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App- Special Events Fall Follies On The Square

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Page 1 of 6 Application for Special
Event Rev. 1/14/20
Commissioners of Leonardtown
P. O. Box 1, 41660 Courthouse Drive
Leonardtown, MD 20650
Phone: 301-475-9791 Fax: 301-475-5350
www.leonardtown.somd.com
SPECIAL EVENT Permit
application And agreement
Event Title: _________________________________________________________________
Event Date: _________________________________________________________________
Event Time: _________ to _________ (Open to the public)
Total Time: _________ to _________ (Including Set-Up and Take-Down)
Event Location Requested: _______________________________________________________
_____ Street Closure Requested – Specify Streets/Intersections __________________________
_______________________________________________________________________________
Name of Sponsoring Organization: __________________________________________________
Organization’s Website URL: ______________________________________________________
Brief Description and Purpose of Event: ______________________________________________
_______________________________________________________________________________
Estimated Attendance: Spectators: _____ Participants: _____ Vehicles: _____
Applicant/Chairperson Contact Information:
Name: _______________________________________________ Today’s Date: _______________
Address: ________________________________________________________________________
City, State, Zip: ____________________________________________________________________
E-Mail Address: _________________________________________________________________
Phone Numbers: ____________________ _________________ ______________________
Cell Work Home
FOR OFFICE USE ONLY
Form filed with COL ___/___/___ ____ check #____________ enclosed
Event Approved ___/___/___ Initials _________ ____ COI attached
CC: LVFD _____ ____ Route Map/Site plan attached
LVRS _____ ____ Traffic Control Plan attached
SMCSO _____ ____ Event added to Master Calendar
EVENT ORGANIZER _____
Page 2 of 6 Application for Special
Event Rev. 1/14/20
Event Information:
1. Equipment: The Applicant is responsible for providing all furnishings required by your event. This
includes advertising, tents, umbrellas, tables, chairs, sound equipment, DJ, band, music/CD’s, CD
player, food, ice, decorations, extension cords, advertising, signage, fans, heaters, trash bags, etc.
2. Tents: Not using tents _____ Number of Tents _______ Sizes _______________________
Number of tents with walls/enclosed sides ____________________________________________
Tents must be provided by the Applicant. The size and location(s) of tents, canopies or other
structures must be indicated on the site plan. Stakes should not be used due to possible
underground lines. A certificate of flame resistance for tents larger than 200 sq. ft. must be
provided by Applicant.
3. Electricity: Not using electricity Town outlets (110V- limited availability) ______
Bringing generator(s) Combination Town outlets and generators (recommended) _____
4. Music: No Music Live music DJ CD’s on Town system
Name of Band/Type of music ______________________________________________________
Providing an Amplified Sound System ______ Requesting use of the Town system _______
The Town’s Sound System broadcasts throughout the Square and is mainly used for
announcements, rather than music. There is only 1 microphone with limited range and does not
include a mixing board or monitors.
5. Stage: Not using a stage _______ Bringing a ____ x ____ platform/stage _____
Requesting Town stage (16’x16’ black metal mobile trailer) _______ Stage lights _________
(Stage may only be used in certain locations; put up, moved and taken down by authorized personnel
and incurs an additional fee. Placement of stage will be designated on the Site Plan.)
6. Restrooms/hand washing stations: No restrooms needed ______ Park Restrooms _______
Number of restrooms with hand sanitizer being ordered: Reg ____ ADA ____ Family____ Sinks ____
A sufficient number of port-o-lets, with hand sanitizer, must be provided by the Applicant, including at a
minimum, one ADA Compliant Unit. Applicant must also provide a hand washing station if providing food or
using animals of any kind during the event.
7.
Trash: No trash bins needed _____ Town trash cans _______
Number of trash barrels and/or recycling bins being provided: _______ Trash ______ Recycle
Current Maryland State law
requires special event organizers using public property, hosting 200 or more
people and serving food and/or drink of any kind to (1) provide a recycling receptacle immediately adjacent
to each trash receptacle (2) to ensure that all recycling receptacles are clearly distinguished by color and/or
signage (3) and to ensure that all collected recylables are picked up or delivered to a recycling facility.
Failure to comply with this mandate could result in fines up to $300 per day.
Page 3 of 6 Application for Special
Event Rev. 1/14/20
8. Food: If at all possible, applicants are encouraged to cooperate with Leonardtown food
establishments - including restaurants, caterers and LBA-approved food truck vendors.
Outsourcing food to vendors from outside St. Mary’s County requires special permission from
the Commissioners of Leonardtown and the Leonardtown Business Association.
