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HomeMy WebLinkAboutStreet Closure - Sam Centellas1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND. INDIANA 46601-1830 Mr. Sam Centellas La Casa de Amistad 746 S. Meade South Bend, IN 46619 4 goU TH B, Al O Vd U PPACF 1865 _ CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS July 12, 2016 RE: Event Name: West Side Wednesday Street Closure: Liberty from Western to W. Jefferson Dear Mr. Centellas: PHONE 574/235-9251 FAx 574/235-9171 The Board of Public Works, at its meeting held on July 12, 2016, approved your request to close the above referenced street for your event scheduled for July 20, 2016 from 1:00 p.m. until 10:00 p.m. For your information, the South Bend Police Department will monitor this event. Enclosed please find a copy of your approved permit. The Bureau of Traffic and Lighting will deliver barricades necessary to close the street to the applicant's address. You will be responsible for their placement and removal at the conclusion of the closing of various streets. Please note that a ten foot (10) clear and unobstructed lane must be maintained at either curb or down the center of the street for emergency purposes and that no fires are allowed in the street. The Applicant will be liable for the replacement cost of $50.00 per cone as a result of any missing or damaged cones. If you have any further questions regarding this matter, please call this office at (574) 235-9251. Sincerely, Linda Iv1. Martin, Clerk Enclosure c: Gene Eyster, Police Department Federico Rodriguez, Fire Department Marcia Qualls, Streets Ed Gleckler, Traffic & Lighting Adam Burke, Downtown South Bend GARY A. GILOT DAVID P. RELOS ELIZABETH A. MARADIK JAMES A. MUELLER THERESE J. DORAU INTER -OFFICE MEMORANDUM BOARD OF PUBLIC WORKS DATE SENT 6/30/2016 TO: ,Ed Gleckler, Traffic & Lighting W�/ ene Eyster, Police Department Corbitt Kerr, Engineering Chris Dressel, Community Investment JFederico Rodriguez, Fire Department Marcia Qualls, Engineering Paula Garis, Park Department Adam Burck, Downtown South Bend (aburck@downtownsoutThbend.com) FROM: Linda M. Martin, Clerk SUBJECT: Non- Residential Block Party LOCATION: Liberty St. from Western to W Jefferson DATE AND TIME: July 20, 2016 SPONSOR: Sam Centellas — La Casa De Amistad DATE DUE: July 5, 2016 FAX OR E-MAIL TO: 235-9171 / Imartin(dsouthbendin.gov RECOMMENDATIONS AND COMMENTS: By Date �4SOUTiI pE tid APPLICATION FOR USE OF, AND BLOCKING OF ACCESS TO THE PUBLIC wl, aGR s RIGHT-OF-WAY FOR NON-RESIDENTIAL BLOCK PARTIES rxe, The Board of Public Works must have FOUR (4) weeks prior notice of the event. A NON-REFUNDABLE APPLICATION FEE OF $125.00, IN THE FORM OF A CERTIFIED CHECK OR MONEY ORDER, PAYABLE TO THE CITY OF SOUTH BEND, MUST BE INCLUDED WITH APPLICATION. ❑ Fee Paid Applicant Name: Address: '424(o S HA�ntl City: S U State: 1 r4 Zip: 4 6G ! Phone: 233..I2,o Ceu.) This application is made to the City of South Bend, Indiana, Board of Public Works, for the use of the specified public right-of-way by Applicant for the holding of the hereinafter described event: Event Name W UyS r 5 r o¢ \nle n r-I es D om Location 2 `b o p coc tc W . w11,s -fit rf (Describe Area/Route) Street Closure Name of Street 1. x L .n '_' From W b` T1,;, 2 V-j To W. S�LGf(e(LSoo Date of Event � V� O 20 1(, ❑ a.m. ❑ a.m. ❑ a.m. Time: Registration/Setup f 00 Rp.m. Start S' 0' f p.m. End 10' 00 (Rp,m, Approximate Number of Attendees 2 S-O Answer the following appropriately: 1. This event will have music (live or other). a. I understand the Noise Ordinance described in the Agreement/Permit 2. Required Information to Accompany Application a. Certified Check or Money Order in the Amount of $125.00, or: b. For Certified Nonprofit Organizations: Copies of the 501(c)(3) Internal Revenue Exemption Status Document and a current copy of Form 990 of Form 990-EZ are included with this application, and additionally filed with the Office of the City Clerk, 41 Floor, County - City Building, 