Fillable Form 133 Special Events Application (City of Celina)

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Form 133 Special Events Application (City of Celina)

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The Form 133 Special Events Application (City of Celina) form is 5 pages long and contains:

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BROWSE CITY OF CELINA (TX) FORMS

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Page 1 of 5
CELINA SPECIAL EVENTS APPLICATION
*COMPLETED APPLICATIONS DO NOT GUARANTEE PERMIT APPROVAL
PERMIT #:
PERMIT FEE:
APPLICATION DATE:
APPLICANT INFORMATION
ORGANIZATION NAME:
EMAIL:
TYPE OF ORGANIZATION:
☐
☐
FOR-PROFIT
☐
GOVERNMENT
☐
☐
NON-PROFIT
TAX ID#:
APPLICANT NAME:
APPLICANT PHONE:
APPLICANT ADDRESS:
CITY:
STATE:
ZIP:
OTHER POINT OF CONTACT:
OTHER P.O.C. PHONE:
EVENT INFORMATION
OFFICIAL EVENT NAME:
EVENT LOCATION AND ADDRESS:
PROPERTY OWNER:
PROPERTY OWNER ADDRESS:
PROPERTY OWNER PHONE:
EVENT PURPOSE:
PROPERTY OWNER EMAIL:
EVENT SETUP DATE:
(IF DIFFERENT FROM EVENT DATE)
COMMENTS:
DAY 1 EVENT DATE:
END TIME:
DAY 2 EVENT DATE:
END TIME:
DAY 3 EVENT DATE:
END TIME:
EVENT TEAR-DOWN DATE:
END TIME:
TYPE OF EVENT:
☐
BICYCLE
☐
CARNIVAL
☐
CONCERT
☐
FESTIVAL
☐
FUNDRAISER
☐
PARADE
☐
RECEPTION
☐
RALLY/WALK/RUN
☐
TIMED RACE
☐
SPORTING EVENT
☐
SCHOOL EVENT
☐
PRIVATE GATHERING
☐
OTHER (DESCRIBE):
IS THIS A FIRST TIME EVENT? ☐YES ☐NO
IF NO, DID YOU ORGANIZE THE LAST EVENT?
☐
YES
☐
NO
IF NO, HAS THE EVENT BEEN HELD IN CELINA? ☐YES ☐NO
IF YES, WHEN WAS THE LAST EVENT:
EST. TOTAL NUMBER OF ATTENDANCE:
EST. PEAK NUMBER OF ATTENDANCE:
IS SITE PLAN ATTACHED?
☐
YES
☐
NO
IS ROUTE MAP ATTACHED?
☐
YES
☐
NO
EVENT OPERATIONS
TRAFFIC CONTROL
DESCRIBE THE AREA OF USAGE. (e.g. course, streets, alleys, etc.)
ARE YOU REQUESTING A ROAD CLOSURE?
☐
YES
☐
NO
IF YES, WHICH ROAD(S):
WILL TRAFFIC SIGNAL OPERATIONS BE
IMPACTED?
☐
YES
☐
NO
ARE YOU REQUESTING THE USE OF GOLF CARTS, GATORS OR ATV’S ON PUBLIC ROADWAYS?
☐
YES
☐
NO
• ALL EVENTS THAT REQUIRE A LANE OR ROAD CLOSURE MUST SUBMIT AN ENGINEERED TRAFFIC CONTROL PLAN.
• TXDOT CONTROLLED ROADWAYS REQUIRE A SEPARATE APPROVAL FROM TXDOT AND ARE THE RESPONSIBILITY OF THE EVENT.
• THE EVENT IS RESPONSIBLE FOR THE RENTAL OR PURCHASE OF TRAFFIC CONTROL DEVICES SUCH AS BARRICADES, CONES, ETC.
•
THE EVENT IS RESPONSIBLE FOR ACQUIRING ANY ADDITIONAL PERMITS OR PERMISSION REQUIRED.
PARKING
WILL THE EVENT HAVE SUFFICIENT PARKING TO ACCOMMODATE ALL ATTENDANTS?
☐
YES
☐
NO
APPLICANT MUST ATTACH A PARKING PLAN EXHIBIT WITH AN ENTRY AND EXIT PLAN WITH ESTABLISHED NUMBER
OF SPACES THE AREA WILL ACCOMMODATE.
