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°4..- W\�j\ 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 Bring Completed Application and Payment to: <br />Public Works Service Center, 731 S. Lafayette Blvd., South Bend, IN <br />• <br />• <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: 03/10/2025 <br />Applicant (Contact) Name: Dominick Rodriquez <br />Applicant (Contact) Phone: 5743100495 <br />Address: 25327 St Rd 23 <br />Organization Name: FOP #36 <br />Contact Email: droddquez@southbendin.gov <br />City/State/ZIP: South Bend, IN, 46614 <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 />Contact Name: <br />Contact Email: <br />Address: City/State/ZIP: <br />Section B - Event Information <br />Event Name: Fallen Officer Scholarship Ride Event Type: (Festival, Race, Parade, Other): Motorcycle Ride <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 a scholarship fund raiser to provide graduating high school seniors a scholarship in honor of the Motorcycle <br />Memorial Scholarship Fund and our fallen SBPD Officers. <br />Date of Event Setup [mm/dd/yy]: 08/16/2025 <br />Time: 1200 hours <br />Begin Date of Event [mm/dd/yy]: 08/16/2025 Time: 1200 Hours <br />End Date of Event [mm/dd/yy]: 08/16/2025 <br />Event Cleanup Completion [mm/dd/yy]: 08/16/2025 <br />Total anticipated attendance: 120 <br />1700 Hours <br />Time: 1700 Hours <br />The proposed event will require the closing of: ® Streets ❑ Sidewalks <br />