HomeMy WebLinkAboutNon Res Block Party - Keller Park ChurchINTER -OFFICE MEMORANDUM
BOARD OF PUBLIC WORKS
DATE SENT 511712017
TO: Ed Gleckler, Traffic & Lighting
Gene Eyster, Police Department
Matt Longfellow, Engineering
Chris Dressel, Community Investment
ederico Rodriguez, Fire Department
icia Qualls, Engineering
�( Kara Wood, Park Department
Jill Sciccitano, Downtown South Bend
FROM: Linda M. Martin, Cleric
SUBJECT: Non- Residential Block Party -Block Party
LOCATION: Bryant St From Sherman to Inglewood
DATE AND TIME: June 'I'Ith. 2017 1:30Dm-4:30om
SPONSOR: Keller Park Church.
DATE DUE: May 223 20017
FAX OR E-MAIL TO: 235-9171 1 Imartin[r_southbendin.gov
RECOMMENDATIONS AND COMMENTS:
By Date
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e, This event is ocal gional/national event (Please circle the
appropriate even ype)
Yes ❑
f. Affected property/business owners have been notified of this event.
Yes ❑
g. I understand that I must arrange a meeting with all affected
governmental agencies to organize the above event (Call Marcia
Yes ElQualls,
Customer Service Manager, 235-5939 to organize meeting).
IF ALCOHOL IS TO BE SERVED OR SOLD
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 be 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.
No
No
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❑�
❑�
pp.
7:
12. APPLICANT agrees to indemnify, defend and hold harmless 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 Permit 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 day of U61,11 __ 20
APPLICANT Signature
Printed Name
/I
BOARD OF PUBLIC WORKS APPROVAL
President Member Member
Member Member Date
RETURN 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: publicwks@southbendin.gov
MISSIONARY
:'EHURCH
wr
.80 Vanguard Drive
;F0. Box 9127, Fort Wayne, IN 0899-9 jZ7
-Far: (260)747.5331
w Ww.mtixa.,Drg
April 10, 2009
To Whom It May Concern:
This letter certifies that Keller Park Missionary Chitrch
> 1003 West .. . 13 ry0m Street, South
Bend, IN 46616-1829 (Employer IdentifIcatiG'T-Number 35-1452661)is a subsidiary
ministry of the Missionary Church, Inc. and as a subordinate is exempt from Federal
income tax under section (501)(c)(3) of the Internal Reveriue,Code as per the letter of
determination issued November 14,4909,vand ' updated on December 16,1993.
Sincerely,
ON
Indiana Department of Rev4nue
Indiana Government Center North Indianapolis, Indiana 46204
Indiana Nonprofit Sales Tax FXenipdon Certificate
(Mis ccttif'tcate may not be used to collect sales tax)
Form NP-1 >
State Form $1065 '' Date Issued ",Taxpayer Identification
(4-03) 1o/2312003 01.08312100 000 0
KELLER PARK MISSIONARY CHURCH
1003 W BRYAN ST
SOUTH BEND, IN 4661'6-1829
Organization. is only exempt froth payment of sales tax on purchases for which the organization is granted exemption.
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