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

Fill Online, Printable, Fillable, Blank City of South Bend Special Event Application Neighborhood (City of South Bend) Form

Use Fill to complete blank online CITY OF SOUTH BEND (IN) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

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

On average this form takes 20 minutes to complete

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

  • 2 signatures
  • 4 check-boxes
  • 70 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of South Bend

BROWSE CITY OF SOUTH BEND (IN) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
City of South Bend Special Event Application
Neighborhood Event
$25 application fee if filed 30 days or greater (up to 180 days) in advance of event.
Review the Instructions on the Special Events page before completing the application. Neighborhood Special
Event applications must be submitted more than 30 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: ______________________________________________
Secondary Contact Name: __________________________________________________________________________________
Contact Phone: _________________________________ Contact Email: ____________________________________________
Address: _____________________________________ City/State/ZIP: ______________________________________________
Section B – Event Information
Event Name :
_______________________________________________ Expected Attendance: _________________________
Requested Street Closure:___________________________________________________________________________________
From (Cross Street):_________________________________________________________________________________________
To (Cross Street): ___________________________________________________________________________________________
Provide a brief description of the event:
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: ________________________________________
Have all residents on the affected block have been notified and invited? Yes No
Please attach a copy of the door hanger or letter used to notify residents in addition to signature attachment.
Number of households fronting the proposed street closure: __________________________________________________
Number of households represented by signatures on attached sheet: __________________________________________
Will this event have music (live or other)? Yes No
Section C – Alcohol
Will alcohol be served or sold? Yes No
If Yes:
o The applicant must apply for and receive a temporary liquor license from the Alcohol & Tobac
co
C
ommission.
o Application cannot be processed without a copy of this license.
o A refundable $400.00 deposit paid by card or check (made to City of South Bend) must be submitted
with application.
o Application cannot be processed without deposit.
o Deposit will be returned upon inspection of event area by the Board of Public Works.
o The applicant must submit a map or drawing of:
o Fencing around serving area
o Trash receptacles
o Events that will have alcohol sales must provide security. If your event will be hiring a security company,
please provide its contact information in sub-section (a) below. Otherwise, please list the names, phone
numbers, and qualifications (e.g. Off-duty police officer, professional security guard, or event applicant)
of three (3) security guards in the fields provided in sub-section (b).
(a
) Security Company Information
Company Name:___________________________________________ Contact Name: ________________________________
Contact Phone: ____________________________________________ Email: _________________________________________
Address:___________________________________________________ City/State/ZIP: ________________________________
(b) Independent Security Information
Name: _______________________________________________________ Contact Phone: _____________________________
Qualifications:______________________________________________________________________________________________
____________________________________________________________________________________________________________
Name: _______________________________________________________ Contact Phone: _____________________________
Qualifications: _____________________________________________________________________________________________
____________________________________________________________________________________________________________
Name: _______________________________________________________ Contact Phone: _____________________________
Qualifications: _____________________________________________________________________________________________
___________________________________________________________________________________________________________
Section D – Food
Will your event have food sales (food vendors, caterers, food trucks, etc.)? Yes No
o If yes, the event coordinator must apply for and receive a St Joseph County Health Department
Temporary Event Permit.
o Vendor(s) must also apply for and receive a St. Joseph County Health permit. Health Permits must be
filed with the county 30 days prior to the proposed event. Each vendor must obtain necessary permits to
serve on-site and display these permits at the event.
o All applications and guidelines can be found on the St. Joseph County Health Department Food Service
web
site at sjchd.org/food-service
.
Please select food types: Food Vendor Caterer Food Truck Other: __________________________
If a Food Truck, please list company name(s):
Pl
ease describe how food will be cooked and served:
Section E – 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):
Le
ngth of Event (Dates/Times): _____________________________________________________________________________
APPLICANT 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, 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
click to sign
signature
click to edit
Section F – Permit & Agreement
1. Pursuant to Local Ordinance No. 10628-18, there is a $25.00 non-refundable fee for applications filed 30
days or greater in advance of the event date. Applications filed less than 30 days in advance of the event
date will not be accepted.
2. All residents within the affected area must be notified of this event. The APPLICANT must obtain
signatures from at least 10 residents that reside along the closed right-of-way and make an attempt to
notify all other affected residents. APPLICANTS must include a copy of a brochure or letter of invitation
distributed to all affected neighbors describing the event purpose, date, and time.
3. The APPLICANT is responsible, prior to the event, for determining if there are any affected residents that
need assistance accessing their residence. The APPLICANT is responsible for providing said resident(s)
access or transportation to their property.
4. The cones will be delivered to the APPLICANT’s address. The APPLICANT assumes full responsibility for
clean-up and assures the City that all cones will be maintained and returned undamaged. The APPLICANT
will be liable for the replacement cost of $50.00 per cone as a result of any missing or damaged cones.
5. Block parties must end by 8:00 p.m.
6. A street will be blocked off from intersection to intersection only. No half-blocks or alleys can be blocked
off.
7. The Special Events Committee reserves the right to deny any block party application based on traffic and
speed limit records. No street may be closed with a speed limit over 30 MPH or considered to be a major
arterial.
8. The Special Events Committee reserves the right to deny any block party application based on information
gathered from the South Bend Police Department or other sources.
9. The APPLICANT agrees to allow residents that live on the above-referenced block access in and out of the
restricted area as needed.
10. The APPLICANT agrees to abide by all terms and conditions of the South Bend Municipal Code and Board
of Public Works’ policy adopted in Resolution No. 10628-18 on December, 11, 2018.
11. Notification of approval/denial of this request will be issued by return of this form, upon signed
authorization by the Board of Public Works.
12. The City of South Bend Noise Ordinance 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 stereos, speakers, musical
instruments, 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).
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.
Date: ___________________________________________
Applicant Signature: ________________________________________________________________________________________
Printed Name: _____________________________________________________________________________________________
SPECIAL EVENTS COMMITTEE APPROVAL
___________________________ ______________________________ ______________________________
President Member Member
___________________________ ______________________________ ______________________________
Member Member Date
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

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

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 16 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document