Sidewalk Cafe - South Bend Brew Werks

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OA ' )11711, 011' % IV APPLICATION FOR SIDEWALK CAFft PERMIT CITY OF SOUTH BEND, INDIANA DATE FEE PAID [:1 $ Applicant's Legal Narne Business Name ?A 1o..Al Address 2- 14 S. M Tcicphonc Number '9-71 - CISS% Proposed Location and Description of Sidewalk Caf6 Title 6 Days of Sidewalk Caf6 Operation Hours of Sidewalk Cafi6 Operation Still Moll Tues Wed Thurs Fri Sat /-Z ot 14A, The following information is REQUIRED for completion of a Sidewalk Caf6 Application: I , Completed/signed application, including a $ 10,00 fee 2. Drawing(s) and description of proposed sidewalk caf6 showing plicernent/diniciisions of proposed. caf6 3. Completed/signed Agreement 4. Certificate of Insurance ($1,000,000/00CUrance and $300,000/person, naming the City of South Bend as additional insured) AFFIRMATION 1, tile undersigned, agree that I will abide by all of the provisions of Section 18-15 Of the South Bend Municipal Code and with all the provisions stated above as conditions of the issuance of this Permit. I further agree to indemnify, defend and hold harmless the City of South Bend from any liability, loss, cost, damage or expenses, including attorney fees, which the City may suffer or incur as the result of any use of the public sidewalks for a sidewalk caf& as permitted herein. I do hereby certify and affirm that all the information given in this application is true to the best of my knowledge, Date Signa'i'tiroo Applicant '4e7r1e' Loof- C. Printed Name 0 wt4 r 1"goe Titic BOARD OF PU I , WORKS APPROVAL President Member 2-eni6e'r V Member Member RETURN FORM TO: Board of Public Works 1316 Comity -City Buildfilg 227 West Jefferson Boolovard Soulli Bend, IN 46601 Phone: (574) 235-9251 e Fax: (574) 235-9171 r9� , )�� i� Date 9