Fillable CITY OF PORT WASHINGTON EVENT PERMIT APPLICATION / (City of Port Washington)

Fill Online, Printable, Fillable, Blank CITY OF PORT WASHINGTON EVENT PERMIT APPLICATION / (City of Port Washington) Form

Use Fill to complete blank online CITY OF PORT WASHINGTON (WISCONSIN) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

CITY OF PORT WASHINGTON EVENT PERMIT APPLICATION / (City of Port Washington)

On average this form takes 28 minutes to complete

The CITY OF PORT WASHINGTON EVENT PERMIT APPLICATION / (City of Port Washington) form is 6 pages long and contains:

  • 0 signatures
  • 62 check-boxes
  • 82 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your City of Port Washington (Wisconsin) forms online.

BROWSE CITY OF PORT WASHINGTON (WISCONSIN) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
1|Page
CITY OF PORT WASHINGTON
EVENT PERMIT APPLICATION / GENERAL EVENT INFORMATION
Special Application Fees: $25 (single day event); $35 (multi day event)
Official Name of Event:
Contact Name/Email:
Cell Phone:
Start Date: End Date:
DATES
MON
TUES
WED
THURS
FRI
SAT
SUN
Setup
Start
End
Cleanup
Location of Event: □ Park/Public Property
□ Public Street/Sidewalk/Alley/Right of Way
□ Private Property
□ Other
Please List Streets That May be Closed or Otherwise Affected by the Event:
Location of Event Parking:
Estimated Attendance Per Day:
□ 0-250 □ 250-500 □ 500-1,000 □ 5,000+
Estimated Attendance Entire Event:
□ 0-250 □ 250-500 □ 500-1,000
□ 1,000-5000
□ 1,000-5000
□ 51+
□ 5,000+
Number of Booths:
□ 0-10 □ 11-25 □ 26-50
2|Page
Type of Event:
□ Civic Group Fundraiser □ Run / Walk
□ Festival / Music Concert □ Religious / Educational
□ Parade □ Sport (fishing, soccer, etc.)
□ Other
Event Will Have:
□ Musical Entertainment / Amplified Sound (if checked, see Municipal Code 9.13.00 for
restrictions)
□ Bounce House
□ Rock Wall
□ Vehicles
□ Animals
Food Truck
s(s)
Dunk Tank
□ Marching Units
□ Water Slides
□ Other high-risk activity
Permit & Other Requirements:
□ Beer and/or wine will be served, sold, etc.
Temporary Class "B" Retailers License
□ Barricades / Detour
s (city streets, roads, etc.)
Approval by Police
□ State Hwy Closures
Police Dept
will file requ
est from the DOT
□ Solid Waste & Recycling
D
isposal Contain
ers & Haul Away
□ Tent and/or canopy
Fire Dept.
Diggers Hotline must be contacted a
minimum of 3 days before digging or stacking
□ Large Generator(s) - separate panel box required
Inspections Permit
□ Fireworks
Fire Dept
□ Activities in a park outside of normal operating
hours
Waiver required by Common Council
□ Non-food related sales or display booths -
DESCRIBE→
Arrangements Have Been Ma
de For:
□ Restrooms & Hand Washing □ Tent Heating
□ Ev
ent Insurance □ Public Safety / EMS Services
□ Fire Ex
tinguisher
s □ A
dvertising Banners/ / Sign
s
□ Drinking-Water □ Waste Water & Grease Removal
□ Weather Contingencies □ LP Gas
3|Page
In the event of Severe Weather or Other Emergency:
Open and Avail
able Shelter Locations Will Include:
Aut
horized Person to Cancel the Event if Necessary: (name, title, and phone number)
Public Safety Site Plan:
Attach a schematic drawing of the event site location. The drawing must be legible and drawn to
as close to scale as possible. The public safety plan must include the following items if they will
be provided or if they are required.
• Beer/Wine Sale Location(s)
• Wristband Booth
• Booths, stages and event structures
• First Aid Station(s)
•
Information / Ticket Bo
oths
•
Fences
• Boundaries of the Eve
nt
• Run/Walk or Parade Route
• Exits & Gates (gates must be numbered)
• Fire Extinguishers
• Severe Weather Shelters
• Fire / EMS access Road
• Private Security Staff L
ocations
• Emergency Contact Event Personnel
• Event Parking
• Barricades
• Generators
• Detour Ro
ute, Including Signage
Provide any additional information the City should consider or may be relevant to a review of
this application. Attach diagrams and/or pictures to the application as needed.
4|Page
State: Zip:
State: Zip:
Organization(s) Sponsoring Event:
Name:
Address:
City:
Name:
Address:
City:
Send Invoices To:
CONTACT INFORMATION
**Either Primary or Secondary Contacts Must Be Onsite at All Times of the Event**
Primary Contact:
Cell #: Daytime Phone:
Email:
Address:
City: State: Zip:
Secondary Contact:
Cell #: Daytime Phone:
Email:
Address:
City: State: Zip:
5|Page
EMERGENCY CONTACT INFORMATION
The public will be notified of safety and/or security issue(s) in the following manner:
□ Contacting Local Police and Fire Services □ Onsite PA System
□ Other
If a private security firm has been contracted, list its information below:
Security Provider:
Contact Person:
Phone Number:
Location of Provider at Event Site:
Location of Missing Persons Station:
