Non Res Block Party - DTSB St Paddy's Day Tent Party and Pub Tour

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APPLICATION FOR USE OF, AND BLOCKING OF ACCESS TO, THE PUBLIC RIGHT-OF-WAY FOR NON-RESIDENTIAL BLOCK PARTIES 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: DOWNTOWN SOUTH BEND, INC SOUTH Address: 217 S. MICHIGAN City: BEND State: IN Zip: 46601 Phone: 574-282-1110 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 ST. PADDY'S TENT PARTY & PUB TOUR Location BAER'S PARKING LOT: 350 S. MICHIGAN ST. SOUTH BEND, IN 46601 (Describe Area/Route) Street Closure Name of Street MICHIGAN ST From WAYNE ST. To WESTERN AVE. Date of Event MARCH 17 20 17 ❑ a.m. ❑ a.m. ❑ a.m. Time: Registration/Setup 12:00 ® p.m. Start 4:00 ®p.m. End 11:00 ® p.m. Approximate Number of Attendees 4500 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, 4ch 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 3. a. This event involves City streets ® Yes ❑ No b. This event involves County roads ❑ Yes ® No c. This event involves State highways ❑ Yes ® No Updated 4/2015 1