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• <br />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 />$100 expedited application fee if filed 30-59 days in advance of event <br />Please Brine Completed Application and Payment to: <br />Public Works Service Center, 731 S. Lafayette Blvd., South Bend, IN <br />Review the Instructions on the Special Events page before completing the application. City and Regional Special <br />Event applications must be submitted more than 30 days in advance of the event date or the application will not <br />be accepted. <br />Section A - Applicant Information I <br />Date of Application: 3I aOaS Organization Name: The Kroc CAI <br />Applicant(Contact)Name: �ea`ror m(ca1,s-i <br />Applicant(Contact)Phone: 5}ut 31Lt as80) Contact Email:£LiANOR.MCCOM'L'jOA)uSc.SALVATrZN <br />Address: 960 W WESTERN MC City/State/ZIP: SOUTtI 6ENf) Lt. 66o 1 AKM'f oP&- <br />List any professional event organizer, event service provider or commercial fundraiser that is authorized to work <br />on your behalf to plan, produce and/or manage your event. <br />Organization Name: <br />• Contact Phone: <br />Address: <br />Event Name <br />5 K .(/OHO R v n Event Type: (Festival, Race, Parade, Other): Pame <br />Event Classification: td Non -Profit' ❑ For -Profit <br />Contact Name: <br />Contact Email: <br />City/State/ZIP: <br />Section B - Event Information <br />❑ City (Civic) Sponsored ❑ Other (If Other, please describe): <br />'The Special Events Committee may request proof of non-profit status. <br />Provide a brief description and timeline of event (Note: A detailed map plan is required in Section H of this <br />application. The description should be a summary overview.) <br />Date of Event Setup [mm/dd/yyj: <br />Begin Date of Event [mm/dd/yyj: <br />End Date of Event [mm/dd/yyj: <br />61a� l;�S <br />6/N$/ aS <br />Event Cleanup Completion (mm/dd/yyl: <br />6/a,g/a.s <br />6 a..r.-. <br />Time: <br />Time: <br />a`-M <br />Time: <br />P M <br />Time: <br />a p r� <br />isTotal anticipated attendance: 3 �� <br />The proposed event will require the closing of: JP <br />treets ❑ Sidewalks <br />