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HomeMy WebLinkAboutSpecial Event - Clover Street Block Party - July 804 ypti FH 6,��0 APPLICATION FOR USE OF PUBLIC RIGHT-OF-WAY FOR EVENT ;A; �(F The following special event has been approved by the Special Events Committee. ►ess Submitted by: Denise Miller Event name: Clover Street Block Event Date: July 8 2023 Street Closure: Clover St between Ruskin & Hildreth Closure Times: 8:00 am to 8:00 pm Sidewalk Closure: ❑ Yes ❑■ No Comments: Neighborhood meet and greet. CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Gary A. Gilot, Member Murray L. Miller, Member Joseph R. Molnar, Vice President Jordan V. Gathers, Member 414 Attest: Theresa M. Heffner, Clerk Date: May 23, 2023 1 • • City of South Bend Special Event Application 2 Neighborhood Event $25 application fee if filed 30 days or greater (up to 180 days) in advance of event. 1865 Please Brine Completed Application and Payment to: Public Works Service Center, 731 S. Lafayette Blvd, South Bend, IN 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: LlaG:a-� Organization Name:. Applicant (Contact) Name: W i Q iurv1 Las lee- c� Applicant (Contact) Phone: S14 4,Lt O O SS y Contact Email: PGr"*ec)-t2 W.ASu✓e 773( JJrna— • I • co Address: 11041 PJ60W Sk- City/State/ZIP: 'JOul� 6LYNA LI661.S Secondary Contact Name: 4 0An&- 4%- -L'W ContactPhone: Contact Email: ®*�ccuSi,r2 %!3�vma:/ca✓` Address: 1101 40- City/State/ZIP: Saw4'i, Ae"d L.V t/AAIS7- Event Name: 1., Ou e 5 BX6C - fQ-V � xpected Attendance: S 0 Requested Street Closure: Uwec �} From (Cross Street): pjable." To (Cross Street): H I I AfP Try Provide a brief description of the event: j}r22�- (,105LLVe ko Nav22 CLU uetc(Li ' }o yy� �w.q � vYni- a�cici- }v luy,cw Ct+c4` �r and allow }:.a �C icy 5 Vta.oa 4un anal Nda- uaov rY 0-107La daC�'c Date of Event Setup [mm/dd/yy): J LtU B c1M3 Time: 8 4M � Begin Date of Event [mm/dd/yy): ILA W ?i a3 Time: 9j a rv, End Date of Event [mm/dd/yy):��tA LV D ��!`� Time: % pr+ Event Cleanup Completion[mm/dd/yy]: jLl OAa3 Time: Om 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 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)? E3'Ves 0 No Will alcohol be served or sold? ❑ Yes E-No 40 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: City/State/ZIP: • (b) Independent Security Information Name: Contact Phone: Qualifications: Name: Contact Phone: Qualifications: Name: Contact Phone: Qualifications: 0 144.7-1071_91MMM • 11 11 Will your event have food sales (food vendors, caterers, food trucks, etc.)? ❑ Yes [a'No o If yes, the event coordinator must apply for and receive a St Joseph County 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 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: pod Prvo ic4CA P e'r h0u6e 0%01CA • City of South Bend Special Events Committee Indemnity & Hold Harmless Agreement Date: u Event Date: JaW �a Event Name: �pt?PX c5� gAoCk— 90elro Organization: Applicant (Contact) Name: WQU caM l,o s ke Applicant(Contact)Phone: L-7q-11t4f7 -056Y Alt. Phone: Email: 77 Address: l/69 8/0r.Cef es City/State/ZIP: Event Location (Please describe): jbwv S)-- A.'e4u.een Length of Event (Dates/Times): 12u�le�:i qnd h1106Y4' S aM - P:� P I 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: Authorized Organizer W Printed Name and Title • Section F - Permit & A¢reement 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). • E • 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: Dn Applicant Signature: Printed Name: Z 5lee— SPECIAL EVENTS COMM ITTEE APPROVAL Ident I�i1 L z �Member Member Member 5-/G -:?3 Date • • �J Neighbor Siomture Sheet - Neighborhood Special Event We have been informed, agree to, and request that the Special Events Committee of the City of South Bend authorize a block party in the area described as: ,� ' bovur :J� from ��JY 1y` to A41 I Jk,6 ..