HomeMy WebLinkAboutSpecial Event - St Joseph Grade School Field Day-June 6 202550 T8 a -
APPLICATION FOR USE OF DL1`
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PUBLIC RIGHT-OF-WAY FOR EVENT
The following special event has been approved by the Special Events Committee. 6s
Submitted by: Denise Miller
Event name: St Joseph Grade School Field Da
Event Date: ,tune 6 2025
Street Closure: St Louis Blvd between E Colfax Ave & E Lasalle Ave
Closure Times: 7:00 am to 4:00 pm
Sidewalk Closure: ❑ Yes ❑■ No
Comments: Annual Field Day will include outdoor games, activities, and
lunch for the entire student body.
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
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Elizabeth A. Maradik, President Joseph R. Molnar, Vice President
Gary A. Gilot, Member Briiaanaa>Micou, Member
Murray L. Miller, Member Attest: Theresa M. Heffner, Clerk
Date: Mav 27, 2025
oF�u�B City of South Bend Special Event Application
�� . Neighborhood Event
�_''�>� � $25 application fee if filed 30 days or greater (up to 180 days) in advance of event.
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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. Neighborhood Special
Event applications must be submitted more than 30 days in advance of the event date or the application will not
be accepted.
Section A - Applicant Information
Date of Application: Ype1 2S Organization Name: ,�oseoh �rarle Sckool
Applicant(Contact)Name: 11&AtA0_k 17V2q
Applicant(Contact)Phone: (S';>(1)220'Z32s"Contact Email: hoyiA ,kiA1 3ok jmn%(.Cbryx
Address: 2I16 �4 +flu 5+ City/State/ZIP: .SDuff- Bond =^) Y66i7
Secondary Contact Name: _NOf o lit 5 i oW.'
Contact Phone: (S74i 386' 38'NO Contact Email: tuS yrG(-i P VGhoo. coryl
Address: 2i6 N iI111 54. City/State/ZIP: 5,- L 11• , T�N W6 17
40 Section B - Event Information
Event Name: Si. S6`Ds�pk cu- kml'If4d J;u Expected Attendance: 4/00-4SD
Requested Street Closure: 5. L65 Obik
From (Cross Street): ti • W+&� Aj-c •
To (Cross Street): F. Id3ikk A/"E
Provide a brief description of the event:
Ouc o-✓•n'jal fitk& DqY well %nck\A9 6j4ocK- 364Vres, Gch\A+M' , &Aa
lwu►L fw- ov( 'eA-h(-c skvd-Ln+- body.
Date of Event Setup [mm/dd/yy]: 6/ 6 /Z S Time: p7a 1 �
Begin Date of Event [mm/dd/yy]: 416 /Z S Time: D ► n.
End Date of Event [mm/dd/yy]: 6 I6 /25- Time: 3 P +
Event Cleanup Completion [mm/dd/yy]: 6 / 612 Time: K (1 A J L
(1b�'��1wt•C� ll`^" b
Have all residents on the affected block have been notified and invited? ❑ Yes [�No
Please attach a copy of the door hanger or letter used to notify residents in addition to signature attachment.
Number of households f ronting the proposed street closure: d.pu,tL hv��g io ornflrC)
Number of households represented by signatures on attached sheet:
Will this event have music (live or other)? ❑ Yes ❑ No
Section C - Alcohol
Will alcohol be served or sold? ❑ Yes 0 No
• If Yes:
o The applicant must apply for and receive a temporary liquor license from the Alcohol & Tobacco
Commission.
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.
o Deposit will be returned upon inspection of event area by the Board of Public Works.
o The applicant must submit a map or drawing of:
o Fencing around serving area
o Trash receptacles
o Events that will 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) Security Company Information
Company
Contact Phone:
(b) Independent Security Information
Contact Name:
Email:
City/State/ZIP:
Name: Contact Phone:
Qualifications:
Name: Contact Phone:
Qualifications:
Name: Contact Phone:
Qualifications:
11
Section D - Food �%
Will your event have food sales (food vendors, caterers, food trucks, etc)? El Yes My No
• o If yes, the event coordinator must apply for and receive a St Joseph County Health Department
Temporary Event Permit.
o 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.
o All applications and guidelines can be found on the St. Joseph County Health Department Food Service
website at sichd.org/food-service.
Please select food types: ❑ Food Vendor ❑ Caterer ❑ Food Truck ❑ Other:
If a Food Truck, please list company name(s):
Please describe how food will be cooked and served:
11
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Section E - Indemnity & Hold Harmless Agreement
OWN
City of South Bend Special Events Committee
Indemnity & Hold Harmless Agreement
Date: W21411i Event Date: 6 /6 Iz 5--
Event Name: '5+• Te5<,ok brmd4, 5r-hoo1 f�--t [Jt C%u
Organization: c.4 • SOScob. G-m&g 5c koo (
Applicant (Contact) Name:
Applicant (Contact) Phone: U7 Y) Z 2 O —2 3 25^ Alt. Phone:
Email:
k6lvin4,VIrlq
30n%&�I. (am
Address:
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(+W S�. City/State/ZIP: S&W1 6,e*,d, �PN Y64 ( 7
Event Location (Please describe):
Evzrr� t�1[es �JlaLe moll-Iy t� s�hoc) Ca.hP�S and PRSGhoo� Ca �S
w iji- 6. ac t irrs at closed s by-M+ d s�Fi �a s sry� hr ch I Gl� cn.
