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Blair HS Homecoming Parade 2010j Nebraska Department of Roads Special Event Permit D OR ,. ?y Nebraska Department of Roads Applicant: City of Blair Beginning Date/Time: Ending Date/Time: 9-10-2010,2:00 p.m. 9 -10 -2010, 3:00 p.m. Event Name: High School Homecoming Parade This permit is subject to the following conditions: • If the event involves other road authorities, approvals must be obtained and coordinated with those road authorities. • Traffic control shall include appropriate advance event notifications, warning signs, event marshals, event field size, event escorts, traffic detours or delays, uniform peace officer requirements, etc. • The existing posted speed limit on the closed highway segment shall not exceed 35 mph. • Additional conditions and requirements: Approved ❑ Denied I t L 1(9 (ate astric Engineer or Designee Signature te Distribution: Applicant, District Engineer, State Patrol Nebraska Department of Roads Applicat 1 J: r OR Nebraska Oepadinentof Roads Event Name: Event Dates and Times: High School Homecoming Parade 9/10/10 Type of Event: Homecoming Parade ® Total Closure ❑ Partial Closure City Requesting: Estimated Number of Participants: Blair, Nebraska 500 Address: 218 South 16 Street, Blair, Nebraska 68008 Contact Person: Telephone No.: Alien Schoemaker 402- 426 -4191 I (we) City of Blair, Nebraska hereby make application for a special event permit upon the right-of-way of highway - __ -� -- _ -� - - -- - -�- 3 between Milepost 448 and Milepost 449 on 9/ 10/10 between 2 PM and T 3 PM. ----- - - - - -- -- ---- ---------- - - - - -- '_.-_ Date._ ---- -, .-- ----- Time--- --- -- - - - -- -- --- -- - - - - -- Time I (we) agree to strictly conform to the exhibits attached hereto, subject to all terms, conditions, agreements, stipulations and provisions contained in the application and permit, and any other regulations, laws, or ordinances. The existing posted speed limit on the proposed closed highway segment shall not be greater than 40 mph, Event Description: (ATTACH EVENT MAP) Close US Highways 30/75 from 2 PM to 3 PM for the purpose of holding a homecoming parade. Fermittee shall defend hold harmless and indemnify the ,State of Nebraska, .Department of Roads, and its officers, agents, employees, and members from all suits or actions which may result from any activity by the permittee, its officers, subcontractors, agents, employees, guests, andparticipants. Allen Schoemaker 218 South 16" Street Name (please print) Signature 6`18 -10 Date (minimum of 30 days prior to event) City, State, and Zip Code 402 *426 - 4191 Telephone No.___ -_.� APPROVAL MUST BE OBTAINED FROM THE CITY, TOWN, OR COUNTY GOVERNMENT IF THE CLOSURE RESTRICTS THE USE OF ANY ROAD, STREET OR HIGHWAY OF THE AFFEC JURISDICTION, Approved by city or town, if applicable: Approved by county, or other governmental entity, if applicable: Name (please print) I * I Y Phone No. Address Blair, Nebraska 68008 Name (please print) Jul. 15, 2010 8:41AM CITY OF BLAIR (402 .426.4191) No, 5308 P. 2 JUL - 1q -dWJW J5: j2 I-fdUM: 1 H OMP50N R6ENCY 1024264729 TO; 4264195 P.1 GATE (MM/DDjY" no CER TIFI CA TE LI ABIL ITY INSURANCE 7/14/2010 PRODUCER THIS CERTIFICATE 19 1 IJBD AS A MATTER OF INFORMATION HOWARD D, THOMPSON AGENCY � INC, ONLY A CONF50 No RIGHT$ UPON THE CERTIFICATE :1712 WASHINGTON STREET HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR BLAIR, NE b 66008 ALTER THE COVERAGE AFFORD�0 qY THE POLICIES BELOW, 402 -426-4707 INSURIERS AFFORDING COVI =RARE NAIC# INSURED City o air INSURER A: EMC Znsuranca om panles 1N9UR5R B: 218 S 16th Str INSURER C; _ Bl air, NE 68008 INSURER D: ^ COVERAGE$ THE POLICIES OF INSURANCS LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THG POLICY PERIOD INDICATED. NOTWITHSTANDING ANY •REQUIREMENT, TERM OR CONDITION OF ANY CONTRAGY OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 8i ISSUED OR MAY PERTAIN, THE INSURANCE AFFOADED BY THE POLIC198 101= SCRIBED HEREIN IS SUBJECT