Fillable Choose One: Parade/Special Event Assembly (Refer to Code (City of Winchester)

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Choose One: Parade/Special Event Assembly (Refer to Code (City of Winchester)

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City of Winchester
WPD-29
Last updated: February 2019
Page 1 of 6
Special Events Application
Choose One: Parade/Special Event Assembly (Refer to Code Section 14-147)
Event:
Date of
Application:
Requested Date:
1
st
Choice
2
nd
Choice
Sponsored By:
ORGANIZERS’ CONTACT INFORMATION
Primary:
Name
Cell Phone
Address
Work Phone
Email
Home Phone
Secondary:
Name
Cell Phone
Address
Work Phone
Email
Home Phone
Requested
Area(s):
Parking Lots Parks Other City Streets/Right of Way
Exact Location for the Event:
Event Hours:
Exact event times: to
Set-up start time:
Clean-up end time:
Anticipated Attendance Per Day:
Participants: (volunteers, staff…)
Spectators:
FOR OFFICE USE
Host Department:
Approved Denied
Chief of Police:
Approved Denied
Primary:
Approved Denied
Insurance Provided? Yes No
Comments/Special Considerations: See last page
Copy To:
City Manager
Chief of Police
Fire Chief
Parks & Rec.
Public Works
Zoning
WPA
Risk Manager
City Engineer
File
Commissioner of the Rev.
Health Dept.
OTW
OTW LLC (Former BB&T)
SU (Feltner)
Civil War Museum
Fred. Co. Parks & Rec.
Other:
Chief of Police Signature: Date:
Special Events Permit #:
Date Application was
received:
The City of Winchester has enacted an ordinance for assemblies, demonstrations, special events and parades in Section
14-146 through 157. All requests must be submitted to the office of the Chief of Police for review. The information
required on this form is consistent to the enacted City ordinance. The information requested by the application form will
be used to determine your eligibility for the special event permit request. Please type or print clearly. The event will not
be considered for approval until the entire application and all of its parts are received. Applications are due to the
Winchester Police Department (231 East Piccadilly Street or 540-542-1314), no later than 60 days prior to the proposed
parade or special event and 5 days prior to an assembly.
City of Winchester
WPD-29
Last updated: February 2019
Page 2 of 6
HOLD HARMLESS AGREEMENT
The below Hold Harmless Agreement must be completed, signed and submitted with this special event
application to be considered for approval.
All permits and/or applications are conditional upon proper insurance, or other City and state agency
requirements. Approved permits will be revoked prior to the event if conditions are not met
I have read the above statements and the below agreement and understand my responsibilities and rights.
_______ (Initial)
________________________________________________________ (Legal name of business/organizer, exactly as
it appears on Certificate of Insurance.), shall defend and hold harmless the City of Winchester, its officers, employees,
agents, and representatives thereof, harmless from all suits, actions, claims of any kind, including attorney’s fees,
brought on account of any personal injuries, damages, or violation of rights sustained by any person or property in
consequence of any neglect on behalf of ________________________________________________________
(Legal name of business/organizer), while their personal property is situated on City property, City streets, and/or right
of ways, as requested on this application.
________________________________________________________ (Legal name of business/organizer)
shall further hold the City of Winchester harmless from any claims or amounts arising from violation of any law,
bylaw, ordinance, regulation or decree.
Legal name of business/organizer (as it appears above): ________________________________________________
By (Signature): _________________________________________________________________________________
Name (Printed): ________________________________________________________________________________
Title: _________________________________________________________________________________________
Address: ______________________________________________________________________________________
Signature: _______________________________________________________ Date: ________________________
Comments/Special Considerations:
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City of Winchester
WPD-29
Last updated: February 2019
Page 3 of 6
Complete the following questions. Please provide additional information as needed.
1. Event Name:
2. Describe your event and the planned activities.
3. Name of insurance company providing Certificate of Insurance
and Endorsement Page for the event: The City shall receive a certificate
and endorsement page of a GL policy in the amount of one million dollars listing the City of Winchester, 15 N. Cameron Street, Winchester, VA
22601) as additionally insured. The endorsement must be issued by the insurance company (notation on the certificate of insurance is not
sufficient). There may be additional insurance amounts required for other permits and approvals depending on your anticipated activities.
4. Has your organization held this
event in the past?
Yes No
Where and when?
