Special Event - VPA 4th of July-July 4 2025

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vYn & 4J City of South Bend Special Event Application • �' . <_ City and Regional Event l: $SO application fee if filed 60 days or greater (up to 360 days) in advance of event $100 expedited application fee if filed 30-59 days in advance of event Please Bring Comolsted Application and Payment to; Public Works Service Center, 731 S. Lafayette Blvd., South Bend, IN Review the Instructions on the Special Events page before completing the application. City and Regional Special Event applications must be submitted more than 30 days in advance of the event date or the application will not be accepted. E q Section A - Applicant Information Date of Application: D> II((I f,� Organization Name: ��A(K A05 Applicant (Contact) Name:_01 lv A 24jQVXh-uT- rAMLAn V-UU�V1 1�1.. Applicant(((C�Conttaact)QPhone:�S7N)✓�'"l�J72 Contact EmailQ,�J"`�/`r ,! n�I n'�4� Address: �/"I J' J'' 4�%IS B1f C� City/State/ZIP: 5U}yt/�'ndj (N yiQ sf �? List any professional event organizer, event service provider or commercial fundraiser that is authorized to work on your behalf to plan, produce and/or manage your event. Organization Name: Contact Phone: • Address: Contact Name: Contact Email: City/State/ZIP: Section B - Event Information f_ra iVIYn Un V * Event Name : _ l O ( J U `� Event Type: (Festival, Race, Parade, Other): TT '�" Event Classification: . Non -Profit' ❑ For -Profit City (Civic) Sponsored ❑ Other (If Other, please describe): 'The Special Events Committee may request proof of non-profit status. Provide a brief description and timeline of event (Note: A detailed map plan is required in Section H of this application. The description should be a summary overview.) Date of Event Setup [mm/dd/yyl: 01104 1 r- Time: N Mom Begin DateofEvent [mm/dd/yy): 0110-1IV� Time: .DDOM End Date of Event [mm/dd/yyl: 01109 / I ZS 0 Time: I D�� Event Cleanup Completion [mm/dd/yyl: LU IDl I Z5 Time: �t/(��Qt,��QM Total anticipated attendance: 00— 1006 • The proposed event will require the closing of: [Streets ❑ Sidewalks Cl05jno) 7c�4rson -dram Mdn✓e 4 U-sA✓c dram g pry,- 10;3oipm .