HomeMy WebLinkAboutSpecial Event - South St. Block Party - July 17APPLICATION 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: South St Block Party
Event Date: 7117121
Street Closure: E South St from Sunnyside to Longfellow
Closure Times: 3:00 prn to 5:00 pm.
Sidewalk Closure: ❑ Yes ❑ X No
Comments: Block party with games and potluck food.
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
8AO
Elizabeth A. Maradik, President
� 7 IF
0_
0 �- ---
Gary A. Gilot, Member
�m
Joseph R. Molnar, Member
Jordan V. Gathers, Member
po", ' 4 7n`&'�
Murray L. Miller, Member
Attest: Anne Fuchs, Clerk
1
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: (D "`i� "a -_ Organization Name: �S_00 i'vl S_,, �O/t
Applicant (ContacU Nae: �i1Pi Ili ' �
mYt'1
Applicant (Contact) Phone: C %H 310 YM Contact
—ct E—mail: —JYL In—tiM ILO r�— —C(J1"1---
C'64'1
Address: lel/^ C �otrF� Si- City/State/ZIP: sct.A--
Secondary Contact Name: Q '�Iau� I� --
Contact Phone: ��-7Lr - gamContact Email: �4 < ,
Address: y e &, xc. Sk _ City/State/ZIP: Sc.,At- 3z. d int Ykoco (ZI
Section B - Event Information
Event Name: tiSt 'lock Por Tc/ Expected Attendance:
Requested Street Closure: �• SOdn� 1 S% - _—__---_--
From (Cross Street):/ �S • nY/l'syi e _------
To (Cross Street): _Z -0oo //ow
Provide
—
Provide a brief description of the event:
dock p;# rt wA gatpLeS � potluck
Date of Event Setup (mm/dd/yy): 7 7 a� Time: 0 O _
Begin Date of Event (mm/dd/yy): _ i f % a Time: --
End Date of Event (mm/dd/yy): O'% / % _— Time: rJ 00 --
Event Cleanup Completion (mm/dd/yy):I 7 a _ Time: /0 ' 00
Have all residents on the affected block have been notified and invited? ry 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: = / ---
Number of households represented by signatures on attached sheet:___ ---
Will this event have music (live or other)? ❑ Yes allo
Sec QQn_j;_ 14Wk9i
yVtll alcohol be served or sold? ❑ yes )Kl No
If yes:
The applicant must apply for and receive a temporary liquor license from the Alcohol & Tobacco
Commission.
11 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.
Application cannot be processed without deposit.
Deposit will be returned upon inspection of event area by the Board of Public Works.
The applicant must submit a map or drawing of:
Fencing around serving area
o Trash receptacles
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
Contact Phone:
(b) Independent Security Information
Name:
Name:
Qualifications:
Name:
Qualifications:
Contact Name:
Email:
City/State/ZIP:
Contact Phone:
Contact Phone:
Contact Phone:
Section Q - Food
Will your event have food sales (food vendors, caterers, food trucks, etc.)? ❑ Yes )q No
If yes, the event coordinator must apply for and receive a St Joseph County Health Department
Temporary Event Permit.
Vendor(s) 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.
All applications and guidelines can be found on the St. Joseph County Health Department Food Service
website at sichd.oraifood-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 Agreernent
City of South Bend Special Events Committee
Indemnity & Hold Harmless Agreement
Date: _ �.' — Event Date:
Event Name: t -t ( I UC f t- ------------ ------
Organization: JCLnn Ji i�G" .1 ---- --
Applicant (Contact) Name:
Applicant (Contact) Phone: 7`f 3'O- �� Alt. Phone: 57`f
Email: J - `c � Q t7�ti �� /" � � r1'1Gu �� /til
Address". I`tli
StdLm V- Frm— t. & Aftr_evm"n
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.
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.
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.
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.
Block parties must end by 8:00 p.m.
A street will be blocked off from intersection to intersection only. No half -blocks or alleys can be blocked
off.
