Laserfiche WebLink
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 must have FOUR (4) weeks prior notice of the event. <br />A NON-REFUNDABLE APPLICATION FEE OF $125.00, IN THE FOW OF A CERTIFIED <br />CHECK OR MONEY ORDER, <br />PAYABLE TO THE CITY OF SOUTH BEND, MUST BE <br />INCLUDED WITH APPLICATION. <br />F-1 Fee Paid <br />Applicant Name: Historic Landmarks Foundation of Indiana c/o Todd Zeiger <br />Address: 801 West Washington City: South Bend State: IN Zip: 46601 <br />Phone: 574-232-4534 <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: Treasure Hunt -North <br />Historic West Washington Neighborhood: West Washington Street (from <br />Chapin/MLK Drive to Elm Street); La Porte Avenue from West Washington Street <br />Location to Colfax Avenue (St. Paul's UMC) <br />(Describe Area/Route) <br />Street Closure Name of Street 1. La Porte Avenue at West Washington Street to Colfax <br />From 1. West Washington Street at Charles Martin/Chapin to Elm Street <br />To <br />Date of Event July 21 20 18 <br />E a. m. a.m. <br />❑ <br />a, M, <br />Time: Registration/Setup 6:00 Ej p.m. Start 8:00 E]p,m. <br />End <br />2:00 <br />E <br />P,M. <br />Approximate Number of Attendees 750 <br />Answer the following appropriately: <br />1. This event will have music (live or other). <br />Yes <br />E] <br />No <br />a. I understand the Noise Ordinance described in the Agreement/Permit <br />Z <br />Yes <br />❑ <br />No <br />2. Required Information to Accompany Application <br />a. Certi:fied 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 />Yes <br />No <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 of the area and setup plan <br />M <br />Yes <br />El! <br />No <br />3. <br />a. This event involves City streets <br />M <br />Yes <br />E] <br />No <br />b. This event involves County roads <br />E] <br />Yes <br />E <br />No <br />c. This event involves State highways <br />❑ <br />Yes <br />No <br />d. This event involves the use of the sidewalk <br />Yes <br />No <br />Updated 4/2015 1 <br />