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HomeMy WebLinkAboutD*A*S*H 5K & Veterans Ceremony QP •G1T Y Qfi• A • 0 SPECIAL EVENT APPLICATION Submittal of this application does not guarantee approval of the event. " WS014.4 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 be-lalf of the applicant may occur.Applications must include a detailed site plan which clearly shows aU 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 nonprof t. please provide proof of organization's nonprofit designation. EVENT INFORMATION Name of Event 0*A'S*H 5K & Veterans Tribute Type of Event: Run/Walk and Veterans Ceremony Saturday, November 11 , 2023 Check-in6a•n.Ceremony 9t5am SK.9 Event Date(s) Event Time: Event Day 2: Event Time: Event Day 3: Event Time: Event Location: Riverside Drive Alternate Date.Time and Location: Will additional time be needed for set up/break down?(ptrasecht+rk) IN YES ❑NO Setup will begin on(date): 1 1-1 1-23 at(time): 7:30am Break down will begin on (date). 1 1-1 1-23 at(time): 11 :30am Please provide a detailed description of your proposed event(be specrrid: 5K with Veterans Tribute. Honor Guard from American Legion/VFW will present flag, play taps, and do a 21-gun salute using ceremonial blanks. Is this event open to the public? `please check) 0 YES 0 NO Estimated attendance* 250 Estimated number of teams participating?(athletic tournament only) "Fees may be assessed d'nng post event inspection it actual attendance exceeds above estimate. 1 ORGANIZATION INFORMATION Organization producing the even::(please check) ❑For Profit IN Nonprofit ❑Governmental ❑Neichborhood Association ❑Other: Name: Jeffersonville Main Street, Inc. - Downtown Revitalization C 3 is_ Street Address: 401 Pearl Street City: Jeffersonville State: IN Zip Code: 47130 Websitewww•JeffMainStreet.org Phone: 812-283-0301 Email. info@JeffMainStreet.org Social Media' On-site Contact Name:Jay Ellis On-site Contact Phone. 502-718-2510 On-site Contact Email1info@JeffMainStreet.org Rhone number and/or email you want the public to contact for more information and to be listed online: www.JeffMainStreet.org Number of years this event has taken place in Jeffersonville: approx 10 Is this event produced in other areas?(pte3secheck) ❑YES Ig NO If so,where? COST b FUNDING Ticket Prices of applicable): Adults Children Seniors How will ticket sale revenue be used? If the proceeds of the event are intended for an organization other than the applicant,please provide the following information: Benefit Organization: Jeffersonville Main Street, Inc. of funds which will be donated: Contact Person: Contact Phone: Terms of the agreement: 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 :Imes.Also, please attach map detailing closures and cross streets. Name of streets: Hard closure on Riverside Drive from Spring Street to Pearl Street, monitored intersections by volunteers for rest of route. Date/Time of Closure: 11-11-23 at 7:30am Date/Time of Opening: 11-11-23 at 11:30am PARKING Will you need any parking lots reserved for non-public use?(please check) ❑YES N NO Will you be using areas For off-site parking?(please check) ❑YES ❑NO TRAFFIC CONTROL Will your event require traffic control?(please check) IN YES ❑NO ALCOHOL Will alcohol be served at your event?(piease check) ❑YES ❑NO FOOD Will food be served at your event?(please check) OYES ®NO If yes,wilt food be self-prepared? (please check) ❑YES ❑NO INFLATABLE ATTRACTIONS: (Please make sure to Include on site map) Will inflatable attrac:ions(bounce houses, slides, games)be part of this event? (please check) ❑YES I]NO If yes,who will staff the attractions? El Vendor ❑Event Staff AMPLIFIED SOUND: Will amplified sound be used at your events(please check) I]YES ❑NO If yes, what will be amplified (music, speeches. etc.)?(please check) DYES ❑NO If yes, what time(s)will sound be amplified? Music, announcements, award winners. If yes,what sound company will provide sound? AUDIOVISUAL EQUIPMENT: Please list any A/V equipment to be used at your event: 3 FENCING (Please make sure to include on site map) Will you be using temporary fencing for your event? (please check) ❑YES p 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) MI YES ❑NO If yes. how many will be used? 10 trash cans If yes,what company will provide refuse and recycling services? RESTROOMS (Please make sure to include on site map) Will your event require temporary restrooms?(please check) IN YES ❑NO If yes, how many?2 If yes, what company will provide restroom services? CLEAN-UP: Will you use a cleaning company for event clean-up?(please check) ❑YES ©NO If yes what company will provide cleaning service? We will leave site as we found it. ELECTRICITY: Will you be using temporary electric(generator) at your event?(please check) Q YES ❑NO If yes, what company will provide electric service? Need electric for PA system TENTS (Please make sure to include on site map) Will you be using tents, stages,ticket booths, etc.at the event?lpiease check) ❑YES NO If yes, will tents be larger than 150 square feet(larger tents require permit)? (please check)❑YES ❑NO If yes, please indicate the number and size of tents and cesribe how tents will be used: If yes for larger tents,what company will be providing tents? PROMOTING/ADVERTISING: What type of promotion/advertising do you have planned for your event? Social media, website, news release. 4 SIGN AND RETURN this completed application with supporting documents to the Jeffersonville Parks Department, Attn: City Events Planning Board. Email: parks,nfo@cityofjeff.net 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. Fa_ ST: 775-4 3 Sig r f 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$150 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$1,000,000 liability.The certificate must list the City of Jeffersonville as additional insured, and must be submitted to the Parks Department at least 10 1 days prior to the event date. This section to be completed by City Events Planning Board PERMIT FEE $ Receipt# APPROVED BY Date Police - //,10� Fire: Lov6►vf /5/3'3 Street: 1A41410 1'1 I -5-23 Parks: Safety: 04i Director I \ cf 16 )0 \ct�-� 5