HomeMy WebLinkAboutSpecial Event - Hispanic Heritage Fun Run-Oct 4 2025SOS UR.-
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APPLICATION FOR USE OF
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PUBLIC RIGHT-OF-WAY FOR EVENT
The following special event has been approved by the Special Events Committee. 1865 x
Submitted by: Denise Miller
Event name: Hispanic Heritage Fun Run
Event Date: October 4 2025
Street Closure: Run will follow Northside Blvd on the sidewalk with SBPD
assist at turn around point near IUSB
Closure Times: 6:00 am to 12:00
Sidewalk Closure: ❑ Yes ❑■ No
Comments: Grassroots event to promote health in minority commUnities.
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
Elizabeth A. Maradik, President
Gary A. Gilot, Member
mom,
Murray L. Miller, Member
Joseph R. Molnar, Vice President
Breana Micou, Member
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Attest: Hillary R. Horvath, Clerk
- City of South Bend Special Event Application
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\� City and Regional Event
$50 application fee if filed 60 days or greater (up to 360 days) in advance of event
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$100 expedited application fee if filed 30-59 days in advance of event
Please Bring 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. City and Regional 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 f
Date of Application: —KIM Organization Name:_��/�
Applicant(Contact)Name: �at/ nu �I✓�< ti/. /
Applicant (Contact) Phone: 17`z Contact Email:
Address: I Z Z 0014f/AP S/ City/State/ZIP: 50L-� `/s Rfall
List any professional event organizer, event service provider or commercial fundraiser that is authorized to work
on your behalf to plan, produce and/or manage your event.
Organization Name:
Contact Phone:
Address:
0
Contact Name:
Contact Email:
City/State/ZIP:
/ Section B - Event Information
Event Name: �� �CPrT�� ��" Zf Event Type: (Festival ac , Parade, Other):
• Event Classification: &Non -Profit* ❑ For -Profit
❑ City (Civic) Sponsored Other (If Other, please describe):
*The Special Events Committee may request proof of non-profit status.
Provide a brief description and timeline of event (Note: A detailed map plan is required in Section H of this
application. The description should be a summary overview.)
Date of Event Setup [mm/dd/yy]: 0 I Z 5 Time: (J oo am,.
Date of Event [mm/dd/yy]: 0 �4 Z 5' Begin Time:
End Date of Event [mm/dd/yy]: 1G/ L f" End Time:
Event Cleanup Completion [mm/dd/yy]: D 0 c ?-r Time: 141114 2 d o in
Rain/Alternative Date: If yes, please provide the date:
Total anticipated attendance: {00
The proposed eventwill require the dosing of: Streets Sidewalks ❑
• Is the event ticketed or includes fees? Yes o
IF YES:
List fees and fee groups below: �e f i 0r. 41a� �e'eo
f�1 S vI li 9 a �awrrc��
Does the event have any partnered sponsorships? ❑ Yes No
IF YES:
List the number of sponsors at each level of partnered sponsorship:
1 A I S 2a 00
f6- r«e.
Is this a returning special event or part of a series of special events? ❑ Yes '
IF YES:
411
Provide the date, location, and attendance of past special events and/or future planned events in the
series:
If YOUR EVENT IS A PARADE, RACE, OR OTHER PROCESSIONAL -TYPE EVENT, complete Section C. Otherwise,
continue to Section D.
• Section C — Parades Races, and other Processional Events
What is the estimated number of parade/race spectators on the proposed route?
Describe any sound equi/p�men't /thattw%ill be used in the parade/race:
Does the event have participant categories? For example, a run that has different race divisions or a parade with
separate walking/marching groups.
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IF YES:
Listcategories and anticipated participants per category:
•
IF YOUR EVENT IS A PARADE, please provide a supplement writing describing the approximate number and
type(s) of animals, vehicles, and Floats participating in the parade? (Note: If using animals in a parade, event
organizers are responsible for cleaning up animal waste left on the parade route.) Describe parade participants
below:
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•
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Section D — Eguipment, Set-up, and Logistics �/
Are you hiring a company to provide entertainment, games or inflatables? El Yes p�' No
IF YES: /
• You must submit proof of insurance forall stage and entertainment companies three (3) weeks before
the event.
Describe any hired entertainment:
Will you be staking any tents, inflatables, portable restrooms or any other anchorings?
IF YES:
❑ Yes XNo
• You must provide proof of locates (locate number) two (2) weeks prior to your event. Locates can be
found by calling 811.
Does your event include the use of fireworks or other pyrotechnics?
