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APPLICATION FOR USE OF <br />The Board of Public Works must have FOUR (4) weeks prior notice of the <br />Sponsor:, Submitted By: <br />Address: <br />City:la <br />State, Zip: qb7 Phone: <br />Email:! 'Q1,41 <br />Sponsor may use the public right-of-way described as (describe route and attach. -map) <br />PLEASE NOTE: THE SOUTH BEND POLICE DEPARTMENT RESERVES THE RIGHT TO <br />CHANGE YOUR ROUTE FOR SAFETY PU <br />Event name: <br />The'Board of Public Works Must have OUR weeks prior ffot;tc'eVmZF67v-e-nTMTurs- . <br />All certificates of insurance, pre -paid costs, maps, and any other applicable information requested <br />or r6quired by the Board of Pit Works have- been provided with this applicationI <br />The event shall be held on AZO 0J2 and no other date <br />Registration time for the event starts at a.m. 'oo <br />6130-m. lee <br />Starting time of the procession is <br />Estimated completion time is fr-_190a.m. m <br />9M <br />This event involves the use of the following roadways <br />This event involves closure of City residential streets <br />This event involves County roads, <br />This event involves State highways <br />This event involves use of a park (Must obtain permission from Park Board) <br />❑ I understand that I must arrange a meetingwith all affected governmental agencies to <br />organize the above event.(Call Marcia Qualls, Customer Service Manager, 235-5939 <br />to organize meeting) I <br />This event involves the use of the sidewalk <br />El Participants must stay on the sidewalk and obey all traffic laws. <br />This event is oca regional/national event (Please circle the appropriate event type) <br />This event wPifle (coordinated with the property owner/business where staging will take place <br />Updated 08/2017 2 <br />