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APPLICATION <br />FOR USE OF, AND BLOCKING OF ACCESS T(3, -THE PUBLIC <br />RIGHT-OF-WAY FOR NON-RESIDENTIAL BLOCK PARTIES <br />The Board of Public Works must have FOUR (4) weeks prior notice of the event. <br />A NON-REFUNDABLE APPLICATION FEE OF $125.00, IN THE FORM OF A CEIn'IFIED <br />CHECK OR MONEY ORDER, PAYABLE TO THE CITY OF SOUTH BEND, MUST BE <br />INCLUDED WITH APPLICATION. <br />F] Fee Paid <br />Applicant Name <br />Downtown South Bend, Inc. <br />Zip <br />Address: 217 S. Michigan St. City: South Bend State: IN 466,01 <br />Phone: 574-968-7293 Email: — kcarter@downtownsouthbend.com <br />This application is made to the City of South Bend, Indiana, Board of Public Works, for the use of the <br />specified public right-of-way by Applicant for the holding of the hereinafter described event: <br />Event Name St. Paddy's Tent Party & Pub Tour <br />Location Baer"s Parking Lot; 350 S. Michigan St.; South Bend, IN 46601 <br />(Describe Area/Route) <br />Street Closure Name of Street _Michigan St. <br />From Wavne St. <br />TO <br />Date of Event March 16 <br />Western Ave. <br />Time: Registration/Setup 12:00 <br />Approximate Number of Attendees <br />20 18 <br />F] Uri. <br />U P.M, <br />4500 <br />F-1 a.m, <br />Start 4:00 [3j p.rn, End <br />Answer the following appropriately: <br />I . This event will have music (live or other). <br />a. I understand the Noise Ordinance described in the Agreement/Permit <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 />Form 990 of Form 990-EZ are included with this application, and <br />additionally filed with the Office of the City Clerk, 4"' Floor, County - <br />City Building, 227 W. Jefferson Blvd., South Bend, Indiana. <br />c. Certificate of Insurance <br />d. Maps, drawings and setup plan of the area <br />e. A copy of a flyer or door hanger that has been distributed to all <br />affected property owners. <br />3. <br />a. This event involves City streets <br />b. This event involves County roads <br />c. This event involves State highways <br />Updated 8/20 17 <br />NO <br />"M <br />I 'IVA <br />El a.m. <br />11 :00 [N p,rn. <br />Yes F-1 No <br />Yes F] No <br />[A Yes No <br />X1 <br />Yes <br />[-] <br />No <br />IN <br />Yes <br />E] <br />No <br />N <br />Yes <br />[j <br />No <br />El <br />Yes <br />FX-1 <br />No <br />Yes <br />01 <br />No <br />1 <br />