HomeMy WebLinkAboutBack Your Blue 5K Run (BPW approved 3/11/26) City of Jeffersonville
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Special Event Application
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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.
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
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 approved by the committee,which are listed below.The security
contract/invoice must be turned in to the Committee at least 30 days prior to the event date.
Vigilance Security
Jason Kerberg
502.751.1061
jasonkerberg@vigilancesecuritygroup.net
*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.
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.)
o Alcohol is allowed outside the POS perimeter, must be in a DORA cup
o 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.)
o 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 Sk or other run/walk event, will be advised to use Chapel Lake Park. New
requests for run/walk events that require street closures will not be accepted.
BUSNINESS/ORGANIZATION INFORMATION
Name: Back Your Blue 5K
For Profit n Non-Profit n Government I ! Neighborhood Assn n Other Li
Address: 4711 New Middle Road Jeffersonville IN 47130
Phone: 502-817-6830
Website: www.infop100.com
Social Media:
Event Contact (name, phone, email):
Darin Broady; 502-817-6830; dbroady@jeffersonvillepdin.gov
/''\ Phone/Email/Website for Public Inquiries: Same as Above; email broady656@icloud.com
List all sponsors affiliated with the event:
EVENT INFORMATION
Name of Event: Back Your Blue 5K
Type of Event: 5K Run
Location: Big 4 Park
Date(s): September/ ,o 9am
apace
Event Times: 5a - 1pm
Setup Time: 6a
Teardown Time: 12p q id('I -X _
Alternate Date (if applicable): 2l c+ 2 2.
Private or Public Event: Private
Estimated Attendance: 1000-1200
Ticketed or Free Event: Pay for 5K entrance
Ticket Pricing (if applicable): $30.00
Is this a fundraiser for a non-profit organization? If so, provide name of the organization and contact info:
FOP Lodge 100/ Jeffersonville Police Department
Detailed Description of Event:
E'h
5K run for supporters of the Back Your Blue 5K.
FOOD/ALCOHOL
Will food be served at the event? If so, list vendor(s): No
Will alcohol be served at the event? If so, list vendor: No
*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): Mulberry Street to Riverside Drive
Riverside Dr from Mulberry to S. Indiana Ave (Soft Closure at River Pointe Plaza
Date &Time of Closure: 8a (Soft Closure as well)
Date&Time of Reopening: 11 a
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:
Just plug in a few places at the Big Four Park
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? Yes
If so, provide the name of the company and contact info:
Spin Around Sound DJ Services. Todd White
Describe any other use of audio/visual equipment at the event(include company info if different from above):
,int Just Audio Equipment that is playing before and during the run.
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
TENTS
REFUSE/RECYCLING
CLEANUP
PROMOTION AND ADVERTISING
Describe the promotional and advertising plan for your event:
We use social media to get runners for the event.
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 Z7. N. S1.e. 2:- 3 13 bi,
PRINTED NAME Darin Broady
TITLE Head Organizer
*Sections below will be completed by Special Events Committee*
COMMITTEE ADVISEMENT
The City of Jeffersonville Special Events Committee hereby APPROVES //�� DENIES
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this application based on the information provided at the meeting on 3131@gv �+. tOttirte).
APPROVED BY QkAf 'O?A(
Committee Director: '-Vr
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Safety Director: (/3„,../ t/�
Police Department: 1 ) k
Fire Department: 14-1L-c.L-t aidn '-
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Parks Department: -
Street Department: /A/011,77,k
*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 COI(s)