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HomeMy WebLinkAboutBuilding Liberty 5K Walk/Run (BPW Approved 8/9/23) • " "'`' SPECIAL EVENT APPLICATION ' �v Submittal of this application does not guarantee approval of the event. � SO This application must be completed in its entirety.Any applications not completed will be denied automatically. Before applying, please acknowledae that addendum will be utilized in instances where additional liability on behalf of the applicant may occur.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. If you are applying on behalf of a nonprofit, please provide proof of organization's nonprofit designation. EVENT INFORMATION Name of Event Building Liberty 5K Walk/Run Type of Event 5k Walk/Run Event Date(s): !C ' 3-t—,26 Event Time: 9.00AM Event Day 2: n/a Event Time. n/a Event Day 3 n/a Event Time. n/a Event Location. Jeffersonville Riverfront Alternate Date, Time and Location 10/21/2023 at 9:00AM, Jeffersonville Riverfront Will additional time be needed for set up/break down? (please check) ■❑YES ❑NO Set up will begin on (date) 10/14/2023 at(time). 7:00AM Break down will begin on (date) 10/14/2023 at(time): 12:00PM Please provide a detailed description of your proposed event (be;pecihcl The Building Liberty 5K Walk/Run is to support Liberty Christian Academy, the primary Guatemalan outreach project of our organization CEIBA VIDA International. It will be a fundraising event to raise awareness of our current building project, "Building Liberty." We have a school in Guatemala that educates and provides both counseling and nutritional services to 45 girls. These girls come from vulnerable situations of abuse, poverty, trafficking, and malnutrition. This 5K Walk/Run will begin at 9:00AM. The course starts and ends at the Jeffersonville RiverStage at the intersection of Spring Street and West Riverside Dr (Jeffersonville, IN 47129). We estimate that we will have around 100 participants the day of the event. Is this event open to the public? (please check) ❑i YES ❑NO Estimated attendance* 100 Estimated number of teams participating? (athletic tournament only) n/a *Fees may be assessed during post event Inspection if actual attendance exceeds above estimate 1 ORGANIZATION INFORMATION Organization producing the event: (please check) ❑For Profit ©Nonprofit ❑Governmental ❑Neighborhood Association r,..\ ❑Other: Name. CEIBA VIDA International Street Address: 3316 STORMELLO LN City: Murfreesboro State: TN Zip Code: 37128 websitewww.ceibavida.org Phone: 812-946-0470 Email: molly@ceibavida.org Social Megceibavidaintl On-site Contact Name:Molly Noonan On-site Contact Phone: 812-946-0470 On site Contact Emailmolly@ceibavida.org Phone number and/or email you want the public to contact for more information and to be listed online: 812-946-0470 and molly@ceibavida.org Number of years this event has taken place in Jeffersonville: 0 Is this event produced in other areas?(please check) 0 YES ©NO If so, where? COST & FUNDING Ticket Prices(if applicable): $30 Adults $30 Children $30 Seniors $30 How will ticket sale revenue be used? The revenue from ticket sales will go directly towards our school building fundraiser, "Building Liberty" - more information can be found here: https://secure.givelively.org/donate/ceiba-vida-international-inc/building-liberty If the proceeds of the event are intended for an organization other than the applicant, please provide the following information: Benefit Organization: of funds which will be donated. Contact Person: Contact Phone: Terms of the agreement: 2 ROAD CLOSURE Will your event require road closures? (please check) ❑YES ©NO /416.\ If yes, please describe the roads that would be closed and provide the opening/closing dates and times.Also, please attach map detailing closures and cross streets. Name of streets: Date/Time of Closure: Date/Time of Opening: PARKING Will you need any parking lots reserved for non-public use? (please check) ❑YES ®NO Will you be using areas for off-site parking?