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APPLICATION FOR SIDEWALK CAFE PERMIT <br />CITY OF SOUTH BEND, INDIANA <br />DATE 4/5/19 <br />FEE PAID $mmlm0i ucl <br />Applicant's Legal Name John MBaranTitle <br />Business Name The General Deli & Cafe <br />Address 609-613 E. Jefferson Blvd. <br />Telephone Number 574-220-6659 <br />Proposed Location and Description of Sidewalk Cafd <br />Street side scating, for deli customers at Cafd tables and laicinic tables l"a,cine Jefferson Blvd. <br />Days of Sidewalk Cafd Operation Sun 1 Mon Tues Wed Thurs Fri Sat <br />p__ 1p a-llp 7a-llp 7a-1lp 7a-llp 9a-111 <br />Hours of Sidewalk Cafe Operation "9a-9 7 <br />The following information is REQUIRED for completion of a Sidewalk Cafd Application: <br />1. Completed/signed application, including a $10.00 fee <br />2. Drawing(s) and description of proposed sidewalk Cafd showing placement/dimensions of proposed <br />Cafd <br />3. Completed/signed Agreement <br />4. Certificate of Insurance ($1,000,000/occurance and $300,000/person, naming the City of South Bend <br />as additional insured) <br />AFFIRMATION <br />I, the undersigned, agree that I will abide by all of the provisions of Section 18-15 of the South Bend Municipal <br />Code and with all the provisions stated above as conditions of the issuance of this Permit. I further agree to <br />indemnify, defend and hold harmless the City of South Bend from any liability, loss, cost, damage or expenses, <br />including attorney fees, which the City may suffer or incur as the result of any use of the public sidewalks for a <br />sidewalk Cafd as permitted herein. I do hereby certify and affirm that all the information given in this application is <br />true to the best of my knowledge. <br />4/05/2019: , <br />Date Si' iatttre of alit ant <br />John M. Baran y II <br />Printed Name <br />_Owner <br />...................................................w�........... <br />....................... <br />...-......... <br />_......._. <br />BOARD OF PUBLIC WORKS APPRO"AIn <br />, il <br />President.......... Me1b"i'beI� �-...._ ...�.�._. �' <br />WAA <br />etar ....... ... <br />C <br />....................._ .... ��.,.,.,.�.,..._......_..... �..m ��.._. <br />Member Member Date <br />RETURN FORM TO: 4 <br />Board of Public Works <br />1316 County -City Building <br />227 West Jefferson Boulevard <br />South Bend, IN 46601 <br />Phone: (574) 235-9251 * Fax: (574) 235-9171 <br />