YO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMIT$ SKOWN MAY tiAVE BEEN REDUC�b BY PAID CLAIMS. INaR DL { 1 2M �2rga; POLICY NUMBER Fa 7 POLICY D T DATE MMI RE LIMITS GENERAL LIABILITY FAC14 OCCURRENCE S 1 , 0 00 }( COMMERCIAL GENERAL LIAB ILITY a aoa�rnnae S l O O. 0 0 Q CLAIMS MADE ® OCCUR _ MED 6XP(Any one pereon) S S j O 0 O A X OD71456 11- 01-09 11-01-10 PERSONAL &ADVINJURv 4 1 1000,000 ' GENERAL AGGREGAYE b 2, 0 0 0 000 GUN1 AGGREGATE LIMIT APPLIEla FEAR; PROpItOTS , COMPIOP AGO a 24 i POLICY DRti LOC AUTOMOSILELIABILIYf COMBINED SINGLE S �. O O O 1 Q Q O ANYAUTO eBI a SOPILYINJURY S ALL OWNEOAD108 acNEDtJLCD AUTOS (P6F Person) . BODILYINJURY A HIRED AUTOS O B 7145 6 11 -01 -09 11- 01-1 NON•OWNEDAUTOS (Pefeaoidoni) 3 PROPERTY DAMAGE $ (PerecclAenq GARAGE LIABILITY AUTO ONLY- FAACCIAENT e OTHERTHAN EAACC ANYAUTO 3 S AUTO ONLY' AG13 EXCESS /UMBRELLA LLAAiLITY EACH OCC URRENCE S 4 000 000 X OCCUR ) CLAIMsMADC AGGRZOATE JS 4, 0 0 0 0 0 0 DL171456 11 -01 -09 11-01--10 � A X bEbU0TI13LE S RETENYION 3 WORMRSCOM K TATT EH• sT EMPLOYEAVLIAOILiTY OH71456 11 - 01-0Q 11- 01--10 C.L.EACHACCIOENY $ 5Q0 r 00_0 ANY PWRIEi RVARTNER/WWWr QFFICERIMEMBER 8XC6J= E-L, DISEASE - EA EMPLOYE $ 5 000 I/yee,dasaibeutAar PECIALPROVISIONSbelm SlL DISEAS -POLICY LIMI'T I S 500,000' OTHER p SCR) PTIONOFOPERATIONSI LOCATION9J /EXCLOSIONSADDEDBY /SPECS PROVISION$ State of Nebraska pepaxtmant of Roade 11sted as additional insur ®d on a p=imary Rand norL baei>a . City of Blair agreGG to Waiv® itm rights Of reoovery against the State. Waivar of Subrogation in favor of the State of Nebraska is inolu4 ®d. E HOLDE State of Nsbraaka, Nebraska Department of Roaaa 4435 south 108th 8t, Omaha, NE 66145 CANCELLATION E►{o1aLb ANY OF THE A80VE OEBCpIBEO POLICIES BE CANCELL0 EEFond THE EXPIRA`rION RATE THEREOF, Y14A ISSUING INSURER WILL ENDFAVOR TO MAI DAYS WRITTEN NOTICE TO THE CERTIFICAYB HOLDER NAMED TO THE LEFT. BUT FAILURE TO PO €O SNAIL IMPOSE NO OBLIGATION OR I.MILITY OF ANY KIND UPON TN6 INSURER, ITS AGENTS OR hrPRESENYAYIVE9 AUA-36A1Ze0_RrAALSENTATPJ5 ACOR029(2001 /68) �^ -6ACORD C RA IP9N 1988 M1___ Is r®177 ��. use of a June 18, 2010 Nebraska Department of Roads District 2 Headquarters Attn: Dale Butler 4435 South 108 Street PO Box 45461 Omaha, NE 68145 -0461 RE: Closing of Highway 30/75 Dear Mr, Butler: The City of Blair would like to request to be allowed to close Highway 30/75 from 14 Street to 18 Street on September 10, 2010 for the High School's Homecoming Parade. I have enclosed a permit application with the required certificate of insurance for the event. If there are any questions, please call me at 402 - 426 -4191. Sincerely, r Allen Schoemaker Director of Public Works EOVAL ROUSIRO OPPORTU14ITY 218 South 16th Street - Blair, Nebraska 68008 - 402 -426 -4191 - Fax 402 -426 -4195 - E -mail cityofblair @ci,blair.ne.us N ebraska D epartment of Road Application for Special Event Permil `� Nebraska Dspartrnent of Roads Event Name: Event Dates and Times: High School Homecoming Parade 9/10/10 Type of Event: Homecoming Parade Total Closure ❑ Partial Closure City Requesting: Estimated Number of Participants: Blair, Nebraska 500 Address: 218 South 16'' Street, Blair, Nebraska 68008 Contact Person: Telephone No.: Allen Schoemaker 402- 426 -4191 I (we) City of Blair, Nebraska hereby make application for a special event permit upon the right -of -way of highway 30175 between Milepost 448 and Milepost 449 on 9/10 between 2 PM and 3 PM. .......... . ... __YN Y _. _ _ -_.r. �_u... ... __...... ) __rr r - -- - -- - -r w Date Time 4 Time I (we) agree to strictly conform to the exhibits attached hereto, subject to all terms, conditions, agreements, stipulations and provisions contained in the application and permit, and any other regulations, laws, or ordinances. The existing posted speed limit on the proposed closed highway segment shall not be greater than 40 mph. Event Description: (ATTACH EVENT MAP) Close US Highways 30/75 from 2 PM to 3 PM for the purpose of holding a homecoming parade. ermittee shall defend, hold harmless and indemnify the State of .Nebraska, Department of Roads, and its officers, agents, employees, and members from all suits or actions which may result from any activity by the permittee, its officers, subcontractors, agents, employees, guests, and participants. Allen Schoemaker 218 South Id' Street Name (please print) Address Signature City, State, and Zip Code _ 6 -18 -10 . ...... __Y__r._� _-- �.