Outside food vendors must offer products or services that are not already conveniently and
reasonably offered by an existing Town establishment.
Outside food vendors may not be set up within 30’ of an established restaurant unless granted
special permission from the Commissioners of Leonardtown, the Leonardtown Business
Association and business.
Food trucks may not be placed in front of or block the view of any establishment, unless that
establishment is closed during the entirety of the event or grants special permission to the event
organizer.
_____ We are cooperating with Leonardtown businesses. No outside food will be sold or
given away at the event
_____ Pre-packaged/sponsored food will be given to event participants
_____ Vendors/organizations will be selling or giving away food/drink or samples of
food/drink
Vendors/organizations giving away food/drink or samples or selling food/drink must be
approved/licensed by the St. Mary’s County Health Department Environmental Section. A hand
washing station must be provided by Applicant and indicated on the site plan. Food vendor’s
Certificate of Insurance including product liability must be obtained no later than 14 business days
before event.
Food providers/vendors_________________________________________________________
Type of food provided _________________________________________________________
9. Alcohol: Not serving/selling alcohol _____ Serving/selling alcohol during the event _____
To serve or sell alcoholic beverages, Applicant must obtain all necessary permits as required by the
Commissioners of Leonardtown and the St. Mary’s County Alcohol Beverage Board. Applicant is
responsible for enforcing the rules and boundaries for Alcohol Consumption provided by the ABB.
Alcohol providers/vendors ___________________________________________________
Type of alcohol provided ____________________________________________________
10. Animals: No animals _____Type(s) of animal(s) __________________ How many? _____
Indicate the location of animals on the site plan. A hand washing station must be provided by
Applicant and indicated on the site plan. Applicant or animal owner(s) must provide Certificate of
Veterinary Inspection and Certificate of Insurance.
11. Amusements: No inflatables or rides _____ Moon Bounce ________
Other _____________________ Name of Provider _________________________________
Please indicate the location(s) of amusements on the site plan. For Public Events, Provider and
Amusement must be insured and registered with the MD State Inspector. Applicant must provide
Certificate of Inspection, a Certificate of Insurance and a sufficient number of volunteers to man the
amusements.
Page 4 of 6 Application for Special
Event Rev. 1/14/20
12. Police Support: No Support Needed _____ Number of COUNTY Deputies Requested _____
The Applicant will be responsible for paying any charges for the presence of police
personnel required for the event. Events over 300 estimated participants or that cross or close
streets or intersections require Police Assistance. It is highly recommended that events involving
alcohol of any kind also request police assistance. The St. Mary’s County Sheriff’s Office has
final approval of the number of officers needed for each event. The organizer will be charged
$50/hour, per COUNTY Deputy. The fee, made payable to the St. Mary's County Sherrif's
Office, will be due before the date of the event.
13. Parking: Parking area is sufficient _____ Overflow parking requested _____
We will be running a shuttle/golf carts from auxiliary lots to event site_____
The Applicant is responsible for requesting use of auxiliary lots, as well as volunteers, signs and
cones to help with parking. If at all possible, event staff and participants should park in public
lots and leave parking closest to the Square available for local business patrons.
14. Staffing: Number of volunteers/paid staff from Sponsoring Organization _____
Number of Community Service Volunteers Requested ________
The Applicant is responsible for supplying the necessary number of volunteers, including making
application to the State’s Attorney’s Office for community service volunteers. Using the form
provided, please fax your request for Community Service to Cathy Conlon @ 301-475-4956 at
least 2 months before your event.
15. Town Assistance
_____
_____ Orange traffic cones (up to 200 - Quantities over 200 must be provided by applicant)
_____ Yellow Safety vests for volunteers
_____ Event Parking signs (Town will provide signs and placement map)
_____ No Parking signs - Town will place signs 2 days prior to event - weather permitting
(minimum order 35, or price per sign + $10 setup fee)
_____ Request on-site emergency services (LVRS and/or LVFD, and/or Command Post)
List any special needs or requests: ________________________________________________
______________________________________________________________________________
16. Attachments: The following attachments should be submitted with this signed Application, as
applicable:
_____ Site Plan, including placement of tents, stage, restrooms, amusements, animals, etc.
______ Traffic Control Plan, including road closures, detours and parking map
______ Mapped route for Walk or Run
______ Mapped route for Parade
______ $1,000,000 General Liability Certificate of Insurance naming the Commissioners of
Leonardtown as Additional Insured
______ Check #________ for $__________ Reservation Fee + $_________ Additional fees
except those to be billed after the event. We are unable to guarantee the requested
event date until the Reservation Fee and the Event and Permit Applications are
received by our Office.
