HomeMy WebLinkAboutSpecial Event - South Bend Farmer’s Market Classic Car Show - August 28IS� c,ot T x BF�i
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APPLICATION FOR USE OF v Yh
PUBLIC RIGHT-OF-WAY FOR EVENT �zf'
The following special events have been approved by the Special Events Committee. ', r ,
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Submitted by: Denise Miller
Event name: South Bend Farmer's Market Classic Car Show
Event Date: 8128121
Street Closure: Eddy St on the North side of the Market to Dead End in front of the Armory.
Closure Times: 8:00 am am to 2:00
Sidewalk Closure: ❑ Yes ❑ X No
Comments: Annual Car Show with live entertainment and Market Cafe.
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
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Elizabeth A. Maradik, President
Gary A. Gilot, Member
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Joseph R. Molnar, Member
Jordan V. Gathers, Member
Murray L. Miller, Member
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Attest: Anne Fuchs, Clerk
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City of South Bend Special Event Application
City and Regional Event
$50 application fee if filed 60 days or greater (up to 360 days) in advance of event
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' $100 expedited application fee if filed 30-59 days in advance of event
Review the Instructions on the Special Events page before completing the application. City and Regional 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: --lb A Organization Name: Sno 1 e6 t mo r51'
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Applicant (Contact) Name:LJi � fl �Cq �(x n K- S 1
Applicant (Contact) Phone: �,,''�- S� I °� Co r ct Email: A r Cc -c, t S U F o m i.. .
Address: i ! () /iln (� �i 5 (� �'' ✓ City/State/ZIP: sc oijai
List any professional event organizer, event service provider or commercial fundraiser that is authorized to work
on your behalf to plan, produce and/or manage your event.
Organization Name. Contact Name:
Contact Phone: Contact Email:
Address: City/State/ZIP:
Section B - Event Information
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Event Name t LaSS,c_ c4a rsg , J Event Type: (Festival, Race, Parade, Other): CCIkL %
Event Classification: ❑ Non -Profit' I'For-Proft
❑ City (Civic) Sponsored ❑ Other (If Other, please describe):
'The Special Events Committee may request proof of non-profit status.
Provide a brief description and timeline of event (Note: A detailed map plan is required in Section H of this
application. The description should be a summary overview.)
Date of Event Setup [mm/dd/yy]: )) `f ��_
Begin Date of Event [mm/dd/yy]: Oq 1 a a I
End Date of Event [mm/dd/yy]: a e 1 .11
Event Cleanup Completion [mm/dd/yy]: --1 a
Total anticipated attendance: ��1!
Time:
Time: q! clo G fit
Time:
Time: L 00 l? (l
The proposed event will require the closing of: IN Streets ❑ Sidewalks
Is the event ticketed or include fees-, ❑ Yes 1krNo If yes, list fees and fee groups below:
Does the event have any partnered sponsorships? ❑ Yes )rNo
If yes, list the number of sponsors at each level of partnered sponsorship:
Is this a returning special event or part of a series of special events? VYes ❑ No
If yes, provide the date, location, and attendance of past special events and/or future planned events in the
series:
If your event is a parade, race, or other processional -type event, please complete Section C. Otherwise,
continue to Section D.
Section C - Parades. Races, and other Processional Events A] /+
What is the estimated number of parade/race spectators on the proposed route?
Describe any sound equipment that will be used in the parade/race:
Does the event have participant categories? For example, a run that has different race divisions or a parade with
separate walking/_m,,arching groups.
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Yes i No
If yes, list categories and anticipated participants per category.
If your event is a parade, what is the approximate number and type(s) of animals, vehicles, and floats participating
in the parade? (Note: If using animals in a parade, event organizers are responsible for cleaning up animal waste
left on the parade route.) Describe parade participants below.
