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APPLICATION ;j;' fF <br />Al <br />FOR USE OF, AND BLOCKING OF ACCESS TO, THE PUBLIC ':w I -FACE <br />RIGHT-OF-WAY FOR NON-RESIDENTIAL BLOCK PARTIES`,'„�_-'z:�,3' <br />iHrs . <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 <br />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 <br />event: <br />Event Name Tree Lighting Ceremony and First Fridays (December 1, 3:30 <br />p.m. to 9.30 p.m.) <br />Location Downtown South Bend <br />(Desedbe Area/Route) <br />Street Closure Name; of Street Washington St. <br />From Michigan St. <br />To Dr, Martin Luther King, Jr. Blvd. <br />Date of Event December 1 20 17 <br />❑ a.m. <br />a.m. <br />Time: Registration/Setup 3:30 ® p,m. Start 5:00 ® p.m. <br />End 9:30 ® P.M. <br />Approximate Number of Attendees 1500 <br />Answer the following appropriately: <br />1. This event will have music (live or other). <br />® Yes ❑ No <br />a. I understand the Noise Ordinance described in the Agreement/Permit <br />® Yes ❑ No <br />2, Required Information to Accompany Application <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 <br />® Yes ❑ No <br />additionally filed with the Office of the City Clerk, Ott' 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 <br />® Yes ❑ No <br />3. <br />a. This event involves City streets <br />® Yes ❑ No <br />b. This event involves County roads <br />❑ Yes ® No <br />c. This event involves State highways <br />[] Yes ® No <br />d. This event involves the use of the sidewalk <br />® Yes ❑ No <br />Updated 4/20t5 1 <br />