Number of STATE Troopers Requested _____
Page 5 of 6 Application for Special
Event Rev. 1/14/20
17. Fees:
Reservation Fee $75.00 (up to 75 people) _____ $150.00 (over 75 people) _______
Stage fee
Vests _____
Skirting _____ Lights ______
Additional trash cans _____ x $________ = $ ____________
Additional recy
cle bins _____ x $________ = $ ____________
Portable restrooms
_____ ADA @ $_______ ea = $ _______
_____ Sinks @ $_______ ea = $ _______
Signs _____ X $ _______ = __________
18. Term and Conditions
a) This event shall adhere to the route, number of participants and vehicles (not more than 10%
higher than the numbers on this permit), dates and times shown on the attached sheets.
b) The Organizer shall ensure that the approved Traffic Control Plan is followed
c) In the event of inclement weather or other emergency requiring access to the requested area
of use, the event may be postponed or cancelled by the event Organizers, the Commissioners
of Leonardtown, or the St. Mary’s County Sheriff’s Department.
d) Immediately following the event, the Organizer shall clean up all litter, temporary signs and
other event materials and return the requested and surrounding areas to a condition equal to
or better than its condition before the event
e) Any changes to this contract or the scope, scale, location, purpose or content of the event
should be filed with the Leonardtown Event Coordinator no less than 2 weeks prior to the
event or risk cancellation and forfeiture of reservation fees.
f) Effective May 2011, The Commissioners of Leonardtown established a reservation fee of
$75 for events expecting less than 75 people and $150 for events expecting more than 75
people. This fee includes the reservation of the park grounds and facilities for the event, as
well as administrative assistance by Town staff. The Commissioners of Leonardtown
reserves the right to amend Reservation Fees and/or establish rental fees for the use of Town
services or equipment. This includes reimbursement for signs, portable restrooms, trash
service and recycling units.
g) Additional stipulations: ______________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Organizer (please print name): __________________________________________________
Representative (please print name): _______________________________________________
Representative Signature: ______________________________________________________
_____ Family size @ $______ ea = $ ______
_____ Regular @ $_______ ea = $ _______
Deputies $50.00/per officer, per hour
Qty___ x Hours___ x $50 =$______
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Page 6 of 6 Application for Special
Event Rev. 1/14/20
19. Organizer’s Acknowledgement
By signing below, the Event Organizers and their representatives agree to the following:
a) I/We hereby affirm that the Organizer of the Event and all Participants will comply with
the Laws of the State of Maryland and the Statutes and Ordinances of St. Mary’s County
and the Town of Leonardtown.
b) I/We will also adhere to the Terms and Conditions set forth in this Permit.
c) The Organizer will obtain Liability and Property Damage Insurance with the limits of
$1,000,000 per incident and provide a Certificate of Liability Insurance for said policy,
specifying the Commissioners of Leonardtown as Additional Insured for this Event.
d) My/Our signatures below confirm that the Organizer and all Participants agree to
indemnify and hold harmless The Commissioners of Leonardtown and its officials,
employees, and agents from and against and all liabilities, judgments, settlements, losses,
costs, or charges (including attorneys’ fees), incurred by the Commissioners of
Leonardtown or any of its officials, employees or agents as a result of any claim, demand,
action or suit relating to any bodily injury (including death), loss of property, damage
caused by, arising out of, related to, or associated with the use of the Property by the User
or by the User’s members, employees, agents or invitees.
e) I/We waive any and all claims against the Commissioners of Leonardtown for any and
all physical loss or damage to the property, including the cost to repair or replace the
property caused by, arising out of, relating to, or associated with the use of the property
by the user of by the user’s members, employees, agents, or invitees.
Organizer (please print name): __________________________________________________
Representative (please print name): _______________________________________________
Representative Signature: ______________________________________________________
20. Agency Approvals
Before signing and giving your approval for your agency, consider the following:
a) Ensure you have the approval authority to sign for your agency to commit manpower and
resources.
b) Ensure you have looked over the entire application package, including the Route Map and
Traffic Control Plan. If you identify any problems, have the event organizer address them
prior to signing.
c) If reimbursement is required, ensure you have a mutually agreed upon amount (in
writing) and terms under which payment will be made.
____________________________________________________ ___________________
Commissioners of Leonardtown Event Coordinator Date
____________________________________________________ ___________________
Commissioners of Leonardtown Town Administrator Date
____________________________________________________ ___________________
St. Mary’s County Sheriff’s Office Date
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Completed 14 July 2020

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