 25) CARRIER NAIC CODE See COI (Acord 25) EFFECTIVE DATE: 7/31/2024 AL UI I IUIVAL Kr-ARAKK,S THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: Acor9 25 FORM TITLE: Certificate of Liability Insurance Additional Insurers Affording Coverage: Insurer letter C: Allianz Global Risk US Insurance Company (NAIC 35300) Insurer letter D: Federal Insurance Company (Chubb) (NAIC 20281) Insurer letter E: Everest National Insurance Company (NAIC 10120) Insurer letter F: Endurance Assurance Corporation (NAIC 11551) Insurer letter G: American Guarantee and Liability insurance Company (Zurich) (NAIC 26247) Insurer letter H: Westfield Specialty Insurance Company (NAIC 16992) Insurer letter I: Great American Assurance Company (NAIC 26344) C: Excess General Liability USL03085024 7/31/2024-7/31/2025 Aggregate $4,000,000 D: Primary Umbrella Liability 79863543 7/31/2024-7/31/2025 Aggregate $25,000,000 E: Excess Liability XC5EX02069241 7/31/2024-7/31/2025 Aggregate $7,500,000 F: Excess Liability EXC30065353300 7/31/2024-7/31/2025 Aggregate $7,500,000 G: Excess Liability AEC011173110 7/31/2024-7/31/2025 Aggregate $15,000,000 H: Excess Liability XSL345214K01 7/31/2024-7/31/2025 Aggregate $10,000,000 I: Excess Liability EXC5772941 7/31/2024-7/31/2025 Aggregate $10,000,000 D: Excess Liability 78187246 7/31/2024-7/31/2025 Aggregate $25,000,000 0— _s ra%.Urcu IU-1 tZUUGIU-II © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ,r fy� , i 6[ i -- ' -43 - Pay ere uthorized Parking Only Monday - Friday gam - 5pm Public Parking Pay !-sere Monday - Friday 5pm or later Saturday & Sunday Pay All Day r r 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: 574,3jffl .RAC, 00 1-7 D� R6 oa LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 I. APPLICATION TYPE Check One: New Renewal Il. BUSINESS DATA A. Business Name: Laz Parking Midwest, LLC X B. Business Address: 1228 N Eddy St City: South Bend State: IN Zip: 46617 C. Mailing Address (If different from above): 1 Financial Plaza, 14th FL 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: 1,200 H. Total Number of Parking Spaces at facility: 1,200 I. Hours during which vehicles may be stored: 24/7 H. Premises are (check one): Leased by Applicant% Owned by Applicant If Leased: Owner's Name: Kite Realty Eddy Street Garage LLC Owner's Business Address: 30 South Meridian Street, Suite 1100 City: Indianapolis State: IN zip: 46204 Owner's Residential Address: City:. State: Zip: J. Insurance Carrier and Amount of Liability Insurance OR Bonding Agent and Amount of Bond: For Office Use Only Application Filed JAN 1 4 2025 Public Works Approval Application Fee PaidJAN 1 4 2025 License Fee Paid j - 4 2025 Sent to Dept. jAN 1 4 292License Number PBP2•Oa6- (05 Not Approved Reason CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS vl�a Elizabeth A. Maradik, President �--•_v Gi�-cil� Gary A. Gilot, Member %yLwy �. 9yte�y Murray L. Miller, Member Joseph R. Molnar, Vice President Bt�reana Micou, Member 1 4 Attest: Theresa M. Heffner, Clerk Date: April R, 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: Heather Parker B. Residential Address: 1 Financial Plaza, 14th FL City: Hartford State: CT C. Residential Telephone Number: 860.522.7641 D. Residential Fax Number: E. Cellphone Number: F. Position with Business: Director of compliance Zip; 06103 IV. OWNERSHIP A. Type of ownership (check one): Sole Proprietorship (If sole proprietorship, proceed to 1). Partnership (If partnership, proceed to 2). X Corporation (If corporation, proceed to3). 1. Sole Proprietor Name: Residential Address: City: 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: State: Legal name of corporation: LAZ Parking Midwest, LLC Date and state of incorporation: Connecticut 2 i p: 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: Narne:Alan Lazowski Title:CEO Officers Business Address: 1 Financial Plaza, 14th FL City: Hartford State: CT Zip: 06103 Name #1: Title: Business Address: City: Residential Address: City: Name #2: Title: State: Zip: State: Zip: Business Address: City: State:, Residential Address: City: State: Name #3: Title: Business Address: Citv: Residential Address: City: 3 p: P: State: Lip: Zip: For all municipal business license questions, contact: City of South Bend -Department of Community Investment 227 West Jefferson Blvd -Suite 1400 5 -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. //"66M, Pa.