The URL can be used to link to this page

Home My WebLink AboutSpecial Event - Reach Out and Touch Faith Baptist Church Praise Party - September 11APPLICATION FOR USE OF z PUBLIC RIGHT-OF-WAY FOR EVENT i MACE � a� The following special event has been approved by the Special Events Committee. 11,63 Submitted by: Denise Miller Event name: Reach Out and Touch Faith Baptist Church Praise Party Event Date: 9111121 Street Closure: Blaine from California to Vassar Closure Times: 10:00 am to 8:00 pm Sidewalk Closure: ❑ Yes ❑■ No Comments: Street blocked off in front of Muessel Elementary School to accommodate vendors. Concert in the parking lot. Ministry reaching out to the community with Jesus Christ. CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Gary A. Gilot, Member "il Joseph R. Molnar, Member 100 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 onr be accepted Section A - Applicant Information x l Date of Application: —� pa C A �n�111t —�+ Organization Name: TU ��-L•� Applicant (Contact) Name: I � �. 7�1. ., n r r_ t Applicant (Contact) Phone: QI'7 3 q 3 14 6t S 0 Contact Email: 14 --ha, P n so' m r Nto 1L1.C)/Vt Address: ��Sq�n� —�--�.Si�City/StatelZlP./ Secondary Contact Nance W Contact Phone: Contact Email• _ Address: --------- City/State/ZIP. oQ ' I SeWon B - Event Irlformatimt Event Name: &Q (j �%ty- /L-� f '� ,. / �,p�f,�i- C f1.NYCl� PY0.1 J�j Pac+-.�i/ �'--`—`�°�---- Expected Attendance: i Requested Street Clowre;—LeOL�g.__—Q lklotvu �DL_�)LLe L(•M l! From (Cross Street); - fwfll C" To (Cross Street): Provide a brief description of the event, s t rub b l "^-kcol 04 i n. 4c1✓l-} � N i t t GcS far t 4- n hers 1 . Tl �a �e 0 i t bye, tran the � I �� a ��), �'Allcet-1�'F- rn ver purrs (o r. n1CI'li3�ytiJ,�( S e�vn I C�Mk.kN% u,i+ ltr?-Tal" cht ��k . � � +V,% Date of Event Sett [mm/dd/yy]: - 'I — 1 1 -a' Begin Date of Event [mm/dd/ YYI: Time; End Date of Event [mm/dd/yy]: -- l �L Time: Event Cleanup Completion Imm/dd/ t - — ril: ��—_ Time: --Aected block have been notified and invited? y 01A Have all residents on the aff Please attach a copy of the door hanger or letter used to notify residents inaddition ❑to No attachment. Number of households fronting the proposed street closure: if households represented by signatures on attached sheet:_ ,I,j�,Q event have music (live or other)? yes 110a � — 0� ❑ No 3t pt.— ,,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 wig 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 k3) 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: Qualifications: Name - Qualifications: Name: Qualifications: COmaa Phone: Contact phone: Contact Phone: Section D - Food M11 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 ounty Health Department Temporary Event Permit. o 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 o All applications and guidelines can be found on the St Joseph County Health Department Food Service website at 51chd.o fo -service. Please select food types: Food Vendor ❑ Caterer ❑ Food Truck ❑ Other: If a Food Truk Please list company name(s): N/A Please describe how food will be cooked and served: &Ww ' ( & ('\ -4\c- o-) d-. K -1-h e,•r, ��fi i^ ccM f-c��w�s �tSL ses it (gid f dU4 11 Date: V — a Event Nam Organization: Section E - Indemnf & Hold Harmaess AAMment City of South Bend Special Events Committee Indemnity & Hold Harmless Agreement 07'w a, Applicant (Contact) Name: Applicant (Contact) Phone: _9N act -�N —F6l V I r - -- __ Alt. Phone: Email: Address: Event Location (Please describeY Length of Event (Dates/Times): City/state/ZIP: 02 1 104m APPLICANT agrees to indemnify, defend and hold hamdess 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 Worksto close a porton of the public right-of- way for the event described above, or for any harm or damage alleged s, have occurred bemuse 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: _ ; f4 Authorized Organizer Signature _ 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. S. 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). 8/12/2021 Blaine Ave & California Ave - Google Maps Google Maps Blaine Ave & California Ave Imagery 02021 CNES / Airbus, IndianaMap Framework Data, Maxar Technologies, USDA Farm Service Agency, Map data 02021 200 ft _.. _ https:llw .google.com/maps/place/Blaine+Ave+/u26+Califomia+Ave,+South+Bend,+IN+46616/@41.6882488,-86.2696158,543m/data=!3m1!1e3!4m... 1/1 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: —�«lg Applicant Signature: -_TCO\ \ Ko.ftxvS D n1T" Printed Name: --------------------------------------------------------------- - resident M tuber SPECIAL EVENTS COMMITTEE APPROVAL ember Member Member Date CITY OF SB SPECIAL EVE 7315 LAFAYETTE BLVD SOUTH BEND, IN 46601 08(12/2021 14:18:22 MID: XXXX)OIXXXXXX401 TID: XXXXX800 DEBIT CARD DEBIT SALE Card a XX)0000;XXXXX2005 Network: MASTERCARD Cho Card: Debit AID: A0000000042203 ATC: 0128 ARQC: 06974A42F52FF67F SEQ #: I W# 21 INVOICE 1 Approval Code: 153117 Ert Metlwd: Cho Read Mode: Iswer • PIN Verfled SALE AMOUNT $3.W Signature Not Required IAN M THOMPSON MERCHANT COPY