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HomeMy WebLinkAboutNon Res Block Party - South Bend Education FoundationINTER -OFFICE MEMORANDUM BOARD OF PUBLIC WORKS DATE SENT 5/30/2017 TO: ,I-trGleckler, Traffic & Lighting Ge e-Eyster, Police Department sLongfellow, Engineering ,,7��Pressel, Community Investment er,co Rodriguez, Fire Department Warcia Qualls, Engineering FROM: Linda M. Martin, Clerk SUBJECT: STREET CLOSURE RECOMMENDATION- Truck Pull LOCATION DATE AND TIME: SPONSOR: DATE DUE: FAX OR E-MAIL TO: South St from Lafayette to Taylor St October 7 2017 from 6am-3 m South Bend Education Foundation June 6, 2017 235-9171 1 Imartin(a)-southbendin.gov RECOMMENDATIONS AND COMMENTS: By Date p APPLICATION YEAGF. 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 MONE ORDER,. PAYABLE TO THE CITY OF SOUTH BEND, MUST BE INCLUDED WITH APPLICATION. ❑ Fee Paid Applicant Name: be n Gk UI C G CND 66 to d a_�I ' Address: a15 5.M vi s-c City: State: Zip: z�i7 Kiv�y ,J42. vZ 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 Gv Ul �JC�-1 " 7�-✓L p� LocationL W\, VJ^P 1:�, _ (Describe Area/Route) Street Closure -Name of Street](/nl-t���� From To C7:2 pm e_r Date of Event C ��200 5 a.m. ER/alm.. ❑ a.m Time: Registration/Setup , ❑ p.m. Starts ' ❑ p.m, End Approximate Number of kttendees Answer the following appropriately: 1. This event will have mu sic (live or other). 50 Yes ❑ No a. I understand the Nc ise Ordinance described in the Agreement/Permit Yes ❑ No 2. Required Information to Accompany Application a. Certified Check or Money Order in the Amount of $ I25.00, or: b. For Certified Nonpr ofit Organizations: Copies of the 501(c)(3) Internal Revenue E emption Status Document and a current copy. of Form 990 of Form 90-EZ are included with this application, and Yes ❑ No additionally filed wi h the Office of the City Clerk, 4`h Floor, County - City Building, 227 IV. Jefferson Blvd., South Bend, Indiana. c. Certificate of Insur nce d. Maps, drawings of I he area and setup plan [ Yes ❑ No 3. a. This event involves City streets Yes ❑ No b. This event involves County roads ❑ Yes 9 No c. This event involves State highways ❑ Yes ® No d. Tills event involves the use of the sidewalk [d Yes ❑ No Updated 4/2015 1 ;3'Cl 8ZT8-E8a HVLS] jauuem uesns dLo:aT LT Ta unr e. This event is a oca egional/national event (Please circle the appropriate event t e) f Affected property(business owners have been notified of this event. g. I understand that ;I must arrange a meeting with all affected governmental age ciies to organize the above event (Call Marcia Qualls, Custom( S xvice Manager, 235-5939 to organize meeting). Alcoholic Bever Certified Check or Money ( • Application cannot be • Deposit will be return( Names and phone numbers • To monitor underage c • Qualifications must t APPLICANT). A drawing must be subrnitte • Fencing around.sery • Trash receptacles. o Ample trash Temporary liquor license, • Call the Alcohol & To • Application cannot be Yes ❑ No Yes ❑ No Yes ❑ No 'ALCOHOL IS TO BE SERVED OR SOLD ;es will be served ❑ Alcoholic beverages will be sold ❑ der for $400.00 must be submitted with application. [] •ocessed without deposit, upon inspection of event area by the Board of Public Works, 'THREE security guards ❑ listed (e.g. Off -duty police officer, professional security guard, or event showing: ❑ z area must be provided to ensure proper disposal of refuse. Commission at (317) 234-4315 for more information. ;sed without a copy of this license. X E'd 021B-EBa [trLSI aaujeM uesn5 dLo=eT LT TZ unr City ofISouth Bend, Indiana + Board of Public Works AND AGREEMENT FOR THE USE OF THE RIGHT-0 -WAY FOR NON-RESIDENTIAL BLOCK PARTIES The Non-residential Block Party will be permitted to take place under the following terms and conditions: 1. Pursuant to Local Crdinance No. 10224-I3, there is a $125.00 non-refundable fee for non- residential Block Pa ties. Non-profit organizations meeting Section 501(c)(3) of the Internal Revenue Code are xempt from the fee provided copies of the 501(c)(3) Internal Revenue Exemption Status Document and a current copy of Form 990 ofForm 990-EZ are filed with this application and with the Office of the City Clerk, 4th Floor, County. -City Building, 227 W. Jefferson Blvd.,. Souh Bend , Indiana. 