HomeMy WebLinkAboutClaysburg Days (BPW approved 2/21/25) August 2, 2025 at Henry Lansden Park - •-
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BUSINESS/ORGANIZATION INFORMATION
Name: (LA ) G 1,2_6 tJ^.)y ,) .) 01,) ' " I "I L. t
For Profit Non-Profit i Government Neighborhood Assn Other
Address: ,p,v(( M IR (L.!y r-} C 1. S06-)u)•=2 L , T-
Phone: �J cc? _ `f c
Website:
Social Media: f t2) ' CLAyS /30(2_G OA/5
Event Contact (name, phone,email): J _� keEl) 66 3- 1 vi c?- SU a
Phone/Email/Website for Public Inquiries:
List all sponsors affiliated with the event:
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EVENT INFORMATION
Name of Event: L p}y_S i3 U % 6 OAys
Type of Event: NU� 4
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Location: IJ i ' LA/3 S() git
Date(s):
Event Times: ) ). _
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Setup Time: Up prVG0Sr Ia.va -
Teardown Time: V S'( v Q'_
Alternate Date (if applicable):; TQ A
Private or Public Event: POnL� G
Estimated Attendance: ; 300 - y D 0_ _•_ _
Ticketed or Free Event:
14,66
Ticket Pricing(if applicable):,
Is this1 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):
yes / T4&
Will alcohol be served at the event? If so,list vendor:
Piv
Note:All vendors are required to provide a Certificate of Insurance that lists City of Jeffersonville as additional
insured. Vendor COls are due at least 30 days prior to the event. If alcohol is being served, the policy must
include alcohol liability coverage.
3
REQUEST FOR STREET CLOSURE
Street Name(s) (include block numbers or cross streets): ______- ____� �: ::� =•3::.. _-: ,::
Date&Time of Closure:
141)6us<_- , a a- __._ __.1ap
Date&Time of Reopening:
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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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PD,' 02 FOM 6 LE cT12zc )( Foj2 oL Bout) E cAs-iL.�S
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? Y's
If so, provide the name of the company and contact info:
Gtoys P-d R-6v,0-5-013
LA-RAY -To► bo\- 50a 13 5- `><�Sa
Describe any other use of audio/visual equipment at the event(include company info if different from above):
/�pN e
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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; 7 �S
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Tuffs erg k.1- rz ")e L..._ __.
REFUSE/RECYCLING <b,
CLEANUP clA.y.stvgCo D/IA
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.
SIGNATURE&DATE /(l`� /-'0-1'1 .2- ?L _ go ,
PRINTED NAME L A�!'(e y 0-0> p
TITLE 1164.5 'p Cam`
*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 mO&) n(0) 2-02- (date).
APPROVED BY ��^ •
Committee Dire ctor:
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\C)2-Al(C-4-143 (6()
Safety Director:
Police Department: 2
Fire Department: /4' L-`C,a--tt�
Parks Department: ,_ --
Street Department: /%
*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 — Tl ip 1ue . rna'l, 20A-Y 2_025
INSURANCE -- -Due; 30‘,1-, Znd 2 7-C
SECURITY CONTRACT — bUe JU1U �- 2_02S
VENDOR COI(s) — Oue• JuvlA �d ?�ZS
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