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Home My WebLink AboutDowntown Holiday Open House . .;t�. ; ' SPECIAL EVENT APPLICATION ;A` �z' Submittal of this application does not guarantee approval of the event. •14- 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' all 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 nonprof t. please provide proof of organization's nonprofit designation. EVENT INFORMATION ( J Name of Event. NGL1-6/1 C' E I (,,Or uSL -7-7A/ I 1AjJ77AV4/ TEF ,�/��'�L£ Type of Event: ES r J/ 7&f�A77fl GSP- Fog I S (&SS N Event Date(s): )1/9/n73 Event Time: 3P,r) 9P%n Event Day 2: Event Time: Event Day 3: Event Time: ,-' Event Location. S`i2-Ai( !�4'2L)Wr'i-�L., COw/�.I, t'VI t)PLEi C/4S?Nu%f1�lji�f /h'v-�d��) Alternate Date,Time and Location: Will additional time be needed for set up/break down?(phase check) 0"ES 0 NO Set up will begin on(date): at(time) Break down will begin on (date): at(time). Please provide a detailed description of your proposed event(be specific): CCcss>ti s 0P nl 7-0 t� ,zsU l401--44 SWilli Is this event open to the public?;please check) YES ❑NO Estimated attendance' )t 1,60 Estimated number of teams participating?(athletic tournament only) "Fees may be assessed during post event inspection ii actual attendance exceeds above estimate. 1 ORGANIZATION INFORMATION Organization producing the even::(please check) ❑For P-ofit Ellonprofit ❑Governmental ❑Neichborhood Association ❑Other:`-y- /- r/ /r ,, Name: 1 er-FEJ 41 v��L rn��l v 5 � IC. C 41 S. Street Address: City: �,,\ State: Zip Code: WebsitP JZ (i-1 -� 1._ Ole, Phone: WO � 2& -o3a) =mail Social Mei1iA. �/ On-site Contact Name kl�y Q 71 On-site Contact Phone: / 5-co ` /,[� p2,570 On-site Contact Email Phone number and/or email you want the public to contact for more information and to be listed online: Number of years this event has taken place in Jeffersonville: Is this event produced in other areas?(please check) ❑YES 0 NO If so,where? COST Et FUNDING /(� Ticket Prices(if applicable) A/ "` 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: of funds which wilt be donated: Contact Person: Contact Phone: Terms of the agreement: 2 ROAD CLOSURE Will your event require road closures?(please check) ❑YES 124 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 Date/Time of Closure: Date/Time of Opening: PARKING Will you need any parking lots reserved for non-public use? (please check) ❑YES Q NO Will you be using areas or off-site parking? (please check) ❑YES 0 NO TRAFFIC CONTROL __.,� Will your event require traffic control? (please check) ❑YES ly NO ALCOHOL Will alcohol be served at your event?(please check) D YES [7NO FOOD Will food be served at your event?(please check) ❑YES Ei NO If yes,will 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 EyNO If yes,who will staff the attractions? ❑Vendor ❑Event Staff AMPLIFIED SOUND: Will amplified sound be used at your event?(please check) E f YFS ❑NO If yes,what will be amplified (music, speeches, etc.)?(please check) ❑YES ❑NO If yes,what time(s)will sound be amplified? w1 t z ON -5-775ELVAL rS If yes,what sound company will provide sound? AUDIO/VISUAL 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) 0 YES 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) ❑YES (21\10 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) Will your event require temporary restrooms?(please check) ❑YES 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 rv0 If yes what company will provide cleaning service? ELECTRICITY: �� Wilt you be using temporary electric (generator)at your event?(please check) ❑YES ft 0 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) 0 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 tyoe of promotion/advertising do you have planned for your event? 4 SIGN AND RETURN this completed application with supporting documents to the Jeffersonville Parks Department, Attn: City Events Planning Board. Email: parksnfo@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. /5/013 Si ur 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$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 )'i) days prior to the event date. • This section to be completed by City Events Planning Board PERMIT FEE $ Receipt# APPROVED BY n Date Police:(Wept '`frk Fire: 2 rcii fj is '9 N, IINr"` "" `, �^�eeri .,- 9-3Street: Parks: 0'.2-)ULek_ % 5 Safety q IS(2.$ Director I 7/_12 cj atiovv, 11612, 5