❑ Yes XO
IF YES:
• Depending on the potential fire risk, applicants may need to receive approval of the South Bend Fire
Department (process facilitated by event coordinator).
• Only consumer grade fireworks can be used during certain time frames (July 41' and New Years).
o A permit must be applied for with the Indiana Department of Homeland Security for Commercial
Grade Fireworks show.
• All entertainment events should have a permit from the IDHS Amusement and Entertainment Permit.
Describe the event's proposed fire -related entertainment:
Will there be any musical entertainment features at the event? XYes ❑ No
IF YES:
Describe the type of music, schedule of sound check/performances, and the names of any artists
oerformino:
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For stage inspections, contact the Department of Homeland Security at 317-232-2222.
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IF YOUR ROUTE CROSSES OVER A STATE ROAD OR A BRIDGE, please contact the following for permission:
State, INDOT: Michael Hurt, mhurtlnaindot.in.aov 119-851-1416
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County Bridges: Andy Hayes, ahavesr8co.st-76seoh. in. us, 574-235-9626
• Section E — Food
Are you having food at your event (food vendors, caterers, food trucks, etc.)? ❑ Yes�<No
IF YES:
• The event coordinator must apply for and receive a St. Joseph County Health Department
Temporary Event Permit.
• Vendor(s) must have a City of South Bend business license for Food Vending Vehicle.
(Contact Michelle Adams at Madam outhbendin.gov)
• 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.
• All applications and guidelines can be found at the St. Joseph County Health Department Food Service
website: slchd.org food service.
Please select food sales types: ❑ Food Vendor ❑ Caterer ❑ Food Truck ❑ Other:
IF A FOOD TRUCK, please list company name:
Describe how food will be cooked and served as well as any preventative safety measures:
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Will alcohol be served or sold?
Section F — Alcohol
❑ Yes )II(No
IF NO: Please continue to Section G —Contingency and Strategic Planning.
IF YES:
The applicant must apply for and receive a temporary liquor license from the Alcohol & Tobacco
Commission. Indiana ATC forms are located at in.00v/atc/2409.htm. (Temporary Permits are near the
bottom of the form list.) Forms must be filed with the district ATC office five (5) days prior to the
requested event date.
o Application cannot be processed without a copy of this license.
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. Deposit will be returned upon inspection of
event area by the Board of Public Works.
Events with 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).
Company Name:
•
Contact Phone: _
Address:
Name:
Qualifications: _
Name:
Qualifications: _
Name:
Qualifications: _
•
Contact Name:
Email:
City/State/Zip:
Contact Phone:
Contact Phone:
Contact Phone:
Section G - Contingency and Strategic Planning
•
•
E
Foreach of the following, please provide detailed descriptions. If you run out of space, attach a response to this
application submission:
• Emergency Safety Plan -This plan should include, but is not limited to:
o The number of public safety personnel.
o If hiring a prime security service, provide contact information, proof of insurance and the number of
hired event personnel.
o Proposed internal communications systems and public address systems.
• Proposed Cleanup Plan -This plan should include, but is not limited to:
o Measures in place to collect and remove trash, litter and recyclables.
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• Inclement Wea her Plan -This plan should include, but is not limited to:
o Safety measures that will betaken in the event of a tornado warning, tornado watch,
thunderstorm, and extreme temperatures.
o Rain date.
o Weather information and forecasts can be found at httos://www.weather.Qov/
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• Proposed Lost and Found Plan -This plan should include, but is not limited to:
o A description of the use of signage, announcements on public address systems or pre -event
handouts.
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Section H - Site Plan / Route Mao
• Site Plan / Route Map - for All Events:
Provide an attached map with the geographic locations of all event items listed below.
• Outline of entire event venue including the names of all affected streets and areas.
• Clear markings for street closures and a schedule for each. Applicants should ensure all roadway
(right of way) closure times are specific and separate from the event setup and event
start/end times (i.e., roadway closures times may not be perfectly identical or linked to the
duration of the event).
o All bridge closures require County Engineering approval. (County Bridges: Andy Hayes,
ahayes@co.styoseph. in. us, 574-235-9626)
o All state road Closures require INDOT approval. (State, INDOT: Michael Hurt,
mhurtlnaindot.in.gov, 219-851-1426)
Location of fencing, barriers, and/or barricades. Indicate any removable fencing and exit locations for
emergency purposes.
Location of all stages, platforms, bleachers, grandstands, tents, booths, cooking areas, vehicles, trailers,
and other temporary structures. Applicants should also clearty mark locations of food and alcohol
serving or sales, if applicable.
The location(s) and number of all portable toilets and wash stations.
