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�L13'Ft-. SIDEWALK CAFE APPLICATION <br />1� <br />^1 <br />City of South Bend - Board of Public Works <br />.. 227 W. Jefferson Boulevard, Ste.1316 <br />ram; South Bend, IN 46601 <br />RESTAURANT/BUSI NE55 INFORMATION: <br />Name of Restaurant/Business: The Early Bird Eatery <br />Address of Proposed Sidewalk Cafe: 117 E Wayne St, South Bend, IN 46601 <br />Mailing Address: <br />Same <br />APPLICANT INFORMATION: <br />Applicant Legal Name: <br />Jennifer Stone Phone: 269-369-1986 <br />Title: 8 Owner ❑ Manager ❑ Other <br />Email Address: Tenn@theearlybirdeatery.com <br />INCLUDE THE FOLLOWING ITEMS WITH YOUR APPLICATION: <br />® Completed application including $10 fee. Make checks payable to City of South Bend. <br />lig Site plan depicting the proposed sidewalk cafe showing placement/dimensions. <br />B Completed Agreement <br />Q 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 />Signature of Applicant: Date: 1-17-2024 <br />OFFICE USE ONLY: [ ,} C00 <br />Date Received: ��,'�" I Fee Paid: ,b � Approval Date: <br />