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45oU TN %0 APPLICATION FOR THE USE OF, AND BLOCKING OF ACCESS TO THE PUBLIC o RIGHT-OF-WAY FOR A RESIDENTIAL BLOCK PARTY w City of South Bend, Indiana • Board of Public Works 1865 PERMIT AND AGREEMENT FOR THE USE OF RIGHT-OF-WAY FOR RESIDENTIAL BLOCK PARTIES Pursuant to Local Ordinance No. 10224-13, there is a $50.00 non-refundable fee for 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, 4ch Floor, County -City Building, 227 W. Jefferson Blvd., South Bend, Indiana. 2. Block parties are allowed solely for neighborhood events. No block parry application will be approved for private parties. 3. All residents within the affected area must be notified of this event. The APPLICANT must obtain signatures from and/or has made an attempt to notify all residents that reside on the block. A copy of a brochure or letter of invitation distributed to all affected neighbors describing the event purpose, date, and time must be included with the application. 4. The cones will be delivered to the APPLICANT'S address. The APPLICANT assumes full responsibility for clean-up and assures the City that all cones will be maintained and returned undamaged. 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 Board of Works 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 Board of Public Works 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 condition of the South Bend Municipal Code and Board of Public Works' policy adopted in Resolution No. 21-2011 on February 28, 2011 11. 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 a party or similar event. The undersigned certifies that he/she is authorized to bind the APPLICANT to the terms hereof. 12. Notification of approval/denial of this request will be issued by return of this form, upon signed authorization by the Board of Public Works.