Fillable City of South Bend Special Event Application Motorcycle (City of South Bend)

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City of South Bend Special Event Application Motorcycle (City of South Bend)

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The City of South Bend Special Event Application Motorcycle (City of South Bend) form is 6 pages long and contains:

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  • 6 check-boxes
  • 54 other fields

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BROWSE CITY OF SOUTH BEND (IN) FORMS

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City of South Bend Special Event Application
Motorcycle Ride
$50 application fee if filed 60 days or greater (up to 360 days) in advance of event
Review the Instructions on the Special Events page before completing the application. City and Regional
Motorcycle Event applications must be submitted more than 60 days in advance of the event date or the
application will not be accepted.
Section A – Applicant Information
Date of Application: ______________________________ Organization Name:______________________________________
Applicant (Contact) Name:___________________________________________________________________________________
Applicant (Contact) Phone: ______________________________ Contact Email: _____________________________________
Address: ____________________________________ City/State/ZIP: _______________________________________________
List any professional event organizer, event service provider or commercial fundraiser that is authorized to work
on your behalf to plan, produce and/or manage your event.
Organization Name: ___________________________________ Contact Name: _____________________________________
Contact Phone: _________________________________ Contact Email: ____________________________________________
Address: ______________________________________ City/State/ZIP: _____________________________________________
Section B – Event Information
Event Name : ____________________________________ Event Type: Motorcycle
Event Classification: Non-Profit* For-Profit
City (Civic) Sponsored Other (If Other, please describe): _____________________________________________
*The Special Events Committee may request proof of non-profit status.
Provide a brief description and timeline of event (Note: A detailed map plan is required in Section H of this
application. The description should be a summary overview.)
Date of Event Setup [mm/dd/yy]: ____________________________ Time: ________________________________________
Begin Date of Event [mm/dd/yy]: ____________________________ Time: ________________________________________
End Date of Event [mm/dd/yy]: ______________________________ Time: ________________________________________
Event Cleanup Completion [mm/dd/yy]: ______________________ Time: ________________________________________
Total anticipated attendance: _________________________
The proposed event will require the closing of: Streets Sidewalks
Is the event ticketed or include fees? Yes No If yes, list fees and fee groups below:
Do
es the event have any partnered sponsorships? Yes No
If yes, list the number of sponsors at each level of partnered sponsorship:
Is
this a returning special event or part of a series of special events? Yes No
If yes, provide the date, location, and attendance of past special events and/or future planned events in the
series:
Section G – Contingency and Strategic Planning
For each of the following, please provide detailed descriptions. If you run out of space, attach a response to this
application submission.
• Emergency Safety Plan – This plan should include, but is not limited to:
o The number of Indiana Law Enforcement Academy certified officers, fire, and emergency
medical personnel, and the need to use any of the City’s public safety or emergency response
services.
o If hiring a security service, provide contact information and the number of hired event personnel.
o Proposed internal communications systems and public address systems.
• Proposed Cleanup Plan – This plan should include, but is not limited to:
o Measures in place to collect and remove trash, litter and recyclables.
• Inclement Weather Plan – This plan should include, but is not limited to:
o Safety measures that will be taken in the event of a tornado warning, tornado watch,
thunderstorm, and extreme temperatures.
Site Plan / Route Map - For All Events:
Provide an attached map with the geographic locations of all event items listed below.
• Outline of entire event venue including the names of all affected streets and areas.
• Clear markings for street closures and a schedule for each.
Section I – Mitigation of Impact
If you are using and/or closing public sidewalks or streets, you are required to notify area business owners and
residents. You must:
o Present your event concept to the surrounding stakeholders (residents, businesses, and neighborhood
groups) that represent the venue area.
Attach a copy of the brochure or door hanger distributed to all affected residents/businesses/neighborhood
groups describing the event purpose, date and time.
Section J – Insurance
A Certificate of Insurance (copy) confirming the existence of a liability policy (General Liability and Automobile
Liability) of not less than $700,000 per occurrence and $1,000,000 aggregate, which specifically names the City
of South Bend, IN as an additionally insured for the event must be submitted. Copy of Certificate of Insurance
must be submitted two (2) weeks prior to the date of the event.
Section H – Site Plan / Route Map
Section K – Indemnity & Hold Harmless Agreement
City of South Bend Special Events Committee
Indemnity & Hold Harmless Agreement
D
ate: ____________________________ Event Date: ______________________________
Event Name: _______________________________________________________________________________________________
Organization: ______________________________________________________________________________________________
Applicant (Contact) Name: __________________________________________________________________________________
Applicant (Contact) Phone: ______________________________________ Alt. Phone: ________________________________
Email: _____________________________________________________________________________________________________
Address: ____________________________________________ City/State/ZIP: _______________________________________
Event Location (Please describe):
L
ength of Event (Dates/Times): _________________________________________________________________________
Insurance Amount: This event is insured for no less than $700,000 per occurrence and $1,000,000 in aggregate,
and the certificate of insurance includes a rider naming City of South Bend, Special Events Committee, and Board
of Public Works as additionally insured for the event.
O
rganization Name: __________________________________________________________ agrees to indemnify, defend
and hold harmless the Civil City of South Bend, Indiana, from any liability, loss, costs, damages or expenses,
including attorney fees, which the Civil City of South Bend, Indiana, may suffer or incur as a result of any claims
or actions which may be made against the City, its agents, employees, or subdivisions by any person, including a
participant in the activity, arising out of the approval of this request by the Civil City of South Bend, Indiana,
through the Board of Public Works, to close a portion of the public right-of-way for the event described above,
or for any harm or damage alleged to have occurred because of the holding of the special event. The
undersigned certifies that he/she is authorized to bind the APPLICANT to these terms.
S
igned on this Date: _________________________
___________________________________________________________________________________________________________
Authorized Organizer Signature
___
________________________________________________________________________________________________________
Printed Name and Title
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Section L – Permit & Agreement
1. Pursuant to Local Ordinance No. 10628-18, there is a $50.00 non-refundable fee for motorcycle rides
applications filed 60 or greater 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.
Da
te: ___________________________________________
Applicant Signature: ________________________________________________________________________________________
Printed Name: _____________________________________________________________________________________________
SPECIAL EVENTS COMMITTEE APPROVAL
_____
______________________ ______________________________ _______________________________
President Member Member
___________________________ ______________________________ _______________________________
Member Member Date
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City of South Bend Special Event Application Motorcycle (City of South Bend)

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Completed 16 July 2020

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