�- __�_ -._- ._....._.______ Date (minimum of 34 days prior to event) Telephone No. + ... • j + ' • • • C • Approved by city or town, if applicable: Name (p lease nt) P J� ., Phone No Approved by copnty, o r other governmental entit if applicable: Name (please print) Phone No.��_______ PRINCIPAL Thomas D. Andenson BLAIR HIGH SCHOOL 440 North Tenth, RO, Box 288 , Blair, NE 68008 402-426-4941 Fax 402-426-4949 June 11, 2010 Blair City Council c/o, Rodney Storm, City Administrator Blair, NE 68008 RE: Homecoming Parade ACTIVITIES DIRECTOR Mar4t Ro GUIDANCE DIRECTOR Karen Gengenbach I am writing this letter to ask permission for Blair High School to hold its annual Homecoming Parade on Friday, September 10, at approximately 2:15 P.M. The route we would like to take would be: High School to Park Street West to 16th Street, South on 16th Street to Washington, West on Washington to 18th Street, South to Lincoln and back East to the intersection of 16th and Lincoln. At this point we would like to hold a community pep rally from approximately 2:45 P.M. to 3:00 P.M. lam sure we would need a police escort and would be most happy to take care of any financial obligations this entails. - I appreciate your consideration of this request and hope we will once again, as in the past, be able to hold this parade/pep rally. I will be awaiting your reply. Sincerely, Thomas D. Anderson Principal 1989 US, Dept. ofEducaflon Secondary School RecogoilionAtovard h4ember North Cenual Association of Colleges.and Schools Nebraska Department of Roads Special Permit NDOR Nebraska Department of Roads Applicant: City of Blair Beginning Date/Time: Ending Date/Time: 9 -10 -2010 2:00 p.m. • i i i ii • Event Name: High School Homecoming Parade This permit is subject to the following conditions: • If the event involves other road authorities, approvals must be obtained and coordinated with those road authorities. • Traffic control shall include appropriate advance event notifications, warning signs, event marshals, event field size, event escorts, traffic detours or delays, uniform peace officer requirements, etc. • The existing posted speed limit on the closed highway segment shall not exceed 35 mph. • Additional conditions and requirements: =00= eer or Designee Signature El Denied Da e Distribution: Applicant, District Engineer, State Patrol Nebraska Department of Roads Application. for Special Event Permit '-N DOR Nebraska Department of Roads Event Name: Event Dates and Times: High School Homecoming Parade 9/10/10 Type of Event: Homecoming Parade ® Total Closure El Partial Closure City Requesting: Estimated Number of Participants: Blair, Nebraska 500 Address: 218 South 16 Street, Blair, Nebraska 68008 Contact Person: Telephone No.: Allen Schoemaker 402 - 426 -4191 i (we) for a special event permit upon the right -of -way of highway hereby make application 30/75 between Milepost 448 and Milepost 449 on 9/10/10 between 2 PM and 3 PM. ----- ___- _.