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Home My WebLink AboutStreet Closure - Archie DonaldsonINTER -OFFICE MEMORANDUM BOARD OF PUBLIC WORKS �'�� DATE SENT 7/6/2017 TO: 'mod Gleckler, Traffic &Lighting Gene Eyster, Police Department '--�Iatt Longfellow, Engineering �_,Ghr' 'bressel, Community Investment `derico Rodriguez, Fire Department arcia Qualls, Engineeri g FROM: Linda M. Martin, Clerk SUBJECT: STREET CLOSURE RECOMMENDATION -Back to School Block Party LOCATION: Bergan St from Huey to Elmer St DATE AND TIME: Auaust 19. 2017 12:00am-8:00nm SPONSOR: Archie Donaldson DATE DUE: July 18, 2017 FAX OR E-MAIL TO: 235-9171 1 Imartin6i southbendin.goy RECOMMENDATIONS AND COMMENTS: By Date APPLICATION Z FOR THE USE OF AND BLOCKING OF ACCESS TO THE PUBLI -y � RIGHT-OF-WAY FOR A RESIDENTIAL BLOCK PARTY �� The Board of Public Works must have four (4) weeks prior notice of the event`.86s A NONREFUNDABLE APPLICATION FEE OF $50.00, IN THE FORM OF A CERTIFIED CHECK OR MONEY ORDER, PAYABLE TO THE CITY OF SOUTH BEND, MUST BE INCLUDED WITH APPLICATION. Applicant Name: r h� `� _:A� v,r1Q.t CQ S-0,0 Address: C a,J City: 5 o L&t.�'�� ,� State: �,��, Zip Phone: 315 - a o $ r% 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 holdiqg of the hereinafter described event: Event Name Street Closure Name of Street (�if 0_2n From �U 1 Date of Event R gw1,3 -_ 19 20 Time Setup �-��. ❑ Start ❑a.m.,R] End Ela-m. Mp"m. a.m. IN p.m. Approximate Number of Attendees � o —� 5 Please answer the following appropriately: • This event will be open to residents outside the immediate [� Yes ❑ No neighborhood. • All residents on the affected block have been notified and invited. A Yes ❑ No copy of the flyer distributed is included. (H 0 N C N�� G �+J) • This event will have music (live or other). Yes ❑ No • Payment of $50.00 fee payable to City of South Bend included or: Yes ❑ No • For Certified Nonprofit Organizations: Copies of the 501(c)(3) Internal ❑ Yes ®'" No 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 Cleric, 4" Floor, County -City Building, 227 W. Jefferson Blvd., South Bend, Indiana. 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. Updated 4/2013 1 Names and phone numbers of THREE security guards IN • 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. APPLICATION THE USE OF, AND BLOCKING OF, ACCESS TO THE PURL RIGHT-OF-WAY FOR A RESIDENTIAL BLOCK PARTY �' PE City of South Bend, Indiana • Board of Public Works PERMIT AND AGREEMENT FOR THE USE OF RIGHT-OF-WAY FOR RESIDENTIAL BLOCK PARTIES Pursuant to Local Ordinance No. 10224-13, there is a $50.00 non-refundable fee for 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 Cleric, 41h Floor, County -City Building, 227 W. Jefferson Blvd., South Bend, Indiana. 2. Block parties are allowed solely for neighborhood events. No block party application will be approved for private parties. 3. All residents within the affected area must be notified of this event. The APPLICANT must obtain signatures from and/or has made an attempt to notify all residents that reside on the block. A copy of a brochure or letter of invitation distributed to all affected neighbors describing the event purpose, date, and time must be included with the application. 4. The cones will be delivered to the APPLICANT'S address. The APPLICANT assumes full responsibility for clean-up and assures the City that all cones will be maintained and returned undamaged. 5. Block parties must end by 8:00 p.m. 6. A street will be blocked off from intersection to intersection only. No half -blocks or alleys can be blocked off. 7. The Board of Works reserves the right to deny any block party application based on traffic and speed limit records. No street may be closed with a speed limit over 30 MPH or considered to be a major arterial. 8. The Board of Public Works reserves the right to deny any block party application based on information gathered from the South Bend Police Department or other sources. 9. The APPLICANT agrees to allow residents that live on the above -referenced block access in and out of the restricted area as needed. 10. The APPLICANT agrees to abide by all terms and condition of the South Bend Municipal Code and Board of Public Works' policy adopted in Resolution No. 21-2011 on February 28, 2011 11. 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 a party or similar event. The undersigned certifies that he/she is authorized to bind the APPLICANT to the terms hereof. 12. Notification of approval/denial of this request will be issued by return of this form, upon signed authorization by the Board of Public Works. 3 13. The City of South Bend Noise Ordinance is in effect at 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). I have read the Application and Permit and the Agreement for the "Use ofRight-of Way for Block Parties" 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 APPLICANT Signature Printed Name BOARD OF PU 3LIC WORKS APPROVAL At, �h tk t1A -_ J,4�56_ U_ Presi ent Member Member ( 1-�ylat/,;�Or 7 Me er Member Date D 14 ► _ 1J UT]t"6 Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, IN 46601 Phone: (574) 235-9251 s Fax: (574) 235-9171 • E-Mail: publicwlcs@southbendin.gov SIDENT SIGNATURES Page of We have been informed, agree to, and request that the Board of Public Works of the City of South Bend authorize a block party in the area described as: r a from to ... 1�1et Name ross Street Cross Street fE Date o vent 1. 6. 2. 3. H 5. Signature n Signature Name \ . y- Name Address % y ` Address Phone No. �� 6(5a Phone No. Date Date Signature r Signature Name Name Address 41 Address Phone No. -0 Phone No. Date / Date 8. Signature �tJ�.�u�' �1 J��,�-Signature r' Name `�CL1..; t ( — R (.I;o&v, Address L3 ' 'er,, a -VI Phone No. 5 Z L-k ' ':) :�2 53 o L4-7i� Date ? -- -;s - t-) Signature Naive Address -2+ (13 � Phone No. Name Address Phone No Date 9. Signature Date -- — � 10. Signatur Nametn& ix s Address ..7 ,A o Phone No. j -'� Date '-7 1 Name Address Phone No. Date Signature Name Address Phone No. Date �.II�1��:�1 ■ `�r � Updated 4/2013 5 CT- c� (71 0 Lj- )