Fillable th Bend Special Event Application City of Sou (City of South Bend)

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th Bend Special Event Application City of Sou (City of South Bend)

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BROWSE CITY OF SOUTH BEND (IN) FORMS

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City of Sou
th Bend Special Event Application
City and Regional Event
$50 application fee if filed 60 days or greater (up to 360 days) in advance of event
$100 expedited application fee if filed 30-59 days in advance of event
Revi
ew the Instructions on the Special Events page before completing the application. City and Regional 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: _______________________________________________
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: (Festival, Race, Parade, Other):_________________
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.)
D
ate 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:
D
oes the event have any partnered sponsorships? Yes No
If yes, list the number of sponsors at each level of partnered sponsorship:
I
s 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:
I
f your event is a parade, race, or other processional-type event, please complete Section C. Otherwise,
continue to Section D.
Section C – Parades, Races, and other Processional Events
What is the estimated number of parade/race spectators on the proposed route? ______________________________
Describe any sound equipment that will be used in the parade/race:
Does the event have participant categories? For example, a run that has different race divisions or a parade with
separate walking/marching groups.
Yes No
If yes, list categories and anticipated participants per category.
If
your event is a parade, what is the approximate number and type(s) of animals, vehicles, and floats participating
in the parade? (Note: If using animals in a parade, event organizers are responsible for cleaning up animal waste
left on the parade route.) Describe parade participants below:
Section D – Equipment, Set-up, and Logistics
Are you hiring a company to provide entertainment, games or inflatables? Yes No
o If yes, you must submit proof of insurance for all stage and entertainment companies three (3) weeks
before the event.
Describe any hired entertainment:
Wi
ll you be staking any tents, inflatables, portable restrooms or any other anchorings? Yes No
o If yes, you must provide proof of locates (locate number) two (2) weeks prior to your event. Locates can
be found by calling 811.
Does your event include the use of fireworks, rockets, lasers, or other pyrotechnics? Yes No
o Depending on the potential fire risk, applicants may need to receive approval of the South Bend Fire
Department (process facilitated by event coordinator).
o Describe the event’s proposed fire-related entertainment:
Will there be any musical entertainment features at the event? Yes No
o If yes, describe the type of music, schedule of sound check/performances, and the names of any artists
performing:
Section E – Food
Are you having food at your event (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 at the St. Joseph County Health Department Food Service
website: sjchd.org/food-service
.
Please select food sales types: Food Vendor Caterer Food Truck Other: _____________________
If a Food Truck, please list company name:
Describe how food will be cooked and served:
Section F – Alcohol
Will alcohol be served or sold? Yes No
If no, please continue to Section G – Contingency and Strategic Planning
If yes:
o The applicant must apply for and receive a temporary liquor license from the Alcohol & Tobacco
Commission. Indiana ATC forms are located at in.gov/atc/2409.htm
. (Temporary Permits are near the
bottom of the form list.) Forms must be filed with the district ATC office five (5) days prior to the
requested event date.
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. Deposit will be returned upon inspection of
event area by the Board of Public Works.
o Events with 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).
If your route crosses over a state road or a bridge please contact the following for permission:
State, INDOT:
Michael Hurt
219-235-7528, Mhurt1@indot.in.gov
County bridges:
Andy Hayes
574-235-9626, ahayes@co.st-joseph.in.us
For stage inspections, contact the Dep
artment of Homeland Security at 317-232-2222.
(a)
Company Name:_____________________________________ Contact Name: _______________________________________
Contact Phone: ______________________________________ Email: _______________________________________________
Address:_____________________________________________ City/State/ZIP: ______________________________________
(b)
Name: _______________________________________________________ Contact Phone: ______________________________
Qualifications:______________________________________________________________________________________________
____________________________________________________________________________________________________________
Name: _______________________________________________________ Contact Phone:_______________________________
Qualifications: ______________________________________________________________________________________________
____________________________________________________________________________________________________________
Name: _______________________________________________________ Contact Phone:_______________________________
Qualifications: ______________________________________________________________________________________________
____________________________________________________________________________________________________________
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 respons
e
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.
• P
roposed 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.
• P
roposed Lost and Found Plan – This plan should include, but is not limited to:
o A description of the use of signage, announcements on public address systems or pre-event
handout
s.
Section H – Site Plan / Route Map
For parades, races and other processional events:
Are you selecting one of South Bend Police Department’s (SBPD) pre-approved race routes? Yes No
You must select from SBPD’s pre-approved race routes (see links on application site) or provide sufficient
evidence of event participation if the applicant is proposing a different route through South Bend.
If your event will not be using a pre-approved race route, the proposed event map should include a route plan
clearly identifying the timing and locations of proposed street closures, and the direction of parade
movement.
If your event will not be using a pre-approved race route, please explain:
Site Plan / Route Map - For All Events:
Pr
ovide 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.
• Location of fencing, barriers, and/or barricades. Indicate any removable fencing and exit locations for
emergency purposes.
• Location of all stages, platforms, bleachers, grandstands, tents, booths, cooking areas, vehicles, trailers,
and other temporary structures. Applicants should also clearly mark locations of food and alcohol
serving or sales, if applicable.
• The location(s) and number of all portable toilets and wash stations.
• The location(s) and number of all trash and recycling containers, including dumpsters.
• The location of generators or any source of electricity.
• Traffic plan and map, including proposed loading/drop off areas, barricades, secured areas, vehicle and
bicycle parking areas, and considerations for TRANSPO bus route changes.
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 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 Tier II and III event
applications filed 60 or greater days in advance of the event, or a $100 non-refundable expedited fee for
applications filed between 30 and 59 days in adva
nce 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.
D
ate: ___________________________________________
Applicant Signature: ________________________________________________________________________________________
Printed Name: _____________________________________________________________________________________________
SPECIAL EVENTS COMMITTEE APPROVAL
___
________________________ ______________________________ _______________________________
President Member Member
___________________________ ______________________________ _______________________________
Member Member Date
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th Bend Special Event Application City of Sou (City of South Bend)

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Completed 16 July 2020

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