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Sftlfon L - Permit_i Agement <br />1 Pursuant to Loea1 Ordinance No 106:91a mere h a S5000 non-•efundable fee for Tie' II and III eve -t <br />appkcabons tiled 60 or greater days Ir advance of the event or, A $100 non-refundable e.pednted fee for <br />appficariont filed between 30 and 59 days ,r advance of the evmL <br />Tqe APPLICANT must comply with all term; and Conditions of Inns Permit and Agreement <br />The APPLICANT must obtain signatures from and, or make an arer.rpt to ndhfy all -es,dent; that resile <br />on the bkxk A copy of A lWMhum a door <br />destirtim Me event ur d cW dstrlbuted to all affected restdentslbusksesses <br />g D Dose date. bene and contact mfonnabon must be included wrth the <br />attachmerfts to this apokatwn The appincarnt is responsible for Providing affected ms,oents and <br />business owner wdt transportation to their property <br />The APPLICANT shall �eunburse t^e Boa•d to, [ <br />necessary he act,.al cost to the Gb rot the eve^[..t deenud <br />5 Notification of approval denial of this feouest w.11 be issued by feturr. of this form. upa' signed <br />authonzabon by Me Special Events Committee <br />6 The APPLICANT shag Provide to the Bond a Certificate of knNKance showing a liability Dokcy ,n fu11 <br />force and effect wrth limits of S700.000.00 Per occurrence and $1.000.000.00 aggregate <br />for this event and the City of <br />South Bend. Sper,al Events ComrWee. and Board of Pubgr works listed as an additional named irnured <br />7 The APPLICAW assumes fug mSc Ohsib lnv for provding ample disposal containers tx ref6se mizyckng <br />and assures the Area will be cleaned up upon the :onctusdn of The event <br />B Barr"Oes wig be dekvered and Picked uP at the event ocaborr The APPLICANT n responsible for <br />seeing that all cones are maintained and returned undamaged <br />9 The APPLICANT *-If follow the C h, Of South Bend Noise Ordmrce which a ,n effect at all hours. <br />Between the hours of 11.00 D M. and 700 a.m. certain mases Are parbcularfy, Prohibited These include <br />Opefat,ng radio receiving sets. mU51Cat MStfUnlen[S <br />audible fiftyPhOnograc*s and other sound reproduction snc <br />dees d <br />1501 feet away as well as shouting, yelling. fdot,ng whrsding or sngmg 'n me streets n a <br />manner to disturb the peace fMurocrpal Code 17-571 <br />1n; The APPLICANT assures the C,ty mat the area v,11 be closed durng the times indicated on the <br />appkcatdn only Event end limes are Pursuant to the recommendations of the South Bend Poke <br />Deoartmmt. <br />I have read the APokcatwn and the Permit and Agreement for This Special Event and I affirm the truth of <br />the In/OnmMIOn provided by me to the bust of my knowledge I understand and agree to the above rules <br />and regulationsand any applicable state and federal taws I also understand that this application rtyv be <br />denied based on any'alse a incomplete �rformation. <br />Date 418121 <br />Appacanf Srgnaturer.-C(UL1tML0r-- <br />DnntM Name Court"Kipker <br />--- <br />SPECIAL ENT SCOMMITTEEAPPROVAI--------�— <br />ResidentMember <br />.nn <br />------ - `---'__-- <br />------------ --------- <br />ember Member Date <br />