Fillable APPLICATIONS MUST BE SUBMITTED 30 DAYS PRIOR TO (Incorporated Village of Sag Harbor)

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APPLICATIONS MUST BE SUBMITTED 30 DAYS PRIOR TO (Incorporated Village of Sag Harbor)

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U.S.A. forms for Incorporated Village of Sag Harbor

BROWSE INCORPORATED VILLAGE OF SAG HARBOR (NY) FORMS

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APPLICATIONS MUST BE SUBMITTED 30 DAYS PRIOR
TO BOARD MEETING AT WHICH YOU WISH TO BE HEARD
ALL APPLICATIONS MUST BE COMPLETE, WITH INSURANCE CERTIFICATES
ATTACHED
APPLICATION FOR USE OF SAG HARBOR VILLAGE PROPERTY
FOR NON-MUNICIPAL PURPOSES
INSTRUCTIONS TO APPLICANTS
Please submit along with a completed Certificate of Liability Insurance as described below to the Village
Clerk, Beth M. Kamper at Village Hall, PO Box 660, Sag Harbor, New York, 11963.
NAME OF APPLICANT:
NAME OF ORGANIZATION (if applicable):
ADDRESS:
PHONE NO.: Fax/Email:
EVENT INFORMATION
TIME REQUESTED: From: (date & hour)
To: (date & hour)
NATURE AND PURPOSE OF EVENT (describe in detail):
ESTIMATED ATTENDANCE
SUBMISSION FEE IS $25.00 PER APPLICATION (Non-Refundable)
V
ILLAGE PROPERTIES AVAILABLE FOR USE (please indicate which properties will be used):
Windmill Park
Marine Park
Long Wharf
Havens Beach: Seeded area east of drainage ditch.
Beach Area
(Applicant must supply lifeguard, certifications must be
attached to application)
Parking Lot (Applicable fees: residents NO/CG, non-residents $10.00/day)
Other Municipal Lots (specify)
Private Property (specify)
MUSIC: YES NO
If YES, please indicate source of the music. i.e., live band, disc jockey, record/tape player, etc.
LIGHTING: YES NO
If YES, please indicate all lighting to be used other than the Village properties preexisting lighting and the
measures to be taken to prevent any source of exterior lighting from becoming visible across property
lines.
TENT (S): YES NO
If YES, please have the attached Tent Permit Application complete and approved by the Fire Marshal.
FUND-RAISER: YES NO
If YES, will there be an admission charge for this event? YES NO
SALES: YES NO
If YES, what kind of sales will the event include? Food/Non-Alcoholic Beverages Crafts
Alcoholic Beverages (Please see rule 1 below)
PARKING: Attendant? YES NO
Other
Number of cars on property: Along Road:
If gathering will take place along a public roadway, such as a race or walk-a-thon, describe route (attach
map if applicable)
SANITATION:
Please state in detail the removal of refuse and provisions for sanitation facilities:
BANNERS: YES NO
If YES, publicity banners for the event described herein will only be permitted on the grassy area of Long
Wharf and shall not exceed a period of 14 days. Banners CANNOT exceed 4 by 6 feet in size.
MUSIC: YES NO
If YES, please indicate source of the music. i.e., live band, disc jockey, record/tape player, etc.
LIGHTING: YES NO
If YES, please indicate all lighting to be used other than the Village properties preexisting lighting and the
measures to be taken to prevent any source of exterior lighting from becoming visible across property
lines.
RULES OF USE FOR VILLAGE PROPERTY FOR NON-VILLAGE USE
1.
Alcoholic beverages of any kind are prohibited on village property (except by permission of Board
of Trustees, which may be withheld. If granted, State Liquor Authority approval shall be obtained).
At any event where there will be alcoholic beverages served, sold, or otherwise available, the
insurance certificate for the event must include “Host Liquor Liability” coverage.
2.
No admission fees may be charged for functions conducted on Village property, and fund-raising
activities are not permitted, except as approved in advance by the Board of Trustees.
3.
If you desire to cancel this application, it should be done at least three (3) days prior to the event by
notification to the Village Clerk.
4.
The user of the Village property must leave it in good order after use.
5.
The user must return all furniture and fixtures used by them to original location.
6.
The applicant agrees to indemnify and hold harmless the Village of Sag Harbor, its employees,
officers, agents, or any other person acting on its behalf, against loss or expense, including
attorney’s fees, except in cases of the Village’s sole negligence, for damage because of bodily
injury, including death at any time resulting therefrom, sustained by any person or persons, or on
account of damage to property arising out of or in the consequence of the use of the property
covered by this application, whether such injury to person or damage to property are due or claimed
to be due to any active or passive negligence of the Village, its employees, officers, agents or any
other persons.
7.
This application shall be accompanied by a Certificate of Comprehensive General Liability
Insurance with limits of not less than $1,000,000 per occurrence (bodily injury/property damage)
and $2,000,000 aggregate. The Village of Sag Harbor must be named as an additional insured for
this activity. Failure to supply the necessary insurance coverage will result in disapproval of this
application. The Board of Trustees may require lower or higher limits of protection in the sole
discretion of the Board of Trustees.
8.
List on reverse side all anticipated use of Village personnel by reason of the approval of this
application.
ANTICIPATED USE OF VILLAGE PERSONNEL
(To Be Filled Out By Applicant)
1. Police:
Number of Officers
Total Number of Hours
Overtime Hours
2. Custodial Services: Number of Persons
Total Number of Hours
Overtime Hours
3. Department of
Public Works Number of Persons
Total Number of Hours Overtime Hours
4. Other Personnel
The applicant further consents to an inspection of the premises by a police officer or other enforcement
officer, upon request, for the purpose of ensuring that the terms and conditions of the permit are met and
agrees to abide by any and all ordinances of the Village of Sag Harbor, including, but not limited to
Chapter 167 “Noise”, and Chapter 265 “Vehicle and Traffic” of the Village of Sag Harbor Code. Copies
of the above mentioned ordinances are available upon request.
Application having been made to the Village Board of the Village of Sag Harbor, Suffolk County, State
of New York, for the issuance of a permit as specified. In the event that this application is granted we do
hereby agree that no events, entertainment, games, mechanical rides, or activities will be operated,
conducted, or maintained upon the premises in connection with the event, except as set forth herein.
Further we hereby agree not to operate any mechanical rides, or cause or permit any noise making devices
to be maintained between the hours of 11:00pm and 7:00am, in accordance with Chapter 33 “Noise” of
the Village of Sag Harbor Code.
Signature
Name (print) of Applicant
ANTICIPATED VILLAGE EXPENSE
(To Be Filled Out By Village Clerk)
Total Dollar Cost as Computed by Applicant:
Anticipated Dollar Cost Computed by Village Clerk:
ACTION TAKEN BY TRUSTESS: Approved:
Disapproved:
Reason(s) Denied:
Approved Conditionally:
Conditions, if any:
Date of Action by Trustees:
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APPLICATIONS MUST BE SUBMITTED 30 DAYS PRIOR TO (Incorporated Village of Sag Harbor)

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Completed 16 July 2020

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