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Home My WebLink AboutClaysburg Days (BPW approved 6/12/24) Jeffersonville City of Jeffersonville , ,, INDIANA ' ' Special Event Application p This application must be completed in its entirety. Any applications not properly completed will be denied. Applications should be submitted by email to: parksinfo@cityofjeff.net Once the application is submitted, it will be added to the agenda for the next scheduled Special Events Committee meeting.The applicant will be notified of the meeting date and time, and is required to attend the meeting for the application to be considered. Special Events Committee meetings are usually the first Tuesday of the month in the Parks office conference room: 500 Quartermaster Court#205. If the event is approved by the Special Events Committee, it will then be presented to the Board of Public Works for final approval. SITE PLAN 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. PERMIT FEE All events approved by the Committee will be charged a $150 permit fee.The fee is payable by cash, check, money order or credit card. Permit fees are due 14 days after the event is approved. If the event is approved, permit fee is due (usually set at$150 per application, but may be increased depending on use of city services, risk assessment or other factors). INSURANCE Event producer must provide a current Certificate of Insurance that lists the City of Jeffersonville as additional insured. The policy must include at least $1,000,000 for general liability coverage. The Committee has the right to require additional coverage as it sees fit. COls are due 14 days after the event is approved. SECURITY Most events approved by the Committee are required to have security on-site during all operating hours. The number of guards required will be determined by the committee, based on an event safety assessment—estimated attendance, alcohol service, risk factors, etc.The Committee may waive the security requirement for small events with minimal risk. Security must be contracted with the companies that are currently approved by the committee, Vigilance Security and Spartan Security. The security contract/invoice must be turned in to the Committee at least 30 days prior to the event date. *The Jeffersonville Police Department does not provide security for events. Their role is limited to enforcing laws and facilitating street closures. IDHS PERMIT Amusement and entertainment permits are required for events that include concerts and other shows, amusement rides, movies and dances. It is the applicant's responsibility to obtain necessary permits from the Indiana Department of Homeland Security.The Special Events Committee does not advise on these requirements.Click here for the IDHS website to learn more about the permit requirements and application. • BUSNINESS/ORGANIZATION INFORMATION Name: L AyS 3' -6 DAY S For Profit El Non-Profit d Government Neighborhood AssnEi Other El Address: ('p'0 80 14 i f f460,1-' 9,.7)113 Phone: So a 5- y 5.16 Website: Social Media: 1 '. Gl-Ot\-/S 11) ? 4 0 Al Event Contact (name, phone, email): 6404) adE 641 i - webs. Cigkisiathtsc�t�1ram: T7E 5 mi I . 00/1 Phone/Email/Website for Public Inquiries: oa S35-4CrX'C List all sponsors affiliated with the event: T —F6AS0NALE uu3 610 Icep- � 20tut AA) Lo o [L 6 A-g_ber4- 5 ).-)-v P n»2 - L o O& 3 dvklft\O Cfco ) EVENT INFORMATION Name of Event: cLRy5 6 J AN/ Type of Event: /J6 G1+133K1-1vo r'ES TVAL Location: ,c , i 5 0 a%,-) P Date(s): R JCuS/ '3 2_0 ),`� Event Times: i a ei‘c n� CONSENT OF APPLICANT 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 and regulations set by the Committee. SIGNATURE & DATE S7 )4 ,A, S / I D/,)-,-i 1 L' ✓ /-----9--- (v /y(..),,J( PRINTED NAME LA-,e.qey R.c /ee,,L,` (2.Oc li TITLE 50PE4 prr ft) tA I-- *Sections below will be completed by Special Events Committee* COMMITTEE ADVISEMENT The City of Jeffersonville Special Events Committee hereby AP ES J DENIES this application based on the information provided at the meeting on 0(0 ) Oil I ?OdLA (date). APPROVED BY Committee Director: aK1J-t\'\dA) � Safety Director: /17 Police Department:? li A Fire Department: j 5&L (/Lat,--- Parks Departm t: Street Department: �Yyyy1A‘_, *The Committee reserves the right to rescind approval of this permit at any time if requirements are not met by applicant in a timely manner, or if the event is determined to be a risk to public safety. REQUIRED SUBMISSIONS (Dates Received) PERMIT FEE INSURANCE SECURITY CONTRACT VENDOR C01(s) FACILITIES AND EQUIPMENT *The City does not provide ancillary facilities, equipment, etc.for special events. List the company and contact info for each of the following that will be used at the event: FENCING 1J RESTROOMS -re 1c TENTS p ,2.'(y aE - Th 5 31 c v z. svz u..E, Lti 1 a� REFUSE/RECYCLING 1-8 pc. CLEANUP G LAYSi)v2 G Lofh Nhs j r PROMOTION AND ADVERTISING Describe the promotional and advertising plan for your event: F�-YAK-5 F,RcE )ao K zd Si-t-6 -,At1 REQUEST FOR STREET CLOSURE Street Name (include block numbers or cross streets): a_U I g i 51_I+ sigevru� , Date &Time of Closure: 40 G v 51 3, 2-t) a-Lf I a GPM Date &Time of Reopening: 40c tIy 3, aOiy Iufin REQUEST FOR ELECTRICAL SERVICE *The Committee will approve the use of City-provided electrical service as it sees fit. Applicant should plan to use portable generators for all electrical needs unless otherwise advised by the Committee. Describe the electrical needs for the event: Pv j-+24)r'\ ►2 a- Oo u i G c►-s;t, �5 AMPLIFIED SOUND *The City of Jeffersonville's noise ordinance requires that all amplified sound cease by 11 pm. Will amplified sound be used at the event? V 6S If so, provide the name of the company and contact info: C1fk'I Ou 2� RAC J,J L o� Cti M evk. - S - 4(3:S- Describe any other use of audio/visual equipment at the event (include company info if different from above): N 0 rJ 6 ft \ (�yp,') * 11 Setup Time: 61f ih I JG UY1 ' t 2 ?'1 C;�� S Teardown Time: ) JQf'‘ IN"v Si 3, ava'`1 C'oS � �l Dke S,Ac Alternate Date (if applicable): e A. C1,). L Ib, sr Private or Public Event: p U f1, "—C. Rh Estimated Attendance: 0 0 Ticketed or Free Event: 11).-6 f� )1' 0 F' Ticket Pricing (if applicable): >D'~ �� "` 56- Is this a fundraiser for a non-profit organization? If so, provide name of the organization and contact info: /v o (Y1 o W 2� AP' 111V t Detailed Description of Event: C L►4'/S Ou r2 6 O l-yS -}- S UA) 6- v F NI U y, m ►Po►2'i'q-,--) '} f-fC—,2 s o uT---1-E C-6 A C ni 6 A-)6? tr oc.v 5&5 p,J So 1�V1)-1L E tiM E ,.)/, FOOD/ALCOHOL Will food be served at the event? If so, list vendor(s): \f 6s/ 'rv3 PC Will alcohol be served at the event? If so, list vendor: J O *All vendors are required to provide a Certificate of Insurance that lists the City of Jeffersonville as additional insured. Vendor COIs are due at least 30 days prior to the event. If alcohol is being served, the policy must include alcohol liability coverage.