• The location(s) and number of all trash and recycling containers, including dumpsters.
• The location of generators or any source of electricity.
• Traffic plan and map, including proposed loading/drop off areas, barricades, secured areas, vehicle and
bicycle parking areas, and considerations for TRANSPO bus route changes.
Section I — Mitigation of Impact
• IF YOU ARE USING AND/OR CLOSING PUBLIC SIDEWALKS OR STREETS:
You are required to notify area business owners and residents in writing 15 days prior to the event.
Attach a copy of the brochure or door hanger distributed to all affected residents/businesses/neighborhood
groups describing the event purpose, date and time.
•
40
• A Certificate of Insurance (copy) confirming the existence of a liability policy (General Liability and Automobile
Liability) of not less than $1,000,000 per occurrence and $2,000,000 aggregate, which specifically names the
City of South Bend, IN as an additionally insured for the event must be submitted. Copy of Certificate of
Insurance must be submitted two (2) weeks prior to the date of the event.
•
40
Section K - Indemnity & Hold Harmless Agreement
• City of South Bend Special Events Committee
Indemnity & Hold Harmless Agreement
Date: U — 2q Z S Event Date:
Event Name:
2rIAi e
Organization: , �l G I/1-6 //J ✓-y s ��-
Applicant (Contact) Name: se-V rrd 4 v /
Applicant (Contact) Phone: S% I(-2/0 — Siff / Alt. Phone:
Email: 'r%dd/5 ) Ir 13 0 ,9nr.c.�. cony
Address:
City/State/ZIP:
zti A6�ir-
Event Location (Please describe): 1 I ! �G,, /( .n/OP � $I �{ b /ld �(
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Length of Event (Dates/Times): /0 _ �(— �{ V i �� 3� 4'`-
Insurance Amount: This event is insured for no less than $1,000,000 per occurrence and $2,000,000 in
• aggregate, and the certificate of insurance includes a rider naming City of South Bend, Spedal Events Committee,
and Board of Public Works as additionally insured for the event.
Organization Name: �a rna /L �� �� agrees to indemnify, defend
and hold harmless the City of South Bend, Indiana, its agents, officers, and employees (collectively ("City),
from any liability, loss, costs, damages or expenses, including attorney fees, which the City, 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 City,
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 Signature:
Printed Name and Title: 5e"("a 4"jt' �%•
Section L - Permit & Agreement
1. Pursuant to Local Ordinance No. 10628-18, there is a $50.00 non-refundable fee for Tier II and III event
• applications filed 60 or greater days in advance of the event, or a $100 non-refundable expedited fee for
applications filed between 30 and 59 days in advance of the event.
2. The APPLICANT must comply with all terms and conditions of this Permit and Agreement.
3. The APPLICANT must obtain signatures from and/or make an attempt to notify all residents that reside
in the area impacted by the event. A copy of a brochure or door hanger distributed to all affected
residents/businesses describing the event purpose, date, time and contact information must be
included with the attachments to this application.
4. The APPLICANT shall reimburse the City for the actual cost of the event, if the City incurs
unexpected, undisclosed expenses related to the event.
5. Notification of approval/denial of this request will be issued by return of this form, upon signed
authorization by the Special Events Committee.
6. The APPLICANT shall provide to the Board a Certificate of Insurance showing a liability policy in full
force and effect with limits of $1,000,000.00 per occurrence and $2,000,000.00 aggregate and the City
of South Bend, Special Events Committee, and Board of Public Works listed as an additional named
insured for this event.
7. The APPLICANT assumes full responsibility for providing ample disposal containers for refuse/recycling
and assures the area will be cleaned up upon the conclusion of the event.
8. The APPLICANT will follow the City of South Bend Noise Ordinance, which 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 radio receiving sets, 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.
• 9. The APPLICANT assures the City that the area will be closed during the times indicated on the
application only. Event end times are pursuant to the recommendations of the South Bend Police
Department and such times will be strictly enforced.
C, J
Date:
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.
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Applicant Signz
Printed Name:
Member
SPECIAL EVENTS COMMITTEE APPROVAL
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Start Line: The SBVPA Cabin at 301 S St Louis Blvd, South Bend, IN 46617
Run on Northside Blvd along the river.
Turn around at Parking lot at 1664-1720 Northside Blvd, South Bend, IN 46615
Finish Line: Behind Cabin at Howard Park 219 S. St. Louis Blvd South Bend, IN 46617
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CITY OF SB SPECIAL EVE
731 S LAFAYETTE BLVD
SOUTH BEND, IN 46601
0829 2025
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