2. The APPLICANT must comply with all terms and conditions of this Permit and Agreement. 3. The APPLICANT sl tall reimburse the Board for the actual cost to the City for the event, if deemed necessary. 4. APPLICANT shall ' clude a flyer or letter describing the details of the event. 5.. Notification of appr al/denial of this request will be issued by return of this form, upon signed authorization by the Board of Public Works. 6. The APPLICANT sh all provide to the Board a Certificate of Insurance showing a liability policy in full force and effec t with limits of $300,000.00 per occurrence and $5,000,000.00 aggregate and the City of Sou t Bend listed as an additional named insured for this event. 7. The APPLICANT Essumes fall 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 de ivered, and picked up at the event Iocation. The APPLICANT is responsible for seeing that all co es are -maintained and returned undamaged. 9. The APPLICANT w 11 follow the City of South Bend Noise Ordinance, which is in effect at all hours. Between the f ours of 11:00 p.m. and 7:00 a.m. certain noises are particularly prohibited. These include operat ng 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 a; application only. Eve Department. 11. IF ALCOHOL IS "I must be submitted w deposit will be returr event, and provided (e,g. Off -duty polic( security guards to me must be submitted st liquor license call the Tres the City that the area will be closed during. the times indicated on the end times are pursuant to the reconaunendations ofthe South Bend Police D BE SERVED OR SOLD a Certified Check or Money Order for $400.00 th application. The application cannot be' processed without a deposit. The ,d by the Board ofPublic Works upon inspection of the event area after the here is no damage to the area. Names, phone numbers, and qualifications officer, professional security guard, or event APPLICANT) of THREE nitor underage drinking, must be submitted with•the application. A. drawing )wing fencing around serving •area,'and trash receptacles. For temporary Alcohol and Tobacco Commission at (317) 234-4315 for more information. 3 a - al ©z T B-SBa I YLS l .jaujem uesn8 ezT:TT LT a2 unr Application cannot 12. APPLICANT agre Indiana, from any 1 Civil City of South made by any perso request by the Boai described above, processed without a copy of this license, to indemnify, defend and hold.harmless the Civil City of South Bend, Aity, loss, costs, damages or expenses, including attorney fees, which the end, may suffer or incur as a result of any claims or actions which may be including a participant in the activity, arising out of the approval of this of Public Works to close a portion of the public right-of-way for the event I have read the Applicati n and Permit and the Agreement for the "Use ofRight-of Way for'Special Events" and I understani I and agree to the above rules and regulations, I also understand that this application may be denie I based on any false or incomplete information. Dated this 2 1 day of '`� 20 d APPLICANT Signature (�( 2�)tJ� _ Printed Name 0J u ail n per- _ BOARD OF PUBLIC WORKS APPROVAL President Me I er Member fd -7Id0 (7 Member Member Date RETURN FORM TO: Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, IN 46601 Phone. (574) 235-9 51 • Pax:. (574) 235-9171 * E-Mail: publicwks@southbendin.gov t, ' d OZ T B-68a HPLS I jaujeM uesn5 dLO : Z T L T i s unr