Temporary Occupancy Permit - East Bank South Bend Development LLC

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City of South Bend/Public Works ,ouI'll de 227 W. Jefferson Blvd o� South Bend, IN 46601 �.e Application and Permit yeas Allowing Temporary Occupancy of Public Property Applicant: East Bank South Bend Development, LLC Date: 2/3/17 Applicant Address: 401 East Colfax Ave, Suite 206, South Bend IN 46617 Project Site Address: Sycamore Street between Lasalle Avenue and Colfax Avenue Note: Occupancy limited to street(s) immediately in front of construction site. Nature and extent of Occupancy (e.g.: proposed construction activities, equipment proposed to occupy public right-of-way, construction deliveries, etc.): To provide a safe environment for our contractors and the general public during the construction process, including 2 weeks to allow crane to place modular boxes. Duration of Occupancy: February 15 - June 30, 2017, 7:00a. - 4:00p. Signature of Applicant:'i THE TERMS AND PROVISIONS OF CHAPTER 6, ARTICLE 5 and CHAPTER 18, ARTICLE 7, Sec 18-62 OF THE SOUTH BEND MUNICIPAL CODE ARE INCORPORATED HEREIN IN THEIR ENTIRETY. FAILURE TO COMPLY WITH THESE PROVISIONS SHALL RESULT IN CANCELLATON OF THIS PERMIT. THIS PERMIT SHALL BE CONDITIONED UPON THE EXECUTION AND FILING WITH THE BOARD OF PUBLIC WORKS OF A BOND IN AN AMOUNT APPROVED BY THE BOARD OF PUBLIC WORKS, CONDITIONED TO INDEMNIFY, SAVE AND KEEP HARMLESS THE CITY OF SOUTH BEND, INDIANA, FROM ANY AND ALL LOSS, EXPENSE, COST OR LIABILITY OF ANY KINDS WHATSOEVER WHICH THE CITY MAY SUFFER OR BE PUT TO FROM OR BY REASON OF ANY ACT OR THING DONE OR NEGLECT TO BE DONE, OR BY VIRTUE OF THE AUTHORITY GIVEN IN SUCH PERMIT. TO BE COMPLETED BY CITY STAFF ONLY: Bond Amount: $ 5000.00 Date Bond Filed: ❑ Compliance with CH 6, ART 5 and CH18, ART 7, Sec 18-62 of the South Bend Municipal Code ❑ Fee Paid Date Issued: BOARD OF PUBLIC WORKS 1ST'U �t President Mem er Issued By: Member Member