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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 I RESTAURANT/BUSINESS INFORMATION: <br />Name of Restaurant/Business:_H_a_m_m_e_r _&_Q_u _ill <br />____________ _ <br />Address of Proposed Sidewalk Cafe: 613 E Jefferson Blvd <br />Mailing Address: 613 E Jefferson Blvd. South Bend, IN 46617 <br />I APPLICANT INFORMATION: <br />Applicant Legal Name: John M Barany Phone: 574-220-6659 <br />Title: iii Owner □ Manager □ Other ---------------- <br />Em a i I Address: thegeneraldeli@yahoo.com <br />[ INCLUDE THE FOLLOWING ITEMS WITH YOUR APPLICATION: <br />0"tompleted application including $10 fee. Make checks payable to City of South Bend. <br />t::fSite plan depicting the proposed sidewalk cafe showing placement/dimensions. <br />�leted Agreement <br />�ificate of Insurance ($1,000,000/occurrence and $300,000 person naming the City <br />of South Bend as additional insured) <br />AFFIRMATION 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 />Signature of Applicant: <br />OFFICE USE ONLY: Date Received: .r'\ � <br />.J... \\) \ " <br />vv �\0' . ' Fee Paid: ,\ q?:J O Approval Date: <br />p \.,