HomeMy WebLinkAboutSpecial Event - Cory Block Party-July 24APPLICATION FOR USE OF
PUBLIC RIGHT-OF-WAY FOR EVENT
The following special events have been approved by the Special Events Committee.
Submitted by: Denise Miller
Event name: Cory Block Party
Event Date: 7124121
Street Closure: E Washington from Sunnyside to Jacob
Closure Times: 12:00 om to 8:00
Sidewalk Closure: ❑ Yes ❑ X No
Comments: Neighborhood block party with Cornhole, kids activities and a potluck
lunch.
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
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Elizabeth A. Maradik, President
Gary A. Gilot, Member
Joseph R. Molnar, Member
Jordan V. Gathers, Member
po"�' 4 7'-�
Murray L. Miller, Member
Attest: Anne Fuchs, Clerk
City of South Bend Special Event Application
Neighborhood Event
$25 application fee if filed 45 days or greater (up to 180 days) in advance of event
$50 expedited application fee if filed 14-44 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 14 days in advance of the event date or the application will not
be accepted.
Section A - Applicant Information
Date of Application:�_ �_ 01 Oa I ---------- —__ Organization Name: _&/ ____________________________
Applicant (Contact) Name:. Tc; ] C oy-
Applicant (Contact) PhoneS73-55_�DIO _Contact 0�ri cu
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Address:11-03 N _SkAl1 .�j Q 41/1
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Secondary Contact Name:
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ContactPlho22ne:�qq--_3_ 8 1�_'_��QContact Email: iil0y��Xt�UQi1n0/b_C4YJ�
Address:] JZ I— _Y�aS� -LCity/State/ZIP: _X0 v t k SLhd j fN-7V�0� 7 _ ,-
Section B - Event Information
Event Name: 11 0 C1V_ I -_a ✓l�____________________,____ Expected Attendance:
Requested Street Closure: � q � 1 —W ASh I n 0I 1- k1 J ---------
461
From (Cross Street):�)_1�f1%l-t_ 1�_________—_--______-__
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To (Cross Street): -------------------------------------------------------------------------------
Provide a brief description of the event:
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Date of Event Setup [mm/dd/yy]: 0 _7_'2+'_202-_J ____-__ Time: _10 u
Begin Date of Event [mm/dd/yy]: D_^_7 2�bZTime: ��rn'_�_-____-�_____________________
End
Date of Event [mm/dd/yy]: _�_ / _ 24_2 U I ___Time: _L,YY1------------ ------------------
Event Cleanup Completion [mm/dd/yy]: Z --2-q-- 2-0-7-1- Time: 3.p-th------------------------------
Have
___________________________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.
�/� y Number of households fronting the proposed street closure:
,L V'_ �/r Number of households represented by signatures on attached sheet:
Yds Will this event have music (live or other)? 0 Yes t� No
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Section C - Alcohol
Will alcohol be served or sold? ❑ Yes 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 N
Contact Phone:
(b) Independent Security Information
Contact Name:
Email:
City/State/ZIP:
Name: ------------------------------------ — ----- Contact Phone: ------------ Qualifications:
Name: ----------- _ Contact Phone:
Qualifications:
Name: ----- —_ ----- — Contact Phone: _—__—
Qualifications:
Section D - Food
Will your event have food sales (food vendors, caterers, food trucks, etc.)? ❑ YesNo
o If yes, the event coordinator must apply for and receive a St Joseph County ealth 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 sichd.orQ/food-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 & HoldH
armlessAgreement
Date: [-�- 2 0 � I ________ Event Date: V_! 2-+ ' 2- 0 21
Event Name:
Organization:!
Applicant (Contact) Name:
Applicant (Contact) Phone
Email:
ma
Alt. Phone: J7_,(___ 07 0-_- --- - -----
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Address: l�=J_ N_ ��l nY)1�1 City/State/ZIP: D _ �ijL�_i_ �/V__' W- 1-7
Event Location (Please describe):
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Length of Event (Dates/Times): 6_7__2-1.
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2. -
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: _'-__I_' A 0 A
Organizer Signature
evl
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, or a $50 non-refundable expedited fee for applications filed
between 14 and 29 days in advance of the event date.
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 Works' 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: _SV-- I --A 0 ;� I ---
--------------------
Applicant Signature:
Printed Name: �J`_I G0�'
Pr ident
Member
SPECIAL EVENTS COMMITTEE APPROVAL
Member
Member
Membe7'
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Date
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VICTORY WITH THE VACCINE!
Summer's here & it's finally time again to celebrate with our 5th Annual EWS Block Party!
It will look & work largely as it has in the past only we've learned a thing or two technology-wise
& will be sending out some sign-ups electronically closer to the big day. Also in keeping with
utilizing things we've learned, we are asking that everyone bring their own seats (should they wish to
actually sit down!) Camp chairs, hammocks, picnic blankets- whatever would be most comfortable
& easiest to tote would be great. We'll also be sure to have a couple sanitation stations & some
big jugs of water & lemonade. Food this year will be potluck-style with everyone ideally
bringing something to share. Specifics for this will be included in our electronic sign-ups
to follow later on. (If we don't yet have your email, please be sure to get it to us.
Our contact info is @ the bottom.)
AND AS FOR FUNV
You can pian on that in spades! Head to the westernmost block of E. Washington St.
at noon. There'll be the Annual Cornhole Tournament & the beloved Shaving Cream
Fight followed by a jump in the Cory's pool. You can also expect the Ice Cream Truck
to stop by & plenty of other fun activities for the kids. We'll have our new Block Party
T-Shim available to purchase on-line so be sure to order those in time to wear
to the celebration. A link for these will also be sent out soon via email.
We're so excited to finally reconnect with our
awesome neighbors! Hope to see you all there.
Wou can dited p6timu /ot
aVi NOTRE DAME
FEDERAL CREDIT UNION
PO Box 7878, Notre Dame, IN 46556
TEL: (574) 239-6611 • (800) 522-6611
Memo: DANIEL P. CORY
71 9159/2712 203131
VOID AFTER 90 DAYS
06/07/2021 $*********25.00
PAY TWENTY FIVE & 00/100 ***************************************************
TO THE CITY OF • •
ORDER OF /
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THE REVERSE SIDE OF THIS DOCUMENT INCLUDES AN ARTIFICIAL WATERMARK - HOLD AT AN ANGLE TO VIEW