Street Closure - Eddy St Commons Coffee & Cars

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APPLICATION FOR USE OF, AND BLOCKING OF ACCESS TO, THE PUBLIC RIGHT-OF-WAY FOR NON-RESIDENTIAL BLOCK PARTIES The Board of Public Works must have FOUR (4) weeks prior notice of the event. A NON-REFUNDABLE APPLICATION FEE OF $125.00, IN THE FORM OF A CERTIFIED CHECK OR MONEY ORDER, PAYABLE TO THE CITY OF SOUTH BEND, MUST BE �^ INCLUDED WITH APPLICATION. J Fee Paid Applicant Name: Carissa McNeil 30 S Meridian St Address: Suite 1100, City: Indianapolis State: IN 46204 Phone: This application is made to the City of South Bend, Indiana, Board of Public Works, for the use of the specified public right-of-way by Applicant for the holding of the hereinafter described event: Event Name Coffee and Cars Location Eddy Street Commons (1234 Eddy Street) (Describe Area/Route) Street Closure Name of Street Eddy Street From Napoleon To Angela Date of Event 7/23 20 16 a.mad .m. Time: Registration/Setup 6 p.m. Start 9 ❑ p.m. m. End 1 �p.m. Approximate Number of Attendees 500 Answer the following appropriately: 1. This event will have music (live or other). ❑ Yes No a. I understand the Noise Ordinance described in the Agreement/Permit JCR/ V Yes ❑ No 2. Required Information to Accompany Application a. Certified Check or Money Order in the Amount of $125.00, or: b. For Certified Nonprofit Organizations: Copies of the 501(c)(3) Internal Revenue Exemption Status Document and a current copy of Form 990 of Form 990-EZ are included with this application, and Yes ❑ No additionally filed with the Office of the City Clerk, 4`h Floor, County - City Building, 227 W. Jefferson Blvd., South Bend, Indiana. c. Certificate of Insurance d. Maps, drawings of the area and setup plan Yes ❑ No a. This event involves City streets Yes ❑ No b. This event involves County roads ❑ Yes No c. This event involves State highways ❑ Yes No d. This event involves the use of the sidewalk Yes ❑ No Updated 4/2015