Street Closure for Special Event Form

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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.) 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

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

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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.
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