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PSPECIAL EVENT SIGNATURE FORM <br />Prior to the Commissioners approval of the 14AI011E1— Of 4OP6- (event) on <br />Or"7- ZgC(&U_''ST- 16-* —20 2-5 (day & date) your request needs to be approved by the appropriate <br />departments affected by the designated route. <br />41 <br />* Emergency Managcmeal —125 S. Lafayelle Blvd., South Bend, IN 46601 <br />Ph. (574) 235-9378 Email. akirsits sicindiana.com <br />I have been contacted regarding this event and give my approval of the event as stated. <br />AI Kirsits, Director Date <br />* SG Joseph Couch Sheriff — 4141 Lathrop St., South Bend, IN 46628 <br />Ph. (574) 245-6540 Fax. (574) 245-6574 <br />I have been contacted regarding this event and give my approval of the event as stated. <br />Bill Redman, County Sheriff Date <br />* St. Joseph Count), Engineering — 217 W. Jefferson Blvd. Rnt. 732, South Bend, IN 46601 <br />Ph. (574) 235-7800 Email. dkozlowski@sjcindiana.com <br />1 have been contacted regarding this event and give my approval of the event as stated. <br />Skv K. Medors P.E.. Countv Engineer Date <br />* South Bend Dept. of Public Works — 227 W. Jefferson Blvd, South Bend, IN 46601 <br />Ph. (574) 235-9251 Fax. (574) 235-9171 <br />1 have been contacted regarding this event and give my approval of the event as stated. <br />Kara M. Boyles, Ph.D., P.E., City Engineer Date <br />* Indiana Dept. of Transportation — 315 East Boyd Boulevard <br />Ph. (219) 851-1426 Fax. (219) 325-7516 <br />1 have been contacted regarding this event and give my approval of the event as stated. <br />Mike Hurt, Plymouth District Date <br />* Mishawaka Engineering Dept. — 600 E. 3n1 St., Mishawaka, IN 46544 <br />Ph. (574) 258-1619 Fax. (574) 258-1776 <br />I have been contacted regarding this event and give my approval of the event as stated. <br />Chris Jam rose, P.E., Mishawaka Engineer <br />