Length of Event (Dates/Times): 616, 9 am — 3 pm�
• APPLICANT 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, 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: if/Z K 12 s—
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Authorized Organizer Signature
1-17-t%elA ^ c4,y — iaw Oav a4-'r
Printed Name and Title
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Section F - Permit & Agreement
1. Pursuant to Local Ordinance No.10628-18, there is a $25.00 non-refundable fee for applications filed 30
days or greater in advance of the event date. Applications filed less than 30 days in advance of the event
• date will not be accepted.
2. All residents within the affected area must be notified of this event. The APPLICANT must obtain
signatures from at least 10 residents that reside along the closed right-of-way and make an attempt to
notify all other affected residents. APPLICANTS must include a copy of a brochure or letter of invitation
distributed to all affected neighbors describing the event purpose, date, and time.
3. The APPLICANT is responsible, prior to the event, for determining if there are any affected residents that
need assistance accessing their residence. The APPLICANT is responsible for providing said resident(s)
access or transportation to their property.
4. The cones will be delivered to the APPLICANTS address. The APPLICANT assumes full responsibility for
clean-up and assures the City that all cones will be maintained and returned undamaged. The APPLICANT
will be liable for the replacement cost of $50.00 per cone as a result of any missing or damaged cones.
5. Block parties must end by 8:00 p.m.
6. A street will be blocked off from intersection to intersection only. No half -blocks or alleys can be blocked
Off.
7. The Special Events Committee reserves the right to deny any block party application based on traffic and
speed limit records. No street may be closed with a speed limit over 30 MPH or considered to be a major
arterial.
8. The Special Events Committee reserves the right to deny any block party application based on information
gathered from the South Bend Police Department or other sources.
9. The APPLICANT agrees to allow residents that live on the above -referenced block access in and out of the
restricted area as needed.
• 10. The APPLICANT agrees to abide by all terms and conditions of the South Bend Municipal Code and Board
of Public Works' policy adopted in Resolution No. 10628-18 on December,11, 2018.
11. Notification of approval/denial of this request will be issued by return of this form, upon signed
authorization by the Board of Public Works.
12. The City of South Bend Noise Ordinance 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 stereos, speakers, musical
instruments, 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).
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.
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Date: y17— y/ZS
Applicant Signature: !v ( '/�—
Printed Name: 14an najA- Qefo = 4-b
SPECIAL EVENTS COMMITTEE APPROVAL
Mem
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AWN OSEPH
CATHOLIC CHURCH
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MEMO
STREET CLOSURE - JUNE 6th
To: St. Louis Street Residents
From: St. Joseph Grade School Field Day Committee
Again this year, St. Joseph Grade School will be holding their annual Field Day
end -of -the -school -year celebration for students. This year's event will be on
Friday, June 61h. We will be closing St. Louis Street between LaSalle and Colfax
from 6:30am until 3:30pm. Please have cars that are parked on St. Louis Street
moved before that time. Alley access will stil► be available as well as parking on
Colfax and LaSalle.
Thank you for your understanding each year! This allows our school and parish
to have a wonderful and safe event for our students.
In Christ,
St. Joseph Grade School Field Day committee
Certificate of Coverage Date:4/30/2025
(Yrtificate Holder
The Diocese of Fort Wayne -South Bend. Inc.
Chancery Office
P O Box 390
This Certificate is issued as a matter of information only and
confers no rights upon the holder of this certificate. This certificate
does not amend, extend or alter the coverage afforded below.
Fort Wayne, IN 46801
Company Affording Coverage
THE CATHOLIC MUTUAL RELIEF
SOCIETY OF AMERICA
10843 OLD MILL RD
OMAHA. NE 68154
Co, cred Location
ST JOSEPH CHURCH
226 N BILL ST
SOUTH BEND, IN 46617-0000
Coverages
This is to certify that the coverages listed below have been issued to the certificate holder named above for the certificate
indicated, notwithstanding any requirement, terra
or condition of any contract or other document with respect to which this
certificate may be issued or may pertain, the coverage afforded described herein is subject to all the terms, exclusions and
conditions of such coverage. Limits shown may have been reduced by paid claims.
Type of Coverage
Certificate Number
Coverage Effective
Date
Coverage Expiration
Date
Limits
Property
Real & Personal Property
D. General Liability
Each Occurrence
1,000,000
General Aggregate
Occurrence
® Claims Made
8679
10/1/2024
10/1,2025
Products-Comp/OP Agg
Personal & Adv Injury
Fire Damage (Any one fire)
Med Exp (Any one person)
Excess Liability
Each Occurrence
Annual Aggregratc
Other
Each Occurrence
Claims Made
Annual Aggregrate
Limit/Cm erage
Description of Operations/Locations/Vehicles/Special Items (the following language supersedes any other language in this endorsement or the Certificate in
conflict with this language)
St. Joseph School's Field Day on June 6, 2025.
Holder of Certificate
Cancellation
Should any of the above described coverages be cancelled
City of South Bend
before the expiration date thereof, the issuing company will
endeavor to mail 30 days written notice to the holder of
certificate named to the left, but failure to mail such notice shall
impose no obligation or liability of any kind upon the company,
its agents or representatives.
0067005422
.Authorised Representative
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