Special Event - SBC-5K Peace Run - August 19

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City of South Bend Special Event Application t \s\) City and Regional Event • y'. $50 application fee if filed 60 days or greater (up to 360 days) in advance of event $100 expedited application fee if filed 30-59 days in advance of event Please Brine Completed Application and Payment to: Public Works Service Center, 731 S. Lafayette Blvd„ South Bend, IN Review the Instructions on the Special Events page before completing the application. City and Regional Special Event applications must be submitted more than 30 days in advance of the event date or the application will not be accepted. Date of Application: Organization Name: C) L jic A M t L' 10AYIC Applicant(Contact)Name: Jen-,4.Iln 1kV'A'%e,S t Applicant (Contact) Phone: C514)356- LOW Contact Email: At Address: (10-2jS iv�.�� City/State/ZIP:t.��i e Tt.� LEfoGS'T List any professional event organizer, event service provider or commercial fundraiser that is authorized to work on your behalf to plan, produce and/or manage your event. Organization Name: Contact Phone: • Address: Contact Name: Contact Email: City/State/ZIP: Section B - Event Information Event Name : S3 C S K tie 4C¢ \`ldA Event Type: (Festival, Race, Parade, Other): _, K Event Classification: ❑ Non-profit- ❑ For -Profit ❑ City (Civic) Sponsored ❑ Other (If Other, please describe): `The Special Events Committee may request proof of non-profit status. Provide a brief description and timeline of event (Note: A detailed map plan is required in Section H of this application. The description should be a summary overview.) Date of Event Setup[mm/dd/yy]: kt,.ct t0%,71Q2_j Time: % ec AA Begin Date of Event [mm/dd/yy]: � -7 Time: A Wt End Date of Event [mm/dd/yy]: \0i, Time: t Event Cleanup Completion [mm/dd/yy]: Time: VL'•00 P M • Total anticipated attendance: 2.OD The proposed event will require the closing of. JYStreets ❑ Sidewalks