Section D - Eouinment Set-up, and Logistics
Are you hiring a company to provide entertainment, games or inflatables? Wes ❑ No
o If yes, you must submit proof of insurance for all stage and entertainment companies three (3) weeks
before the event
Describe any hired entertainment r
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Will you be staking any tents, inflatables, portable restrooms or any other anchorings? ❑ Yes bjrNo
o If yes, you must provide proof of locates (locate number) two (2) weeks prior t4your evertr�s Locates can
be found by calling 81L V10 (i() a v , ur eve }G
Does your event include the use of fireworks, rockets, lasers, or other pyrotechnics? ❑ Yes If ,NO
o Depending on the potential fire risk, applicants may need to receive approval of the South Bend Fire
Department (process facilitated by event coordinator).
o Describe the event's proposed fire -related entertainment
Will there be any musical entertainment features at the event? X(Yes IF No
o If yes, describe the type of music, schedule of sound check/performances, and the names of any artists
performing. f Li (S n ICS�I
t I to I-Pf n >r1e4i+- m 'kL
For stage inspections, contact the Department of Homeland Security at 317 -232 -2222 -
If your route crosses over a state road or abridge please contact the following for permission:
State, IN DOT: County bridges:
Michael Hurt Andy Hayes
219-235-7528, Mhurtl@indotin.gov 574235-9626, ahayes@co styoseph.irnus
Section E - Food
Are you having food at your event (food vendors, caterers, food trucks, etc.)? 4 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 at the St Joseph County Health Department Food Service
website: sichd.org/food-service. r
Please select food sales types: ❑ food Vendor ❑ Caterer ❑ Food Truck Q- Other.If a Food Truck, please list company name
Describe how ood will be cooked and served: W�1 U `�
Cvovea e,K) i�nll A- serve& uall.) rAS 4-ey
Section F - Alcohol
Will alcohol be served or sold? .kYes ❑ No
If no, please continue to Section G - Contingency and Strategic Planning
If yes:
o The applicant must apply for and receive a temporary liquor license from the Alcohol & Tobacco
Commission. Indiana ATC forms are located at in.gov/atc/2409.htm (Temporary Permits are near the
bottom of the form list.) forms must be filed with the district ATC office five (5) days prior to the
requested event date.
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 Deposit will be returned upon inspection of
event area by the Board of Public Works.
Events with 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).
Company Name: Contact Name:
Contact Phone:
(b)
Name:
Email:
Crty/State/ZIP:
Contact Phone:
Name: Contact Phone:
Qualifications-
Name: Contact Phone:
Qualifications:
Section G - Contingency and Stratezrc Planning
For each of the following, please provide detailed descriptions. If you run out of space, attach a response to this
application submission.
• Emergency Safety Plan - This plan should include, but is not limited to:
o The number of Indiana Law Enforcement Academy certified officers, fire, and emergency
medical personnel, and the need to use any of the Citys public safety or emergency response
services.
o If hiring a security service, provide contact information and the number of hired event personnel.
o Proposed internal communications systems and public address systems.
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• Proposed Cleanup Plan - This plan should include, but is not limited to:
o Measures in place to collect and remove trash, litter and recyclables.
• Inclement Weather Plan - This plan should include, but is not limited to:
o Safety measures that will be taken in the event of a tornado warning, tornado watch,
thunderstorm, and extreme temperatures.
Proposed Lost and Found Plan - This plan should include, but is not limited to:
o A description of the use of signage, announcements on public address systems or pre -event
handouts._i_ 1
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Section H - Site Plan / Route Mao
For parades, races and other processional events:
Are you selecting one of South Bend Police Department's (SBPD) pre -approved race routes? ❑ Yes ❑ No
You must select from SBPD's pre -approved race routes (see rinks on application site) or provide sufficient
evidence of event participation if the applicant is proposing a different route through South Bend.
If your event will not be using a pre -approved race route, the proposed event map should include a route plan
clearly identifying the timing and locations of proposed street closures, and the direction of parade
movement
If your event will not be using a pre -approved race route, please explain:
Site Plan / Route Map - For All Events:
Provide an attached map with the geographic locations of all event items listed below.
• Outline of entire event venue including the names of all affected streets and areas.
• Clear markings for street closures and a schedule for each.
• Location of fencing, barriers, and/or barricades. Indicate any removable fencing and exit locations for
emergency purposes.
• Location of all stages, platforms, bleachers, grandstands, tents, booths, cooking areas, vehicles, trailers,
and other temporary structures. Applicants should also clearly mark locations of food and alcohol
serving or sales, if applicable.
• The location(s) and number of all portable toilets and wash stations.
