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Home My WebLink AboutNon Res Block Party - Sunnyside Presbyterian ChurchINTER -OFFICE MEMORANDUM BOARD OF PUBLIC WORKS DATE SENT 4/18/2017 TO: Ed Gleckler, Traffic & Lighting Gene Eyster, Police Department Matt ngfellow, Engineering ris Dressel, Community Investment �derico Rodriguez, Fire Department Garcia Qualls, Engineering Kar ood, Park Department I Sciccitano, Downtow South Bend FROM: Linda M. Martin, Clerk SUBJECT: Non- Residential Block Party LOCATION: S. Frances St. from Washinqton to Jefferson DATE AND TIME: June 18. 201718:30 a.m. to 1:00 mm. SPONSOR: Sunnyside Presbyterian Church DATE DUE: May 2, 2017 FAX OR E-MAIL TO: 235-9171 1 lmartin@southbendin.gov RECOMMENDATIONS AND COMMENTS: By Date K 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. ❑ Fee Paid Non Profit Applicant Name: Sunnyside Presbyterian Church 115 South Frances Address: Street City: South Bend State: IN Zip: 46617 Phone: 574,287-1524 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 Church Picnic ---Keeping children safe by having 1 block closed for a short time. Location Front Lawn----115 South Frances Street (Describe Area/Route) Street Closure Name of Street south Frances Sheet From —Washington To - Jefferson Date of Event June 18, 20 17 X❑ a.m. Time: Registration/Setup ❑ p.m. Start 8:30 AM End 1:00 PM Approximate Number of Attendees 200 Answer the following appropriately: 1. This event will have music (live or other). a. I understand the Noise Ordinance described in the Agreement/Permit 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(e)(3) Internal Revenue Exemption Status Document and a current copy of Form 990 of Form 990-EZ are included with this application, and additionally filed with the Office of the City Clerk, 41h Floor, County - City Building, 227 W. Jefferson Blvd., South Bend, Indiana. c. Certificate of Insurance d. Maps, drawings of the area and setup plaza 3. ❑ Yes X No ❑ 'Yes X No ❑ Yes ❑ No X Yes ❑ No a. This event involves City streets X Yes ❑ No b. This event involves County roads ❑ Yes X No c. This event involves State highways ❑ Yes X No Updated 4/2015 1 d. This event involves the use of the sidewalk e. This event isra�in"Hv gionallnational event (Please circle the appropriate ee) f Affected propeity/business owners have been notified of this event. g. Y understand that I must arrange a meeting with all affected governmental agencies to organize the above event (Call Marcia Qualls, Customer Service Manager, 235-5939 to organize meeting). X Yes ❑ No X Yes ❑ No ❑ Yes X No P40 0 ck � el6"� b (Oc( X Yes ❑ No IF ALCOHOL IS TO IBE SERVED OR SOLD N40 tA-160t,,01 Alcoholic beverages will be served ❑ Alcoholic beverages will be sold ❑ Certified Check or Money Order for $400.00 must be submitted with application. • Application cannot bo processed without deposit. • Deposit will be returned upon inspection of event area by the Board of Public Works. Names and phone numbers of THREE security guards • To monitor underage drinking. • Qualifications must be listed (e.g. Off -duty police officer, professional security guard, or event APPLICANT). A drawing must be submitted showing: • Fencing around serving area • Trash receptacles. o Ample trash receptacles must be provided to ensure proper disposal of refuse. Temporary liquor license. • Call the Alcohol & Tobacco Commission at (317) 234-4315 for more information. • Application cannot be processed without a copy of this license. V.e--�`Q--, \4 C1t1S e— —� i P-aol( e-S le c16 tp IV 0 C 7 a City of South Bend, Indiana • Board of Public Worlo PERMIT AND AGREEMENT FOR THE USE OF THE RIGHT-OF-WAY FOR TON -RESIDENTIAL BLOCK PARTIES The Non-residential Block Party will be permitted to take place under the following terms and conditions: 1. Pursuant to Local Ordinance No. 10224-13, there is a $125.00 non-refundable fee for non- residential Block Parties. Non-profit organizations meeting Section 501(c)(3) of the Internal Revenue Code are exempt from the fee provided copies of the 501(c)(3) Internal Revenue Exemption Status Document and a current copy of Form. 990 of Form 990-EZ are filed with this application and with the Office of the City Clerk, 4th Floor, County -City Building, 227 W. Jefferson Blvd., South Bend, Indiana. 