5. Is this event a fundraiser for your
organization?
Yes No
6. Will you be requiring assistance
from Winchester Fire and Rescue?
IF YES, 60 day notice required. A dedicated unit
will require a unit and personnel fee. NOTE: A
non-dedicated unit may have to leave for other
emergencies.
Yes No
What kind of assistance?
Fire Engine
Dedicated Unit? Yes or No
Ambulance Time Frame: to
First Responder Gator
7. Will you be requesting assistance
from the Police Department?
IF YES, 60 day notice required.
A fee may apply.
Yes No
What kind of assistance?
8. Will items be left overnight?
IF YES, any propane or other hazardous
chemicals must be constantly attended.
Yes No
What and where?
9. Will you have private security on
site?
Yes No
Who?
10. Will alcohol be served?
IF YES, 60 day notice required.
All state and local ordinances must be followed.
NOTE: Alcohol is NOT permitted on park
grounds.
Yes No
Event must obtain and submit a VA ABC permit;
comply with state code and 16-32; and 14-150 of the
City Ordinance. Additional security requirements and
fees may apply.
11. Will food be served?
IF YES, 60 day notice required.
Yes No
You must have a permit from the local Health
Department (540) 722-3480 at least 30 days prior to
the event. A vendor list shall also be submitted.
12. Will food, merchandise or services
be sold?
IF YES, 60 day notice required.
All vendors except those selling unprocessed
food products must have a current business
license. Contact the Winchester Commissioner
of the Revenue. The collection and filing of any
applicable taxes will be the responsibility of the
individual vendor.
Yes No
Event Organizer must submit vendor list to
Winchester’s Commissioner of the Revenue,
Treasurer, and Fire Marshal in advance of the event.
Contact the Fire Marshal’s Office for a copy of the fire
safety guidelines for Vendors and Exhibitors and to
schedule an inspection of the vendors’ setup.
13. Will admission fees, entry fees or
other fees be charged as part, or in
association with the event?
IF YES, you must contact Winchester’s
Commissioner of the Revenue (540) 667-1815
at least 30 days prior to the event.
Yes No
Fee amounts?
GENERAL EVENT INFORMATION
City of Winchester
WPD-29
Last updated: February 2019
Page 4 of 6
14. Will the activity require the
blocking of any surrounding
streets?
IF YES, 60 day notice required.
Yes No
Provide details below.
Blocked Street:
From (Street):
To (Street):
Day/Time
Closed:
Day/Time
Re-opened:
# of
Barricades
15. Street sweeper requested?
Does not apply to Loudoun Street Mall.
Yes No
Street(s):
By When? (Day/Time):
16. Electricity requested?
Yes No
Location(s): Purpose:
By When? (Day/Time):
17. Water/Hydrant hook-up requested?
IF YES, 60 day notice required.
Yes No
Location(s): Purpose:
By When? (Day/Time):
18. Trash boxes requested?
Event Organizer must set-up boxes and
remove all trash.
Yes No
How many?
Deliver To/Location:
19. Will the event need barricades or
fencing material?
IF YES, 60 day notice required.
Yes No
Type:
Location(s):
20. Will amplification equipment be
used?
NOTE: All events must comply with the City of
Winchester’s noise ordinance (Chapter 17).
Yes No
What length of time?
Location(s):
21. Portable restrooms requirements.
The estimated # of people expected
to attend the event will determine the
# of portable restrooms needed.
If using portable restrooms, 60 day notice
required. Indicate preferred location on site
plan.
÷ 100 =
# of # of
people restrooms
NOTE: The Health Department requires one
portable restroom and one hand washing
station per 100 people (include at least one
handicap accessible portable restroom in total).
22. Will you bring the following?
IF YES, 60 day notice required.
Yes No
Choose all that apply.
Tables:
#
Chairs:
#
Gators/Golf Carts
Size(s): ________________
Type: __________________
Location(s) for Use:
Tents:
#
Size(s): _______________________________
Location: ______________________________
900+ sq.ft. must be inspected and have an Occupancy
Permit issued. NO EXCEPTIONS.
All tents should be adequately anchored.
Stage (size):
Contact Zoning and Inspections regarding stage inspection.
See question #23.
Radio Remote
Signs/Banner
Sign(s): _____________
Location: ____________
City of Winchester
WPD-29
Last updated: February 2019
Page 5 of 6
23. Will there be any other temporary
structures used in conjunction with
your event? (Examples: stage, large
tents, bleachers, inflatables, etc.)
