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HomeMy WebLinkAboutSpecial Event - Ellsworth Annual Block Party - July 3gut rH'R APPLICATION FOR USE OF PUBLIC RIGHT-OF-WAY FOR EVENT The following special event has been approved by the Special Events Committee. 18hs Submitted by: Denise Miller Event name: Ellsworth Annual Block Party Event Date: July 3 2023 Street Closure: S Ellsworth P1 between Wilson/Washington Closure Times: 12:00 pm to 11:00 pm Sidewalk Closure: ❑ Yes ❑■ No Comments: Neighbors gather with picnic food, games, music and social time. CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Joseph R. Molnar, Vice President Gary A. Gilot, Member Jordan V. Gathers, Member %yg"�' .4 72� Y vVv 4 Murray L. Miller, Member Attest: Theresa M. Heffner, Clerk Date: June 13, 2023 1 • ,,, City of South Bend Special Event Application G d Neighborhood Event _ rue J $25 application fee if filed 30 days or greater (up to 180 days) in advance of event. \lBtiS 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 evert date or the application will not oe acceprep. Date of Application: ✓ / GnnlirantWnntartl Namp- Applicant (Contact) Phone:, Address: /. ~f J' Secondary Contact Name: Contact Phone: n Address:''' • Event Name: Requested Street Closure Section A - Applicant Information Organization Name: �fii NLrclprf�� From (Cross Street): V JV Y To (Cross Street): / / Provide a brief description of the a nt: & Wh &V (. - Email: /ZIP: AV 7,°31 U Date of Event Setup [mm/dd/yy]: --77 0 / Time: //y OC dvYl Begin Date of Event [mm/dd/yy]: o a3�ada3 Time: DHl End Date of Event [mm✓ddA y]: / Time: /0 Pam' i 1 n 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 resident in addition to signature attachment • Number of households fronting the proposed street closure: �t Number of households represented by signatures on attached sheet: /U Will this event have music (live or other)? M Yes ❑ No Will alcohol be served or sold? ❑ Yes No • !'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 re ndable $400.00 deposit paid by card or check (made to City of South Bend) must be submitted with a lication. A lication cannot be processed without deposit. - :L ...:II L L.. J .. L. L .. L o The applicant st submit a map or drawing of: o Fencing oundservingarea o Trash rece acles o Events that will have cohoi sales must provide security. if your event will be hiring a security company, please provide its conta t information in sub -section (a) below. Otherwise, please list the names, phone numbers, and qualificatio s (e.g. Off -duty police officer, professional security guard, or event applicant) of three (3) security guards' the fields provided in sub -section (b). (a) Security Company Information Company Name Contact Phone: Address: • (b) Independent Security Information Contact Name: Email: City/State/71P: Name: Contact Phone: Qualifications: Name: Cont a Phone: Qualifications: Name: Contact Phone. Qualifications: C1 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. n All applications and guidelines can be found on the St Joseph County Health Department Food Service website at sichd.ore/food-service.-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: 9) n U Y •1 1�_-n� � ._,...: a .. .- - City of South Bend Special Events Committee • Indemnity & Hold Harmless Agreement Date: u� D� o20,2 %� EvenAt%ate: emu- c/ 6W 3 Event Name: t�dl/r �/f1fi8D Organization: k'S Applicant (C/oon�tact)QPho�ne:.5-'/ 4 / -/✓ I? U Alt. Phone: Email: Address: City/State/ZIP: Event Location (Please describe): -IX-4 leUS- � �% C 0�r5 cNe� / j%/ 44e,7 • 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 _.