DESCRIBE THE AREA OF USAGE FOR PARKING AND THE REQUESTED MODIFICATIONS OF USAGE. INCLUDE ALL
PARKING PLANS FOR THE EVENT ALONG WITH WRITTEN VERIFICATION FROM PROPERTY OWNER(S):
asdfasd
Page 2 of 5
PUBLIC SAFETY
EVENT CRITERIA MAY DEEM THE NEED FOR POLICE PERSONNEL. THIS INCLUDES EVENT SECURITY AND TRAFFIC CONTROL. THE
RATE FOR POLICE OFFICERS IS $40.00/HR. PER OFFICER. EVENTS WITH MORE THAN 3 OFFICERS WILL REQUIRE ONE (1)
SUPERVISOR AT A RATE OF $45.00/HR.
DOES THE EVENT AGREE TO PAY THE COST OF POLICE SERVICES IF NEEDED?
☐
YES
☐
NO
EVENT CRITERIA MAY DEEM THE NEED FOR FIRE AND EMS PERSONNEL. THE RATE FOR FIRE/EMS IS $40.00/HR. PER
PERSONNEL. EVENTS WITH MORE THAN 3 FIRE OR EMS PERSONNEL WILL REQUIRE ONE (1) SUPERVISOR AT A RATE OF
$45.00/HR. DOES THE EVENT AGREE TO PAY THE COST OF FIRE AND EMS SERVICES IF NEEDED?
☐
YES
☐
NO
RESTROOM FACILITIES / TRASH AND RECYCLING
IDENTIFY THE # OF PERMANENT RESTROOM FACILITIES AT THE EVENT LOCATION FOR MALE: FEMALE:
IDENTIFY THE NUMBER OF PORTABLE RESTROOMS BEING PROVIDED: COMPANY:
LIST THE LOCATIONS OF PERMANENT AND PORTABLE RESTROOM FACILITIES:
NUMBER OF STAFF TO CLEAN AND STOCK RESTROOM FACILITIES:
NUMBER OF DUMPSTERS/CONTAINERS NEEDED:
DELIVERY DATE:
PICKUP DATE:
THE SERVICES PROVIDED BY THE CITY OF CELINA MAY INCLUDE THE USE OF A DUMPSTER, IF REQUESTED PRIOR TO
THE EVENT.
IS THE EVENT REQUESTING THE USE OF CITY PROVIDED DUMPSTERS OR TRASH CONTAINERS?
☐
YES
☐
NO
NUMBER OF STAFF WHO WILL BE WORKING TRASH REMOVAL:
WILL WATER SUPPLY BE NEEDED FOR RESTROOMS OR ANY OTHER NON-CONCESSION ITEM?
☐
YES
☐
NO
HEALTH / FOOD SAFETY / CONCESSIONS / ALCOHOLIC BEVERAGES
WILL FOOD BE PREPARED AT THE EVENT?
☐
YES
☐
NO DESCRIBE:
WILL ALCOHOL BE SERVED AT THE EVENT?
☐
YES
☐
NO
DESCRIBE:
• NO FOOD OR FOOD PRODUCTS SHALL BE STORED OR PREPARED AT HOME OR AT AN OFF-SITE LOCATION AND BROUGHT TO THE
EVENT AND SERVED.
• NO ALCOHOLIC BEVERAGES WILL BE DISTRIBUTED, CONSUMED, OR POSSESSED IN CITY PARKS OR CITY STREETS IN ACCORDANCE
WITH CITY ORDINANCES. CONTACT CITY SECRETARY AT (972) 382-2682.
• A SPECIAL EVENT PERMIT FOR ALCOHOL ON PRIVATE PROPERTY MAY BE PERMITTED WITH A T.A.B.C. LICENSE.
• FOOD VENDOR APPLICATION AND CONCESSIONS INFORMATION, CONCERNING TEMPORARY EVENT HEALTH PERMITS, MAY BE
OBTAINED FROM THE PERMITS DEPARTMENT AT CITY HALL AT (972) 382-2682.
NUMBER OF NON-FOOD VENDORS / BOOTHS:
NUMBER OF FOOD VENDORS:
DOES CONCESSION REQUIRE WATER?
☐
YES
☐
NO
DOES CONCESSION REQUIRE ELECTRICITY?
☐
YES
☐
NO
IF YES, WHAT VOLTAGE?
