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HomeMy WebLinkAboutNon Res Block Party - Therese DorauAPPLICATION FOR USE OF AND BLOCKING OF ACCESS TO THE PUBLIC RIGHT-OF-WAY FOR NON-RE'SIDENTIAL BLOCK PARTIES The Board of Public 'Forks 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, MIDST BE INCLUDED WITH APPLICATION. [:] Fee Paid Applicant Name: Therese Dorau, City of South, Bend Office of Sustainiability Address: 227 W Jefferson Blvd STE 1316 City: South Bend State: IN Zip: 46601 Phone: 574-235-9323 Email: tdorau@southbendin.gov 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 Mav the 4th Electric Vehicle Ride & Drive Event Location 122 S. Michigan Street, South Bend, IN (Describe Area/Route) Street Closure Name of Street 10 parking spaces only (no street closure), east side of S Michigan Street From South Bend' Chocolate Cafe To ADA Reserved Barking Space (see attached illustrations) Date of Event May 4 20 13 F� a.m. ® a.m. ® a.m. Time. Registration/Setup 4 ® p.rm Start 5 [ p.m. End. S p.m, Approximate Number of Attendees 50 Answer the following appropriately: 1. This event will have music (live or other). a. I understand the Noise Ordinance described in the Agreement/Permit 2, Required Information to Accompany Application a. Certified Check or Money Order in the Amount of $125.00, or: b. For Certified Nonprofit Organizations: Copies of the 501(c)(3) Internal 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 Clerk, 41h Floor, County - City Building, 227 W. Jefferson Blvd., South Bend , Indiana. c. Certificate of Insurance, d. Maps, drawings and setup plan of the area e. A copy of a flyer or door hanger that has been distributed to all affected property owners. 3. a. This event involves City streets b. This event involves County roads c. This event involves State highways Updated 8/201.7 ❑ Yes ® No Q Yes ❑ No n Yes ❑ No R Yes ❑ No nX Yes No ❑ Yes Q No ❑ Yes 0 No I d. This event involves the use of the sidewalk 0 Yes ❑ No e. This even is a locally gional/national event (Please circle the ❑ yes ❑ No appropriate event type) f Affected property/business owners have been notified of this event. x❑ Yes ❑ No g. There is/are resident(s) affected by the event that may need ADA ❑ Yes ® 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 EZ Yes ❑ No Qualls, Customer Service Manager, 235-5939 to organize meeting). 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 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 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.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 license 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 of the public right-of-way for the event described above. I have read the Application and Permit and the Agreement for the "Use of Right -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 1 9th day of March 20 APPLICANT Signature Printed Name Therese Donau M BOARD OF PUBLIC WORKS APPROVAL President Member Member Member Member RETURN FORM TO: Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, IN46601 Phone: (574) 235-9251 Dat& City of South Bend, Indiana • Board of Public Works ram: l Cll 1�1�� 3�iff.' 1 �TQ,# [M7 �. ►`f 117 " rY if /:'N I rC1Zr�1 C '7r 401 i1FF`! The Non-residential Bloch Patty will be permitted to tape place under the following terms and conditions: 1. Pursuant to Local Ordinance No. 10224-13, there is a $125.00 lion -refundable fee for noun- residential Bloch 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 Clerk, 4th Floor, County -City Building, 227 W. Jefferson Blvd., youth Bend , Indiana. 2, The APPLICANT must comply with all terms and conditions of this Perin it and Agreement. 3. All residents and businesses within the affected area must be notified of this event. The APPLICANT must obtain signatures from and/car 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 liability policy 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 Bernd Noise Ordinance, which is in effect at all hours. Between the hours of 11:00 p.rn. 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 1.3-57). 12. The APPLICANT assures the City that the area will be closed during the times indicated on the 3 Parking Space Reservation Request: Map and Site Setup Plan May the W4 Electric Vehicle Ride and'! Drive Event 10 requested parking spaces are marked by the red box. The primary electric vehicle test drive area is marked by the green box, with overflow and local EV owner displays in the red area. Test drive vehicles will use the south exist, depending on access restrictions due to nearby construction. Test drive vehicles will be discouraged from using the red parking spaces, to avoid backing up into S Michigan St traffic, Shm ma"Citles,xnc, BEN � ��^NV��f������. ,^ MACOG =��v*o^�"m~u � �- ----WdA — rKLKN Descrptionof event: The Electric Vehicle Ride & Drive event will educate the public about the benefits of electric vehicles and provide an opportunity to test drive or ride as a passenger in currently available plug-in hybrid and all -electric vehicles, Local electric vehicle owners will be welcome to display their vehicle and speak with the public about their experience. Local and regional dealers will provide vehicles for test drives and will manage the driver's license requirement and liability through their own waivers.