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HomeMy WebLinkAboutSpecial Event - Clover St Block Party - June 29APPLICATION FOR USE OF PUBLIC RIGHT-OF-WAY FOR EVENT ;.�.._ The following special event has been approved by the Special Events Committee. Submitted by: Denise Miller Event name: Clover Street Block P Event Date: 6/29/24 Street Closure: Clover Street between Hildreth & Ruskin Closure Times: 8:00 am to 8:00 pm Sidewalk Closure: ❑ Yes ❑r No Comments: Annual neighborhood block party featuring potluck food, kids games and prizes. CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS la�a Elizabeth A. Maradik, President Gary A. Gilot, Member Murray L. Miller, Member Mw I Joseph R. Molnar, Vice President Breana N. Micou, Member Attest: Laura D. Hensley, Acting Clerk Date: March 26, 2024 ` f4icTg,_R;,, 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. �s Please Bring Completed Apolication 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. Date of Application: c, 127 /0-V Organization Name: Applicant(Contact)Name: `A ) Ur CIM Applicant (Contact)Phone:.57/'4/4U 0554 Contact Email: /zJ �c�rn�a5cc✓e773�9/114�Corrr Address: 110c1 Oyue-r City/State/ZIP: Soy. In ge-A-L/PJ Ybcy� Secondary Contact Name: _ _ /a ran q Lw 4 PY - LcpSke Contact Phone: �Y7 1 &7 br(O% ContactEmail: 1'erFe_rJ tectgr�i p 7)g Q9Ena./coi,. Address: //U `% (7 by i1-e✓ S City/State/ZIP: f Event Name: V 0 a z,r S } N- 6C /L I" Expected Attendance: 50 Requested Street Closure: C%OUev 5� From (Cross Street): To (Cross Street): Provide a brief description of the event: 6}me4 e_bo5u_� -4' k_-v.,e kl cth�ooe-5 fc) cie_i- �-o L_nc�w eack c4ka-r c onak_ 6A0\,' t4^2 IcM:5 �-o kov-e_ Fw, L.\ji4kc)Lx+- a-h¢ wovvy OP ve4Nict-'P_S Date of Event Setup(mm/dd/yyj: cJLAfA _ 99 aoay Time: 8 4"-1 Begin Date of Event [mm/dd/yyj: JL4447 -2 9 4c&2 t/ Time: 9 'tm End Date of Event [mm/dd/yyj: 2U c/ Time: -7 gr'+7 Event Cleanup Completion[mm/dd/yyj: Jctu -907YTime: 00f 7 Have all residents on the affected block have been notified and invited? ❑ 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: 12 a �n/ g Number of households represented by signatures on attached sheet: / of &5ji 'S oj ,a rx»d Will this event have music (live or other)? ❑ Yes / Section C - Alcohol Will alcohol be served or sold? ❑ Yes 9�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 Contact Phone: (b) Independent Security Information Contact Name: Email: City/State/ZIP: Name: Contact Phone: Qualifications: Name: Contact Phone: Qualifications: Name: Contact Phone: Qualifications: Will your event have food sales (food vendors, caterers, food trucks, etc.)? ❑ Yes ZrNo 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.ora/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: /'1 W City of South Bend Special Events Committee Indemnity & Hold Harmless Agreement Date: a 3, aD'- Event Date: Event Name: Organization: Applicant (Contact) Name: 0'D1 11I CWVv Applicant (Contact) Phone: 57 `{ - y 4 0 - O 55q Alt. Email: Address: ��U� G'DU2� `�9' City/State/ZIP: 50u-� ('Le-vvok ik3 41Ot5� Event Location (Please describe): Cots--z tr >' Length of Event (Dates/Times): JyVU- L�q aod'-4 ?I 0�� b eV^ 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: ), 01-) I a Organizer Signature 1i/11,04IV7 Ca Printed Name and Title 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: al 7/a0 '- l Applicant Signature: Printed Name: Z /M 4�" Member 40 SPECIAL EVENTS COMMITTEE APPROVAL Member Member Member Date • • Neighbor Sgnature 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: Ot)w from to //,�( U CJ Street Name Cross Street Cross Street Date of Event: J I p �(� act `emu Oz- �16. 1. Signature Signature Name '' ••'' L(J i /�Ir0.Yvl (.