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3 <br />a. Certified Check or Money Order in the Amount of $125.00, or: <br />b. For Certified Nonprofit Organizations: Copies of the 501(c)(3) <br />Internal Revenue Exemption Status Document and a current copy of <br />Form 990 of Form 990-EZ are included with this application, and x Yes ❑ No <br />additionally filed with the Office of the City Clerk, 4' Floor, County - <br />City Building, 227 W. Jefferson Blvd., South Bend, Indiana. <br />c. Certificate of Insurance <br />d. Maps, drawings of the area and setup plan x❑ Yes ❑ No <br />a. This event involves City streets <br />x❑ <br />Yes ❑ <br />No <br />b. This event involves County roads <br />R <br />Yes ❑x <br />No <br />c. This event involves State highways <br />❑ <br />Yes ❑x <br />No <br />d. This event involves the use of the sidewalk <br />x❑ <br />Yes ❑ <br />No <br />e. This event is a local/regional/national event (Please circle the <br />x❑ Yes ❑ No <br />appropriate event type) <br />f. Affected property/business owners have been notified of this event. <br />x❑ Yes ❑ No <br />g. I understand that I must arrange a meeting with all affected <br />governmental agencies to organize the above event (Call Marcia <br />Yes ❑ No <br />Qualls, Customer Service Manager, 235-5939 to organize meeting). <br />x <br />IF ALCOHOL IS TO BE SERVED OR SOLD <br />Alcoholic beverages will be served ❑ Alcoholic beverages will be sold ❑ <br />Certified Check or Money Order for $400.00 must be submitted with application. ❑ <br />• Application cannot be processed without deposit. <br />• Deposit will be returned upon inspection of event area by the Board of Public Works. <br />Names and phone numbers of THREE security guards ❑ <br />• To monitor underage drinking. <br />• Qualifications must be Iisted (e.g. Off -duty police officer, professional security guard, or event <br />APPLICANT). <br />A drawing must be submitted showing: ❑ <br />• Fencing around serving area <br />• Trash receptacles. <br />o Ample trash receptacles must be provided to ensure proper disposal of refuse. <br />Temporary liquor license. ❑ <br />• Call the Alcohol & Tobacco Commission. at (317) 234-4315 for more information. <br />• Application cannot be processed without a copy of this license. <br />