227 W. Jefferson Blvd., South Bend, Indiana. c. Certificate of Insurance 3 d. Maps, drawings of the area and setup plan a. This event involves City streets b. This event involves County roads c. This event involves State highways d. This event involves the use of the sidewalk Yes ❑ No Yes ❑ No 9 Yes ❑ No 0 Yes ❑ No ® Yes ❑ No ❑ Yes ® No ❑ Yes 2 No Er Yes ❑ No Updated 4/2015 1 e. This event is loc 1/regional/national event (Please circle the ® yes El No appropriate event type) f. Affected property/business owners have been notified of this event. Yes ❑ No g. I understand that I must arrange a meeting with all affected governmental agencies to organize the above event (Call Marcia yes ❑ No Qualls, Customer Service Manager, 235-5939 to organize meeting). Rr It' ALCOHOL IS TO BE SERVED OR SOLD Alcoholic beverages will be served ® Alcoholic beverages will be sold Certified Check or Money Order for $400.00 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. Names and phone numbers of THREE security guards • To monitor underage drinking. • Qualifications must be listed (e.g. Off -duty police officer, professional security guard, or event APPLICANT). A drawing must be submitted showing: • Fencing around serving area • Trash receptacles. o Ample trash receptacles must be provided to ensure proper disposal of refuse. Temporary liquor license. • Call the Alcohol & Tobacco Commission at (317) 234-4315 for more information. • Application cannot be processed without a copy of this license. -pLrTH 64, o`� yq City of South Bend, Indiana • Board of Public Works MCE PERMIT AND AGREEMENT FOR THE USE OF THE RIGHT-OF-WAY FOR NON-RESIDENTIAL BLOCK PARTIES The Non-residential Block Party will be permitted to take place under the following terms and conditions: 1. Pursuant to Local Ordinance No. 10224-13, there is a $125.00 non-refundable fee for non- residential Block Parties. Non-profit organizations meeting Section 501(c)(3) of the Internal Revenue Code are exempt from the fee provided copies of the 501(c)(3) Internal Revenue Exemption Status Document and a current copy of Form 990 of Form 990-EZ are filed with this application and with the Office of the City Clerk, 4th Floor, County -City Building, 227 W. Jefferson Blvd., South Bend, Indiana. 2. The APPLICANT must comply with all terms and conditions of this Permit and Agreement. 3. The APPLICANT shall reimburse the Board for the actual cost to the City for the event, if deemed necessary. 4. APPLICANT shall include a flyer or letter describing the details of the event. 5. Notification of approval/denial of this request will be issued by return of this form, upon signed authorization by the Board of Public Works. 6. The APPLICANT shall provide to the Board a Certificate of Insurance showing a liability policy in full force and effect with limits of $300,000.00 per occurrence and $5,000,000.00 aggregate and the City of South Bend listed as an additional named insured for this event. 7. The APPLICANT assumes full responsibility for providing ample disposal containers for refuse/recycling and assures the area will be cleaned up upon the conclusion of the event. 8. Barricades will be delivered and picked up at the event location. The APPLICANT is responsible for seeing that all cones are maintained and returned undamaged. 9. The APPLICANT will follow the City of South Bend Noise Ordinance, which is in effect at all hours. Between the hours of 11:00 p.m, and 7:00 a.m. certain noises are particularly prohibited. These include operating radio receiving sets, musical instruments, phonographs and other sound reproduction devices if audible fifty (50) feet away, as well as shouting, yelling, hooting, whistling, or singing in the streets in a manner to disturb the peace (Municipal Code 13-57). 10. The APPLICANT assures the City that the area will be closed during the times indicated on the application only. Event end times are pursuant to the recommendations ofthe South Bend Police Department. 