� /ce Name KO 10' GAMM" Address , Address 1115Phone C S f No.6741 qO vssy Ph�,e"° 574 6)90 Date a as I Date 2. Signature All tanm 7. Signature Name Name V a O Q ` Address 110 v c�� Address tl°bCIDVe f Phone No. �}/ Z (1 D Phone No. 5�4) 6 9 4 Date �aA Date 3• Signature 8. Signature Name Name o O en Address ' c)lO �\ l� st Address O l`1 off r Phone No. - 7 2 7 Phone No. 1s�4 a8 -6 9 $ Date r,l Date 4. Signature 9. Signature Name dr. d Named Address dq 77 Address IIO9I�G�tRQ���II Phone No. Zq 1 Phone No. Date �/J _ G 2 G� Date 2 �a � S• Signature 10. Signature Name O E %� 7QK - Name Address A L 0 !/L�;C i Address Phone No. 5 y Phone No. 57 - Date 'L - % 2 - �` Date -aa Vis • • Nekthbor Sienatum Sheet - Neiahbofiood 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: from to h Street Name Cross Street Cross Street Date of Event: fJW�2 ,�q ac�a 1. Signature 6. Signature v Name wUJ Name Address t Address 1 I � 7 Phone No. G J Phone No. � L Date a Date t 2. Signature ,Ox f /y>/,am k �� 7. Signature Name Name l Do 0 k-� sY- Address )-c ? 0' Address 0 Phone No. 2 G y - ? r? Phone No. I Date 2 _ Z L-Z Date 3• Signature 8. Signature 101� WI Name �1 /J Name Address /O T %V s-,- Address 1011 owes S� Phone No. 5' 71/' _ 3 Zy&c301/ Phone No. Date Z� �Z -Z� Date 4. Signature /' 9. Signature Name ✓ `_ �� Name Address n Address 1 '! t o l W �� Phone No. �- �/� %C, Phone No. Date < / _ Date S• Signature 10. Signature �G Name <"' Name Address ���� .� Address Phone No.� \ C / Phone No. Date 7.J,-�-? r/ 11 C • Neighbor Signature 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: &k&/- from [ ` to 464 Al Street Name Cross Street Cross Street Date of Event: , /i i iAn V1 aoa y VJ�' �C., 1. Signature - � i . 6. Signature g Name Name Address 10 /d���� Address Phone W. l/ �j �1-s Phone W. Date i 2. Signature /J L 7. Signature Name r' Name Address �/ CI /nv� //j U Address Phone No. JL _ Phone No. Date _ 7 y L Date 3. Signature 8. Signature Name Name Address Address Phone No. Phone No. Date Date 4. Signature 9. Signature Name Name Address Address Phone No. Phi No Date Date 5. Signature 10. Signature Name Name Address Address Phone No. Phone No. Date Date 2127/24, 12:43 PM Clover St & Hildreth St - Google Maps Google Maps Clover St & Hildreth St Clover St bet Hildreth St and Ruskin St 4 T O u " 0 � � onimistrationowlding l u 'a Indiana ity— Cr\ y :ouch Bendend Bookstore Bre x stole 0 © Q The Bock FI M Ma eullding Ruskin St Ruskin St Ruskin St Ruskin St - 11w C'Jubho.s, Q YMCA Cooper m °a m O x o ✓+ n v' Vouch Center '+° m 9 E N IUSR Den ,Idwlde ° ". m m i Paw, N 3 Education and -A o Buildmg Parking Q % Qi '.V iy nsae i,` • Bw Sri7o v ARC Document Solutions Hildreth St Hild,e ih Q d0 o 3r Hildreth St De: orx, Br.;'k Pavers Pl Purdue - Pu,dmy 4o'"hs, South Bend Area RFALiORS O Northshore Apartments • ae ejYd v x u � £ sn Indlana RIhLr n Service Company e 933 Force 5 m dye °Oy The Moryan. Pennsylvania Ave C, P, `r ! ✓ Oy.P Q oryhsi0e d 3 v vetera ns -i ,;1 C 6 o- Memorial Park / Go glee , t Ts Cradle GfQ LveDaye rte Dean coewu(Lon Ct 0\�a �Ja - ,ice Q01\D�' Map data ©2024 Google 200 ft' https://www.googlm/maps/place/Clover+St+^/o26+Hildreth+St,+South+Bend+IN+46615/@41.662752 ,-86.2291995,17z/data=!3m1!4b1!4m6!3m5! 1 sOx8816cd 1 cc80f2Od3:Oxcfd76aace6d25c38!8m... 1/1 • 6749401 CITY OF SB SPECIAL EVE 731 S LAFAYETTE BLVD SOUTH BEND, IN 46601 0227 2024 11:12:59 MID: XRXXXXXfDIX%f(401 TID: XX M371 CREDIT CARD VISA SALE Card # R10(XX)IX)000C 2867 Chio Card: VISA DEBIT AID A00000000310t0 11 #: I ba¢n #: 6 !NvOICE I ADaoval Code: 158,66 5m,W#10d: Contactle:: None: lzm SALE AMOUNT $ 51 11 0 I agee to pay above total amount accordtg to card issuer agreernent. (Merdmt agee wt V CredR VoLft) VISA CARDHOLDER MERCHANT COPY 0 0 From: Please contact Bill for any questions and donations for kids games and prizes 574-440-0554 •