2. The APPLICANT must comply with all terms and conditions of this Permit and Agreement. 3. The APPLICANT shall reimburse the Board for the actual cost to the City for the event, if deemed necessary. 4. APPLICANT shall include a flyer or letter describing the details of the event. 5. Notification of approval/denial of this request will be issued by return of this fbiln, upon signed authorization by the Board of Public Works. 6. The APPLICANT shall provide to the Board a Certificate of Insurance showing a liability policy in full force and effect with limits of $300,000.00 per occurrence and $5,000,000.00 aggregate and the City of South Send listed as an additional named insured for this event. 7. The APPLICANT assumes full responsibility for providing ample disposal containers for refuse/recycling and assures the area will be cleaned up upon the conclusion of the event. 8., Barricades will be delivered and picked up at the event location. The APPLICANT is responsible for seeing that all cones are maintained and returned undamaged. 9. The APPLICANT will follow the City of South Bend Noise Ordinance, which is in effect ar all hours. Between the hours of 11:00 p.m. and 7:00 a.m, certain noises are particularly prohibited. These include operating radio receiving sets, musical instruments, phonographs and other sound reproduction devices if audible fifty (50) feet away, as well as shouting, yelling, hooting, whistling, or singing in the streets in a manner to disturb the peace (Municipal Code 13-57). 10. The APPLICANT assures the City that the area will be closed during the times indicated on the application only. Event end times are pursuant to the recommendations of the South Bend Police Department. 11. IF ALCOHOL IS TO BE SERVED OR SOLD a Certified Check or Money Order for $400.00 must be submitted with application. The application cannot be processed without a deposit. The deposit will be returned by the Board of Public Works upon inspection of the event area after the event, and provided there is no damage to the area, Names, phone numbers, and qualifications (e.g. Off duty police officer, professional security guard, or event APPLICANT) of THREE security guards to monitor underage drinking, must be submitted with the application. A drawing must be submitted showing fencing around serving area, and trash receptacles. For a temporary liquor license call the Alcohol and Tobacco Commission at (317) 234-4315 for more information. Application cannot be processed without a copy of this license. 12, APPLICANT agrees to indemnify, defend and hold hartnless the Civil City of South Bend, Indiana, from any liability, loss, costs, damages or expenses, including attorney fees, which the Civil City of South Bend, may suffer or incur as a result of any claims or actions which may be made by any person, including a participant in the activity, arising out of the approval of this request by the Board of Public Works to close a portion of the public right-of-way for the event described above. I have read the Application and Petmit and the Agreement for the "Use of Right -of -Way for Special Events" and I understand and agree to the above rules and regulations. I also understand that this application may be denied based on any false or incomplete information. Dated this 18th day of April 20 17 APPLICANT Signature Printed Name P&fir James B. Miller BOARD OF PUBLIC WORKS APPROVAL President Member e er 0 4 ram-----d,1Lr� Member Me ber Date RE, TC7RN FORM TO: Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, IN 46601 Phone; (574) 235-9251. • Fax: (574) 235-9171 • E-Mail: publicwl[s@southbendin.gov Entity Type: lloliiesti I!€guprq i:CoijloratE oil" ? Business Status: Active Creation Date: 03/14/1951 Business Entity Report 03/31/2017 Du -.Date: Principal Office Address-, 115 SOUTH TRANCES STREET, SOUTH BEND, IN, 46617 - 3120, USA Domioile of State: Indiana Title Name Address President Chuck Viater 115 SOUTH FRANCi1S STREET, SOUTH BEND, IN, 46617, USA Secretary Paw:1 Horvath 115 South Frances Street South Send, IN, 46617 - 3120, USA Treasurer D SCOTT OTX 115 SOUTH PRANCES STREET, SOUTH BEND, IN, 46617, USA c"r t'rW �' ! x'�1��s�� .r � s i�Aik� -' �,.� . V i.•i i .., MEMO r� Narac: D. SCOTT DIX Address: 115 SOUTH FRANCES STREET,, SOUTH BEND, IN, 46617- 3120, USA