Fillable 2020 Special Event Permit Application (City of Golden Valley)

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2020 Special Event Permit Application (City of Golden Valley)

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2020 Special Event Permit Application
Complete this application in accordance with the City of Golden Valley Special Event Policy and return it to the City Clerk’s oce at least
45 days before the starting date of the event. Please be aware there is a $25 non-refundable application fee, and additional fees may be
charged based on the type of event and City services required.
By submitting a Special Event Permit Application, you and your organization agree to the terms outlined in the Special Events Policy and
all other ordinances, laws, and City requirements that may apply to this special event.
Name of special event Name of organization
Event purpose
Main Contact For Event
Name Daytime phone
Address City State Zip
Email address
Contact person during event Cell phone number during event
Property owner at permit location, if dierent than applicant
Printed name ___________________________________ Signature
X ________________________________ Date _________________
Event Information
Event type: Parade Run Walk
Street dance Other
Event date(s)
Event start time Run/Walk start time Event end time
Location of event
Location where applicant has conducted similar event in past ve years
Description of event, activities, or route
Number of people participating Event length (miles, if applicable)
Number of spectators (if applicable) Number of vehicles involved (if applicable)
Number of units in parade (if applicable) Number of animals participating (if applicable)
Impacted properties:
Private property
City park
City sidewalk/trail
City street
County/State highway
Public waterway
Minneapolis Park & Rec Board parkway
Description of services requested (City personnel, equipment, or property)
Public safety provisions (trac control, signage, safety personnel, etc)
Parking provisions
City Clerk
| 7800 Golden Valley Road, Golden Valley, MN 55427-4588
763-593-8012 | TTY: 763-593-3968 | www.goldenvalleymn.gov | kluedke@goldenvalleymn.gov
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1/2020
2020 Special Event Permit Application
Event Security Plans
Applicant will maintain adult supervision of the event at all times. Additional security may be stipulated by the police chief. Security
will be billed per the Special Event Policy. If you have questions about the amount of security to provide, contact the Police Depart-
ment at 763-593-8079.
If event security will be provided by the applicant, explain arrangements:
If the applicant is requesting the Police Department to provide security, please explain your request:
Date: ______________ Time: _____________________ to ______________________ Number of ocers: _______________________
Date: ______________ Time: _____________________ to ______________________ Number of ocers: _______________________
Park Use If your event requires the use of a City park, you must complete this section.
Name of park Location of park
Shelter(s) to be used Number of people attending
Required Attachments Must be attached to the Special Event Permit Application when submitted.
Certicate of liability insurance
An event map is required if event will use streets and/or sidewalks (for a parade, run, etc) or will use multiple locations. Attach a
complete map showing assembly and dispersal locations, route plan, and any streets or parking lots you are requesting be blocked.
If organization is a non-prot please attach a copy of the 501(c)3 statement.
Tent permit application is required for any tent that exceeds 400 square feet.
Temporary liquor license application is required for the sale of alcoholic beverages.
Mobile Food Vending application is required for operation of a food truck.
Fireworks display applications are available upon request.
City Clerk | 7800 Golden Valley Road, Golden Valley, MN 55427-4588
763-593-8012 | TTY: 763-593-3968 | www.goldenvalleymn.gov | kluedke@goldenvalleymn.gov
Event Information (cont.)
Is the event in coordination with another event: No Yes Event name: ______________________________________________
Amplied sound? No Yes Provide a description of any recording and sound amplication equipment to be used at your event and the times.
Restrooms provided? No Yes How many? Company contracted for restrooms
Trash disposal? No Yes Company contracted for trash disposal
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2020 Special Event Permit Application
Thank you for your interest in hosting a special event in Golden Valley. To help you achieve the most successful event possible for
your organization, we are providing a list of standard services/items and the associated fees you may incur as part of planning your
event. Not all events will require all services/items, nor is this list intended to represent all services and items that may be necessary
for the operation of your event.
City Personnel (cost per hour)
Overtime will be calculated at 1½ time the rate.
Public Works --------------------------------------- $62
Fire (paid on-call) --------------------------------- $35
Fire (full time) ------------------------------------- $75
City Personnel (cost per hour)
Minimum 2 hours per employee.
Police Ocer -------------------------------------- $85
with car -------------------------------------- $110
Community Service Ocer ------------------- $35
with car -------------------------------------- $50
Reserve Ocer
with car -------------------------------------- $25
Minimum of 3 hours per ocer.
Vehicles (cost per hour)
Pick-Up Truck --------------------- $45
Utility Truck ------------------------ $100
Garbage Truck -------------------- $125
Dump Truck ----------------------- $125