� Street Name Cross Street Cross Street Date of Event: J L L11 / av a3 1. Signature 6. Signature Name / S Name!ai Address O�Y s Address �0110 0, �E\ Phone No. �1i O �_ 77 Phone No. /L Date Date Z• Signature 7• Signature Name Name N�•�e c�-5 Address G c ICirc • Address Phone No. T f - ^ 6 t / � I l� Phone No. S � � �� -7 Date �1 (1 ZG� Date 3. Signature /' B. Signature Name Name I/ (j(- Address I C lUv el Address l /�� 7 0 . _ Phone No. 57 4 33U _ l c o 1 l i Phone No. ,4 -Fl Il Date /I I Date y _ y. _ 4• Signature 9. Signature Name Name Address L Address j Q l I Q �. 1 1 Phone No. Phone No. Date -3 Date S• Signature i12 \\_ 10• Signature Name n -�a Name K j11L Address ' Q n n 1 l� l�� Address I c' 1 Phone No. -I I Phone No. Date LA_ � ' � Date S J • • Neighbor Signature Sheet — Nei¢hborhood Special Event We have been informed, agree to, and request that the Special Events Committee of the City of South Bend authorize a party iin� the area described as: block i` 610 . e J� from to Jluil Street Name Cross Street Cross Street Date of Event.. JLI l l $ '�4'CoL3 1. Signature �� ` _ n2 v �.f/ 6. Signature -� Name r L (� (i l/ Name 1I Address I / U O Address 1 Phone No. S - 315 13 q z Phone No. C O J/ Date Ii/1y�202,2 Y Date � 2. Signature 7- Signature �'i Name Name Address Address Phone No. Phone No. Date L Date 3. Signature 8. Signature ' Name Name Address Address i f Phone No. .� Phone No. Of c Z! Y Date I Date 4• Signature 9- Signature s Name TA / Name AddressZ 3 Address Phone No. S r1 S _ © Phone No. Date I _7a �} ._ Date S• Signature 10- Signature Name T / ', 1 'tl�r - G r cv-�k rt Name Address ,� vi �- Address Phone No. Phone No. Date Date © y E • O c w E L u S Esther St '_ L c 2 N � E � b Q N c ana i LU o «u c. , Y 0 4 N A Ox�j x (LNo 13 11 G1 Che51Q' u �a w %V U'CQ Ji .EC EY i w N p'7 C N 4 m Q LUM ¢a ca S Esther St Twyckenham Dr y „ Clover St Q Q° c D w C > w a c) M J i A h Oakland St w a 00. Q N O 0 � 03 0 a ua C o� a U Oa vv 0 } N V a. N v N q E N 00. y° m r ° is siiagoy U O � Bellevue Ave S Twyckenham Dr Oakland St Emerson Ave Roberts St a Louise St Louise St Q• woo O U U Q Y U a0 iy } 00. N d G r• Clover St c a cc Q v � N L 0- C p b z Oakland St 5 03 a v M O O7 Emerson Ave 0 20;`� BLOCK PARTY 2023 Clover st Ideas and sign ups Bill -1109 clover st 574-440-0554 ! Everyone is invited to participate July 8 2023 and we hope to make this an annual event! Please consider donating an item or for an event for the party. You can even donate money or get together with other neighbors to go in on something as a group., a few ideas are listed below. Please return this form to 1109 Clover Street by June 10, 2023 side walk chalk, bubbles, balloons, treat bags, Silly String, Noise Makers etc.. We are looking for people interested in providing entertainment, a Game Moderator, etc. Below are ideas, but feel free to reach out with your input! Volunteer Dunk Tank Bounce House, Slip and Slide We are also looking for any games such as Ring Toss, Bean Bag Toss, Corn Hole, Giant Jenga, Also we need as many volunteers to help run kids games and activities Objectives To keep these kids busy and enjoy the open street with out worrying about flying cars and to meet and greet with neighbors on the block n CITY OF SB SPECIAL EVE 731 S LAFAYETTE BLVD SOUTH BEND, IN 46601 051;01.!2023 09:26:50 NO: XXXXXXXXXX)CX401 TIC: XXW800 DEBIT CARD DEBIT SALE Cad t X)OOOOOIXXXXX2867 Network: VISA Ch4 Cad: US DEBIT AID: A0000000980840 ATC: 01CD ARQC: OFCBD9BCBF4DO6D1 SEQ #: I W #: SO INVOICE 2 Approval Code: 982793 Entry Metw: Contactim Mode: Issuer • PIN Verft SAIE AMOUNT $3-W SOW Not Requued VISA CARDHOLDER MERCHANT COPY 0 NEIGHBORHOOD BLOCK WlY WHEN: Jay N fROMMM-]PM Please contact bill for anc questions and donations for kids games 574-440-0554 r- I