Loading...
HomeMy WebLinkAboutSpecial Event - Women's Recovery Walk-Oct 11 2025h APPLICATION FOR USE OF PUBLIC RIGHT-OF-WAY FOR EVENT ^y '' P"C9 The following special event has been approved by the Special Events Committee. `° J I6sre Submitted by: Denise Miller Event name: Women's Recovery Walk Event Date: October 112025 Street Closure: Brief crossing at Sample St and Fellows Closure Times: 1 1:00 am to 2:30 Sidewalk Closure: ❑ Yes ❑■ No Comments: In partnership with several organizations, Dismas House of Indiana hopes to raise awareness for women's recovery. CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Gary A. Gilot, Member Murray L. Miller, Member 1�oz 7Tt Joseph R. Molnar, Vice President Breana Micou, Member h "L f #DYxff , Attest: Hillary R. Horvath, Clerk Date: September 23, 2025 • C J C 1 «, &, City of South Bend Special Event Application 2, 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 Bring Completed Appiication 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. C f Section A—AppBrantInformation Date of Application: 0 I fI l �5 Organization Name: �(S/y1 aS Ip US E (� F I Na ha Applicant (Contact) Name: AmDk':i- � goe-Dor` Applicant (Contact) Phone: � F14) ) f.%� 'V,, i5 Contact Email: Q ()��pi; ff 9 Address: 4o�L E. 2bj;� Sr City/State/ZIP: S�Uf H CJE%`��+ 1 LROW 1 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 Name: Contact Phone: Contact Email: Address: City/State/ZIP: • 0 0 ` I Section B — Event Infannation Event Name: l� S fC�L�Ni�6 nt Type: (Festival, Race, Parade, other): / •5 ml WALE Event Classification: M Non-Profe ❑ 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/yy]: 10 111 IA5 Time: c 1 00 Am Date of Event [mm/dd/yy]: 10I 11')6 Begin Time: I 00 A"vl End Date of Event [mm/dd/yy]: l0 / 1 /'a5 End Time: • 00 Pm Event Cleanup Completion [mm/dd/yy]: 10111 1 Z Time: A Jo PM Rain/Altemative Date: If yes, please provide the date: I Total anticipated attendance: 505 The proposed event will require the closing of: ®Streets Is the event ticketed or includes fees? ❑ Yes a No IF YES: • Ust fees and fee groups below: Sidewalks Does the event have any partnered sponsorships? ■ Yes ❑ No IF YES: List the number of sponsors at each level of partnered sponsorship: - LIFE IaE,-mom �e-Ps 1N�7lAAJA 0oziERv folz ► n E0'O\1=R\/ WE-LLS OF INsPAa7ii0rJ �W&A UPPER (ZOOM) 4W\)F_Pv Is this a returning special event or part of a serjA of special events? ❑ Yes M No IF YES: Provide the date, location, and attendance of past special events and/or future planned events in the series: If YOUR EVENTISA PARADE RAC4 OR OTHER PROCESSIONAL-TYPEEVENr 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: 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: . Listcategories and anticipated participants percategory: r i u IF YOUR EVENT IS A PARADE, please provide a supplement writing describing the approximate numberand 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: 11 • Section D — EauiomeM. Set-up. and Logistics Are you hiring a company to provide entertainment, games or inflatables? ❑ Yes ■ No 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 i No 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 or other pyrotechnics? ❑ Yes No • IF YES: • Depending on the potential fire risk, applicants may need to receive approval of the South Bend Fire Department (process facilitated by event coordinator). • Only consumer grade fireworks can be used during certain time frames (July 4' and New Year's). o A permit must be applied for with the Indiana Department of Homeland Security for Commercial Grade Fireworks show. All entertainment events should have a permit from the IDHS Amusement and Entertainment Permit. • Describe the event's proposed fire -related entertainment: Will there be any musical entertainment features at the event? ❑ Yes 0 No 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: 0 State, INDOT, Michael Hurt, mhurtlnindbtin.00v 219-851-1426 County 8ndges., Andy Hayes, ahvyes(&co.st joseah. in. us, 574-235-9626 r-I u • Section E — Food Are you having food at your event (food vendors, caterers, food trucks, etc.)