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City of South Bend Special Event Application <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 Brine 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 />Section A - Applicant Information <br />Date of Application: <br />Applicant (Contact) <br />Applicant (Contact) Phone: <br />r3__2 -IQ� Contact Email: <br />Address: 53� N m k City/State/ZIP:' <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 />Ao\ <br />Address: <br />Contact Name: <br />Contact Email: <br />City/State/ZIP: <br />1( (o Section B - Event Information <br />Event Name ent Type: (Festival, Race, Parade, Other): <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 />Date of Event Setup (mm/dd/yy <br />Begin Date of Event f mm/dd/yy <br />End Date ofEvent [mm/dd/yyi: <br />Event Cleanup Completion [mn <br />Time: U ' ' <br />Time: eau <br />Time: I <br />Time: <br />lam*,. Total anticipated attendance: o� <br />The proposed event will require the closing of: Streets ❑ Sidewalks <br />