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APPLICATION <br />FOR USE OF AND BLOCKING OF ACCESS TO THE PUBLIC <br />RIGHT-OF-WAY FOR NON-RESIDENTIAL BLOCK PARTIES <br />The Board of Public Works most have FOUR (4) weeks prior notice of the event, <br />A NON-REFUNDABLE APPLICATION FEE OF $125.00, IN THE FORM OF A CERTIFIED <br />CHECK OR MONEY ORDER, PAYABLE TO THE CITY OF SOUTH BEND, MUST BE <br />INCLUDED WITH APPLICATION. <br />❑ Fee Paid <br />Applicant Name: South Bend Venues Parks & Arts <br />Address: 301 S St Louis Blvd City: South Bend State: IN Zip: 46617 <br />Phone: 574-235-5799 <br />This application is made to the City of South Bend, Indiana, Board of Public Works, for the use of the <br />specified public tight -of -way by Applicant for the holding of the hereinafter described event: <br />Event Name Best Week Ever <br />Locations Purple Porch Co -Op parking lot and a portion of Hill Street <br />(Describe Area/Route) <br />Street Closure Name of Street Hill Street <br />From Colfax St <br />To The alley to the west of Purple Poreli Co -Op, across to Northern Electric Co. <br />We will be setting up vendors in the lot north of Northern Electric (owned by <br />Northern Electric — we have been given permission to use the lot and they have <br />been notified of the street closure). <br />Date of Event Wednesday, May 30 20 18 <br />❑ a.m. ❑ a.m. <br />❑ a.m. <br />Time: Registration/Setup 1.00 p.m . Start 4:00 �jpa . <br />End 8:00 `n <br />® p.i <br />Approximate Number of Attendees 1,000 <br />Answer the following appropriately: <br />1. This event will have music (live or other),] <br />Yes ❑ No <br />a,. I understand the Noise Ordinance described in the Agreement/Permit <br />Yes ❑ No <br />2. Required Information to Accompany Application <br />a. Certified Check or Money Order in the Amount of $125.00, or: <br />b. For Certified Nonprofit Organizations: Copies of the 501(c)(3) <br />Internal Revenue Exemption Status Document and a current copy of <br />Forth 990 of Form 990-EZ are included with this application, and <br />Yes ❑ No <br />additionally filed with the Office of the City Clerk, 0 Floor, County - <br />City Building, 227 W. Jefferson Blvd., South Bend, Indiana. <br />c, Certificate of Insurance <br />d. Maps, drawings of the area and setup plan <br />LP Yes ❑ No <br />3, <br />a. This event involves City streets <br />( Yes ❑ No <br />b. This event involves County roads <br />❑ Yes [ No <br />Updated 4/2015 <br />1 <br />