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Section L - Permit & Agreement <br />1. Pursuant to Local Ordinance No. 10628-18, there is a $50.00 non-refundable fee for Tier II and III event <br />applications filed 60 or greater days in advance of the event, or a $100 non-refundable expedited fee for <br />applications filed between 30 and 59 days in advance of the event. <br />2. The APPLICANT must comply with all terms and conditions of this Permit and Agreement. <br />3. The APPLICANT must obtain signatures from and/or has made an attempt to notify all residents that <br />reside on the block. A copy of a brochure or door hanger distributed to all affected residents/businesses <br />describing the event purpose, date, and time must be included with the attachments to this application. <br />4. The APPLICANT is responsible, prior to the event, for determining if there are any residents or business <br />owners affected that could potentially need assistance in accessing their property. The applicant is <br />responsible for providing said resident/business owner transportation to their property. <br />5. The APPLICANT shall reimburse the Board for the actual cost to the City for the event, if deemed <br />necessary. <br />6. Notification of approval/denial of this request will be issued by return of this form, upon signed <br />authorization by the Special Events Committee. <br />7. The APPLICANT shall provide to the Board a Certificate of Insurance showing a liability policy in full <br />force and effect with limits of $700,000.00 per occurrence and $1,000,000.00 aggregate and the City of <br />South Bend, Special Events Committee, and Board of Public Works listed as an additional named insured <br />for this event. <br />8. The APPLICANT assumes full responsibility for providing ample disposal containers for refuse/recycling <br />and assures the area will be cleaned up upon the conclusion of the event. <br />9. Barricades will be delivered and picked up at the event location. The APPLICANT is responsible for <br />seeing that all cones are maintained and returned undamaged. <br />10. The APPLICANT will follow the City of South Bend Noise Ordinance, which is in effect at all hours. <br />Between the hours of 11:00 p.m. and 7:00 a.m. certain noises are particularly prohibited. These include <br />operating radio receiving sets, musical instruments, phonographs and other sound reproduction devices <br />if audible fifty (50) feet away, as well as shouting, yelling, hooting, whistling, or singing in the streets in a <br />manner to disturb the peace (Municipal Code 13-57). <br />11. The APPLICANT assures the City that the area will be closed during the times indicated on the <br />application only. Event end times are pursuant to the recommendations of the South Bend Police <br />Department. <br />I have read the Application and the Permit and Agreement for this Special Event and I affirm the truth of <br />the information provided by me to the best of my knowledge. I understand and agree to the above rules <br />and regulations, and any applicable state and federal laws. I also understand that this application may be <br />denied based on any false or incomplete information. <br />Date: <br />Applicant Signature: <br />Printed Name: <br />President <br />Member <br />SPECIAL EVENTS COMMITTEE APPROVAL <br />Me ber Memb <br />Member <br />Date <br />