__ -- -- -------------- - - - - -- -- -- -- -- - - - - - - - - -- - - - - - -__ ------------ --- - - - Date ime me -- I (we) agree to strictly conform to the exhibits attached hereto, subject to all terms, conditions, agreements, stipulations and provisions contained in the application and permit, and any other regulations, laws, or ordinances. The existing posted speed limit on the proposed closed highway segment shall not be greater than 40 mph. Event Description: (ATTACH EVENT MAP) Close US Highways 30/75 from 2 PM to 3 PM for the purpose of holding a homecoming parade. Permittee shall defend, hold harmless and indemnify the State of Nebraska, Department of Roads, and its officers, agents, employees, and membersfrom all suits or actions which may result from any activity by the permittee, its officers, subcontractors, agents, employees, guests, andparticipants. Allen Schoemaker ------------ - - - - -- --- - - - - -- -------------------- _----------- --- - ------ --- - - - - -- -- - - -- Name (please print) Signature Blair, Nebraska 68008 City, State, and Zip Code 6 -18 -10 402426 -4191 ----- - ----------- - -- ---- Date (minimum of 30 days prior to event) __--- _ --- w ------ -__ .___----- ___ ------- _...___,�__________ Telephone No.-`__ ------ _-- _ ---------------- ____�... APPROVAL MUST BE OBTAINED FROM THE CITY, TOWN, OR COUNTY GOVERNMENT IF THE CLOSURE RESTRICTS THE USE OF ANY ROAD, STREET OR HIGHWAY OF THE AFFECTED JURISDICTION, Approved by city or town, if applicable: ._ 1 _ �'_ — ' _ �_ __� ______��,_ �_ 402 -42 - 4191 - - -M Name (please print) Phone No. 218 South 16 Street Address Approved by county, or other governmental entity, if applicable: a ___------ Name (please print)_..__�. ..___ . -- - Phone No.-- - - - -�- eneral Instructions Pa ini State Highway Clre for ecial Vent Nebraska Department of Roads To close a State highway within a community for the purpose of a bona fide local event, the following will be required: • An official request, in writing, 30 days in advance, will be presented to the NDOR by the city hosting the event. • The city is responsible for meeting the MUTCD requirements for all traffic control. • A contact person(s) for traffic control. • The city is responsible for placing detour signs and for operating and maintaining a suitable detour route. • NDOR will not furnish items such as signs, posts, barricades, or other traffic control devices and will not set up or take down for the local event. • General Liability insurance is required. The permittee shall submit a Certificate of Liability Insurance in accordance with the provisions of Section 7 below. • A signed and dated permit must be received, prior to the event, which approves application for temporary closure of any State road or use of right of way. Section 1. The Nebraska Department of Roads (State) reserves the right to revoke or suspend this permit for noncompliance with the permit conditions and instructions. The State's Maintenance Superintendent shall be notified at least 48 hours prior to the start of the event closure and again immediately after the event is closed and highway is ready for traffic Section 2. By the beginning of any closure, the permittee accepts and is hereby bound by the terms and conditions of this permit. Either this copy or a duplicate copy of the entire permit must be available for inspection on the event location at all times. Section 3. The permittee agrees to accept full responsibility to the public for loss or damage caused by, or directly traceable, to this event on the highway or right of way. The permittee will hold the State harmless from any suits brought against the State arising out of permittee's activities. Section 4. The permit conditions and traffic control information are noted on the face of the permit. If the permittee fails to complete the conditions and requirements prior to the closure, the permit may be suspended or revoked. Section 5. The traveling public shall be protected from the activities of the permittee by means of signs, flaggers and traffic control devices as specified in conditions and in the Manual on Uniform Traffic Control Devices for Streets and Highways. any other federal, state, county, city or other political subdivision's rules, regulations, ordinances or statutes which may regulate the performance or occupation or detouring of traffic being permitted by the State on its highway and right -of- -way. It is the sole responsibility of the permittee to comply with any other governmental or political subdivision's rules, regulations, ordinances or statutes. Section 7. General