? 0 Yes ❑ No IF YES: The event coordinator must apply for and receive a St. Joseph County Health Department Temporary Event Permit. • Vendor(s) must have a City of South Bend business license for Food Vending Vehicle. (Contact Michelle Adams at Madamsa)southbendin.gov) • 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.org/food-service. Please select food sales types: ❑ Food Vendor ❑ Caterer ❑ Food Truck ❑ Other: IF A FOOD TRUCK, please list company name: NE- i_sori 's Por2T,a Pr Describe how food will be cooked and served as well as any preventative safety measures: r60D (,CAI LL IJC l� ) 4E PA2afro Lor c F 74E D1Sm,a2> .4;06, E-NC i NJO of 0AL-IG Lto;l- E . S(xrN BEND, 11,l 4{o(pD 0 Section F — Alcohol Will alcohol be served or sold? ❑ Yes M No IF NO: Please continue to Section G — Contingency and Strategic Planning. IF YES: The applicant must apply for and receive a temporary liquor license from the Alcohol & Tobacco Commission. Indiana ATC forms are located at in.00v/atc/2409.htrn. (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. Application cannot be processed without a copy of this license. • A refundable $400.00 deposit paid by card or check (made to City of South Bend) must be submitted with application. Application cannot be processed without deposit. Deposit will be returned upon inspection of event area by the Board of Public Works. 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 fiekls provided in sub -section (b). Company Name: • Contact Phone: _ Address: Name: Qualifications: _ Name: Qualifications: _ Name: Qualifications: _ • Contact Name: Email: City/State/Zip: Contact Phone: Contact Phone: Contact Phone: Section 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 public safety personnel. o If hiring a prhate security service, provide contact information, proof of insurance and the number of hired event personnel. o Proposed internal communications systems and public address systems. The event will request a police escort to ensure safe passage of participants, control traffic at intersections and crosswalks, prevent unauthorized vehicles from entering the route, and assist in addressing saety or emergency concerns. Patrol vehicle(s) will be requested to lead, guide, block and/or tail the walk if resources of SBPD allows for it.There will be an on site safety lead who will carry emergnecy contact lists, a cell phone, and a first aide kit. 911 will be called for medical emergencies and there will be at least one individual on the walk certified in CPR/First Aide. Proposed Cleanup Plan -This plan should include, but is not limited to: o Measures in place to collect and remove trash, litter and recydables. rµ6 OR6.4r4(zsTrC roNS Par�,PATjtja WILj[ BE PkDVi0rn1(3 PEOPLE/TO ft&&1,J • WE DO -r At,triG ip!ATe— l DEP�2r s Sr f f�E NEE ► I NC-i WrU. QE Bk_)Dnl [DokIt'J6 • Inclement Weather Plan -This plan should include, but is not limited to: o Safety measures that will betaken in the event of a tornado waming, tornado watch, thunderstorm, and extreme temperatures. o Rain date. o Weather information and forecasts can be found at httos•//www.weather.gov/ iut Eve w t uw &&&feEu_E:D /F-rgE-P-6 is AAC-> (wE11Tl_�� ( jp24\Ja�)D) 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. A FLVE12 U)/U, US8p Of l �fJe /LIL ftI D A E C� • 40 Section H —Site Plan / Route Mao 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. Applicants should ensure all roadway (right of way) closure times are specific and separate from the event setup and event start/end times (i.e., roadway closures times may not be perfectly identical or linked to the duration of the event). All bridge closures require County Engineering approval. (County Bridges: Andy Hayes, ahayesCWco.st joseph.in.us, 574-235-9626) All state road Closures require INDOT approval. (State, INDOT: Michael Hurt, mhurflnaindof.in.gov, 219-851-1426) • 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 strictures. Applicants should also dearly mark location: 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. SLE MQF> avne 1h Gas Bj EV charging . W Ho E-Monrcc• ST 4 ` House oflnhi DISMAS '- icN� of Inana, Inc STOP 3 HUBED DISMAS HOUSE E Trdl k 7 min E Sample St, c _ Oh , STOP 2 YWCA STOP 1 �- LTC Life Treatment Centers, Inc. = r 2 r o N 0 1 q q N C: ry n le .... 