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For all municipal business license questions, contact: City of South Bend • Department of Community Investment <br />227 West Jefferson Blvd • Suite 1400 S -South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 <br />LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY <br />MUNICIPAL CODE SECTION - 4-39 <br />I. APPLICATION TYPE Check One: <br />II. BUSINESS DATA <br />A. Business Name: LAZ Parki <br />New Renewal <br />Midwest, LLC <br />X <br />B. Business Address: 430 E Lasalle Ave <br />City:South Bend State; IN Zip: 46617 <br />C. Mailing Address (If different from above): 1 Financial Plaza, 14th FL <br />City. Hartford State: CT <br />D. Business Telephone Number: 860.522.7641 <br />E. Business Fax Number: <br />zip: 06103 <br />F. E-Mail Address: compliancemail@lazparking.com <br />G. Maximum Number of Vehicles that can be parked at facility at onetime: 25 <br />H. Total Number of Parking Spaces at facility: 25 <br />I. Hours during which vehicles maybe stored: 24/7 <br />H. Premises are (check one): Leased by Applicant% Owned by Applicant <br />If Leased: <br />Owner's Name: <br />Owner's Business Address: <br />City: State: Zip: <br />Owner's Residential Address: <br />City: State: Zip: <br />J. Insurance Carrier and Amount of Liability Insurance OR Bonding Agent and Amount of Bond: <br />For Office Use Only <br />Application Filed BAR 2 4 2025 Public Works Approval <br />Application Fee Paid i1I K ?, 4 AYF License Fee Paid MAR 4 202S <br />Sent to Dept. MAR 2 1' MIS License Number P6.PAQa5- Vj j <br />Not Approved <br />Reason <br />1 <br />