Occupancy Permit Extension - Contract Land Staff

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City of South Bend/Public Works 0,0UT11,0 227 W. Jefferson Blvd 0 South Bend, IN 46601 4 1"k f;A(M 0 Application and Permit 1865 * Affowing Extended Occupancy of City Right of Way Applicant: Contract Land Sta:ff for Black and'! Veatch Date: 09-14-2018 Applicant Address: 11401 Lamar Avenue, Overland Park, KS 66211 Project Site Address: Where Belleville Circle runs into S. Lombardy Drive in SW South Bend Note: Occupancy limited to street(s) immediately in front of construction site, Nature and extent of Occupancy (e.g.: proposed construction activities, equipment proposed to occupy public (ight-of-way, construction deliveries, etc.): This is an aerial electrical transmission line rebuild and the crew needs access to reach the tower site. I have included the original permit issued along with overheads with this submission. New Expiration date requested would be November 5, 2018. Signature of A THE TERMS AND PROVISIONS OF CHAPTER 6, ARTICLE 5 and CHAPTER 18, ARTICLE 7, Sec 18-62 OF THE SOUTH BEND MUNICIPAL CODE ARE INCORPORATED HEREIN IN THEIR ENTIRETY. FAILURE TO COMPLY WITH THESE PROVISIONS SHALL RESULT IN CANCELLATON OF THIS PERMIT. THIS PERMIT SHALL BE CONDITIONED UPON THE EXECUTION AND FILING WITH THE BOARD OF PUBLIC WORKS OF A BOND IN AN AMOUNT APPROVED BY THE BOARD OF PUBLIC WORKS, CONDITIONED TO INDEMNIFY, SAVE AND KEEP HARMLESS THE CITY OF SOUTH BEND, INDIANA, FROM ANY AND ALL LOSS, EXPENSE, COST OR LIABILITY OF ANY KINDS WHATSOEVER WHICH THE CITY MAY SUFFER OR BE PUT TO FROM OR BY REASON OF ANY ACT OR THING DONE OR NEGLECT TO BE DONE, OR BY VIRTUE OF THE AUTHORITY GIVEN IN SUCH PERMIT. TO BE COMPLETED BY CITY STAFF ONLY. Bond Amount: $ Date Bond Filed: IA14 Compliance with CH 6, ART 5 and CH 18, ART 7, Sec 18-62 of the South Bend Municipal Code ElFee Paid Date Issued: Z�2 L Issued By: 02 BOARD OF PUBLIC WORKS Presid Member Membe,/ Member