HomeMy WebLinkAboutSt. Augustine Church October Fest September 28, 2024 from 3:00 pm to 10:00 pm (BPW approved 9/11/24) Jeffersonville City of Jeffersonville
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Special Event Application
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
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. COIs 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 TtTI
Name:
For Profit I 1— Non-Profit I Government I I Neighborhood Assn Other
Address: �—��5� • ► S �' F r e 2 SDNJ*► "�
Phone: (A\a) _aus-TJi
Website: W w Q.)• )� e� �Uc� E�O.-1 �10tL ' - g
Social Media:
Event Contact (name, phone, email):
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Phone/Email/Website for Public Inquiries: ( \ ) ' 1J. - Vim 1 _
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List all sponsors affiliated with the event: (1 \ \-) 1 - 1 C-‘
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EVENT INFORMATION
Name of Event: ' vquS-\`
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Date(s): Epp
Event Times: `.up _ p',pp c, c"(1
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Setup Time: S A
Teardown Time: i t OO n
Alternate Date (if applicable): rc
Private or Public Event: u� 1 tC.
Estimated Attendance: a s,CEO •
Ticketed or Free Event: r �-
Ticket Pricing (if applicable):
Is this a fundraiser for a non-profit organization? If so, provide name of the
organization and contact info:
Detailed Description of Event:
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FOOD/ALCOHOL
Will food be served at the event? If so, list vendor(s): �� S
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Will alcohol be served at the event? If so, list vendor:
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*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.
REQUEST FOR STREET CLOSURE
Street Name (include block numbers or cross streets): r
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Date &Time of Closure: A`, • G1 1 cT � a'� L-'
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Date &Time of Reopening: 'cl '
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:
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AMPLIFIED SOUND
*The City of Jeffersonville's noise ordinance requires that all amplified sound cease by 11 pm.
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Will amplified sound be used at the event?
If so, provide the name of the company and contact info:
Describe any other use of audio/visual equipment at the event (include company info if different from above):
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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
RESTROOMS I
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REFUSE/RECYCLING 1
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CLEANUP
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PROMOTION AND ADVERTISING
Describe the promotional and advertising plan for your event:
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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.
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PRINTED NAME
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*Sections below will be completed by Special Events Committee*
COMMITTEE ADVISEMENT
The City of Jeffersonville Special Events Committee hereby APPROVES DENIES
this application based on the information provided at the meeting on 9 • 3. aoay (date).
APPROVED BY
Committee Director a-C ' ( I C / 46 4 iV -
Safety Director:
Police Department: - �-.
Fire Department: ., 1_c�., (WW1
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Parks Department: f\`4)6,/
Street Department: /� ��%�/14_
*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 $ 150 - Sep-.. li p
INSURANCE we_ tp} I-it-h
SECURITY CONTRACT— ibce, } , 23c6
VENDOR COI(s) — Ni l A
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