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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 />RESTAURANT/BUSINESS INFORMATION: I <br />Name of Restaurant/Business: <br />LaSalle Grill <br />Address of Proposed Sidewalk Caf6: <br />Mailing Address: <br />115 W Colfax Avenue <br />115 W Colfax Avenue, South Bend IN 46601 <br />I APPLICANT INFORMATION: I <br />Applicant Legal Name: <br />Laurel KA k 574-539-9802 <br />Phone: <br />Title: El Owner 0 Manager 0 Other <br />Email Address: <br />laurel@lasallegrill.com <br />I INCLUDE THE FOLLOWING ITEMS WITH YOUR APPLICATION: <br />19 Completed application including $10 fee, Make checks payable to City of South Bend. <br />ff] Site plan depicting the proposed sidewalk cafi6 showing placement/dimensions. <br />City has the site plan <br />M Completed Agreement <br />EN Certificate of Insurance ($1,000,000/occurrence and $300,000 person naming the City <br />of South Bend as additional insured) <br />AFFIRMATION <br />1, 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 />caf6 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: Date: <br />01/17/2024 <br />OFFICE USE ONLY: V <br />Date Received. Fee Paid: Approval Date: <br />