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HomeMy WebLinkAboutStreet Closure - Youth Service Bureau of St Joseph CountyINTER -OFFICE MEMORANDUM BOARD OF PUBLIC WORKS DATE SENT 6/2/2017 TO: d Gleckler, Traffic & Lighting Gene Eyster, Police Department , /Matt Longfellow, Engineering Chris Dressel, Community Investment Federico Rodriguez, Fire Department Aarcia Qualls, Engineering Kara Wood, Park Department Jill Sciccitano, Downtow South Bend FROM: Linda M. Martin, Clerk M- SUBJECT: Non- Residential Block Party LOCATION: Michigan St from Western Ave to Wayne St September 22, 2017 6:30am to September 23, 2017 DATE AND TIME: 9:00pm SPONSOR: Youth Service Bureau of St. Joseph County DATE DUE: May 2, 2017 FAX OR E-MAIL TO: 236-9171 1 ImartinCc�southbendin.gov RECOMMENDATIONS AND COMMENTS: By Date APPLICATION FOR USE O.I++' AND BLOCKING OF ACCESS TO THE PUBLIC RIGHT-OF-WAY FOR NON-RESIDENTIAL BLOCK PARTIES The Board of Public Works must have FOUR (4) weeps 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 Applicant Nanae: trQi (_c Address:-,� 4d- city:State: _Z) Zip: Phone: S_-)4—Q'j S7 Email: r ,Sae•-1C . e �.a r rn ,C S.__ G • Dr 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 Location A00 1'r�'T'z2le� (Describe ArcdRoute) Street Closure Name ofStrect 4" i From To Date of Event ?� ' 1_ — 20 r ��� j a 111. I'irr►e: Reg s€rafii�ni�Setup �� � ❑l P.1m Start Approximate Number of Attendees 500 "" )00 ,4 00 .m. ❑ a.111. C3 ❑ p.m, Enid � E+�. n. Answer the following appropriately: l . 'Phis event will have music (live or other). Yes ❑ No a. I understand the Noise Ordinance described in the Agreement/Pernait [4 Yes ❑ No 2, Required Information to Accompany Application a. Certified Check or Money Order in the Announrt of $125.00, or: b. For Certified Nonprofit Organizations: Copies of the 501(c)(3) Internal Revenue Exemption Statics DOeunleilt and a current copy of Form 990 of Form 990-EZ are included with this application, and Yes ❑ No additionally filed with the Office of the City Cleric, 41" Floor, County - City Building, 227 W. Jefferson Blvd., South Bend, Indiana. c. Certificate of Insurance d. Maps, drawings and setup plan of the area �es ❑ No e. A copy of a flyer or door hanger that has been distributed to all `']IYes ❑ No affected property owners. 3. a. This event involves City streets Yes ❑ No b. This event involves County toads ❑ Yes A-­'yNo c. This event involves State highways [❑ Yes [q----No Updated 8/2017 1 d, This event involves the use of the sidewalk M-- y s ❑ No e. This event is a ocal/r onal/national event (Please circle the des ❑ No appropriate event type) f, Affected property/business owners have been no iifted of This event. �rYes ❑ No g. There islare resident(s) affected by the event.that may need ADA ❑ Yes 2---No 'transportation assistance to their residence. h. I understand that I must arrange a meeting with all affected governmental agencies to organize the above event (Call Marcia Yes ❑ No Qualls, Customer Service Manager, 235-5939 to organize meeting). Ip ALCOHOL I5 TO BF, 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. a Deposit will be returned upon inspection of event area bythe Board of Public Works. ❑ Names and phone numbers of THREE security guards, • To monitor underage drinking. o 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 o 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 only. Event end times are pursuant to the recommendations ofthe South Bend Police Department, 13. IF ALCOHOL IS TO DF, 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 Iicense call the Alcohol and Tobacco Commission at (317) 234-4315 for more information. Application cannot be processed without a copy of this license. 14. 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 ofthe public right-of-way for the event described above. I have read the Application and Permit and the Agreement for the "Use ofRight-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 20 APPLICANT Signature Printed. Name C C r' " RD OF P 1..1C WOIt11-S Al'PltO V AI- 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 �-5 n m v rs ol-ij)mo -pasop aq p1nom laajlS ueBIL131A -cj w 0 0 R 0 T (7 (T wi 11 Form ST 105 ln(liau;l I)t'pa11111vill0I k12t�llut "lair 14,1111 S91l,S It u's 0General Sales lax 1'.Sl1ii1plioll CelAific Ile Ifllhsn;l it, si,lI.ICiI trail nmtrh;mt. ;it It I1n,lIlc•�,t"♦ 14k-;tlyd ulit,ldr In(1iana Isar Inr III i, rrrlillrstr..I tic rlatIIIod CwIIIIalinn roll t €� .112„�\I'd IV% IIT, II;uI,1 F\011lpliurl ,euulr of ullIn quit', ;[it, 111.1 tali,[ lilt, purrtl:l,t•, Mum Iftili;II)j tcn ICIJ, 'I'lliN cxctupliou cciAlicale ran rint hr' k�,ttt'd [III- Iltc purchu.r nl' (gililtlat, .fchic.lo. «irfr'Ct•r.(rfi, lit, 40-rNJl, 11(lrrha,cl InlJc1 No irpi+lvied %6111 tilt, hrparrmt-nl „I Ilrtcnm' „I the .t1, pl,ggi;Ilr I,I iri;' .ttllhcrl it) tit Ihr purch;t.CI *, ,Istr of (r,idenco. hilt-" lax 1111,114 lit, r11,11•I;t'11 uulrss 1t1 IIlI11rn111dmi ill P;14'lt sceli(III is I'tllk Comph-It'd hi Ilit' puk'CjI;IS I% I'#Jr Ila,t r, nol ;1111r I, pll,rlel:' ;,I! woullr,I inkItillation Ilimi 11:1. 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SOler mils( keep This ccrtiiicmV lilt Tilt, lu sulJpurl csrtnlit .ti;llrti. Newmark Grubb .:, 100 E. Wayne St, South Bend Over The Edge is a chance to repel 70 feet off the side of the 00 E. Wayne St. building in downtown South Bend! Participants will each raise $1,000 o repel and funds go to provide -nrnediate safety and and hope for omeless youth in St. Joseph ,ounty. Sept. 23, 2017