�ea�z, 1 /7/2025 Signature 4 Date AR r.�F7 DATE (MMIDDIYYYY) LLL!!! L/ CERTIFICATE OF LIABILITY INSURANCE 1/7/2025 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: SUSIe Guarino McGriff Insurance Services LLC PRONE FAX 150 S. Warner Road, Suite 460 ;� e 1 610-233-4 , No); King Of Prussia PA 19406 "'At susan, uariio mr riff.com INSURED 151LAZKARP LAZ Parking Midwest, LLC 500 S. Front St., Suite 210 Columbus OH 43215 INSURERS AFFORDING COVERAGE NAIC # INSURER A: National Union Fire Ins Co of Pitt. PA 19445 B: AIU Insurance Com2any 19399 -INSURER INsuRERc: Allianz Global Risks US Insurance Co 35300 INSURER D INSURER F: �^W=MAr_Co 11CDTICW`ATC uu 1lle921=13• coa-7-7ne2-7 RFVICIrIAI MIIMRFR- 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. 11 LTR TYPE OF INSURANCE AD04ISU POLICY NUMBER MM/DDIYYYY POLICYETT pMIDD/YYYY LIMITS A GENERAL LIABILITY Y Y 3609369 7/31/2024 7/31/2025 EACH OCCURRENCE 1 $1,000,000 CLAIMS -MADE F7x OCCUR ff7MERCIAL DAMAGE TO -RFNTT=5 PREMI occurrence $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY r PECOT- 71 LOC $ OTHER: A AUTOMOBILE LIABILITY Y Y 3135689 7/31/2024 7/31/2025 2:1,!IEDSINGLELIMIT eccrdent $5,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY L.AUTOS ONLY BODILY INJURY (Per accident) $ I POPE JTY AMAGE $ C X UMBRELLALIAB X OCCUR Y Y SEE SCHEDULE 7/31/2024 7/31/2025 EACH OCCURRENCE S100,000,000 X AGGREGATE s 100.000,000 EXCESS LIAB CLAIMS -MADE DM I I RETENTION S I $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y Y WC014111735 7/31/2024 7/31/2025 l;X I FER OTH- STATUT E.L. EACH ACCIDENT $ 1,000,000 $ 1,000.000 OFFICER/MEMBER EXCLUDED? FKJNIA (Mandatory in NH) E L, DISEASE - EA EMPLOYEE I IF yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE- POLICY LIMIT . $ 1,000,000 A Garagekeepers Liability Y Y 3135689 7/31/2024 7/31/2025 1.000.000 B Stop Gap Liability WC014111735 7/31/2024 7/31/2025 Limits 1M/1M/1M DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) If agreed upon in a written contract or agreement, City of South Bend is included as an additional insured for general liability, but only with respect to the operations of the named insured. Re: L22903- Eddy Street Commons at Notre Dame CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of South Bend ACCORDANCE WITH THE POLICY PROVISIONS. 227 W. Jefferson Boulevard South Bend IN 46601 AUTHORIZED REPRESENTATIVE USA 2d-1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 151LAZKARP LOC #: See COI (Acord 25) ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED McGriff Insurance Services, LLC POLICY NUMBER See COI (Acord 25) See COI (Acord 25) CARRIER NAIC CODE See COI (Acord 25) EFFECTIVE DATE: 7/31/2024 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: Acord 25 FORM TITLE: Certificate of Liability Insurance Additional Insurers Affording Coverage: Insurer letter C: Allianz Global Risk US Insurance Company (NAIC 35300) Insurer letter D: Federal Insurance Company (Chubb) (NAIC 20281) Insurer letter E: Everest National Insurance Company (NAIC 10120) Insurer letter F: Endurance Assurance Corporation (NAIC 11551) Insurer letter G: American Guarantee and Liability Insurance Company (Zurich) (NAIC 26247) Insurer letter H: Westfield Specialty Insurance Company (NAIC 16992) Insurer letter I: Great American Assurance Company (NAIC 26344) C: Excess General Liability USL03085024 7131/2024-7/31/2025 Aggregate $4,000,000 D: Primary Umbrella Liability 79863543 7/31/2024-7/31/2025 Aggregate $25,000,000 E: Excess Liability XC5EX02069241 7/31/2024-7/31/2025 Aggregate $7,500,000 F: Excess Liability EXC30065353300 7/31/2024-7/31/2025 Aggregate $7,500,000 G: Excess Liability AEC011173110 7/31/2024-7/31/2025 Aggregate $15,000,000 H: Excess Liability XSL345214KOl 7/31/2024-7/31/2025 Aggregate $10,000,000 I: Excess Liability EXC5772941 7/31/2024-7/31/2025 Aggregate $10,000,000 D: Excess Liability 78187246 7/3112024-7/31/2025 Aggregate $25,000,000 Page 2 of 2 AL;UKU 9 Ul (MIJIBIU11) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD — MOWN:* r� J� 1 v TICKET IN VEHICLE LEAVE T t _ray At Emit Gage . Credit or Debit Card Only -NO CASH - OFFICE HOURS: Sam - 5pm Mon. - Fri. (574) 232-3805 E31P "Idor&AWWAW CITY LICENSE sOW2022-am mllRFiLi GRQUP �Y s TR Q'O G�3�A M DNS NOTRB @ DAME PUBLIC PARKING FIRST 2 HOURS FREE EVENT RATES MAY VARY P"