Liability Limits of at least $1,000,000 per occurrence, $2,000,000 general aggregate. The State of Nebraska, Department of Roads, shall be named as Additional Insured on a primary and non - contributory basis. Applicant agrees to waive its rights of recovery against the State. Waiver of Subrogation in favor of the State shall be added to, or included in, the policy. Automobile Liability Limits of at least $1,000,000 CSL per Accident; Coverage shall apply to all Owned, Hired, and Non -Owned Autos. Workers' Compensation Limits: Statutory coverage for the State where the project is located. Employer's Liability Limits: $100,000 each Accident; $100,000 Disease (per person); $500,000 Disease (policy limit). Applicant agrees to waive its rights of recovery against the State. Waiver of Subrogation in favor of the State of Nebraska, Department of Roads, shall be added to, or included in, the policy. Section 6. The granting of this permit by the State does not relieve the aoolicant from comblvina with Jul, 15, 2010 8.41AM CITY OF BLAIR (402. 426. 4191) JUL- 2010 15:31 FROM :THOMPSON RCENCY #1024264729 TOy4264195 No, 5308 P, 2 P.1 Q� CERTIFICATE OF LIABILITY INSURANCE 7/14/ PRODUC HOWARD D. THOMP AGENCY, INC. 1712 WASKINGTON STREET BLAIR, NE. 66008 402 - 4264707 THIS CERTIFICATE 19 wiLi AS A MATTFR OF INFORMATION ONLY ANQ CONFERS NO RIGHT$ UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFOROM OY THE POLICIES BELOW. INSURIEOS AFFORDING COVFRAoE NAIC# I NSURED city CI lair 216 S 16th S tre et Blair, NE 66008 INsu13E:R a: EMC Insl7 C o mpaniei LIMITS INSUP46P B: _ GENERAL LIABIL(TY INSURER C: 1 000 INS D: SIESI a aoaumnee _ S INSURER E; !vA \/ t7 wrace THE POLICIES OF INSURANCE LISTER BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWiTHSTAND(NG ANY -REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WI RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED RY TIDE POLIGIl=S orm SCRIBED HEREIN is SUBJECT To ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY JiAVE BEEN 116DUGE) 8Y PAID CLAIMS. { INDR CZ POLICY NUMBER Fo y M D T DATE LIMITS _ GENERAL LIABIL(TY EACH OCCURRENCE S 1 000 X COMMERCIAL G):NERAL LIABILITY SIESI a aoaumnee _ S 100 0 00 CLAIMS MADE ® OCCUR MED EXP(Any one person) 6 5 A X 007,145E 11-01 -09 11-01-•10 PERSONAL& VINJURY a 1 000 000 (GENERAL AGGREGATE 4 2,0 000 K xriN _ POL,CYE i 2w 'L AOf�REAATE LIMIT APPLIES PER; PRDOUCT'S , COMP /OP AGO o 0 0 0 , 0 0 O LOC AU TOMOSILELIABILIIY COMBINED SIN ©LE LIMIT l 000 F 000 ANYAUTO (ES Mddenl) SODILYINJURY S ALL OWNEOAUTOS ScHEDtiLGD AUTOS (Per person) SODILYINJU 3 A HIRED AUTOS OE71456 11 -01 -09 11 - -10 NON•DWNEDAUTO$ (Pereacidoni) PROPERTY DAMAGE S (Perecodeni) GARAGELMILITY AUTO ONLY -EA ACCIDENT Q , ANYAUTO OTHERT14AN EsAACG $ AUTU ONLY: Anti $ EXCE391UM6Rtri.LA LABILITY RACH OCC URRENCE $ 4 000 000 x OCCUR ) CLI►1MSNIADE A©GAPGATE 18 , 000 000 bL171456 11 -01 -09 11-01 -10 � A X bEwowi i5 RETE NYION 3 x JA WORKERSCOMPENSATIONAND EMPLOYERS'LIABILITY OH71456 11- 01-0Q 11- 01-10 EH• G.L.FACHACCIDENY $ 500 L 000 A O FFICF�EMBBPR WWWDSM G �� E•L. DI SEASE - EA EMPLOYE $ SOO 000 If yyes,desaibednder PECIALPROVISIONS below E,L, DISEASE POLICY LIMIr $ 500,000 OTHER p SLRIPTIONOPOPERATIONSILOCA7 IONS /WHICLES /EXCLUSIONS ADDED BYENDORSEMENTIB � PEC PROVISION$ State of Nebraska Department of Roads listed au additional incur ®d on s Qri.mw�y and non-contributory bae l a . City of Blair agrees to waive its ri4hta of recovery against the State. waiver of Subrogation in favor of the State of Nebraska is inolu4: ®d. State of Nebraska Nebraek•a Department of Roads 4435 South 108th St. Omaha, NE 68145 GANGCLLA1ILJN 13HOlULb ANY OF THE ABOVE DEBCRIBEO POLICIES BE CANCEE.LEO EE90111! `PIill EiXPIRAYION DATE TH9REOF, T1121SSUINO INSURER WILL ENDEAVOR TO MA(L_ DAYS WRITTEN NOTICE TO THE CERTIFICAYE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SML IMPOSE NO OBLIGATION OR 1."ILFTY OF ANY KIND UPON THS INSURER, ITS AGENTS OR REPI3ESENTATiVE9 AcORD2G(ao01 /t)8) �^ � ACORD RA 1WN1A86