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HomeMy WebLinkAboutNon Res Block Party - Urban Adventure1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND. INDIANA 46601-1830 Mr. Jonathan Jones 2203 Basin Street South Bend, IN 46614 � O SOU TH BAN Al U ^ IC7',' PR CR iy;] 1865 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS July 26, 2016 PHONE 574/235-9251 FAX 574/235-9171 RE: Event Name: Urban Adventure Street Closure: South Lafayette Boulevard from West Monroe St to West Western Ave Dear Mr. Jones: The Board of Public Works, at its meeting held on July 26, 2016, approved your request to close the above referenced street for your event scheduled for July 30, 2016 from 7:30 a.m. until 2:00 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 the street. 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 M. Martin, Clerk Enclosure c: Gene Eyster, Police Department Federico Rodriguez, Fire Department Marcia Qualls, Streets Ed Gleckler, Traffic & Lighting Adam Burck, 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 7/11/2016 TO: J d Gleckler, Traffic & Lighting a/Gene Eyster, Police Department orbitt Kerr, Engineering Chris Dressel, Community Investment /Federico Rodriguez, Fire Department "J Marcia Qualls, Engineering Paula Garis, Park Department Adam Burck, Downtown South Bend (aburck@downtownsouthbend.com) FROM: Linda M. Martin, Clerk✓ SUBJECT: Non- Residential Block Party LOCATION: S. Lafayette Blvd. from W. Monroe to W. Western DATE AND TIME: July 30, 2016 SPONSOR: Urban Adventure DATE DUE: July 19, 2016 FAX OR E-MAIL TO: 235-9171 / Imartin ftouthbendin.gov RECOMMENDATIONS AND COMMENTS: By Date 0450U TH gory APPLICATION z FOR USE OF, AND BLOCKING OF ACCESS TO THE PUBLIC w MCH RIGHT-OF-WAY FOR NON-RESIDENTIAL BLOCK PARTIES " a� 1865 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: Jonathan Address: 2203 Basin St. City: South Bend State: IN Zip: 46614 Phone: (574)707-5345 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 Urban Adventure Games Location downtown South Ben Street Closure Name of Street S. Lafayette Blvd. Notre Da (Describe and Downtown Mishawaka. From W. Monroe St. To W. Western Ave. Date of Event Saturday, July 30th 20 16 ® a.m. ® a.m. Time: Registration/Setup 7:30 ❑ p.m. Start 8:00 El P.M. , ❑ a.m. End 00 Xp.m. Approximate Number of Attendees 1,200 Answer the following appropriately: 1. This event will have music (live or other). ® Yes ❑ No a. I understand the Noise Ordinance described in the Agreement/Permit ® Yes ❑ No 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 ❑ Yes ❑ No additionally filed with the Office of the City Clerk, 41h Floor, County - City Building, 227 W. Jefferson Blvd., South Bend, Indiana. c. Certificate of Insurance d. Maps, drawings of the area and setup plan ❑ Yes ❑ No k�' a. This event involves City streets ® Yes ❑ No b. This event involves County roads ❑ Yes ❑ No c. This event involves State highways ❑ Yes ® No d. This event involves the use of the sidewalk ❑ Yes ❑ No Updated 4/2015 1 e. This event is a local/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 Qualls, Customer Service Manager, 235-5939 to organize meeting). ® Yes ❑ No IF 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. F SOU T(J &t O Nd City of South Bend, Indiana • Board of Public Works W r PERMIT AND AGREEMENT FOR THE USE OF $865 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 of the 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 of Public 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 29th day of June 20 APPLICANT Signature Printed Name I BOARDOF PUBLIC WORKS APPROVAL Presitlent Member Member k %1 i '/�Z 6 Member Me ber 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 • E-Mail: publicwks@southbendin.gov State of Indiana Office of the Secretary of State CERTIFICATE OF INCORPORATION of URBAN ADVENTURE GAMES, INC. I, CONNIE LAWSON, Secretary of State of Indiana, hereby certify that Articles of Incorporation of the above Non -Profit Domestic Corporation have been presented to me at my office, accompanied by the fees prescribed by law and that the documentation presented conforms to law as prescribed by the provisions of the Indiana Nonprofit Corporation Act of 1991. NOW, THEREFORE, with this document I certify that said transaction will become effective Wednesday, December 03, 2014. In Witness Whereof, I have caused to be affixed my signature and the seal of the State of Indiana, at the City of Indianapolis, December 3, 2014. CONNIE LAWSON, SECRETARY OF STATE 2014120402819/2014120485862 organization exempt from federal taxation under Section 501(c)(3) of the Code and the Regulations or the corresponding provisions of any subsequent federal tax laws. ARTICLE VI. Registered Agent and Registered Office The name and street address