NOTE:
*If temporary structures will be used,
permits, insurance, and inspection are required.
Contact the Zoning and Inspections office (540)
667-1815 and Fire Marshal’s Office (540) 662-
2298.
Yes No
Type:
Size:
Quantity:
Location(s):
24. Will the event require use of any
parking lots as staging areas or
additional spectator parking?
IF YES, contact the Winchester Parking
Authority at (540) 722-7575 or
wincparking@winchesterva.gov to initiate the
request process.
Yes No
List lots:
Hours:
Areas:
25. Will you need space for primitive or
RV camping?
IF YES, 60 day notice required.
Yes No
Notify the Health Department with plan and submit
with this application.
26. Will there be balloon or helicopter
rides?
IF YES, 60 day notice required.
Yes No
Type:
27. Will there be any mechanical rides?
IF YES, 60 day notice required.
NOTE: An amusement device permit is needed
from the
Zoning and Inspections office. (540)
667-1815
Yes No
Type:
28. Will there be animals?
IF YES, 60 day notice required.
Yes No
Type:
Quantity:
29. Will there be fireworks, open
flames, pyrotechnics, or fire art
performances?
IF YES, 60 day notice required. Contact
Winchester Fire and Rescue for application and
permit process.
Yes No
Location:
30. Will there be a parade, organized
run or walk?
IF YES, 60 day notice required. A site plan
must be submitted along with this application.
Yes No
Location:
Route:
a. List the streets that will be partially or entirely occupied during the event under question #14
b. Will there be vehicles in the
parade, run or walk?
Yes No
Type:
Quantity:
31. Do you intend to have any
professional photography or
commercial videography
conducted on City Property?
Insurance required. See question #3.
Yes No
Type:
Location(s):
32. What items or tasks will your organization be providing or performing for the event? (Please list all)
33. Please attach a site plan of your event to this application.
City of Winchester
WPD-29
Last updated: February 2019
Page 6 of 6
A. If your request is in Jim Barnett Park, does your
event require shutting down any of the following?
Check all that apply.
Athletic Fields Any Park Road
War Memorial Building City Roads
Shelters Other
B. I understand that my organization will charged a fee by Winchester Parks & Recreation for the use of the
above facilities and for event maintenance and services. _________ (initial)
If any alleys or streets, such as Indian Alley or Boscawen Street, will be blocked, list under question #14.
If any parking lots will be requested, see question #24.
Will the event require use of the steps or lawn of the
1840 Courthouse?
IF YES, contact the Shenandoah Valley Battlefields Foundation at (540)
740-4545 or info@svbf.net to obtain permission.
Yes No
SUBMIT TO: Winchester Police Department, 231 E. Piccadilly Street, Winchester, VA 22601 or FAX: (540) 542-1314
NOTE: Your application will be reviewed by several City of Winchester departments. Additional information may be
required before granting permission for the event. An Event Organizer will be required to sign a Hold Harmless
Agreement
prior to the event. The Event Organizer may be required to sign a Memorandum of Understanding prior to
the event
permit being issued. The event permit must be available on site during the event.
Approval/Denial Process:
Police Dept. City Depts. & Application & WPD Chief Memo of
Receives Other Agencies Docs Returned Approval/ Denial Understanding
Application Review To Police Dept. May Be
Developed
COMPLETE A & B IF EVENT IS IN JIM BARNETT PARK
COMPLETE IF EVENT IS IN OLD TOWN WINCHESTER
Special conditions apply when using the Old Town Mall as a venue. Contact the Downtown Manager at (540) 535-
3660 or OTW@winchesterva.gov to discuss your plans. Conditions and regulations are subject to change at the
discretion of the Downtown Manager and/or as revisions and amendments occur with regard to City zoning, codes and
regulations. Event Organizers are responsible for ensuring that all participating vendors comply with the conditions.
Will the event require use of the Taylor Pavilion?
IF YES, a separate application, including additional insurance listing Taylor
Master Tenant, LLC as additionally insured and a rental fee is required.
Contact Old Town Winchester at (540) 535-3660 to obtain the application.
Yes No
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Choose One: ParadeSpecial Event Assembly (Refer to Code (City of Winchester)

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Completed 17 July 2020

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