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HomeMy WebLinkAboutNon Res Block Party - City of South Bend VPA - Best Street Festival EverAPPLICATION FOR USE OF, AND ]BLOCKING OF ACCESS TO, THE PUBLIC RIGHT-OF-WAY FOR NON-RESIDENTIAL BLOCK PARTIES 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 MONEY ORDER, PAYABLE TO THE CITY OF SOUTH BEND, MUST BE INCLUDED WITH APPLICATION. ❑ Fee Paid Applicant Name:, )49h wp D D. 504 11� D VENU(-6 i�" i &,XS Address; De ~ S. �r 4AUCity: W -?4Wtate: zrU Zip: Yb6 /'7 Phone: ' 5-7aq Email: KMD0 i/1, lb 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 ? �m . SjaeT Fos�41la� . . Location kkt- 141 (Describe Area/Route) Street Closure Name of Street it From S-r. To,,, t Date of Event l ttes. j, 20 .r } ® a.m. 9 a.m. I �'„�` ' ❑ a.m. Time: Registration/Setup ❑ p.m. Start ❑ p.m. End , Kp,m. Approximate Number of Attendees [- g D Q ` � _ V Answer the following appropriately: ` ` • `. 1. This event will have music Div or other). 'Yes ❑ No a. I understand the Noise Ordinance described in the Agreement/Permit:." .® Yes ❑. No, 2. Required Information to Accompany Application a. Certified Check or Money Order in the Amount -of $125.00, or: 2i b. For Certified Nonprofit Organizations: Copies of°the 501(c)(3) Internal Revenue Exemption Status Docume4bgpd 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 Clerk, 4ffi Floor, County - City Building, 227 W. Jefferson Blvd., South Bend, Indiana. c. Certificate of Insurance d. Maps, drawings and setup plan of the area y Yes ❑ No e. A copy of a flyer or door hanger that has been distributed to all ® Yes ❑ No affected property owners. 3. a. This event involves City streets Yes ❑ No b. This event involves County roads ❑ Yes Dj� No c, This event involves State highways ❑ Yes. No - Updated 8/2017 I d. This event involves the use of the sidewalk e. This event is loc regionallnational event (Please circle the appropriate event type) f. Affected properWbusiness owners have been notified of this event. g. There is/are resident(s) affected by the event that may need ADA 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 Qualls, Customer Service Manager, 235-5939 to organize meeting) N Yes ❑ No Yes ❑ No Yes ❑ No ❑ Yes g No NYes ' ❑ No 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. Names and phone numbers of THREE security guards • To monitor underage drinking. • Qualifications trust be listed (e.g. Off -duty police officer, professional security guard, or event APPLICANT)_ A drawing must'be submitted'showing: • Fencing around sewing 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. U C FEW u City of South Bend, Indiana o Board of Public Works PERMIT AND AGREEMENT FOR THE USE OF THE RIGHT-OF-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 Ordinance No. 10224-13, there is a $125.00 non-refundable fee for non- 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 ofForm 990 of Form 990-EZ are filed with this application and with the Office of the City Clerk, 4th Floor, County -City Building, 227 W. Jefferson Blvd., South Bend, Indiana. 2. The APPLICANT must comply with all terms and conditions of this Permit'and Agreement. 3. All residents and businesses 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 door hanger distributed to all affected residents/businesses describing the event purpose, date, and time must be included with the application. 4. The applicant is responsible, prior to the event, for determining if there are any residents or business owners affected that could potentially need assistance in accessing their property, The applicant is responsible for providing said resident/business owner transportation to their property. 5. The APPLICANT shall reimburse the Board for the actual cost to the City for the event, if deemed necessary. 6. APPLICANT shall include a flyer or letter describing the details of the event. 7. Notification of approval/denial of this request will be issued by return of this form, upon signed authorization by the Board of Public Works. 8. The APPLICANT shall provide to the Board a Certificate of Insurance showing a liabilitypolicy in full force 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. 9. The APPLICANT assumes full responsibility for providing ample disposal containers for refuse/recycling and assures the area will be cleaned up upon the conclusion of the event. 10. Barricades will be delivered and picked up at the event location. The APPLICANT is responsible for seeing that all cones are maintained and returned undamaged. 11. The APPLICANT will follow the City of South Bead Noise Ordinance, which 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). 12. The APPLICANT assures the City that the area will be closed during the times indicated on the 3 application only. Event end times are pursuant to the recommendations of the South Bend Police Department. 13. IF ALCOHOL IS TO BE 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& 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 license call the Alcohol and Tobacco Commission at (317) 234-4315 for more inforriiation. 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 of the public riglit-of-way for the event described above. I have read the Application and Permit and the Agreement for the "Use of Izight-of-Way for Special Events" and I understand and agree to the above i ales and regulations. I also understand that this application may be denied based on any false or incomplete information. .,? v-4- Dated this day of moo 20 APPLICANT Signature Printed Name BOARD OF PUBLIC WORKS APPROVAL President Member, 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 BEST. WEDNESDAY. EVER May 30th, 2,018 2900 Bloick Western Ave. , J III ° 1°.i.,.!�'''y'iiii{ipi m i 2801 W. Western Ave (C and J Sales) Back Up Site: 2909 W. Western Ave South Bend, IN 46619 Beer Tent Music Rppr ent S" T lvew Music I 2801 W. Western, Ave (C and JI Sales) Back Up Site; 29019 W. Western Ave South Bend, IN 46619 Rental Tent from Burns Entire Tent area will be fenced Bar Area (21+) will have barrier Must show ICE to enter Bar area Secondary Fencing 00 ti Hard Fencing all aroundRE ' r� / Z�11111�1�7 ME ME "S I I Stanchion I Bar Area I 20 x 30 Tent % I I !!/ (21+ Areal I I I / or L I EntrantIAL V------- -- ..------------- North Western Ave C I Jefferson Q¢. South �Q. Bronson QBelmon I M I'M