• The location(s) and number of all trash and recycling containers, including dumpsters.
• The location of generators or any source of electricity.
• Traffic plan and map, including proposed loading/drop off areas, barricades, secured areas, vehicle and
bicycle parking areas, and considerations for TRANSPO bus route changes.
section I - Mitigation of Impact
If you are using and/or closing public sidewalks or streets, you are required to notify area business owners and
residents. You must:
o Present your event concept to the surrounding stakeholders (residents, businesses, and neighborhood
groups) that represent the venue area.
Attach a copy of the brochure or door hanger distributed to all affected residents/businesses/neighborhood
groups describing the event purpose, date and time.
Section J - Insurance
A Certificate of Insurance (copy) confirming the existence of a liability policy (General Liability and Automobile
Liability) of not less than $700,000 per occurrence and $1,000,000 aggregate, which specifically names the City
of South Bend, IN as an additionally insured for the event must be submitted. Copy of Ceftificate of Insurance
must be submitted two (2) weeks prior to the date of the event
Section K - Indemnity & Hold Harmless Agreement
City of South Bend Special Events Committee
Indemnity & Hold Harmless Agreement
Date: 11 �/lI Event Date: A I
Event Name:
Applicant (Contact) Name ` -,CA T 1 ([m rd
Applicant (Contact) Phone: S % 9 —QU — QZ',/ Alt Phone: d lC — 3 q `f —7r'1Q d
Email:
Address: i 10& A 1 l i—Ah S , d -Q Fjl i/CL City/State/ZIP: RO U I", '.S Q,Y..(1J-;�U
Event Location (Please describe): At 0 r v, S �-e mac:
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Insurance Amount This event is insured for no less than $700,000 per occurrence and $1,000,000 in aggregate,
and the certificate of insurance includes a rider naming City of South Bend, Special Events Committee, and Board
of Public Works as adddionally insured for the event
Organization Name: LllorS a d 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, Indiana, 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:
Authorized Organizer Signature
rnnreu Name anu i me
Section L - Permit & Agreement
1. Pursuant to Local Ordinance No. 10628-18, there is a $50.00 non-refundable fee for Tier 11 and III event
applications filed 60 or greater days in advance of the event, or a $100 non-refundable expedited fee for
applications filed between 30 and 59 days in advance of the event
2. The APPLICANT must comply with all terms and conditions of this Permit and Agreement
3. The APPLICANT must obtain signatures from and/or make 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, time and contact information must be included with the
attachments to this application. The applicant is responsible for providing affected residents and
business owners with transportation to their property.
4. The APPLICANT shall reimburse the Board for the actual cost to the City for the event, if deemed
necessary.
5. Notification of approval/denial of this request will be issued by return of this form, upon signed
authorization by the Special Events Committee.
6. The APPLICANT shall provide to the Board a Certificate of Insurance showing a liability policy in full
force and effect with limits of $700,000.00 per occurrence and $1,000,000.00 aggregate and the City of
South Bend, Special Events Committee, and Board of Public Works listed as an additional named insured
for this event
7. 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
8. 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.
9. The APPLICANT will follow the City of South Bend 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).
10. The APPLICANT assures the City that the area will be closed during the times indicated on the
application only. Event end times are pursuant to the recommendations of the South Send Police
Department.
I have read the Application and the Permit and Agreement for this Special Event and 1 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:(' ( L�a I
Applicant Sign;
Printed Name:
sident
Member
SPECIAL EVENTS COMMITTEE APPROVAL
Member
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Farmers Market Inc.
1105 Northside Blvd.
South Bend, IN 46615
574-282-1259
12132
DATE
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Farmers Market Inc.
1105 Northside Blvd.
South Bend, IN 46615
574-282-1259
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BEER/ WINE AUTHORITY /TYPE 118
State Form 35494 (R10 /3-20)
INSTRUCTIONS:
1. Applicant must complete all requested information.
2. Please type or print clearly.
3. Submit application and payment to the local excise district office.
4. All events are $50.00 per day (905/AC 1-11.1-1). Business checks and money
orders made payable to the Indiana Alcohol and Tobacco Commission are accepted.
5. Serving past midnight, no later than 3AM, is one (1) dau.
6. No rain checks on any of the listed events.
Visit hftos://www.in.cov/atcfised2379.htm for additional information about the districts.