-__..IL [ _I _L' .1 '_L ..L -J '.__L LI _!-L 'L L ._1 . VI IIM1MI PiOI..iYII V1 Pllr V,P 11'.J V. P..LIVI IJ.VIPVI•... IY..IIIPY..Q(jP..... .... VILY, 14i Orjl.l•N,..I,IIJ\V VI.Jf VI 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: Authcrlznd Printed Name and Title C� '% -1 mk= "I71 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. 9 All rocirlcn#c IAA+hin the nffartcri area most K. nntificrl of this cvont The APPI Ir ANT most nht�in 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 describingthe 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 responsibic for providing sa'w resident's) 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 Sneed 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 --s needed. is10. 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, sneakers, 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). 0 11 Date: 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. Anplirant Signature! Printed Name: President Member 40 CpF(IGI C\/CNTC rC)UUITTFL AOPPC)17AI . _MemberMerr e/IartI6IVC "ei-t ( i Member 6 -G -13 Date • Goggle Maps N Ellsworth PI & E Washington St N O Julia Robbins Team, Homes By The Bend... gton St I St E Washington St 0 CE W £Jeffers on Blvd 3 12 f 97 E Wayne St Om E Washington St People of Praise O o Trinity School ,Devon cir at Greenlawn E Jefferson Blvd N W h E Wevne w we E Jefferson Blvd N Gpogle D o d z C o i w n 0 o v -�i v • E Washington St n 2 8 F C y N � rn m y, � tJ 0 v Jefferso N fA O c E � n m 4 4 x o a N C O 6 9 Starz Academy O E PDO Preschool 0 E Washington St N O M a O Wilson Ave N O F O Forever[ Daycare W n Blvd O DLZ Map data ©2023 Google 200 ft r • C -qm�Srly—mStaK 4OOT%t__ I ` z have bee:.::,.r..:..e.,, agree to, and request that L.e Special' events Committee ofthe City of South Send authorize a block party in the area described as: �,�r f em �i l cS e vl to A1 rklo Date of Event: 1. I signature � 1 � b. SiP�� �,? I Lt-•�_ a7 ( $( 9 I. Address Ill N• Ott cwvt- el Address 1 2 7 J� Phone No. 5- , 315 'S 2_ 1 j Phone No. C I _ ✓ : - 3 , �_ r . 5 "3/.�3 2 Signature l 7• Signature Name h i� eae 5{qIiJl- Name /Jl Phone No. tj, 30 Phone No. 5- 7 Z 3 2 g Z 56 Date 5 l Date S. s- z o 23 1 Name /� •�� . Name (✓ C r , Address 01 S EIISOI,:4 `• Address y S 5 zF/kdI"fi / C .s.Wv_.... Date 5 23 Date S �-� .Z o 2 4. Signature �`i.G.-w� 9' r Signature v,. i i 64� Ce jd„ �� _ (I(I - f Address III $ S4 Phone No. I Date. I 5•. Signature Name ! l Address j �Z Phone No. 1 Date n 1 Sw c. ^ 1 I I I Address Phone No. I I. Date Is7q-a33- 1-5&5(/-)l 3 a 10. Signature Name I Phone No. Date 5-7 C, 8-0�' Ellsworth Place 6th annual BLOCK PARTY July 3 6:00pm to dark Giant Slip `N Slide LIVE music by Clave Caribe Fireworks Burgers and hot dogs provided Please bring side dish or dessert to share. If possible, bring your own chair. Dessert Derby is back! With prize for the best dessert! Two categories: 1) Cookies and bars 2) Cakes and pies Bring dessert by 6:45pm. For dessert questions contact Karen Xenakis 574-213-0463 Questions? Contact Matt Ingle 574-714-8430 Street will be closed. Please plan accordingly. Cash donations accepted to help cover costs of party Venmo: @mattingle24. Band will also be accepting donations. 4) MARY OLEN 134 S. ELLSWORTH PL SOUTH BEND, IN 46617-3427 574-993-9841 .. "_�6�2"2 5545 e�ie�o•y] DATE S a✓ (NOVA FEDEjjRA((LCREDIT UNION ry��y��/�� MEMO {�v1.i 7�1 0�?)I r 1:27i29068i�: 8�90 0942IIm 5545