of the Corporation's Registered Agent and Registered Office for service of process is: Lynn Kachmarik, 54438 Old Bedford Trail, Mishawaka, Indiana 46545. The undersigned Organizer represents that the registered agent named herein has consented to the appointment of registered agent. ARTICLE VII. Membership The Corporation shall not have members. ARTICLE VIII. Provisions for Conduct of Affairs of Corporation Section 8.01. Management of Corporation. The affairs of the Corporation shall be managed by the Board of Directors of the Corporation. Section 8.02. Number. The number of Directors may be fixed from time to time by the Bylaws of the Corporation. Section 8.03, Code of Bylaws. The Board of Directors of the Corporation shall have the power to make, alter, amend or repeal the Bylaws of the Corporation. Section 8.04. Limitation on Powers of the Board of Directors. Notwithstanding any contrary provisions in these Articles, the Board of Directors shall not have the power or authority to take or authorize any action which shall deprive the Corporation of its status as an exempt organization under the provisions of Section 501(c)(3) of the Code. Section 8.05. Amendment of Articles of Incorporation. The Board of Directors of the Corporation has the right to amend, alter, change or repeal any provisions contained in these Articles of Incorporation or in any amendment hereto, in any manner now or hereafter prescribed or permitted by the Act or any amendment thereto; provided, nevertheless, that such power of amendment shall not authorize any amendment which would have the effect of disqualifying this Corporation as an exempt organization under the provisions of Section 501(c)(3) of the Code, or such equivalent provision as may hereafter exist from time to time. Section 8.06. Indemnification. The Corporation shall indemnify every person who is or was a director or officer of the Corporation (each of which, together with such personas heirs, estate, executors, administrators and personal representatives, is hereinafter referred to as an Indemnitee) to the fullest extent permitted by Chapter 16 of the Act, provided that such person is determined to have met the standards of conduct specified in the Act. Further, the Corporation shall, to the fullest extent permitted by the Act, pay for or reimburse the reasonable expenses incurred by every Indemnitee who is a party to a proceeding in advance of final disposition of ARTICLES OF INCORPORATION — URBAN ADVENTURE GAMES, INC. PAGE 2 IN WITNESS WHEREOF, the undersigned incorporator of said Corporation, executes these Articles of Incorporation and verifies, subject to penalties of perjury, that the statements contained herein are true - Executed this 4ay day of Olt2014. N LIr chmarik, Incorporator SBDS024529070 ARTICLES or INCORPORATION -- URBAN ADVENTURE GAMES, INC. PAGE 4 ACORO® CERTIFICATE OF LIABILITY INSURANCE ilr.. DATE(MMIDD/YYYY) 7'/18/2016 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 CONTACT NAME: ZZBllsiness Group PHONE 10 Ex,(800)814-2122 ac No:1e00)936-2122 Gibson Insurance Agency, Inc. 130 S Main St, Ste 400 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIL If PO Box 11177 INSURERA:Cincinnati Specialty Underwriter 13037 South Bend IN 46601-0177 INSURED INSURER B Urban Adventure Games INSURERC: PO Box 63 INSURER D NSURER E Granger IN 46530 1. URERF: COVERAGES CERTIFICATE NUMBER:7-29-16 to 7-30-16 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. INSR LTR TYPE OF INSURANCE AD L SUBR POLICY NUMBER POLICY EFF (MMIDDnYYYYI POLICY E%P IDDIYYYYMOCCURRENCE LIMITS X COMMERCIAL GENERAL LIABILITY NCE $ 11000,000 A CLAIMS -MADE �X OCCUR NTED ccurrence 100,000 $CSUOOe7023 ne person) $ Excluded 7/29/2016 7/30/2016 V INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY [:]JEBT r7 LOG PRODUCTS-COMP/OP AGG $ 2,000,000 $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea..itlent $ _ BODILY INJURY (Per person) ANVAUTO $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accitlent ( ) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Peraccitlent $ is UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $. WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITV YIN STATUTE ER E.L. EACH ACCIDENT $ ANY PROPRIETORRARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? NIA E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under E.L. DISEASE -POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) South Bend Parks Department 321 E. Walter St. South Bend, IN 46614 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/JAIMIE CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS02512m4nn Google Maps Page 1 of 1 Go gle Maps Imagery 02016 Google, Map data ©2016 Google 100 ft https://www.google.com/maps/@41.6718169,-86.2510814,329m/data—!3ml!le3 7/19/2016