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1 #i " , <br />IT <br />ill <br />APPLICATION CAR SIDEWALK CAA F PERiVII"t p k <br />CITY OF SOUTH BEND, INDIANA " r <br />DATE Aj2A12018 FEE PAID E] $ <br />Applicant's Legal Name <br />Business Name <br />Address <br />Telephone Number <br />Alicia Shea <br />Bruno°s Pizza. <br />Title Manager <br />131 S. Michigan Street, South Bend IN 46601 <br />574,234.2222 <br />Proposed Location and Description of Sidewalk. Cafe <br />am --0]rZ1MAQI [01it._ <br />Days of Sidewlk CaI56 Operation <br />flours of Sidewalk Cafi6 Operation <br />►+nn��n�r:i�r�wr.���.s+�a� <br />a��.��■.���,.. <br />The following information is REQUIRED for completion of a Sidewalk Cafe Application: <br />l . Completed/signed application, including a $10.00 fee <br />2. Drawing(s) and description of proposed sidewalk cafe showing placement/dimensions of proposed <br />cafe <br />3. Completed/signed Agreement <br />4, Certificate of Insurance ($1,000,000/occurance and $300,000/person, naming the City of South. Bend <br />as additional insured) <br />AFFIRMATION <br />1, the undersigned, agree that 1 will abide by all of the provisions of Section 18-15 of the South Bend Municipal <br />Code and with all the provisions stated above as conditions of the issuance of this Permit. I further agree to <br />indemnify, defend and hold harmless the City of South Bend from any liability, loss, cost, damage or expenses, <br />including attorney fees, which the City may suffer or incur as the result of any use of the public sidewalks for a <br />sidewalk cafe as permitted herein. I do hereby certify and affirm that all the information given its this application is <br />true to the best of my knowledge. <br />04/2412018 ° <br />Date Signature of Applicant <br />Alicia Shea <br />Printed Name <br />Manager <br />Title <br />BOARD OF PUBLIC WORKS APPROVAL <br />A) <br />President Me be Member <br />Merrrber Member Date <br />RETURN FORM TO: <br />Board of Public Works <br />1.316 County -City Building <br />227 West Jefferson Boulevard <br />South fiend, IN 46601 <br />Phone: (574) 235-9251 9 Fax: (574) 235-9171 <br />IP <br />