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APPLICATION <br />FOR USE OF AND BLOCKING OF ACCESS TO THE PUBLIC <br />RIGHT-OF-WAY FOR NON-RESIDENTIAL BLOCK PARTIES <br />The Board of Public Works must have FOUR (4) weeks prior notice of the event. <br />A NON-REFUNDABLE APPLICATION FEE OF $125.00, IN THE FORM OF A CERTIFIED <br />CHECK. OR MONEY ORDER, PAYABLE TO THE CITY OF SOUTH BEND, MUST BE <br />INCLUDED WITH APPLICATION. <br />❑ Fee Paid <br />Applicant Name: Downtown South Bend, Inc. <br />Address: 217 S. Michigan St, City: South Bend State: IN Zip: 46601 <br />Phone: 574-968-7293 <br />This application is made to the City of South Bend, Indiana, Board of Public Works, for the use of the <br />specified public right-of-way by Applicant for the holding of the hereinafter described event: <br />Event Name <br />Location <br />Art Beat (August 19, 11 a.m. to 7 rn.) F,iti / Te 4 . l a_ /� <br />Downtown South Bend C/ <br />(Describe Area/Route) <br />Street Closure Name of Street Michigan St. from C01faX to West"n Ld Yt,� <br />From Washington St, from TCU to MLK <br />Jefferson from Leighton Garage to MLK <br />To MLK from 1 to Jeffe s� l <br />Date of Event August i& I -� 20 17 ti <br />lffk-® a.m. <br />8/ , ❑ a.m. 8/19, ❑ a.m. <br />Time: Registration/Setup 6:00 ® p.m, Start . End 1-t.00 ® p.m. <br />Approximate Number of Attendees 12,000 q <br />Answer the following appropriately: <br />1. This event will have music (live or other). <br />® Yes ❑ No <br />a. <br />I understand the Noise Ordinance described in the Agreement/Permit <br />® Yes ❑ No <br />2. Required <br />Information to Accompany Application <br />a. <br />Certified Check or Money Order in the Amount of $125.00, or: <br />b. <br />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 <br />Yes ❑ No <br />additionally filed with the Office of the City Clerk, 41" FIoor, County - <br />City Building, 227 W. Jefferson Blvd., South Bend, Indiana. <br />c. <br />Certificate of Insurance <br />d. <br />Maps, drawings of the area and setup plan <br />® Yes ❑ No <br />3. <br />a. <br />This event involves City streets <br />® Yes ❑ No <br />b. <br />This event involves County roads <br />❑ Yes ® No <br />Updated 4/20I5 1 <br />