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/'r 6 , SIDEWALK CAFE APPLICATION <br />City of South Bend - Board of Public Works <br />:f 227 W. Jefferson Boulevard, Ste. 1316 <br />3= South Bend, IN 46601 <br />RESTAURANT/BUSINESS INFORMATION: <br />Name of Restaurant/Business: Hammer & Qui II <br />Address of Proposed Sidewalk Cafe:. <br />613 E Jefferson Blvd <br />MailinQAddress:613 E Jefferson Blvd. South Bend, IN 46617 <br />[APPLICANT INFORMATION: <br />Applicant Legal Name. John M Barany Phone: 574-220-6659_ <br />Title: B Owner ❑ Manager ❑ Other <br />Email Adidress:.thegeneraldeli@yahoo.com <br />INCLUDE THE FOLLOWING ITEMS WITH YOUR APPLICATION: <br />1�rCompleted application including $10 fee. Make checks payable to City of South Bend. <br />❑ Site plan depicting the proposed sidewalk cafe showing placement/dimensions. <br />ompleted Agreement <br />5,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 knowledge. <br />Signature of Applicant: Date: -9-b 01 Z� <br />OFFICE USE ONLY. - <br />Date Received: .�'''� Fee Paid: �'�-jJ Approval Date: <br />