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Street Closure for Special Event Form

  1. Instructions

    1). Complete this form, and attach all additional documents, including but not limited to maps, Certificate of Insurance, and return to Michigan City Clerk’s Office, 100 E. Michigan Boulevard, Michigan City, Indiana. Read the Board of Public Works & Safety’s Policy Regarding Special Events for Street Closures, copies of said policy are available in the Clerk’s Office. The Policy prescribes the applicable insurance requirements.

  2. 2.) This form and any attachments must be submitted to Clerk at least sixty (60) days in advance of special event if you are seeking permission to close City street(s) for an event that has never been approved by Board of Public Works & Safety (“Board”) or a modification to an event which has been previously approved by Board.

  3. 3.) Clerk will forward this information to City Departments for their review and recommendation. In addition, Clerk will place this Request on the Board’s Agenda for their next public meeting. The Board’s regular meetings are held on the first and third Monday of every month at 8:30 a.m. in Common Council Chambers (lower level City Hall). Requests must be received in the City Clerk’s Office by 12:00 p.m. (C.S.T) on the Wednesday before the scheduled board meeting.

  4. 4). You should appear at the Board’s regular meeting to answer any questions or concerns the Board may have regarding your request.

  5. If different from street address

  6. Primary Phone Type*

  7. Secondary Phone Type

  8. Do you have maps, drawings, of area and set-up plan to attach?*

  9. Will alcohol be served or sold? *

  10. If serving alcohol, do you have a liquor license?

  11. Will you be hiring off-duty security?

  12. Do you have a Certificate of Liability Insurance to attach?*

  13. If attaching a CoLI, is the City named as an Additional Insured?

  14. Does your CoLI contain a clause that the policy may not be canceled or modify without 30 day advance notice to City?

  15. I have read the Board of Works & Safety Police regarding Special Events for Street Closures and agree to all the terms and conditions of said policy.*

  16. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

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  18. This field is not part of the form submission.