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Home My WebLink AboutSpecial Event - Lewis Block Party - September 6APPLICATION FOR USE OF PUBLIC RIGHT-OF-WAY FOR EVENT The following special event have been approved by the Special Events Committee. Event name: Event Date Submitted by: Denise Miller Lewis Block P 916121 Street Closure: N Coquillard Dr from Rockne to Cherry Tree Closure Times: 2:00 pm to 8:00 pm Sidewalk Closure: ❑ Yes ❑ X No Comments: Block party (no Alcohol) for neighbors on triangle Coquillard/Cherry Tree/Rockne. CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Gary A. Gilot, Member e�zM Joseph R. Molnar, Member Jordan V. Gathers, Member po"�' '4 7'Y Murray L. Miller, Member Attest: Anne Fuchs, Clerk 1 JE��B i City of South Bend Special Event Application �I Neighborhood Event g $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: August 9, 2021_____ Organization Name: Applicant (Contact) Name:James M. Lewis ---------------------- (574) 276-0726 jlewis@thkiaw.com Applicant (Contact) Phone: Contact Email: Address: 633 N Coquillard Dr. _--_—City/State/ZIP: South Bend, IN 46617 ----___-- Secondary Contact Name: __—---___--- Greta Roemer Lewis Contact Phone: ------------------ (574) 274-3520 --contact Email: jaygreta@sbcglobal.net Address: City/State/ZIP:--------------------- ---------------------- 633 N Coquillard Dr South Bend, IN 46617 --____----- Section B - Event Information Block Party Event Name:---_---- Requested Street Closure:_N. Coquilard Dr. From (Cross Street):_ROckne — — -- To (Cross Street): _ Cherry Tree Expected Attendance: 40_50 Provide a brief description of the event: Block party (no alcohol) for neighbors on triangle Coquillard/Cherry Tree/Rockne. We have done this on and off for 10+ years. Date of Event Setup [mm/dd/yy]: 9/6/2021 — — -- Time: 2pm Begin Date of Event [mm/dd/yy]: 96/2021 ---—Time: 4pm End Date of Event [mm/dd/yy]: 9/6/2021— —_ -- Time: 6pm Event Cleanup Completion [mm/dd/yy]: 96/2021---- Time: Bpm Have all residents on the affected block have been notified and invited? E 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: approX 15 - --------- Number of households represented by signatures on attached sheet: 10 — _— _-- Will this event have music (live or other)? ❑ Yes 0 No 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 Name:_________________ Contact Name: Contact Phone: _ Email: Address:_______ ____ City/State/ZIP: (b) Independent Security Information Name: Contact Phone: Name: Contact Phone: Qualifications: Name: Qualifications: 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 sichd.org/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 & Hold Harmless Agreement Date: August 9, 2021-- Event Date: Sept. 6, 2021 Event Name: Block Party Organization: Applicant (Contact) Name: James -M. Lewis ---------- Applicant (Contact) Phone: (574) 276-0726....... 274-3520 _ _______ Alt. Phone: Email: laygreta@gmail.com --------------------------------- --------------------------- - 633 N. Co uillard Dr. South Bend, IN 46617 Address: _ _ 4 _— City/State/ZIP: Event Location (Please describe): Labor Day Block Parry on N. Coquillard between Rockne and Cherry Tree Length of Event (Dates/Times): 96/2021 from 4-6pm APPLICANT agrees to indemnify, defend and hold harmless the Civil City of South Send, 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 Djte: ��l — 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 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: Applicant Printed Name: Ja Pksident Mer SPECIAL EVENTS COMMITTEE APPROVAL ember Member Member i- 13-')-I Date 117 PM Mon Aug 9 Search here Corby Blvd z 01\111\11110t Bader Ave Cedar St Google ®3031 G00910 f-1 In Ro�kne of RocKne Ot 2---. s, C', s, Od ao se 0 Corby Blvd <51 J` Gr > O Ib 3 j c o ti U C z z Cedar St ? 1 59% W=, z ® r Y 0 0 C 0 z 8 Corby Bi, .1% ce O O 3 C 0 Bader Ave ►A Country C/4 II Country CI 0 0 0 3 C O iA � a 10 Cedar St 0 0 C O zO I am in favor of closing N. Coquillard Drive between Rockne and Cherry Tree Lane from 4:00 to 6:00pm on Monday September 6, 2021, for a block party: Name(print) Address Street Signature �. �2yv�p� Nl<I�.u1S 633 �o 2. 1"'1941 N al I ver a&OLU 11 3. ,� �� o v, wl `� 4. k �� 22 M�f�� 5. I � J 6. GRETA ROEMER LEWIS o3-91 JAMES M. LEWIS 633 N COOUILLARO SOUTH BEND, IN 466172226 Pay to the Order oL `Key Private Bank KeyBank National Assotaatmn 1-877-634-2968 Key.com For %j/ k Lk 1:01. 100 10391: 9090 24 28 eawr 6015 9 . Date B-iameta Sol eawr