(please check) ❑YES C10 TRAFFIC CONTROL Will your event require traffic control? (please check) ®YES 0 NO ALCOHOL Will alcohol be served at your event? (please check) ❑YES ®NO FOOD Will food be served at your event? (please check) ❑YES j2<0 If yes,will food be self-prepared? (please check) ❑YES ❑NO INFLATABLE ATTRACTIONS: (Please make sure to Include on site map) Will inflatable attractions(bounce houses,slides,games) be part of this event? (please check) ❑YES ©NO If yes,who will staff the attractions? ❑Vendor 0 Event Staff AMPLIFIED SOUND: Will amplified sound be used at your event? (please check) ❑YES IN NO If yes,what will be amplified (music, speeches,etc.)? (please check) ❑YES ❑NO If yes,what time(s)will sound be amplified? n/a If yes,what sound company will provide sound? n/a AUDIO/VISUAL EQUIPMENT: Please list any A/V equipment to be used at your event: n/a folt FENCING (Please make sure to include on site map) Will you be using temporary fencing for your event? (please check) OYES ©NO If yes,what company will provide fencing? n/a REFUSE AND RECYCLING (Please make sure to include on site map) Will you need refuse containers(dumpsters) for your event? (please check) ❑YES ®NO If yes, how many will be used? n/a If yes,what company will provide refuse and recycling services? n/a RESTROOMS (Please make sure to include on site map) Will your event require temporary restrooms? (please check) ❑YES ©NO If yes, how many?n/a If yes,what company will provide restroom services? n/a CLEAN-UP: Will you use a cleaning company for event clean-up? (please check) ❑YES El NO If yes,what company will provide cleaning service? n/a ELECTRICITY: Will you be using temporary electric(generator)at your event? (please check) DYES ©NO If yes,what company will provide electric service? n/a (-N.\ TENTS (Please make sure to Include on site map) Will you be using tents, stages,ticket booths, etc. at the event?(please check) ©YES ❑NO If yes,will tents be larger than 150 square feet(larger tents require permit)? (please check)❑YES ®NO If yes, please indicate the number and size of tents and desribe how tents will be used: There will be 2 10x10 tents, one for race check-in and last minute sign up. The other tent will be for information and merchandise. If yes for larger tents, what company will be providing tents? n/a PROMOTING/ADVERTISING: What type of promotion/advertising do you have planned for your event? All promotion/advertising will be on our website www.ceibavida.org and our social media pages " CEIBA VIDA International. 4 SIGN AND RETURN this completed application with supporting documents to the Jeffersonville Parks Department, Attn: City Events Planning Board. Email: parksinfomityofieff.net Mail: 500 Quartermaster Court Jeffersonville, IN 47130 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 set by the City Events Planning Board. )-) . . (,) 07/14/2023 Signa e of Applicant Date *Upon approval by the City Events Planning Board, applicant will be required to pay the Special Event Permit Fee determined by the Board. This fee is usually set at 5150 per application, but may be increased depending on use of city services, risk assessment or other factors. **A certificate of insurance is required for all events, with minimum coverage of 51.000,000 liability. The certificate must list the City of Jeffersonville as additional insured, and must be submitted to the Parks Department at least 10 days prior to the event date. This section to be completed by City Events Planning Board PERMIT FEE $ Receipt# APPROVED BY Date W-1—2,A Police Fire: /<c-C-Lt_t rrsc-t Street: `i I1 Parks: i 6 i �_l %�%// kl-/ -A Safety. ,j ,` =� Director: 1 \-7141.-; :::.'""1"egoik 5 PROPOSED ROUTE The proposed course starts and ends at the Jeffersonville RiverStage at the intersection of Spring Street and West Riverside Dr (Jeffersonville, IN 47129). The event will take place solely on West Riverside Drive with the participants turning around to come back at Lewis & Clark Statue by the Falls of the Ohio. There will be 3 water stations along the route as noted below. Additionally, there will he 2, 10X10 tents set up. One tent will he set up for registration and merchandise by the Jeffersonville RiverStage. The second tent will be set up at the turn around by the Lewis & Clark Statue. This tend will serve as a base to receive water,information, and first aid if necessary. 11111 \ a i Vintage I ire Museum if 1 i M r: .. .., e .4 St. T41. ot 4. 9 Falls o0�PY�: Ems the Ohio G '�, r�S`r't State`Park — c 0 Ot + Ashla .Ozark 4.ao 1400* . AL * a�w•1AN' . � ce P ck .\.. , Ohio River .__ ... ___._ __. __ .,