City Of Michigan City Board Of Public Works And Safety Agenda Request Form printable pdf download

City Of Michigan City Board Of Public Works And Safety Agenda Request Form

City of Michigan City Board of Public Works and Safety Agenda Request Form

The Board of Public Works and Safety meets on the 1

and 3

Monday of each month at 9:00 a.m. in

the City Council Chambers located in the lower level of City Hall.

In order to be placed on a Board of Works meeting agenda, Individuals, Businesses, or Organizations

are required to complete and submit an Agenda Request Form including any supporting

documents.

The deadline for submitting the completed Agenda Request Forms and supporting documents is the

Wednesday before the next regular Board of Works meeting. Agenda requests must be received in

the City Clerk’s Office by 12:00 p.m. on the Wednesday before the scheduled board meeting. This

deadline will be strictly enforced. No exceptions will be granted.

Please make sure that your contact information is accurate in case we need to get in touch with you.

A Certificate of Insurance showing a liability policy in full force and effect with limits of

$1,000,000.00 aggregate and naming the City of Michigan City as an additional insured for this

event must be attached to your application before being placed on the meeting agenda.

RETURN FORM TO: Michigan City Board of Public Works & Safety

c/o: City Clerk

100 E. Michigan Blvd.

Michigan City, IN 46360

Any questions regarding this request contact City Clerk’s Office 873-1410

Date Submitted: ______________________

Requested Meeting Date: _____________________

Name of Person Submitting Request:

__________________________________________

Name of Organization/Business (if applicable): __________________________________________

Address:

__________________________________________

Contact Phone Number:

__________________________________________

Type of Request:

_____ Streetlight

______ Street Closure

_______Walk/Run

(Check One)

_____ Vendor License

______ Block Party

_______ Parade

_____ Other (Explain) _____________________________________________

Date of Event: ______________________

Time(s) Requested for Event: __________________

Description of Request:

___________________________________________________________

________________________________________________________________________________

APPROVED BY THE BOW 07/20/2015

City Of Michigan City Board Of Public Works And Safety Agenda Request Form

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