HomeMy WebLinkAboutLeprachaun Run (BPW approved 1/22/2025) • _
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BUSINESS/ORGANIZATION INFORMATION a fib' aoakA
Name: rn CC=4/ 't-7.,✓ (4/ Z f(/ )
For Profit Non-Profit X Government Neighborhood Assn Other
Address: 3Z�n t , i�.q/�/f�T oSf A¢
Phone: .5 C2 - 5,5 y ' 72`/S
Website: r -
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Social Media: //?CV tvfn, L ICI
Event Contact (name, phone, email): ?b7)
Phone/Email/Website for Public Inquiries: Chewe
F/'c' e
List all sponsors affiliated with the event: �-21- f C; C/C)i /, h )a c//-r7wK.-5
EVENT INFORMATION
Name of Event: �rJ -' c./7G,(.r7 /?1..n
Type of Event: /r e.,
Location: 2.7? Pe,\,,5,1--)t J�i116'�
Date(s): 5_i/. z� �
Event Times: ..T.1e - p/r)
REQUEST FOR STREET CLOSURE
Street Name(s) (include block numbers or cross streets):
7/l/mil Si/> ,L Cfi1'l ;.%El=/-,4m/ i d[, ), '/.' g/?I d6; L 5/iv
/60 /406/4- 41= I4- 1L/t'UT 6. 2 s—
Date &Time of Closure: o i 56 _ 3 _// 2 f
Date &Time of Reopening:
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: /I.,G,/vt
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? r. -
If so, provide the name of the company and contact info:
/i,;',/cd 717 4= 3
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 /VWVe- _
RESTROOMS ,Lt -J70/7T-9
1
TENTS /1/4/1/C.
REFUSE/RECYCLING A701/1/
CLEANUP
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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SIGNATURE&DATE /� �-��� Ya z /2 •Z
PRINTED NAME `' ,,lc �ESs-,tri•ic,
TITLE ` ,i7t) Zvi /TA) —
*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 CA, 1y (date).
APPROVED BY
Committee Director:
Safety Director:
Police Department:
Fire Department: (-.
Parks Department: `pt,( 1 CMr
Street Department: A141/11,74;
*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 5 It 00 / Due. '• O\ • 28 Z�
INSURANCE O e-'- 02 . tt• 25
SECURITY CONTRACT OUP ��UE
VENDOR COI(s) p,J (P-
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Setup Time: _i T oa/),,��
Teardown Time: k.zi! p,,7
Alternate Date (if applicable):
Private or Public Event:
Estimated Attendance: / 7s7- 2 ,S e)
Tied or Free Event:
Ticket Pricing (if applicable): 'i;ZCr _ �� 5
Is this a fundraiser for a non-profit organization? If so, provide name of the organization and contact info:
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Detailed Description of Event:
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FOOD/ALCOHOL
Will food be served at the event? If so, list vendor(s):
-74/S v'rti'T Gc' L. is 7/4
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1✓/L /-/df /? FS CrzV's//3 L L—
Will alcohol be served at the event? If so, list vendor: ��'/`� dam " CT ���nf�73
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Note:All vendors are required to provide a Certificate of Insurance that lists 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.
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