Non Res Block Party - The Well at River Park Grace

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a. Certified Check or Money Order in the Amount of $125.00, or: b. For Certified Nonprofit Organizations: Copies of the 501(c)(3) Internal Revenue Exemption Status Document and a current copy of born 990 of Form 990-CZ. are included with this application, Yes No and additionally filed with the Office of the City Clerk, 01 Floor, County -City Building, 227 W. Jefferson Blvd., South Bend , Indiana. c. Certificate of Insurance d, Maps, drawings of the area and setup plan Yes No a. This event involves City streets Yes No h. This event involves County roads Yes No ' c. This event involves State highways Yes No d. This event involves the use of the sidewalk Yes (!0) e. This event is a localtregionailnational event (Please circle the Yes No appropriate event type) Ne& f—:� \/(?-Y" f. Affected property/business owners have been notified of this event. No g. I understand that I must arrange a meeting with all affected governmental agencies to organize the above event (Call Marcia Qualls, Customer Service Manager, 235-5939 to organize Yes T, No meeting). IF ALCOHOL 1S TO BE SERVED OR SOLD Alcoholic beverages will be served Alcoholic Leverages will be sold Certified Check or Money Order for $400.00 must be submitted with application, ' Application cannot be processed without deposit. ' Deposit will be returned upon inspection of event area by the Board of Public W'orks. Names and phone numbers of THREE security guards • To monitor underage drinking. Qualifications must he listed (e.g. Off -duty police officer, professional security guard, or event APPIKANT). .A drawing must be submitted showing: Fencing around serving area Trash receptacles. O Ample trash receptacles must be provided to ensure proper disposal of refuse. Temporary liquor license. ' Call the Alcohol & Tobacco Commission at (317) 234-4315 for more information. 6 Application cannot he processed without a copy of this license.