If the Event Takes Place on City Property (Parks, City Streets, or Other City-Owned Facilities) in Whole
or In Part:
□ I have reviewed the proposed location for the event, and I have determined it is
suitable for our proposed use.
□ I understand
and acknowledge that it is the event organizer's responsibility to inspect the
area in which the event is to take place and notify the City Police Department (262-284-2611) of
any safety concerns.
□ I have reviewed and understand the City's Insurance Requirements for the Event as
described in
this document.
□ I have enclosed the event's Public Safety Site Plan.
□ I have enclosed other information that we believe is necessary or helpful to describe the
planned event.
SIGNATURE
I am autho
rized to sign this application on behalf of the event sponsor. The information contained in this
application for an event permit is true, correct, and complete to the best of my knowledge. If there are
any changes to the event, I agree that I will immediately notify the City of Port Washington of these
changes and request approval of them.
(Sign Name) (Date Signed)
(Printed Name) (Print Title with Organization)
Return Completed Applications and Application Fees To:
Susan L. Westerbeke, City Clerk
City of Port Washington, 100 W Grand Ave, Port Washington, WI 53074
(W) 262-284-5585 (F) 262-284-7224 swesterbeke@cpwwi.org
____________________________________________________ _________________________
EVENT INDEMNIFICATION
AND HOLD HARMLESS AGREEMENT
EVENT:
EVENT ORGANIZER(S):
In consideration of permission granted by the City of Port Washington, Wisc
onsin, to hold the Event
named hereinbelow, the undersigned Event Organizer(s) (hereinafter referred to as “Organizer,”
whether one or more) hereby agrees to indemnify, defend, and hold harmless the City of Port
Washington, Wisconsin, and its officers, appointed and elected officials, agents, departments,
employees, boards, commissions, committees, members and volunteers (hereinafter collectively
referred to as the “City”) from and against any and all claims, actions, liabilities, damages, losses,
expenses, and reasonable attorney’s fees (hereinafter collectively referred to as the “Claims”) for
any bodily injury, including death, and/or any loss of or damage to property caused or alleged to be
caused, in whole or part, by any negligent or intentional acts or omissions of Organizer or by any of
Organizer’s officers, employees, agents, owners, directors, employees, contractors or subcon-
tractors, or by any person under their right of control insofar as permitted by law. This indemnity
includes any Claims arising out of or in connection with the permitted Event, namely:[insert name of
event]
This Indemnification further includes, but is not limited to: any Claims based on or arising out of the
violation, or alleged violation, of any federal, state, county or municipal statute, ordinance, rule,
regulation, guideline or court order; any Claims related to or arising out of a claimant’s alleged
exposure to or contact with any persons present at the Event who are or may be infected with
coronavirus disease (COVID-19) caused by severe acute respiratory syndrome 2 virus (SARS-
CoV-2) or other coronaviruses, whether or not said persons are symptomatic at the time of alleged
transmission; and any Claims based on the City’s issuance of a permit or license to Organizer to
hold the Event on City property. Organizer expressly acknowledges that it is responsible for all
COVID-19 and other coronavirus-related claims arising from the holding of the Event. It is the intent
of the City and Organizer that the City shall in all cases be indemnified by the Organizer from and
against all Claims relating to the Event. It is agreed that where this Indemnification is applicable,
Organizer shall be responsible for primary loss investigation, defense, and judgment for damages,
costs, and disbursements. Organizer further agrees to waive all rights of subrogation it has or may
have against the City for any damages or losses arising from the Event.
The person(s) signing this Event Indemnification and Hold Harmless Agreement hereby certifies
that they have full authority to enter into this Agreement on behalf of the Organizer(s) of the Event.
Event Organizer(s):
(Print Name of Sponsor)
by:
(Signature & title) (Print name of signer) (Insert date of Signing)
by:
(Signature & title) (Print name of signer) (Insert date of signing)
___________________________
__________________________
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

CITY OF PORT WASHINGTON EVENT PERMIT APPLICATION (City of Port Washington)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 20 August 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document