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For all municipal business license questions, contact; City of South Bend • Department of Community Investment <br />227 West Jefferson Blvd • Suite 14005 South Bend, Indiana 46601. 574.235.5912 - F: 574,235.9021 <br />CK# 193os7 <br />LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY <br />MUNICIPAL CODE SECTION - 4-39 <br />I. APPLICATION TYPE Check One: New Renewal x <br />II. BUSINESS DATA <br />A. Business Name: LAZ Parking Midwest, LLC <br />B. Business Address: 1228 N. Eddy Street <br />City: South Bend State: Indiana Zip; 46617 <br />C. Mailing Address (If different from above): c/o Heather Mortimer 15 Lewis Street <br />City: Hartford State: CT <br />D. Business Telephone Number: 86U22.7641 x7793 <br />E. Business Fax Number: 860.524.8249 <br />F. E-Mail Address: hmortimer@lazparking.com <br />Zip: 06103 <br />G. Maximum Number of Vehicles that can be parked at facility at one time: 1200 <br />H. Total Number of Parking Spaces at facility: 1200 <br />1. Hours during which vehicles may be stored: 24 Hours <br />H. Premises are (check one): Leased by Applicant x Owned by Applicant <br />If Leased: <br />Owner's Name: Kite Realty Eddy Street Garage <br />Owner's Business Address: 1234 N, Eddy Street, Suite 115 <br />City: South Bend State: Indiana Zip; 46617 <br />Owner's Residential Address: <br />City: <br />State: <br />Zip: <br />J. Insurance Carrier and Amount of Liability Insurance OR Bonding Agent and Amount of Bond: <br />Broker: Amity Insurance Agency/ Lexington Insurance Company <br />For Office Use Only <br />Application Filed FEB 0 8 2017 Public Works Approval <br />Application Fee Paid FEB 0 8 m7lLicense Fee Paid FEB =7_ <br />Sent to Dept_ FEB 0 8 2017 License Number I -7D38 <br />Not Approved <br />Reason <br />3041:d Of PeMac Work - <br />I <br />M <br />