131cyC v friers,fly rVads — Dedicated lanes --- D'rVunpaved trails Mip Jdtd . Nf s (;d qle Unity. 3taie. 'ern, r'n.a.y 0 • Section I — Mitiaation of Impact IF YOU ARE USING AND/OR CLOSING PUBLIC SIDEWALKS OR STREETS: You are required to notify area business owners and residents in writing 15 days prior to the event. Attach a copy of the brochure or door hanger distributed to all affected residents/businesses/neighborhood groups describing the event purpose, date and time. • 0 • Is NOTICE TO LOCAL BUSINESS OWNERS MITIGATION OF IMPACT WOMEN IN RECOVERY WALK 2025 Community Walk to Celebrate Healing and Recovery =J Saturday, October 11, 2025 Q 11:00 AM — 2:00 PM Q Temporary rolling road closure — See attached route What to Expect The walk is approximately 1.5 miles long with brief stops to collect prizes and hear individuals stories of recovery. However, the plan is to ensure the walk moves steadily and continuously Rolling road closures will be in effect for brief intervals (15-20 mins max) as participants pass. Streets will reopen immediately after walkers move through. Access to businesses will be preserved as much as possible during the event. Police escorts have been requested along with a permit for the safety of participants and the community Why This Matters The Women in Recovery Walk is a celebration of resilience, sobriety, and second chances. Hosted by Dismas House of Indiana, with participation from other community organizations including YWCA, Life Treatment Centers, Upper Room, Wells of Inspiration. this event brings together our community to support women on their journey to recovery. We're committed to minimizing disruption to your business while creating space for hope and healing. Need More Info? Contact us at: %& [574] 233-8522 ® [Email Address] andrea@dismasin.org Thank you for your patience, understanding, and support! Together, we walk for change. — Dismas House of Indiana and Life Treatment Centers Section J — Insurance A Certificate of Insurance (copy) confirming the existence of a liability policy (General Liability and Automobile Liability) of not less than $1,000,000 per occurrence and $2,000,000 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. • 1 U • E ACOROe CERTIFICATE OF LIABILITY INSURANCE 1`i- DAIS IMYYI /2025 09/D812025 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: N 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 endomemem, A statement on this certificate does not confer rights to the certificate holder in lieu of such endomement(s). PRODUCER HealyGroup 1753.5 Generations Drive South Bend, IN 46635 CoirrACANE C Bekky Gmsllans PL. 574-968-1512 l6 (574)243-3214 bgroshansl@hsalygroup.com aB111e313 AFFORDING COVERAGE MCI aretRrERA; Philadephialnsurance Companks 18058 "AnO Dismas House of Indiana aBINER a: 521 S St Joseph St South Bend, IN 46601 INSURER c NSURERD: _ IIISUREa E: ASIetERF COVERAGES CERTIFICATE 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 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. N511 TYPE OF fISURANCELM POLICY NUMBER POLICY EfT POLICY OIP LMRS A ✓ COM1BRou. GENERAL MABLIrY CLAIMRAIADE ✓ OCCUR Y PHPK2552069-007 06130I2025 06MOt2026 EACH OCCURRENCE S 1,000,000 PREMISES avananmi $ 100,000 NED EXP (My am pasan7 S 5,000 PERSONAL aAW INAXiY f 1,000,000 GENL AGGREGATE LNm APPLIES PER: ✓ POLICY JECDT LOC OTHER GENERAL AGGREGATE S 2,000.ODO PRODUCTS-CDMPAIPAGG $ 2.000.000 S AYTOMOBLELWLRY ANY AUTO OAMED SCHEDULED AUTOS ONLY _ AUTOS HIRED NON-0NMEO ADTDS ONLY AUTOS ONLY COEBNEO SINGLE LMrt flEse� a eODLY INJURY (Pe, PaFm) S BODILY INJURY IP. smdeH) f PROPERTY DAMAGE f s A ✓ UMBRELLALIAS ✓ ocam EXCESSL 11 CIANSAIADE DED ✓ RETENTIONS 10000 PHUB863053-007 06/302025 OMM026 EACH OCCURRENCE S 1,000,000 AGGREGATE E 1,000,000 = i WORNFAa COMPENSATION ANDEMPLDYERSLuelm• YIN ANYPROPRETOILPARTN %%ECUTIVE OPFICERAAEMBERF%cwDEm farldaVNy In NHI N yyeecc.. deFTnbe lmder OESLRIFIRM OF OPERATIONS bao NIA PER OTH- STATUTE ER EL EACH ACCIDENT EL USEASE-EA EIN.OYE S E.L. DISEASE - POLICY LIAR S i OESCRPTIONOFOPEI MNSILOCATIONSI VENCLES IACORD 1M. AddAimal Remadu schMuN,mrymHu[ne0Hmare awcemreaufred) City of South Bend is fisted as additional insured. 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 West Jefferson Blvd. AUr1wR®REPRESFNSATAr£ South Bend, IN 46601 X-1 0'` ©1989-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo am registered marks of ACORD Section K - Indemnity & Hold Harmless Agreement • City of South Bend Special Events Committee Indemnity & Hold Harmless Agreement Date: _ ( 6 19,5 '' 1 EventDate: I ,O�I,,o 'j Event Name: �YYI S W &t x- roQ &r'aLE�// Organization: 7i5MAS/�4use OF 1IV7/A�/� Applicant (Contact) Name: 4N/Ii A Applicant (Contact) Phone /( Alt Phone: (57�) Email: a��p� l�Cll` �i`1 U 1• Address:40, r SOirN I ury/State/ZIP: Event Location (Please describe): Length of Event (Dates/Times): 'V I ii /a5 / — .CcP • Insurance Amount: This event is insured for no less than $1,000,000 per occurrence and $2,000,000 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:-DU3M4 905C OF WDANA agrees to indemnify, defend and hold harmless the City of South Bend, Indiana, its agents, officers, and employees (collectively r0ty'l, from any liability, loss, costs, damages or expenses, including attorney fees, which the City, 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 City, 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 ofthe holding of the special event. The undersigned certifies that he/she is authorized to bind the APPLICANT to these terms. Signed on this Date: Authorized Organizer Signature: • Printed Name and Title: DIRE0702- OF COmrALN, Section L — Permit & Agreement • 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 in the area impacted by the event. 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. 4. The APPLICANT shall reimburse the City for the actual cost of the event, if the City incurs unexpected, undisclosed expenses related to the event. 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 $1,000,000.00 per occurrence and $2,000,000.00 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. S. 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, 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. • 9. The APPLICANT assures the City that the area will be dosed during the times indicated on the application only. Event end times are pursuant to the recommendations of the South Bend Police Department and such times will be strictly enforced. 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: q / U /d Applicant Signz Printed Name: 0 Member SPECIAL EVENTS COMMITTEE APPROVAL er Member er Date 0 • • 6749401 CITY OF SB SPECIAL EVE 7315 LAFAYETTE BLVD SOUTH BEND, IN 46601 09i091j2025 15:50:53 CREDIT CARD VISA SALE Cad n XXXXXXX%XXfC 7223 $N u: 1 Batch A: 51 INVOICE 1 Appoual Code: 419005 bib vMetw: Maui Mode: Onlrx Tax Atqultt: $0.00 gad Code: M SALE AMOUNT $100,W CUSTOMER COPY C, • 0 6749401 CITY OF SB SPECIAL EVE 7315 LAFAYETTE BLVD SOUTH BEND, IN 46601 091092025 15:50:53 MID: XXXXX OtXXXXX401 Ta XXXXX371 CREDIT CARD VISA SALE Cad u XXXXXXXXYJA7223 SEQ F Batch a'. 51 INVOICE I AWoval Code: 41900` 510vMethod: Mawal Mode: Wine Tax A "t: 10.00 Cad Code: M SALE AMOUNT $200 X I agree to pay above total awt according to cad issuer agreement. (Merchant agreement if Credit Voidner) MERCHANT COPY