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Home My WebLink AboutMuster Parade & Water Pumping at Ohio River de . `T "r ,1 . y SPECIAL EVENT APPLICATION �. �; V,,w Submittal of this application does not guarantee approval of the event. OSO14 • This application must be completed in its entirety.Any applications not completed will be denied automatically. Before applying,please acknowledge that addendum will be utilized in instances where additional liability on behalf of the applicant may occur.Applications must include a detailed site plan which clearly shows all temporary structures including but not limited to tents,portable toilets,stages,bleachers,dumpsters,fencing,inflatables,etc.at the time of submission. If you are applying on behalf of a nonprofit, please provide proof of organization's nonprofit designation. EVENT INFORMATION Name of Event. /1(1 % 4 /� Type of Event: ?4 A Di (t)A- i ic'IC f �/i+i t'i�cc r� T v /1� iD �/�l 4/L-ie . 5 Event Date(s). -�� ) S' i' �/ el 2 Event Time: // 0 f//'�1`4 2)- e,''fir' (. -ff Event Day 2: Event Time: Event Day 3. Event Time. Event Location: Alternate Date, Time and Location: ....... Will additional time be needed for set up/break down?(please check) ❑YES El NO Set up will begin on(date) at(time): Z Break down will begin on (date). at (time): `?�, N( Please provide a detailed description of your proposed event(be spec hc): IF ri I "L. g.,..,,, "I'7'z-‘-e-2..&k.c.",.- „eA.}.-t-Zel ela-4-G4,---& l_...c/-,6,/,_4-1,,- ...e,,,,e.... „ ( '41 - etc l � ` j 6 ) i______ ___ , CY ",... 1 4, _ - -t---7---6,---,.. 1444- : . 1 1 \ _1 Is this event open to the public? (please check) BYES ElNO I 5l ' i Estimated attendance' ,9 1 t,' Estimated number of teams participating?(athletic tournament only) 'Fees may be assessed during post event inspection it actual attendance exceeds above estimate 1 ORGANIZATION INFORMATION Organization producing the event:(please check) ❑For Profit JX1 Nonprofit ❑Governmental 0 Neighborhood Association ❑Other: '/ A, Name: f//NTAB6& /J � / 7i15'E-ti Street Address: 7t' "iR/A/ _ STD T City: ZrOFf e R 5Mti11/44 E' State:41— Zip Code? '/ ?7 • Website"41144 yin cc�sur. -tV12. Phone: (-F/2- •Z f 2 - V 7Os Email: /41:.:444-4071. C Social Media. rG2 O iJ Fog,' On-site Contact Name. Cq On-site Contact Phone: h'D Z- - (9! ✓,b/7-- 2- On-site Contact Email. 21-"Ata-27,-e ez.o' - Phone number and/or email you want the public to contact for more information and to be listed online: 2-) c:2 Z7 evtrac4-e-e. 'ear. Number of years this event has taken place in Jeffersonville: Is this event produced in other areas?(please check) ❑YES ®NO If so,where? COST b FUNDING Ticket Prices(If applicable): • Adults Children Seniors How will ticket sale revenue be used? /z4,0 �O'b �f If the proceeds of the event are intended for an organization other than the applicant,please provide the following information: Benefit Organization: %of funds which will be donated: Contact Person: Contact Phone: Terms of the agreement: /�1 2 ROAD CLOSURE Will your event require road closures?(please check ❑YES ( .NO If yes,please describe the roads that would be closed and provide the opening/closing dates and times.Also, please attach map detailing closures and cross streets. Name of streets: DateTme of Closure: DateTme of Opening: PARKING Will you need any parking lots reserved for non-public use?(please check) ]YES ❑NO e- Will you be using areas for off-site parking?(please check) OYES ❑NO 4#, e-pttof TRAFFIC CONTROL /`I Will your event require traffic control?(please check) {�YES 0 NO U"'`ry&�`�`�'`�''641.441—a�� ,sj3_., ALCOHOL Will alcohol be served at your event?(please check) to YES ❑NO M ,`'� FOOD Will food be served at your event?(please check) ]YES ❑NO at /1/ If yes,will food be self-prepared?(please check) f3 YES 0 NO INFLATABLE ATTRACTIONS: (Please snake sure to Include on the snap) Wilt inflatable attractions(bounce houses,slides,games)be part of this event?(please check) ❑YES RI NO If yes,who will staff the attractions? 0 Vendor 0 Event Staff AMPLIFIED SOUND: Will amplified sound be used at your event?(please check) YES 'NO If yes,what will be amplified(music,speeches,etc.)?(please check) ®YES ❑NO 1-1^'�/f � U If yes,what time(s)will sound be amplified? L. /1/ t If yes,what sound company will provide sound? AUDIO/VISUAL EQUIPMENT: Please list any AN equipment to be used at your event: 3 FENCING (Please make sure to Include on site map) r"'\ Will you be using temporary fencing for ydur_event?(please check) OYES gi NO If yes,what company will provide fencing? REFUSE AND RECYCLING (Please make sure to Include on site map) Will you need refuse containers(dumpsters)for your event?(please check) OYES III NO If yes,how many will be used? If yes,what company will provide refuse and recycling services? RESTROOMS (Please make sure to include on site map) Wilt your event require temporary restrooms?(please check) OYES p]NO If yes,how many? If yes,what company will provide restroom services? CLEAN-UP: Will you use a cleaning company for event clean-up?(please check) ❑YES [;i3 NO If yes,what company will provide cleaning service? ELECTRICITY: Will you be using temporary electric(generator)at your event?(please check) ❑YES NO If yes,what company will provide electric service? TENTS (Please make sure to Include on site map) Will you be using tents,stages,ticket booths,etc.at the event?(please check) ❑YES )NO If yes,will tents be larger than 150 square feet(larger tents require permit)?(please check)❑YES 0 NO If yes,please indicate the number and size of tents and desribe how tents will be used: If yes for larger tents,what company wilt be providing tents? PROMOTING/ADVERTISING: What type of promotion/advertising do you have planned for your event? 443— ) � •.� ) 4 SIGN AND RETURN this completed application with supporting documents to the Jeffersonville Parks Department. Attn City Events Planning Board. Email: parksinfooicityofjeff i! ' Mail. 500 Quartermaster Court Jeffersonville,IN 47130 Applicant agrees that the contents of the application are complete, true and accurate to the best of their knowledge. information and belief, and agrees to ensure compliance with the policies set by the City Events Planning Board. c-7 A'5 Signature of Applicant Date *Upon approval by the City Events Planning Board, applicant will be required to pay the Special Event Permit Fee determined by the Board.This fee is usually set at S150 per application. but may be increased depending on use of city services, risk assessment or other factors. **A certificate of insurance is required for all events, with minimum coverage of 51,000,000 liability. The certificate must list the City of Jeffersonville as additional insured. and must be submitted to the Parks Department at least 10 days prior to the event date This section to be completed by City Events Planning Board PERMIT FEE $ fi CC Receipt# APPROVED BY Date 1-�1—; �p2 Police / Fire. z 3 Street: I I //- Parks: ,c Y-+ Safety: Directorrk"".cd5 5