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.l SIDEWALK CAFE APPLICATION <br />City of South Bend - Board of Public Works <br />227 W. Jefferson Boulevard, Ste.1316 <br />`= South Bend, IN 46601 <br />RESTAURANT/BUSINESS INFORMATION: <br />Name of Restaurant/Business:h:.,,:Cn' l4- Pat'c k �o <br />Address of Proposed Sidewalk Cafe: 1 2 3 IV -f ' S t , <br />Mailing Address: <br />APPLICANT INFORMATION: <br />Applicant Legal Name: Phone: 5'�-_� <br />Title: ❑ Owner �9 Manager ❑ Other <br />Email Address: <br />INCLUDE THE FOLLOWING ITEMS WITH YOUR APPLICATION: <br />❑ Completed application including $10 fee. Make checks payable to City of South Bend. <br />❑ Site plan depicting the proposed sidewalk cafe showing placement/dimensions. <br />❑ Completed Agreement <br />❑ Certificate of Insurance ($1,000,000/occurrence and $300,000 person naming the City <br />of South Bend 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 <br />South Bend Municipal Code and with all the provisions stated above as conditions of the <br />issuance of this Permit. I further agree to indemnify, defend and hold harmless the City of <br />South Bend from any liability, loss, cost, damage or expenses, including attorney fees, which <br />the City may suffer or incur as the result of any use of the public sidewalks for a sidewalk <br />cafe as permitted herein. I do hereby certify and affirm that all the information given in this <br />application is true to the best of my kn wledg <br />Signature of Applicant: Date: <br />OFFICE USE ONLY: <br />Date Received; .tits Fee Paid��\$�a dO Approval Date: <br />— A� <br />