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.
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.
The APPLICANT agrees to allow residents that live on the above -referenced block access in and out of the
restricted area as needed.
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.
Notification of approval/denial of this request will be issued by return of this form, upon signed
authorization by the Board of Public Works.
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
edenied based on any false or incomplete information.
Date:
Applicant Signature:
Printed Name:
Pr 'dent^ G �^
,
Member
SPECIAL EVENTS COMMITTEE APPROVAL
Member \\�
r
Membe
Member
-7-4- *;L -f
rr.�
^� ri
SOUTH STREET
ROCK THE
BLOCK
JOIN US FOR FOOD AND GAMES THIS
JULY 17TH 3:00-8:00 PM.
RSVP to Sheila Timler (sheilatimler@gmail .com)
with any questions or to volunteer
Neighbor Signature Sheet Nrlgtlburhrwd
5imial Event
We haw hero Intool"I Aglee to, ant, rrqur`I Ilial Ilio "WLIAI
I Vel
t%Committer,
of the
CITY of SCA III, tseoll Auttraoe a
block Palh In the algia Ik•<, uhrd as:
fromto
I t ;1 11 �kl3i tilc--
-
---
.
Nam Cross
Street Na
Stn
/ Goss StrM
Date of Event
—
1.
6•
Signature
_
signature
Name
�`�`�1.' C,C ic•
- �—
Name
_
���
-
Address
Address _
��
Phone No.
Phone No.
l7�
Date
Date
7
Signature
2
Le
Name
�,; �tVJ «n
Name Bz�nl.��d
Address
l
Address i 4o9 E. S r,,4:1h 5-t-
Phone No.
Phone No. S %v- 34,0 -?V6 (
13.
Date
Signature
-
'-
Date /� 07 /
3. Si
Signature (I It�u'
Name
I
Name II
'�k- ('Vdel
((A
Address
.-..
_
Address 1411II E Sci,xl,'5t
No.
Phone No.Phone
5�iA-310- `�6
Date /
Date //
9
Signature�r
Y ?tit
a. Signature / / -
Q�t!
Name
Address
Name
Address
NOLs O
Phone No.�-
��
Phone No.
5 4'
10.
Date
Signature
Name
Address
(.0/1 ce �I
t i . `� t
Date 1 a.
5. Signature �7 _
ft
Name _
Address _
Phone No.
Date
_
/ _
Phone No.-
Date
I -) t
I
al
a'
E
E
tj
Twyckenham Or
0
u
N
N
C �
o � _
N d
0= W
� C n
SEddy St_.
3
8
N
C
Z 3 p
f�
Twyckenham Or s
8
n
m
i
a
Q
�i
S
of
�• �
a
� n
O
o
Twyckenham Or
0
u
N
N
C �
o � _
N d
0= W
� C n
SEddy St_.
3
8
N
C
Z 3 p
f�
Twyckenham Or s
8
n
m
i
a
�i
S
of
�• �
O
o
j 4z
n
c
m
O
b
m
M
N/
v ,
o-
z>
t.
za
's
Northside 8lad ��,��`
Jet
S"30, r
CITY OF SB SPECIAL EVE
731 S LAFAYETTE BLVD
SOUTH BEND, IN 46601
06;2112021 15:52:46
MID: WMAU401 TIO: XXXXX800
CREDIT CARD
VISA SALE
Card 9 pO{X)IXXXlWOl9942
Cho Card: CAPITAL ONE VISA
AID; A0000000031010
ATC: 015D
ARQC: 9D2BCASA71515694
SEQ A: I
BaOdr #: 14
INVOICE I
Approval Cade: 07381D
Entry McOwd: Cho Read
Mode'. Issue
SALE AMOUNT 0.00
I agree to pay above total Ward
accordig to card zwer agreement.
(Merdunt agreement I Credit VUWI
SHEILA TIMLER
MERCHANT COPY