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HomeMy WebLinkAboutSpecial Event - Hernandez Birthday Party - May 15APPLICATION FOR USE OF PUBLIC RIGHT-OF-WAY FOR EVENT s; The following special events have been approved by the Special Events Committee. Submitted by: Denise Miller Event name: Hernandez Birthday Party Event Date: 5/15/21 Street Closure: Phillipa from Western to Huron Closure Times: 4�m to 9 pm Sidewalk Closure: Comments ❑ Yes ❑ X No Indoor and outdoor Birthda Party/Family Reunion on busy street. CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Gary A. Gilot, Member Joseph R. Molnar, Member Jordan V. Gathers, Member Murray L. Miller, Member Attest: Anne Fuchs, Clerk 1 City of South Bend Special Event Application Neighborhood Event $25 application fee if filed 30 days or greater (up to 180 days) in advance of event. Review the Instructions on the Special Events page before completing the application. Neighborhood Special Event applications must be submitted more than 30 days in advance of the event date or the application will not be accepted. Section A - Applicant information Date of Application: 04/07/21 Family Reunion PP _Organization Name: Applicant (Contact) Name:_Leonarda Alcantara Hernandez - -------------------------------------- Applicant (Contact) Phone: (574) 514-0779 contact Email: alcantaraleonarda@gmail.com Address: City/State/ZIP: 430 S Phillipa St. South Bend IN 46619 _ Rigoberto Lopez Mejia - — _ — — Secondary Contact Name: _ _ Contact Phone: (575) 312-4850 -- - --f Contact Email: 70rigolopez@gmail.com City/State/ZIP: Address: 430 S Phillipa St, South Bend IN 46619 —� -___- --------------------------- Event Name: Birthday Party --------------- Section B - Event Information Expected Attendance: 12 Kids 10 Parents Requested Street Closure:S Phillipa St. From (Cross Street): Western r To (Cross Street): Huron _ Provide a brief description of the event: want the street closed because the cars pass really fast here and there will be kids and I want to do it inside and out. (Birthday Party.) Date of Event Setup [mm/dd/yy]:05/15/21 ---------- Begin Date of Event [mm/dd/yyj: 05/15/21_______4 End Date of Event [mm/dd/y,,. 05/15/21_ _Y Event Cleanup Completion [mm/dd/yyl: 05/16/21 Time: 3:00-8:00 Time: 4:00 Time: 9:00 Time: 12:30 Have all residents on the affected block have been notified and invited? ® Yes ❑ No Please attach a copy of the door hanger or letter used to notify residents in addition to signature attachment. Number of households fronting the proposed street closure: 19 houses Number of households represented by signatures on attached sheet: 19 ' Will this event have music (live or other)? 0 Yes ® No Section C - Alcohol Will alcohol be served or sold? ❑ Yes 7 No If Yes: o The applicant must apply for and receive a temporary liquor license from the Alcohol & Tobacco Commission. o Application cannot be processed without a copy of this license. o A refundable $400.00 deposit paid by card or check (made to City of South Bend) must be submitted with application. o Application cannot be processed without deposit. o Deposit will be returned upon inspection of event area by the Board of Public Works. o The applicant must submit a map or drawing of: o Fencing around serving area o Trash receptacles o Events that will have alcohol sales must provide security. If your event will be hiring a security company, please provide its contact information in sub -section (a) below. Otherwise, please list the names, phone numbers, and qualifications (e.g. Off-duty police officer, professional security guard, or event applicant) of three (3) security guards in the fields provided in sub -section (b). (a) Security Company Information Company Name :_-.—......... .................. Contact Name: Contact Phone: -------------........ ---------�- ----- Email:-------_--.------� Address:___ ................................ City/State/ZIP: (b) Independent Security Information Name: — ----- — ------------- --_ ---------------- Contact Phone: Qualifications: ------------ Name: Qualifications: __....... Name: Qualifications: --------------- ----------- --- -----------_ Contact Phone: ------------------ - ---- --------------------- Contact Phone: Section D - Food Will your event have food sales (food vendors, caterers, food trucks, etc.)? ❑ Yes © No o If yes, the event coordinator must apply for and receive a St Joseph County Health Department Temporary Event Permit. o Vendors) must also apply for and receive a St. Joseph County Health permit. Health Permits must be filed with the county 30 days prior to the proposed event. Each vendor must obtain necessary permits to serve on-site and display these permits at the event. o All applications and guidelines can be found on the St. Joseph County Health Department Food Service website at s'ci1 �d.org/foaod-service. Please select food types: ❑ Food Vendor ❑ Caterer ❑ Food Truck ❑ Other: If a Food Truck, please list company name(s): Please describe how food will be cooked and served: Section E - Indemnity & Hold Harmless Agreement City of South Bend Special Events Committee Indemnity & Hold Harmless Agreement Date: 04/07/21 Event Date: 05/15/21 — — ---- — — — Event Name: Birthday Party ______ Family Reunion W Organization: -- y ---- --- ----- --- - -- --- Leonard] Alcantara Hernandez Applicant (Contact) Name: _ _�—___�� Applicant (Contact) Phone_ _(574) 514-0779 Alt. Phone: Email: alcantaraleonarda@gmail.com -___-._ _--__ ___-_ _-_.