Fillable CITY OF TULLAHOMA SPECIAL EVENT PERMIT APPLICATION Note: (City of Tullahoma)

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CITY OF TULLAHOMA SPECIAL EVENT PERMIT APPLICATION Note: (City of Tullahoma)

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1
June 2020
CITY OF TULLAHOMA
SPECIAL EVENT
PERMIT APPLICATION
Application is Due No Later than 14 Days Prior to Scheduled Event.
Please read application carefully and fully complete each section.
Note: Filing this application does not guarantee that your request will be granted.
Please check
all that apply:
Please supply the following information. For additional space, use separate sheets of paper and attach to the application.
1) Location Requested (if Temporary Street Closure only, list major roads to be closed);
if you are reserving a Pavilion, you must attach a copy of your completed reservation
form from the Recreation Department to this application; and attach a completed
Recreation Special Event Permit Application (if required).

Name/Purpose of Event:

Date or Dates of Event:
 Time of Event:

Time of Street Closure (if applicable):
Set-Up Date/Time:
Tear-Down Date/Time:
6) Name of Applicant and Organization Requesting Permit:
7) Person in charge on day of event:
Cell:
E-mail Address:
Street closure
Parade
Other special event
Beer served (separate permit required)
____
______
____
____
7A) List Names and Current Home Addresses of All Organizers (attach
additional sheets if needed):
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
2
June 2020
8) ENCLOSE A MAP of the event site, detailing any temporary or permanent
structures, street closures, parking, etc. If applicable, list the location, blocks,
streets, and/or intersections in which such event will occur.
9) An estimated number of participants and an estimated number of attendees
expected to attend during the course of the event:
10) Is your organization based in Tullahoma? Circle Yes or No
(If No, please state where: )
11) Is your organization authorized to do business in Tennessee? Circle Yes or No
12) Will you charge an admission/participation fee (including vendors)? If Yes, please
specify how much per person/vendor:
13) Will any charity, gratuity, or offers be solicited or accepted during the event? Circle
Yes or No
14) Is this event a fundraiser? Circle Yes or No. If Yes, what organization will be the
benefactor of event?
15) Will parking in the area of the event need to be restricted or prohibited?
Circle Yes or No
16) Will any sound amplification equipment be used during this event? Circle Yes or No.
If No, please skip to Question #17.
• For what purpose will sound amplification be used (i.e. announcements,
entertainment, etc.)?
• What type of sound amplification will be provided (DJ, Band, etc.)? Please list all
that apply.
3
June 2020
• During what
time
period
is sound
amplification requested?
• If for entertainment, give details of entertainment being provided (i.e. number of
musicians, type of music, amp wattage, etc.).
17) Will any stages, amusement attractions, amusement rides, including inflatable's, be
erected for the event? Circle Yes or
No.
If Yes, Applicant must give specific
details as to the location and type of games/activities. i.e. inflatable's, horseshoes,
relay races, etc. along with the name of the company providing the stages and/or
activities. Ap plic a nt mus t a ls o inc lude a c op y o f tha t c omp a n y’s ins ura nce
certificate indicating coverage and listing the City of Tullahoma as additional
insured. ***For stages, tents, inflatable's, etc. constructed on site prior to the event,
that date must be included on Certificate of Insurance provided to the City of
Tullahoma. Stages MUST be removed from site at end of event. ***Rented
inflatable's/interactive that are set-up and manned by applicant must be included
specifically in applicant’s Certificate of Insurance.
18) What, if any, vendors will be present at event? (i.e. medical related, shirts, arts, etc.)
Please provide list. Use additional sheets.
19) Will food, beverage, or merchandise be sold or given away? Circle Yes or No.
If Yes, clean-up is required. Please provide name of clean-up provider, contact,
and phone number of person on-site during event.
20) *Note: Events that include deep frying cooking oil operations are required to have a
grease pit on-site and contract with a grease waste hauler to handle the grease
waste and removal of the grease pit. The primary event sponsor is required to
remove all cooking grease from the site immediately after the event. Illegal dumping
of cooking grease will be prosecuted.
4
June 2020
21) Will alcohol, beer, and/or wine be sold or given away? Circle Yes or No. If Yes, a
permit from the relevant board is required.
22) Will your event include tents or other temporary structures, propane use, or open
flames? Circle Yes or No. Safety measures must be provided on all tents,
especially those set-up prior to the actual event. Tents should be taken down the
date the event has ended.
Return application to:
City Recorder’s Office
City of Tullahoma 201
W. Grundy Street
Tullahoma, TN 37388
931-455-2648
TITLE VI OF THE 1964 CIVIL RIGHTS ACT
“No person in the United States shall, on the ground of race, color, or national origin be excluded from
participation in, be denied the benefits of, or be subjected to discrimination under any program or activity
receiving federal financial assistance.”
The City of Tullahoma does not discriminate based on race, color, or national origin in federal or state
sponsored programs, pursuant to Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d). For more
information or to file a complaint against the City of Tullahoma under Title VI of the 1964 Civil Rights Act,
contact the Title VI Coordinator:
Casta Brice
City of Tullahoma
201 W. Grundy Street
Tullahoma, TN 37388
931-455-2648
The City of Tullahoma is committed to providing reasonable access and accommodations upon request for
people with disabilities. Please call the Human Resources Department at 931-455-2648 for specific requests.
5
June 2020
PLEASE READ ATTACHMENTS
BEFORE SIGNING
APPLICATION
1) I/We agree to abide by all ordinances and regulations of the City of Tullahoma and all conditions
placed upon the event by the City Administrator and the Board of Mayor and Aldermen.
2) I/We do swear or affirm that all the information given in this application is true and complete.
3) I/We do hereby agree to indemnify and save harmless the City, its aldermen, boards,
commissions, officers, employees and agents, from all suits, actions, damages or claims to
which the City may be subjected of any kind or nature whatsoever resulting from, caused by,
arising out of or as a consequence of such event and the activities permitted in connection there
with, and to submit a certificate of insurance to the City Recorder prior to the event in an amount
acceptable to the City Administrator.
4) I/We understand that I/We assume the responsibility of the actions of any vendors, planners, and
related parties for this event.
5) I/We understand that granting of Special Event Permit does not imply granting of any other permit
that is separately required.
6) The application for an event permit shall be filed not less than 14 days nor more than 364 days
prior to the scheduled date of such event. Suggested filing is at least 45 days prior to scheduled
event. Events should not be advertised or promoted until an event permit has been obtained
from the City. Failure to file in a timely manner may result in denial of permit.
BY: Date:
(Signature
and Title – must
be officer of organization)
Return C
ompleted Forms at City Hall to: Rosemary Golden, City Recorder
□
Approved by Police Chief
□
Approved by Fire Chief
□
Approved by Director of Recreation
□
Approved by Director of Public Works
□
Approved by Director of Planning and Codes
Final Approval by the City Administrator on , 20
City Administrator
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Completed 16 July 2020

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