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HomeMy WebLinkAboutSpecial Event - Ellsworth Block Party-July 3 2025APPLICATION FOR USE OF u: PUBLIC RIGHT-OF-WAY FOR EVENT s..j..` r ti. The following special event has been approved by the Special Events Committee. Submitted by: Denise Miller Event name: Ellsworth Block Party Event Date: July 3 2025 Street Closure: S Ellsworth PI from Wilson to Washington Closure Times: 5:00 pm to 11:00 pm Sidewalk Closure: ❑ Yes ❑■ No Comments: Neighbors gather for food, games and community. CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Joseph R. Molnar, Vice President 49,� 6vo Gary A. Gilot, Member Briana Micou, Member Murray L. Miller, Member Attest: Hillary Horvath, Acting Clerk Date: 6/24/25 1 eP City of South Bend Special Event Application w1dII Neighborhood Event • \r" _= 7 $25 application fee if filed 30 days or greater (up to 180 days) in advance of event. 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: S/01-/ ! yyo'? Organization Name: Applicant(Contact)Name: //C� -Y/ ©lee Applicant (Contact) Phone: 7 Email: Address: City/State/ZIP: Secondary Con qt ame: Contact Phone: Address: • Event Name: IV Requested Street Closure From (Cross Street):_ To (Cross Street): City/State/ZIP: Provide a brief description 9f the event: / Date of Event Setup [mm/dd/yy]: -7 C?! Time: /7l Begin Date of Event [mm/dd/yyl:-7 /-3 r�� Time: End Date of Event [mm/dd/yy]: 02 Time: 12�) Event Cleanup Completion [mm/dd/yy]: Time: �4:2� 4rt✓►' 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: 1p Number of households represented by signatures on attached sheet: Will this event have music (live or other)? L9esYes 0 No /Section C - Alcohol Will alcohol be served or sold? ❑ Yes H No • If Yes: T 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: n \_ (b) Independent Security Information Name: Qualifications: Qualifications: 0 Contact Name: City/State/ZIP: Contact Phone: Phone: Contact Phone: Section D - Food Will your event have food sales (food vendors, caterers, food trucks, etc.)? ❑ Yes Or/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.ora/food Please select food types: ❑ Food Vendor ❑ Caterer ❑ Food Truck ❑ Other: O G% e If a Food Truck, please list company name(s): Please describe how food will be cooked and served: 0 Section E - Indemnity & Hold Harmless Agreement City of South Bend Special Events Committee • Indemnity & Hold Harmless Agreement /oZ Date: Eve�ntoDate: �91 � "�, Event Name: �iiISL�O �.l �L ���G J4 {' ar- N Organization: ii<-c C5t4-10- -UI I Applicant (Contact) Name: // Applicant (Contact) Phone: lf�7 �Alt. Phone: Email: i%ia lee7 io19d tedik Address: my pl City/State/ZIP: '-50 R', Kw Event Location (Please describe) Length of Event (Dates/Times): • APPLICANT agrees to indemnify, defend and hold harmless the Civil City of South Bend, Indiana, from any liability, loss, costs, damages or expenses, including attorneyfees, 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 M Printed Name and Title 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: Applicant Signature: Printed Name: -11 mawv is SPECIAL EVENTS COMMITTEE APPROVAL MemberL�/ `— Member b-ir -a6' Date • • 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 Na E%l WO kl it , / j / S O Cross Street Date of Event: 1. Signature 6. Signature Iq Name J� Name �.t�av�Cor�n.o Address // / (�/�{ u7/4 � Address 103 Phone No. 57q _ 3V _ 8� 7 Phone No. 574- 3)1 3'7�77 I Date 5 Date S/L 1� Poe - 2. Signature 7. Signature Name I YJQ//_ YJ v' 1 Name I p J r 0 Address137 —c"8I„ LI Address I ,t tti+ar Phone No. - a33 0.3 P Phone No. /t )—QO Y"'"' / A DatgJ Date / 3. Signature 8. Signature Name `.)�fql. aw Name G.r-C-•. /� Address �, Address NI - Phone �- �• 4. Signature 9. Signature Name h Nnn�,e. , Name CQ�'JGLf p Address i,ZI �. L' Cr - Address ! Phone No. 7/ !' R) 6) 90 Z IJCl/JZ,'� Phone No. p /L � 3- p Date 1 2— 5 f l P /' Date -� 5. Signature 10. Signature Name MlP L Name C ( W c� s' Address [ NVva'_I t P I. Address -51- a61/ao�-!�- Phone No. Phone No. Date Date fk S Esthe 5 - 7=St , _ SEsther St� .. _ 4, �.. -EG) Ave S Greenlawn Ave S Greenl awn Ave to r .. -x' 0 la.y7 t' ry'00 tP S Ellswort S Ellsworth PI - ,�.o N. 74 '4 i - f. 1. _ 5 Co uillard Dr S Co9 uillard Dr N 1` r sr :WII I� :L"a ^f S Haw,thorne_Dr_< S Hawthorne Dr N. Hawthorr MARY OLEN 719OM2712 5685 134 T BEND, IN PL tIPT-P 50UTH BEND, IN 46617.3427 DATE i74-993-9843 PAY THE i L INOVA FEDERAL CREDi NION 7 Alt>to r t:27129068 1t: 819090912tN 568 r1 LJ n LJ Ellsworth Place 6th annual BLOCK PARTY July 3 6:00pm to dark Giant Slip `N Slide LIVE music by Clave Caribe Fireworks E 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. u