--__ Address: 430 S Phillipa _ _ city/state/zlP: South Bend IN 46619 _-__-. _ _ Event Location (Please describe): Street Houses Length of Event (Dates/Times): 05/15/213_00-8.00 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 against the City, its agents, employees, or subdivisions by any person, including a participant in the activity, arising out of the approval of this request by the Civil City of South Bend, Indiana, through the Board of Public Works, to close a portion of the public right-of- way for the event described above, or for any harm or damage alleged to have occurred because of the holding of the special event. The undersigned certifies that he/she is authorized to bind the APPLICANT to these terms. Signed on this Date: 04/07/21 Authorized Organizer Signature Leonarda Alcantara Hernandez Printed Name and Title Section F - Permit & Agreement 1. Pursuant to Local Ordinance No. 10628-18, there is a $25.00 non-refundable fee for applications filed 30 days or greater in advance of the event date. Applications filed less than 30 days in advance of the event date will not be accepted. 2. All residents within the affected area must be notified of this event. The APPLICANT must obtain signatures from at least 10 residents that reside along the closed right-of-way and make an attempt to notify all other affected residents. APPLICANTS must include a copy of a brochure or letter of invitation distributed to all affected neighbors describing the event purpose, date, and time. 3. The APPLICANT is responsible, prior to the event, for determining if there are any affected residents that need assistance accessing their residence. The APPLICANT is responsible for providing said resident(s) access or transportation to their property. 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. The APPLICANT will be liable for the replacement cost of $50.00 per cone as a result of any missing or damaged cones. 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 Special Events Committee 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 Special Events Committee 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 conditions of the South Bend Municipal Code and Board of Public Warks' policy adopted in Resolution No. 10628-18 on December, 11, 2018. 11. Notification of approval/denial of this request will be issued by return of this form, upon signed authorization by the Board of Public Works. 12. 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 stereos, speakers, musical instruments, 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 the Permit and Agreement for this Special Event and I affirm the truth of the information provided by me to the best of my knowledge. I understand and agree to the above rules and regulations, and any applicable state and federal laws. I also understand that this application may be denied based on any false or incomplete information. Date: 04/07/21 K Applicant Signature: _____---__— -------------- Printed ----_ Printed Name: Leonarda Alcantara Hernandez -.../ ";Z;'�- President SPECIAL EVENTS COMMITTEE APPROVAL --�----- Meer M emberLJ Member Member Date CITY OF SB SPECIAL EVE 731 S LAFAYETTE BLVD SOUTH BEND, IN 46601 04/12/2021 08:47:29 MID: XXXXXXXXXXXX401 TID: XXXXX800 DEBIT CARD DEBIT SALE Card # XXXXX)OOU(XXX9001 Network: VISA Chip Card. US DEBIT AID: A0000000980840 ATC: 0006 ARQC: 989A9DA785544B70 SEQ #: 1 Batch #: 8 INVOICE 1 Approval Code: 084708 Entry Method: Cho Read Mode: Issuer - PIN Verified SALE AMOUNT $251 Signature Not Required RIGOBERTO LOPEZ META MERCHANT COPY 4/ I LILVL I 4au I-nlllppa of - uoogle maps Google Maps 430 Philippa St Map data ©2021 100 ft r 430 Philippa St Building O Directions Save Nearby stars ?anthers GRIAT A C Rdh & C. phone Rom Hammes Bancorp QCHICAGO CI11S v B _ B-- - ------ - W Western Ave-- W Western Ave W Western Ave B W Western ✓ VO. W Western Ave „ B v _ - -_ O- O _ 9 v © 9 Maralhon Gas © Patricia Ann Florist Boost Mnblle . Q CIaW,a s Hair Salon Ls C;as M mGos ,,, ;,;;; H,..a,,��� [eu el,me mai _ Camkerla los gallos De M,.-4oa, ar !A!•wcan Anv_•ican Majestic Irngauon 'V430 Philippa St, South �- F w G W Mon,ae':I W Monroe St W -Aanroe St _ Bend, IN 46619 MOAeUpBVV=1 U _ Q 3 ' Ci 'ecarc rn Horan St `m v Etemal Life Deliverance — & Worship Center G �gle - Map data ©2021 100 ft r 430 Philippa St Building O Directions Save Nearby Send to your Share phone 0 430 Philippa St, South Bend, IN 46619 Photos hff--//re—,--1.—/--lnl-1A f`)+Dh it ill— Q+ +CZ— -+F—P—A + I NI+A rr,10/nnvl1 A71 nwir,-RR')R71Q7r, 1R,/An+—IA-9; 1':tmA 11 ef1vAR 111')ofFA Af.QO 1/7 Neighbor Signature Sheet - Neighborhood Special Event We have been informed, agree to, and request that the Special Events Committee of the City of South Bend authorize a block party in the area described as: from �� V l l �to �� rLj . 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