Sidewalk Cafe - Vegetable Buddies

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Applicant's Legal Name Jefftey Harrison Title Owner Business Name Vep-etable Buddies :address 129 l9 Michigan St South Bend, IN 46601 Telephone Number 574-232-0954 Proposed Location and Description of Sidewalk Cafe In Front of Vegetable Buddies Days of Sidewalk Cafe Operation Sun Mori flues Wed Thurs Fri. Sat 5:OOPM 5:OOPM 5:OOPM 5:OOPM- — 2:00 50OPM- Flours of Sidewalk Cafe Operation x x 12:OOAM 12:0OAM 12:00am AM 2:OOAM The following information is REQUIRED for completion of a Sidewalk Cafe Application: 1. Completed/signed application, including a $10.O�O fee 2. Drawing(s) and description of proposed sidewalk cafe showing placement/dimensions of proposed cafe 3. Completed/signed Agreement 4. Certificate of Insurance ($1,000,O�OO/occurance and $300,000/person, naming the City of South. Bend as additional insured) AFFIRMATION 1, the 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 cafe 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 { Sigilallof A plicant Printed Name Title BOARD OF PUBLIC WORKS APPROVAL , i"� -"�\L - ^t " M- President'-' Mj� ber Me ber Member RETURN FORM TO: Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Mend„ IN 46601 rz) r Date 4