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1, This event will have music (live or other), <br />x❑ Yes <br />❑ <br />No <br />a. <br />I understand the Noise Ordinance described in the Agreement/Permit <br />x❑ Yes <br />❑ <br />No <br />2. Required 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 Docuinent and a current copy of <br />Form 990 of Form 990-EZ are included with this application, and <br />x Yes <br />❑ <br />No <br />additionally filed with the Office of the City Clerk, 4'1' Floor, 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 />x❑ Yes <br />❑ <br />No <br />3. <br />a. <br />This event involves City streets <br />x❑ Yes <br />❑ <br />No <br />b. <br />This event involves County roads <br />❑ Yes <br />❑x <br />No <br />c. <br />This event involves State highways <br />❑ Yes <br />❑x <br />No <br />d. <br />This event involves the use of the sidewalk <br />x❑ Yes <br />❑ <br />No <br />e. <br />This event is a loctegr;Inational event (Please circle the <br />x❑ Yes <br />ElNo <br />appropriate event <br />£ <br />Affected property/business owners have been notified of this event, <br />x❑ Yes <br />❑ <br />No <br />g.' <br />I und6starid that I must arrange a meetirig with all affected <br />governmental agencies to organize the above event (Call Marcia <br />x Yes <br />❑ <br />No <br />Qualls, Customer Service Manager, 235-5939 to organize meeting). <br />11I+ 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, RY& ` <br />* Application cannot be processed without deposit. At sft Fe , xq <br />w Deposit will be returned upon inspection of event area by the Board of Public Works, &4 [ A Vi i <br />Names and phone ntunbers of THREE security guards ptt)J1 <br />To monitor underage drinking. <br />® Qualifications must be listed (e.g. Off -duty police officer, professional security gu�yr& <br />APPLICANT). <br />A drawing must be submitted showing. <br />Fencing around serving area <br />Trash receptacles. <br />o Ample trash receptacles intrst 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 />