Deliver or mail completed application and payment to:
DISTRICT 1
52422 County Road 17
Bristol, IN 46507
Telephone: (574) 264.9480
DISTRICT 2
1353 South Govemors Drive
Columbia City, IN 46725
Telephone: (260) 244-4285
DISTRICT 3
41 West 300 North
Cmwrordsville, IN 47933
Telephone: (765) 362.8815
DISTRICT 4
651 S. Commerce Drive
Seymour, IN 47274
Telephone: (812) 523.8314
DISTRICT 5
3650 South US Hwy 41
Vincennes, IN 47591
Telephone: (812) 882-1292
DISTRICT 6
6400 East 30th Street
Indianapolis, IN 46219
Telephone: (317) 541-4100
STEP 1. GENERAL INFORMATION
N\8ma^of ��p-p/lic�nt applying forQpensjjL%(orgenizatbn, club, corporation, indwidual)
(!
TM Pertna number (issued byATC)
S '�'U
Add
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s of applicant (number and street, dty, state, and 2/P cotle)
o� tick -
E-mail address
�M
Name penton making plication
(Wit � ��
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Fax number
(5-7Y)An(�0
Emergency contact teleone number
( �c()2�-I2jg
Prin name of con atferson event
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Emergency contact telephone number
(57ti>a�a1aSo)
STEP 2. EVENT INFORMATION
Beginnin day
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Beginning date (month, day, year) dm, day
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Ending date (month, day, year)
Time of event
Start time IXAM ❑ PMEntl time
❑ AM PM
Type or description of event
Exact address of event (numberand street airy tate, and ZIP code)
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STEP 3. FLOOR PLAN (See Step 4, Number 2.)
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Page 1 of 2
STEP 4. ACKNOWLEDGMENT
In order to qualify for this authority to serve beer and wine, the following guidelines must be met:
1. There must be a well defined premises, i.e. building, tent, enclosure, or fenced4n or designated area.
2. You must have a defined floor plan or diagram. This is to be drawn on Page 1, Step 3 of this application. If minors are to be present, you must have
a defined separation between the bar area and family. area. (Must be on floorpfan.)
3. There shall be NO carryout privileges, NO carry-in privileges and NO spirituous beverages allowed.
4. Each applicant must designate an individual to be responsible for the event and such person shall sign the authority.
5. ANY and ALL persons dispensing or accepting payment for alcoholic beverages MUST POSSESS a valid ATC employee permit.
6. The event must meet applicable Indiana State Board of Health requirements, particularly with regard to restroom facilities.
7. If the event is held in a town park, you must have approval from the town board.
8. Legal Hours of dispensing alcoholic beverages: (Prevailing time)
Monday through Saturday — 7 AM to 3 AM the following day
Sunday — 7 AM to 3 AM the following day
9. Applicant must file with the district office at which the event will be held at least five (5) days prior to the event.
I O.The authority must be posted in the most conspicuous place at the location of the event. An excise officer or commissioner, for good cause, has the
authority to revoke the authority during the event.
STEPS. COMMUNITY CLEARANCE
I.Sid of Shed county, orCMarshall ofjurisdiction where the event will beheld
Date signed (month, day, year
2. SIgnatulne of the mayor (d the event Is held in Port Wayne)
Date signed (month. day, year)
Note:
Please post your approved request in a conspicuous place where the alcoholic beverages are being dispensed at the location.
If for any reason this request is denied, you may be notified either in person or by telephone.
I swear or affirm under penalties of perjury that the information is true and accurate.
Signs tu mti I t (your I acknowledges that you have read and will abide by the miss and guidelines.)
Date signed (month, day, year)
/
7-f3-,q/
FOR DISTRICT USE ONLY
District number
Date issued (month, day, year)
Reviewed by Excise Police District Representative
❑ Approved ❑ Denied
Page 2 of 2
12139
Farmers Market Inc.
1105 Northside Blvd.
South Bend, IN 46615
574-282-1259 71-1212-712
PAY 9
TO THE11 ( DATE 7 -
ORDER OF �n ia^4 � 11-0idJ � 1() CX" Cd 1"CG Qn 1 $ C-,,� �� e
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