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HomeMy WebLinkAboutProcession - St Joe County 4H Fairground.. ,,,�.:, ,,�,. Y ,� r ��w _. �.. M�-�.� E ��..s. 'L."- APPLICATION FOR USE OF PUBLIC RIGHT-O&WAY FOR PROCESSIONS The Board of Public Works must have FOUR (4) weeks prior notice of the Sponsor: rj 1 -1 Oe .ram Ui7[ilitted By: ,e � CA 1� a L".E.. - Address: $ City: Win- iL State: •-t \n Zip: `-1 fit, t y Phone: S 71-1 - Z 9 I - Y L-/00 i i Sponsor may use the public right -of -wad described as (describe route and attach map) 3 1 PLEASE NOTE: THE SOUTH BEND POLICE DEPARTMENT RESERVES THE RIGHT TO CHANGE YOUR ROUTE FOR SAFETY PURPOSES Event name: coc, „t. ST asc � y 0 Pl. ,.. �c, .ra ' L D t -1. ❑ The Board of Public Works must have FOUR (4) weeks prior notice before event occurs ❑ All certificates of insurance, pre -paid costs, maps, and any other applicable information requested or required by the Board of Public Works have been provided with this application ❑ The event shall be held on TKI a. 20 1 `7 and no other date ❑ Registration time for the event starts at 7 4�p.m. ❑ Starting time of the procession is 93O dMp.m. El Estimated completion time is /� l -rip m This event involves the use of th, E} This event involves City ❑ This event involves Cour ❑ This event involves State ❑ This event involves use o ❑ I understand that I mus organize the above eves to organize meeting) following roadways roads a park (Must obtain permission from Park Board) arrange a meeting with all affected governmental agencies to (Call Marcia Qualls, Customer Service Manager, 235-5939 © This event involves the use of the sidewalk o,41'/ 1'0,� .ems ,� 4) vQ �L- ❑ Participants must stay on the sidewalk and obey all traffic laws. This event is a ocal eal This event will be coordinated wi event (Please circle the appropriate event type) the property owner/business where staging will take place Updated 4/06/16 3 1 3 PERMIT/AGREEMENT FOR A PROCESSION 1. Sponsor shall reimburse the Board for the actual cost to the City for the event, if deemed necessary. 2. Sponsor shall provide to the oard a Certificate of Insurance showing a liability policy in frill farce and effect with !limits of $300,000.00 per occurrence and $5,000,000.00 aggregate and the City of South Bend listed as an additional named insured for this event. 3. Sponsor shall provide to thl Board all additional licenses, permits and documentation required for the event. 4. Sponsor agrees to abide by' all terms and conditions of the Board's policy governing walks, runs, parades or other imilar event adopted by the Board on March 3, 1985. 5. In order to ensure public safety during the event, the Board agrees to furnish traffic planning, materials, equipment and personnel as deemed necessary by the Police Department Traffic Bureau, the Bureau of Traffic and Lighting, and, where applicable, the Board of Park Commissioners. i 6. Sponsor acknowledges that the Police Department reserves the right to change this route for safety purposes. 7. In consideration for approval by the Board and the use of the sidewalks for the purposes set out above, the undersigned agrees and undertakes to hold the Civil City of South Bend, Indiana, free and harmless from any liability loss, costs, 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 said activity, arising out of the approval of the request to use the sidewalks indicated in the City of South Bend. The undersigned certifies that he/she is authorized to bind the above mentioned sponsor to the terms hereof. $. Notrfrcadon of approvalldeniall of this request will be issued by return of this form, upon signed authorization by the Board of Public Works I understand the above rules and regulations and that this application may be denied based on any false or incomplete information. 3 M� Sponsor Signature -� Printed Name `fie V1 � ,; I t, Title OARD President Member r- d ?1e izS � e � L" ber .APPROVAL Member Date IRTUM FORM TO: Board of Public Works I316 County -City Building 227 West Jefferson Boulevard I South Bend, IN 46601 Phone: (574) 235-9251 9 FaX: (574) 235-9171 0 E-Mail: publicwks@soulhbendin.gov N r-t Se, I SIC ;,30,54- W a (fdo PO(,(7-(f ejs - e (0- qoofi--�,— Ap ✓wn t I all Or Eas