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APPLICATION <br />C <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 $1.25.00, 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: Mara Wood, South Bend Venues Parks & Arts <br />Address: 301 S. St. Louis Blvd. City; South Bend State: IN <br />Zip: 46617 <br />Phone: 574-235-5799 . <br />This application is made to the City of South Bend, Indiana, Board of Public Works, for the use of the <br />specified public fight -of -way by Applicant for the holding of the hereinafter described event: <br />Event Name Best, Week, Ever. 2018 <br />L6cation Rum Village Park/Mountain Bildng Trails on Gertrude <br />(Describe Area/Route) <br />Street CIosure Name of street Gertrude <br />From Ewing <br />To Chippewa <br />I <br />Date of Event Sunday, June V 20 18 <br />❑ am. ❑ a.m. <br />❑ a.m. <br />Time: Registration/Setup 12:00 [Rp.m. Start 2:00 ❑ p.m. <br />End 6.00 ❑ p.m. <br />Approximate Numiber of Attendees ' 2,000 <br />Answer the following appropriately; <br />1. This event will have music (live or other). <br />x k❑ Yes ❑ No <br />a. I understand the Noise Ordinance described in the Agreement/Permit <br />xM 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, 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 <br />xR Yes ❑ No . <br />3. <br />a. This event involves City streets <br />x® Yes ❑ No <br />b. This event involves County roads <br />[j Yes E]x No <br />c. This event involves State highways <br />❑ Yes ©x No <br />d. This event involves the use of the sidewalk <br />❑ Yes Mx No <br />Updated 4/2015 <br />1 <br />