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City of South Bend, Indiana + Board of Public Works <br />PERMIT AND AGREEMENT FOR THE USE OF <br />THE RIGHT-OF-WAY FOR NON-RES]DENTIAL BLOCK PARTIES <br />The Non-residential Block Party will be permitted to take place tinder the following terms and <br />conditions: <br />I . Pursuant to Local Ordinance No, 10224-13, there is a S 125,00 non-refundable fee for non- <br />residential Block Parties. Non-profit organizations meeting Section 501(c)(3) of the Internal <br />Revenue Code are exempt from the fee provided copies of the 501(c)(3) Internal Revenue <br />Exemption Status Documcnt and a current copy of form 990 of Form 990-EZ are filed with <br />this application and with the Office of the City Clerk, 4th Floor, County -City Building, 227 <br />W'. Jefferson Blvd., South Bend , Indiana. <br />2. The APPL.ICANI' must comply with all terms and conditions of this Permit and Agreement. <br />3. The APPLICANT shall reimburse the Board for the actual cast to the City for the event, if <br />deemed necessary. <br />4. APPLICANT shall include a flyer or letter describing the details of the event, <br />5. Notification of approval/denial of this request will be issued by return of this form, upon <br />signed authorization by the Board of Public Works. <br />6. The APPLICANT shall provide to the Beard a Certificate of Insurance showing. a liability <br />policy in full force and effect Nvith limits of $ 300,000,00 per occurrence and $5,000,000.00 <br />aggregate and the City of South Bend listed as an additional named insured for this event. <br />7. The APPLICANT assumes full responsibility for providing, ample disposal containers for <br />refuselrecycling and assures the area will be cleaned up upon the conclusion of the event. <br />8, Barricades will be delivered and picked up at the event location. The APPLICANT is <br />responsible for seeing that all cones are maintained and returned undamaged. <br />9. The APPLICANT will follow the City of South Fiend Noise Ordinance, which is in effect at <br />all hours. Between the hours of 11:00 p.m. and 7:00 a.m. certain noises are particularly <br />prohibited. These include operating radio receiving sets, musical instruments, phonographs <br />and other sound reproduction devices if audible fifty (50) feet away, as well as shouting, <br />yelling, hooting, whistling, or singing in the streets in a manner to disturb the peace <br />(Municipal Code 13-57). <br />10. The APPLICANT assures the City that the area will be closed during the tinges indicated on <br />the application only. Event end times are pursuant to the reconrzuendations of the South Bend <br />Police Department. <br />11, IF ALCOHOL IS TO BE SERVED OR SOLD a Certified Check or Money Order for <br />$400,00 must be submitted with application. The application cannot be processed without a <br />deposit. The deposit will be returned by the Board of Public Works upon inspection of the <br />event area after the event, and provided there is no damage to the area. Names, phone <br />numbers, and qualifications (e.g. Off -duty police officer, prnf'essiotral security guard, or event <br />APPLICANT) of Tl4REE security guards to monitor underage drinking, must be submitted <br />4 <br />