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03/06/2023 <br />4 THE; City of South Bend Special Event Application <br />%d` t <br />City and Regional Event <br />$50 application fee if filed 60 days or greater (up to 360 days) in advance of event <br />$100 expedited application fee if filed 30-59 days in advance of event <br />Please Bring Completed Application and Payment to: <br />Public Works Service Center, 731 S. Lafayette Blvd., South Bend, IN <br />Review the Instructions on the Special Events page before completing the application. City and Regional Special <br />Event applications must be submitted more than 30 days in advance of the event date or the application will not <br />be accepted. <br />Date of Application: <br />03/06/2023 <br />Section A - Applicant Information <br />Organization Name: Stanley Clark School <br />Applicant (Contact) Name: Tom Carter <br />Applicant (Contact) Phone: 574-286-5594 Contact Email: scarter829@gmail.com <br />Address: <br />3123 Miami Street <br />City/State/ZIP: South Bend, IN 46614x <br />List any professional event organizer, event service provider or commercial fundraiser that is authorized to work <br />on your behalf to plan, produce and/or manage your event. <br />Organization Name: <br />Contact Phone: <br />Address: <br />Event Name: <br />Clark Run 5K <br />Contact Name: <br />Contact Email: <br />City/State/ZIP: <br />Section B - Event Information <br />Event Type: (Festival, Race, Parade, Other): Race <br />Event Classification: ® Non -Profit' ❑ For -Profit <br />❑ City (Civic) Sponsored ❑ Other (If Other, please describe): <br />'The Special Events Committee may request proof of non-profit status. <br />Provide a brief description and timeline of event (Note: A detailed map plan is required in Section H of this <br />application. The description should be a summary overview.) <br />This is the loth Annual Clark Run. It's a 5K Run and a 3.5K Walk. Both events start at 10:00 AM. We will <br />be returning to the original course route. <br />Date of Event Setup [mm/dd/yy]: 10/21/2023 <br />Time: <br />8:30 AM (Registration) <br />Begin Date of Event [mm/dd/yy]: 10/21/2023 <br />Time: <br />10:00 AM (Run/Walk Starts) <br />End Date of Event [mm/dd/yy]: 10/21/2023 <br />Time: <br />11:00 AM (Race Completes) <br />Event Cleanup Completion [mm/dd/yy]: 10/21/2023 <br />Time: <br />12:00 PM (Event Closes) <br />Total anticipated attendance: <br />200-300 <br />The proposed event will require the closing of: ❑x Streets ❑ Sidewalks <br />