Boom Truck ----------------------- $125
Fire Engine------------------------- $250
Aerial Truck ------------------------ $350
Plus sales tax on equipment rentals
Permits & Licenses
Tent/Canopy Inspections – required for tent exceeding
400 sq ft and canopies exceeding 700 sq ft (per site) ----------------------------------- $50
Each additional tent and/or canopy (per site) -------------------------------------- $25
Mobile Food Vending
Non-residential zoning districts
Up to three days (City park – limit three days) ------------------------------- $40 per day
Up to 120 days ----------------------------------------------------------------------- $150
Temporary Liquor License --------------------------------------------------------------------- $100
Fireworks/Pyrotechnic Special Eects ------------------------------------------------------ $350
Permit fee includes rental of re engine and crew for one hour stand by at display.
Park Fees
Small Park Shelter (up to 50 people)
Resident -------------------------------------------------------------------------------- $115
Non-resident -------------------------------------------------------------------------------- $130
Large Park Shelter (up to 100 people)
Resident -------------------------------------------------------------------------------- $150
Non-resident -------------------------------------------------------------------------------- $170
No amplied music allowed without approved sound permit.
Entire park (up to 12 hours), plus facility rental fees
Resident -------------------------------------------------------------------------------- $300
Non-resident -------------------------------------------------------------------------------- $450
Picnic Shelter Damage Deposit --------------------------------------------------------------- $250
Equipment Use Fee Permit
(inatable, climbing wall, zipline, etc) -------------------------------------------------------- $50
Additional portable toilets and/or hand wash stations
(at the discretion of City sta) ----------------------------------------------------------------- $62.50 regular or wash sink, $160 ADA units (subject
to change based on current market rate)
Plus sales tax on equipment rentals
City Clerk | 7800 Golden Valley Road, Golden Valley, MN 55427-4588
763-593-8012 | TTY: 763-593-3968 | www.goldenvalleymn.gov | kluedke@goldenvalleymn.gov
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1/2020
2020 Special Event Permit Application
The applicant hereby agrees to save, defend, hold harmless, and indemnify the City of Golden Valley and all of its ocers, departments, agencies,
agents, and employees (collectively the “City”) from and against any and all claims, losses, damages, injuries, nes, penalties, and costs, including
attorney’s fees, charges, liability, or other exposures, however caused, resulting from, arising out of, or in any way related to the applicant’s event as
herein described and applicant’s use of City property and/or right-of-way. Nothing herein shall have any eect on the City’s right to assert any liability
defense in accordance with Minnesota Statutes.
The City, in its sole discretion, may require the Applicant to obtain liability insurance coverage(s) for any event. If the City noties the Applicant in
writing that liability insurance is required, the Applicant must provide proof of the appropriate liability insurance(s) in the amount(s) provided herein.
The Applicant must provide the City with a Certicate of Insurance showing proof of the required liability insurance(s). The City must be listed as an
additional insured on all liability policies. Applicant’s insurance shall act as the primary insurance coverage for any claims of loss covered by the insur-
ance policy.
The Applicant must obtain commercial general liability insurance or equivalent special event coverage protecting Applicant and City from claims for
damages or bodily injury and property damage which may arise out of or in connection with the event’s operation and use of the City’s property or
right-of-way. This general liability insurance policy shall be in an amount not less than $2 million per occurrence.
If alcohol will be served or included in Applicant’s event, Applicant must obtain liquor liability (also known as dram shop) insurance in an amount not
less than $1 million per occurrence.
The City reserves the right to modify these insurance requirements at its sole discretion based on the nature and scope of Applicant’s proposed event.
Signature of Event Applicant
I understand that I may be required to obtain insurance coverage as outlined herein before the City will approve my use of City property or
right-of way. I hereby agree to obtain such coverage as the City may deem necessary and to provide City all necessary documentation of such
insurance coverage. I further certify under the penalty of perjury that I am authorized to execute contracts and other instruments and legally
bind the Applicant.
Signature of event applicant X_________________________________________ Date submitted to City _______________________
Printed name and title of event applicant ____________________________________________________________________________
City Clerk | 7800 Golden Valley Road, Golden Valley, MN 55427-4588
763-593-8012 | TTY: 763-593-3968 | www.goldenvalleymn.gov | kluedke@goldenvalleymn.gov
This document is available in alternate formats upon a 72-hour request. Please call 763-593-8006 (TTY: 763-593-3968) to
make a request. Examples of alternate formats may include large print, electronic, Braille, audiocassette, etc.
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2020 Special Event Permit Application (City of Golden Valley)

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Completed 3 August 2020

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