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APPLICATION FOR USE OF AND BLOCKING OF ACCESS, TO PUBLIC RIGHT-OF-WAY FOR A RIESIDENTIAL BLOCK PARTY City of South Bend, Indiana e Board of Public Works, PERMIT AND AGREEMENT FOR THE USE OF RIGHT-OF-WAY FOR BLOCK PARTIES I Pursuant to Local Ordinance No. 10102-11, there is a $50.00 non-refundable fee for residential Block Patties, Non-profit organizations meeting Section 501(c)(3) of the Internal Revenue Code are exempt fi-orn the fee provided copies of the 501 (c) (3) Internal Revenue Exemption Status Document and a current copy of Form 990 or Form 9990�-EZ are filed with this application. 2. Block parties are allowed solely for neighborhood events. No block party application will be approved for private patties. 3. All residents within the affected area must be notified of this event. The APPLICANT must obtain signatures from and/or has made an attempt to notify all residents that reside oil the block. A copy of a brochure or letter of invitation distributed to all affected neighbors describing the event purpose, date, and time must be included with the application, 4. The applicant is responsible, prior to the event, for determining if there are any residents affected that could potentially need assistance in accessing their residence. The applicant is responsible for providing said resident access or transportation to their property. 5. The cones will be delivered to the APPLICANT'S address. The APPLICANT assumes full responsibility for clean-up and assures the City that all cones will be maintained and returned undamaged. The APPLICANT will be liable for the replacement cost of $50.00 per cone as a result of any missing or damaged cones. G. Block parties must end by 8:00 p.m. 7. A street will be blocked off from intersection to intersection only. No half -blocks or alleys can be blocked off. 8. The Board of Works reserves the right to deny any block party application based on traffic and speed limit records. No street may be closed with a speed limit over 30 MPH or considered to be a major arterial. 9. The Board of Public Works reserves the right to deny any block party application based on information gathered from the South Bend Police Department or other sources. 10. The APPLICANT agrees to allow residents that live on the above -referenced block access in and out of the restricted area as needed. 11. The APPLICANT agrees to abide by all terinsand condition of the South Bend Municipal Code and Board of Public Works' policy adopted in Resolution No. 21-2011 on February 28, 201 I 12. APPLICANT agrees to indemnify, defend and hold harmless the Civil City of South Bend, Indiana, fi-om any liability, loss,, costs, damages or expenses, including attorney fees, which the Civil City of South Bend, may suffer or incur as a result of any claims or actions which may be made by any person, including a participant in the activity, arising out of the approval of this request by the Board of Public Works to close a portion of the public right-of-way for a party or similar event. The undersigned certifies that he/she is authorized to bind the APPLICANT to the