Special Event - Livestrong at the YMCA 5K - August 7

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Will there be any musical entertainment features at the event? ❑ Yes ® No If yes, describe the type of music, schedule of sound check/performances, and the names of any artists performing: For stage inspections, contact the Department of Homeland Security at 317-232-2222. If your route crosses over a state road or a bridge please contact the following for permission: State, INDOT: County bridges: Michael Hurt Andy Hayes 219-235-7528, Mhurtl@indot.in.gov 574-235-9626, ahayes@co.st-joseph.in.us Section E - Food Are you having food at your event (food vendors, caterers, food trucks, etc.)? ❑ Yes 0 No o If yes, the event coordinator must apply for and receive a St Joseph County Health Department Temporary Event Permit. o Vendor(s) must also apply for and receive a St. Joseph County Health permit. Health Permits must be filed with the county 30 days prior to the proposed event. Each vendor must obtain necessary permits to serve on-site and display these permits at the event. o All applications and guidelines can be found at the St. Joseph County Health Department Food Service website: sichd.ora/food-service. Please select food sales types: ❑ Food Vendor ❑ Caterer ❑ Food Truck ❑ Other: If a Food Truck, please list company name: Describe how food will be cooked and served: Section F - Alcohol Will alcohol be served or sold? ❑ Yes 0 No If no, please continue to Section G - Contingency and Strategic Planning If yes: The applicant must apply for and receive a temporary liquor license from the Alcohol & Tobacco Commission. Indiana ATC forms are located at in.gov/atc/2409.htm. (Temporary Permits are near the bottom of the form list.) Forms must be filed with the district ATC office five (5) days prior to the requested event date. o Application cannot be processed without a copy of this license. A refundable $400.00 deposit paid by card or check (made to City of South Bend) must be submitted with application. c Application cannot be processed without deposit. Deposit will be returned upon inspection of event area by the Board of Public Works. o Events with have alcohol sales must provide security. If your event will be hiring a security company, please provide its contact information in sub -section (a) below. Otherwise, please list the names, phone numbers, and qualifications (e.g. off-duty police officer, professional security guard, or event applicant) of three (3) security guards in the fields provided in sub -section (b).