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HomeMy WebLinkAboutSpecial Event - Boys & Girls Club End of Summer Celebration - July 19APPLICATION FOR USE OF PUBLIC RIGHT-OF-WAY FOR EVENT The following special event has been approved by the Special Events Committee. Event name: Event Date: Street Closure: Submitted by. Denise Miller BGC End of Summer Celebration -july 13 2023 Wall St between Greenlawn Ave/Ironwood Dr Closure Times: 5:30 pm to 8:45 pm Sidewalk Closure: ❑ Yes © No Comments: Potawatomi Park reserved for Boys & Girls Club outdoor gathering. CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Gary A. Gilot, Member Murray L. Miller, Member k�,p1 TR AF, l •� ;i PFAI'F- a - t 11165 Joseph R. Molnar, Vice President NY Jordan V. Gathers, Member Attest: Theresa M. Heffner, Clerk Date: June 13, 2023 1 of BP�o City of South Bend Special Event Application Neighborhood Event o • �' $25 application fee if filed 30 days or greater (up to 180 days) in advance of event. • 1865 i 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 complet N,>98�--�` q s Event applications must be submitted more than 30 days in advance c r n Cy be accented. Section A - Anplicant Informati Date of Application: 0 _ Z 3 Organization Nam Applicant (Contact) Name: &V/ 0 CI'/ V A 7\ /- Applicant (Contact) Phone: 71I - L to - (o? I Contact Email: _ Address: S O Z L Sa,4f '�4 City/State/ZIP: S Secondary Contact Name: Alex �,/a,,la,\ Contact Phone: 2 `/O - 'PSE - O i d�O Contact Email G Address: 5�Z L $ rlc S� City/State/ZIP: • / / Section B - Event Information Event Name: ��(r t'c^ trr S-Mh r i de4—'txpecteclAttendance: Requested Street Closure: / W 0 It Spier- 4- -From (Cross Street):/ f e<n In w A 14 I/C To (Cross Street): Z r or w xi d 0l ', Provide a brief description of the event: Sco Date of Event Setup [mm/dd/yy]: 7,/Iq/21Time: /� 3 0 n N Begin Date of Event [mm/dd/yy]: Z 3 Time: CX) /Yl End Date of Event [mm/dd/yy]: �'//5Z 3 Time: 00 O/K Event Cleanup Completion [mm/dd/yy]: _ 7// Z 3 Time: g' W �, M Have all residents on the affected block have been notified and invited? Kyes ❑ 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: Q Number of households represented by signatures on attached sheet: Will this event have music (live or other)? X'Yes ❑ No Section C - Alcohol Will alcohol be served or sold? ❑ Yes 7_No • T 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 Trash rerpptarles 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 TT Company Name: S 13 10y�l Contact Name: S-7(— Z 3 S Q 2 o Contact Phone: • (b) Independent Security Information Email: City/State/ZIP: Name: Contact Phone: Qualifications: Name: Contact Phone: Qualifications: Name: Contact Phone: Qualifications: 40 Section E - Indemnity & Hold Harmless Agreement City of South Bend Special Events Committee • Indemnity & Hold Harmless Agreement Date: 2 Event Date: 4 - Z 7 Event Name: l30Z5 4 C�� Organization: Applicant (Contact) Name: Applicant (Contact) Phoney 2 Yo foe - 0/ 4 D Alt. Phone: Email: C1 WNN'ZA Address: S 0 4- t /c S City/State/ZIP: Event Location (Please describe): 2n� e �Grlt Length of Event (Dates/Times): T0-1/1PGYL / Pn enrr Off" 'ice �(.,, W e Ore 5 PeSe�v,�� -rGt . 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 maybe 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: /Z/ Z -1 Authorized Organizer Signature t1✓��O �'✓YF Jl /`("�'C5 (/��LGf+�r Ya'' 9','5 t &/"/, G/O. Printed Name and Title 0 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 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: • 11 Section F - Permit & Aereement 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:��/Z 3 Applicant Signature: Printed Name: President Member • V�e/< SPECIAL EVENTS COMMITTEE APPROVAL &!'l0%fC &'m 6'-t Member G-6-,�3 Date Google Maps Wall St & S Greenlawn Ave 1 a m Southwood Q Ave Southwood Ave Potawatoml Zoo -nunat animal park Drain Surgeon 0 B Hoover Ave n tat Ave " Potawatomi Hoover Ave Park Wall St St Wall St John Adams High School r m TMayicalMlnkz'EMishawaka Ave Beauty Bar IU South Bend ® ' Farm Makin Waves 0 Wall St Splash Pad® ,p Hastings St t Wall St Wall St L.BJ's Tax Cafe Q N Kids Kingdom at F Potawatomi Park g Kid's Kingdom n 0 Family Dollar o ,r. Potawatomi Q Allies Cafe 8 Catering R B. Conservatories -- Mobil Ill ae ,,,r ,,el .jpoaIe South Bend Fire Station 9 mei economy t E mis wake Ave Mattress Center Soul Fire m A o 0�..,......1. Map data @2023 Google 200 ft r Cl CITY OF SB SPECIAL EVE 731 S LAFAYETTE BLVD SOUTH BEND, IN 46601 06i051023 14:55:18 MID: xXXXX%Y,AXX%X401 TID: XM800 CREDIT CARD VISA SALE Cad u XX)OtXXXXXX O 0586 Chip Cad: VISA CREDIT AID: A0000000031010 ATC: 008E ARQC: 99EFO87ADB9C735A SEQ #: 1 Bath #: 55 INVOICE 1 Approval Cade: 315055 Enlry Medved: Oho Read Mode: Issuer Tax Arwt: $0.00 SALE AMOUNT 02 I agree to pay above total amount accordN to card issuer agreement. (Merdmt agreement V Crect Voudw) 1ETY STANTON•VERDUZCO MERCHANT COPY 11