HomeMy WebLinkAboutEncroachment - Jackie Appleman City of South Bend VPA�rr
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APPLICKHON
"
FOR THE USE OF CITY STREET LIGHTS FOR THE INSTALLATION OF BANNERS AND PROVISIONS
ALLOWING TEMPORARY CONhNUANCE OF 'SAME
Date:
APPLICANTINFORMATION
Applicant Name:
Business Name:
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Address:
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City/State/Zip:
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Phone Number:
2—, S V o Fax No.:
Email:
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INSTALLER'S INFORMATION
Business Name:
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Address:
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City/State/Zip:
Phone:
Fax No.:
BANNER INFORMATION
Banner Description: SICd " o
Banner Size: 2.L/ )(
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Location of Installation:Ml'sac,42alz Auc
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Period of Time for Installation: V 11 ` — / ///1 Event:
The above information is to the best of my knowledge accurate and correct with regard to the request to iooLc.
install banners on City of South Bend street lights. Attached to this application is a picture of the banner for
content at)nroval. A
Date: // / r Signature:
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)235-917'1
Submitted By:
Title: %I i` Y1C . T�;'-ec-4c
FOR CITY USE ONLY
RECOMMENDATION
Engineering
Building
Legal
Communications &'Special Projects
Other
RE, VOCABLE PE RMIT 5 'y
RECOGNITION OF USE OF CITY STREET LIGHTS FOR THE INSTALLATION OF BANNERS
AND PROVISIONS ALLOWING TEMPORARY CONTINUANCE OF SAME
Notice to:
Herein, "APPLICANT".
The installation of banners upon City of South Bend street lights will be permitted to remain and continue under the
following terms and conditions for a period of five (5) years:
1) The installation shall be done from a bucket truck, from the pavement, not on the public sidewalk;
2) The applicant shall be liable for any and all damage to the light pole, resulting from the installation,
and/or the removal of the banner;
3) The installation shall be done in conjunction with the South Bend Street Department and shall not
interfere with any street signs already in place on the pole;
4) Until such time as the BOARD OF PUBLIC WORKS (BOARD) of the CITY OF SOUTH BEND
(CITY) shall determine that such installation is in any way impairing or interfering with the highway
or with the free and safe flow of traffic thereon;
5) Said installation shall not in any way prejudice or preclude the CITY'S rights with respect to the future
use of the portion of the right-of-way;
6) The installation as it now exists shall in no manner be added to or enlarged in its present scope or
dimensions;
7) In the event of change of ownership of the fixture or any other item of personal property which
constitutes the aforesaid encroachment, this permit shall become null and void;
8) The CITY shall not be liable to APPLICANT for any damages caused to APPLICANT that arise out of
or is incidental to any activity and/or incidences authorized by this permit;
9) In consideration of the granting of this Permit by the BOARD, APPLICANT shall indemnify, hold
harmless and defend the CITY from and against any and all actions or causes of action which the
CITY may suffer or incur by reason of bodily injury, including death, to any person, or persons, or by
reason of damage to or destruction of any property, including the loss thereof, arising out of or in any
manner connected with any activity and/or incidences authorized by this permit and/or any activities
and/or incidences incidental thereto, or which the CITY may sustain or incur in connection with any
litigation, investigation, or other expenditures incidental thereto, including any suit instituted by the
CITY to enforce the obligation of this agreement of indemnity.
It is the intent of the parties hereto that the APPLICANT shall indemnify the CITY under this
indemnification clause to the fullest extent permitted by law, except that APPLICANT shall not
indemnify CITY for any damage or expense caused by the sole negligence of the CITY.
This approval shall be binding upon everyone past or present, claiming any interest in and to the
aforementioned installation.
ACCEPTANCE OF TERMS AND CONDITIONS
A
I accept and agree to be bound by all of the terms and conditions oft permit.
651
Date: fq Signature:
Title V-rrt-
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Approved by the BOARD of Public Works this L day of 20_Lf
,;72
Board Member B-o—arT—Meinl3cr Board Member f.
Board Member Board Member