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SIDEWALK CAFE APPLICATION <br />City of South Bend -Board of Public Works <br />227 W Jefferson Boulevard, Ste 1316 <br />South Bend, IN 46601 <br />I RESTAURANT/BUSINESS INFORMATION: <br />N f R t t/B . Cinco 5 International ame o es auran usmess: ___________________ _ <br />Add f P d S.d lk c f, 112 w Colfax ave South bend In 46601 ress o ropose I ewa a e: _________________ _ <br />Mailing Address: 112 w Colfax ave South bend In 46601 <br />I APPLICANT INFORMATION: <br />Applicant Legal Name: Leonard0 Duran Phone: 574.5201455 <br />Title: !!!I Owner □ Manager □ Other ----------------- <br />Em a ii Address: Cinco5sb@gmail.com <br />] INCLUDE THE FOLLOWING ITEMS WITH YOUR APPLICATION: <br />□Completed application including $10 fee. Make checks payable to City of South Bend. <br />D Site plan depicting the proposed sidewalk cafe showing placement/dimensions. <br />D Completed Agreement <br />D Certificate of Insurance ($1,000,000/occurrence and $300,000 person naming the City <br />of South Bend as additional insured) <br />AFFIRMATION <br />I, the undersigned, agree that I will abide by all of the provisions of Section 18-15 of the <br />South Bend Municipal Code and with all the provisions stated above as conditions of the <br />issuance of this Permit. I further agree to indemnify, defend and hold harmless the City of <br />South Bend from any liability, loss, cost, damage or expenses, including attorney fees, which <br />the City may suffer or incur as the result of any use of the public sidewalks for a sidewalk <br />cafe as permitted herein. I do hereby certify and affirm that all the information given in this <br />application is true to the best of my knowledge. <br />OFFICE USE ONLY: <br />Date Received: Fee Paid: Approval Date: 5/27/2021 $10.00