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F t f City of South Bend Special Event Application <br />2 City and Regional Event <br />d <br />$50 application fee if filed 60 days or greater (up to 360 days) in advance of event <br />$100 expedited application fee if filed 30-59 days in advance of event <br />Please Brine Completed Application and Payment to: <br />Public Works Service Center, 731 S. Lafayette Blvd., South Bend, IN <br />Review the Instructions on the Special Events page before completing the application. City and Regional Special <br />Event applications must be submitted more than 30 days in advance of the event date or the application will not <br />be accepted. <br />Section A - Applicant Information <br />Date of Application: 5 I I I 23 Organization Name: UnJy Clarcievns ZnG <br />Applicant (Contact) Name: Se.l i vla� A tegvk+- r <br />Applicant(Contact)Phone: �S}u} s51-Z3(-8 Contact Email: SQ-ti1(\GP'f[aeUni-hggedens.6-1 <br />v J <br />Address: 3�01 praSi %\v41 City/State/ZIP: Soo}h I�enGi 1 iJ . N66 Z$ <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 />r1 <br />Contact Name: <br />Contact Email: <br />City/State/ZIP: <br />Section B - Event Information <br />Event Name: Wesk Slat Loa (Y- Event Type: (Festival, Race, Parade, Other): F[5 �,'✓ cc � <br />COwtwtuMn 1 Event 3chct,�r Gt< <br />Event Classification: (A Non -Profit' ❑ For -Profit c ,d <br />�o otJ�MVSi G, t Vi5U41 <br />❑ City (Civic) Sponsored ® Other (If Other, please describe): We c 1 s .'de o f Sp" f n r ch R o u r <br />ne;gkQer n�•d <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/yyl: 01I2-fIVS Time: <br />Begin Date of Event [mm/dd/yyl: O } 11-: <br />Time: <br />End Date of Event [mm/dd/yyl: D -+ [ ZI Z 5 Time: <br />Event Cleanup Completion [mm/dd/yyl: <br />Am <br />II I}N� <br />L[ PM <br />bT ll-f /25— Time: 1 PM <br />Total anticipated attendance: ^' I bob <br />The proposed event will require the closing of: a Streets ❑ Sidewalks <br />