HomeMy WebLinkAbout2nd Annual Jeff Summer Kickoff (BPW approved 3/11/26) City of Jeffersonville
/:~ Q` ' ' N\
Special Event Application
lication
FRSONa
Any individual, business or organization planning a special event on any property owned by the City
of Jeffersonville, or is requesting any type of city services for the event, a Special Event Permit must
be issued.The permit application should be submitted at least 60 days prior to the event in order to
be considered.This application must be completed in its entirety. Any applications not properly
completed will be denied.
The applicant is required to attend a multi-departmental Special Events Committee meeting, which
takes place each month at Jeffersonville City Hall on the first Tuesday of the month at 10:00 AM. An
invitation to the meeting will be emailed once the application, route plan and/or site plan is
received.To be placed on the agenda, email your completed Event Permit Application and
documents to:parksinfo@cityofieff.net
This is the first step in a two-step process. Once the Special Events Committee has reviewed it, it
will be taken to the Board of Public Works for final approval.
1ON 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 non-refundable permit fee, which will be
based on the need for city services and determined at the committee's discretion.The permit fee
base rate is $150, but may be increased based on the need for city services, risk assessment and
■ other factors.This applies to individuals, businesses and non-profit organizations.The fee also is
applied for events that are "sponsored" by the City of Jeffersonville or one of its departments.The
fee is payable by cash,check, money order, or credit card. Permit fees are due 14 days after the
event is approved.
INSURANCE
Event host must provide a current Certificate of Insurance that lists the City of Jeffersonville as
additional insured.The policy must include at least $1,000,000 for general liability coverage. Any
vendors for said event serving food, beverages, or alcohol must also provide a COI that lists the City
as additional insured.The Committee has the right to require additional coverage as it sees fit or
terminate an event if requirements are not met. All COIs are due at least 30 days prior to the event
date. Failure to turn in COls by the deadline may result in the event permit being revoked.
SECURITY
Most events approved by the Committee are required to have security on-site during all operating
hours.The number of guards required will be determined by the committee, based on an event
safety assessment—estimated attendance, alcohol service, risk factors, etc.The Committee may
BUSINESS/ORGANIZATION INFORMATION
Name:
For Profit (1\-1c;n-Profit Government Neighborhood Assn Other
Address: Za(yD 1V. Sara Dr Ve,
Phone: 43°5q - 5f 9• 71r$fl
Website: 1/1rj 111'�".1 •
C CA.k. D Y1►rr1On r r t. t)trn
Social Media: Wipc
Event Contact (name, phone, email):
c5/- 5 9- 7ggi
6hur;crnu045 7 . g►">la.+1 . C�►'''�-
Phone/Email/Website►h for Public Inquiries:
link; - triT ' ext ocol-I on n.c n r o-f t+ e cowl.
List all sponsors affiliated with the event:
CCC Jf
E INFORMATTION
Nameof Event: / 1 yaj Somme,-
Type of Event: t O)fl ' "J' ce
Location4,0eLlatir / Q
Date(s): `j it < 1 Z-Ip
Event Times: %% D r f0►.D Q ("^^.
Setup Time: (V.b'0Qr►
/"1
Breakdown Time (completed by): 7, P r\
Alternate Date (if applicable): `f 1 Z(p
13N,
Private or Public Event: ,vCr
Estimated Attendance: ID 0
Ticketed or Free Event: -
Ticket Pricing(if applicable): Wilk
Is this a fundraiser for a non-profit organization? 140
If so, provide name of the organization and contact info:WI ft
e.ornfuDetailed Description of Event: I>S" Fv1A4r64
97kAtt tririPLI 14241414 I /Y4
FOOD/ALCOHOL
Will food be served at the event? If so, list vendor(s):r
S -
Will alcohol be served at the event? If so, list vendor: ND
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.
P'1
REQUEST FOR STREET CLOSURE
Street Name (include block numbers or cross streets): N
Date &Time of Closure:
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 electfevoitle, pryigcal�nteepds for the event: Q�,�"
watt)
0
AMPLIFIED SOUND
The City of Jeffersonville's noise ordinance requires that all amplified sound cease by 10 pm on
Sunday-Thursday and 11 pm on Friday-Saturday.
Will amplified sound be used at the event? TA
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):
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 kI`a-
RESTROOMS /AA►
TENTS ^f Ac
REFUSE/RECYCLING ►✓li
r".�
CLEANUP 1.1`pc•
PROMOTION AND ADVERTISING
How will the event be promoted?
OTHER NOTES
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 .
PRINTED NAME S Crle,r r i 2 r�1,0� �O.1 vvt4 .�,
TITLE /3�t t`kOft-
*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
-;, 3I3Ja(Olate).
APPROVED BY
Committee Director: \4-''l 'NC(.3
Safety Director:T 9_,-n
2 Police Department:• U A
Fire Department: l7,---c-•i ?adet
Parks Department:
/
Street Department: /1a7
*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.
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 or 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.
ALCOHOL
Anyone requesting to have alcohol served at an event must use a vendor that has an alcohol
catering license and is currently approved by the committee—The Alcove, Ramiro's Cantina or Pearl
Street Taphouse.The event must also adhere to the following guidelines:
• ATC Catering Permit for the event on the specified date(s)
• COI listing City of Jeffersonville as *additional insured (must include alcohol liability)
If event is located in the City's DORA district:
• DORA Permit for the event on the specified dates(s)
• Barricades surrounding the POINT OF SALE ONLY(fencing, bike rack, etc.)
Alcohol is allowed outside the POS perimeter, must be in a DORA cup
Alcohol is only allowed in the DORA district perimeter
If the event is not located in the City's DORA district:
• Barricades surrounding ENTIRE area where alcohol will be *consumed (fencing, bike rack,etc.)
Alcohol is not allowed outside the consumption perimeter
*All permits and COls must be submitted to the Committee at least 30 days prior to the event date.
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.
NOTES
Due to the amount of city services required, and the restrictions caused to the public, non-city
parades will not be approved.
Anyone requesting 5k or other run/walk event, will he advised to use Chapel Lake Park. New
requests for run/walk events that require street closures will not be accepted.