Special Event - Bacon Around the Bend 5K - June 19

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Section L - Permit & Agreement Pursuant to Local Ordinance No. 10628-18, there is a $50.00 non-refundable fee for Tier II and III event applications filed 60 or greater days in advance of the event, or a $100 non-refundable expedited fee for applications filed between 30 and 59 days in advance of the event. 2. The APPLICANT must comply with all terms and conditions of this Permit and Agreement. 3. The APPLICANT must obtain signatures from and/or make an attempt to notify all residents that reside on the block. A copy of a brochure or door hanger distributed to all affected residents/businesses describing the event purpose, date, time and contact information must be included with the attachments to this application. The applicant is responsible for providing affected residents and business owners with transportation to their property. 4. The APPLICANT shall reimburse the Board for the actual cost to the City for the event, if deemed necessary. 5. Notification of approval/denial of this request will be issued by return of this form, upon signed authorization by the Special Events Committee. 6. The APPLICANT shall provide to the Board a Certificate of Insurance showing a liability policy in full force and effect with limits of $700,000.00 per occurrence and $1,000,000.00 aggregate and the City of South Bend, Special Events Committee, and Board of Public Works listed as an additional named insured for this event. 7. The APPLICANT assumes full responsibility for providing ample disposal containers for refuse/recycling and assures the area will be cleaned up upon the conclusion of the event. 8. Barricades will be delivered and picked up at the event location. The APPLICANT is responsible for seeing that all cones are maintained and returned undamaged. 9. The APPLICANT will follow the City of South Bend Noise Ordinance, which is in effect at all hours. Between the hours of 11:00 p.m. and 7:00 a.m. certain noises are particularly prohibited. These include operating radio receiving sets, musical instruments, phonographs and other sound reproduction devices if audible fifty (50) feet away, as well as shouting, yelling, hooting, whistling, or singing in the streets in a manner to disturb the peace (Municipal Code 13-57). 10. The APPLICANT assures the City that the area will be closed during the times indicated on the application only. Event end times are pursuant to the recommendations of the South Bend Police Department. I have read the Application and the Permit and Agreement for this Special Event and I affirm the truth of the information provided by me to the best of my knowledge. I understand and agree to the above rules and regulations, and any applicable state and federal laws. I also understand that this application may be denied based on any false or incomplete information. Date: April 13, 2021 Applicant Signature: Printed Name: A y t 4a -Brown SPECIAL EVENTS COMMITTEE APPROVAL -------- o4AV President Me ber Mern Member Member Date