11. IF ALCOHOL IS TO BE SERVED OR SOLD a Certified Check or Money Order for $400.00 must be submitted with application. The application cannot be processed without a deposit. The deposit will be returned by the Board ofPublic Works upon inspection of the event area after the event, and provided there is no damage to the area. Names, phone numbers, and qualifications (e.g. Off -duty police officer, professional security guard, or event APPLICANT) of THREE security guards to monitor underage drinking, must be submitted with the application. A drawing must be submitted showing fencing around serving area, and trash receptacles. For a temporary liquor license call the Alcohol and Tobacco Commission at (317) 234-4315 for more information. Application cannot be processed without a copy of this license. 12. 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 by any person, including a participant in the activity, arising out of the approval of this request by the Board of Public Works to close a portion of the public right-of-way for the event described above. I have read the Application and Permit and the Agreement for the "Use of Right -of -Way for Special Events" and I understand and agree to the above rules and regulations. I also understand that this application may be denied based on any false or incomplete information. Dated this Z T4 day of 20 16 APPLICANT Signature Name /j ,BOARD OF PUBLIC WORKS APPROVAL 1. c Preside Member Member Member M be Date RETURN FORM TO: Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, IN 46601 Phone: (574) 235-9251 • Fax: (574) 235-9171 9 E-Mail: publicwks@southbendin.gov '``C- "NCERTIFICATE OF LIABILITY INSURANCE °ATE(MMDDYYYY) 7/l/2016 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 Gibson Gibson Insurance Agency, Inc. 130 S Main St, Ste 400 NAMichelle Wasoaki PHONE (800)814-2122 FAX 1800)836-2122 NC No: Xi7r�eSS,�asoski@gibsoninB.com PO Box 11177 South Bend IN 46601-0177 INSURERS AFFORDING COVERAGE NAIC II INSURER A:Cincinnati Ina Cc 10677 INSURED La Casa de Amistad, Inc. 746 S Meade Street INSURERS Accident Fund Com an INSURERC: INSURER D: INSURER E South Bend IN 46619 INSURER F: THIS IS TO CERTIFY THAT THE POLICIES UINSURANCE 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. INTR TYPE OF INSURANCE DL SUBR POLICY NUMBER MM/DCVIYYYY MM%DCDYITEYYPY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR ETD 0234312 2/15/2016 2/15/2017 EACH OCCURRENCE $ 11000,000 DAM E TO RENTED PREMI E Ea occur r nee $ 11000,000 MED EXP(Any one person) $ 10,000 PERSONAL S ADV INJURY $ 11000,000 GEML X AGGREGATE LIMIT APPLIES PER: POLICY PRO- E]LOC JECT OTHER: GENERAL AGGREGATE $ 11000,000 PRODUCTS - COMP/OP AGG $ 11000,000 A AUTOMOBILE LIABILITY ANY AUTO AOSCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS ETD 0234312 2/ 15/2016 2/15/2017 COMBINED SING Ea accident LE LIMIT $ 11000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) -PROPERTY $ -DAMAGE Per accident) $ B UMBRELLA LIAB EXCESS LIAB OCCU CLAIMSR -MADE WCV6098384 2/15/2016 2/15/2017 EACH OCCURRENCE $ AGGREGATE $ DIED I RETENTION WORKERS COMPENSATION ANDEMPLOYERS'LIABILITV YIN ANY PROPRIETORIPARTNEWEXECUTIVE OFFICERIVEMBER EXCLUDED? ❑N/A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below X PER OTH- STATUTE ER $ E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE -EA EMPLOYE $ 500, 000 E.,.'A. . DISASPLLIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is additional insured with respect to general liability coverages as required by written contract. Board of Public Works 1316 County -City Building 227 West Jefferson Blvd South Bend, IN 46601 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 Ins Agency/MWASOS Al. V mu LD (ZU l4/Ul ) INS025 nm4nv 1988-2014 The ACORD name and logo are registered marks of ACORD All riahts reserved : Benclix Dr S Bendix Dr b.0 c CiJ a� tip F— y O' U fu fQ . i CL N c� G L N (U a-.+ G� N L S Liberty St S Liberty St M Oj fj > 2 Q C b.o a .�C E w 3 f6 L ti o v� U. 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