HOW WILL ELECTRICAL SERVICE BE SUPPLIED?
☐
GENERATOR
☐
PUBLIC UTILITIES
ATTACH A LIST OF PROVIDERS, CONTRACTORS AND A LIST OF ITEMS OFFERED.
PUBLIC INFORMATION / NOISE / NOTIFICATIONS / SIGNAGE
WHAT SOUND AMPLIFICATION WILL BE USED AT THE EVENT?
☐
NONE
☐
RECORDED MUSIC
☐
LIVE MUSIC
☐
OTHER (EXPLAIN)
WILL CELINA RESIDENTS LIKELY BE AFFECTED BY THE EVENT? ☐YES ☐NO IF YES, HOW WILL RESIDENTS BE
NOTIFIED OF THE EVENT?
DESCRIBE THE PROCESS OF PARKING, REGISTRATION AND SIGNAGE USED TO ASSIST THIS PROCESS:
EVENTS USING ANY SIGNS, MUST OBTAIN A SEPARATE PERMIT FROM DEVELOPMENT SERVICES LOCATED AT CITY
HALL OR BY CALLING (972) 382-2682. (TEMPORARY, DIRECTIONAL, FLAGS, BANNERS, INFLATABLE, OR SIMILAR).
WILL THE EVENT HAVE ANY PYROTECHNIC (FIREWORKS) DISPLAY?
☐
YES
☐
NO
IF YES, LIST THE VENDOR, PROPERTY OWNER AND GIVE DETAILS OF THE DISPLAY.
IF THE EVENT IS A PARADE, COMPLETE THE FOLLOWING INFORMATION:
ASSEMBLY LOCATION:
NUMBER OF PARTICIPANTS:
NUMBER OF VEHICLES:
TENTS OR STRUCTURES?
☐
YES
☐
NO
IF YES, LIST NUMBER AND SIZES:
Page 3 of 5
INSURANCE, SAFETY PLAN, AND DISCLAIMER INFORMATION
•
THE EVENT MUST CARRY PROPERTY, BODILY INJURY, AND MUNICIPAL LIABILITY INSURANCE OF AT LEAST $1,000,000.00 PER
OCCURRENCE. THE CITY OF CELINA MUST BE SHOWN AS AN ADDITIONAL NAMED INSURED PARTY ON THE INSURANCE
DECLARATION. ONE (1) ORIGINAL COPY OF INSURANCE MUST BE SUBMITTED NO LESS THAN THIRTY (30) DAYS PRIOR TO THE
EVENT.
• ALL EVENTS MUST INCLUDE A SITE PLAN AND ROUTE MAP.
• THE FIRE CODE REQUIRES A PUBLIC SAFETY PLAN FOR ALL EVENTS. THE REQUIRED PLAN MUST ADDRESS HOW THE ORGANIZER
PLANS TO ALERT BOTH THE ATTENDEES AND EMERGENCY SERVICES PERSONNEL. IT MUST ALSO SHOW A PLAN TO MOVE
ATTENDEES TO SAFETY AND PROVIDE POLICE AND FIRE ACCESS TO THE SCENE. THIS APPLICATION DOES NOT PROVIDE ENOUGH
DETAILED INFORMATION TO DETERMINE IF THIS PLAN IS REQUIRED FOR YOUR EVENT. CONTACT THE CELINA FIRE DEPT. AT 972-
382-2653 FOR SPECIFIC GUIDELINES AND REQUIREMENTS.
• A FEE OF $50.00 (NON-REFUNDABLE) IS REQUIRED PER APPLICATION. PAYMENT TO THE CITY OF CELINA IS DUE UPON RECEIPT OF
APPLICATION AND BEFORE THE APPLICATION CAN BE REVIEWED.
• ANSWER ALL INFORMATION PERTAINING TO THE EVENT, AS ACCURATELY AS POSSIBLE. AFTER COMPLETION, RETURN TO THE CITY
OF CELINA AT 142 N. OHIO DR. CELINA, TX 75009
• ALL REQUIRED CITY DEPARTMENTS WILL REVIEW THIS APPLICATION AND RESPOND WITH A DECISION TO APPROVE, DENY OR
REQUEST ADDITIONAL INFORMATION.
• ONCE THE APPLICATION IS APPROVED, A MEETING DATE WILL BE SET WITH ALL DEPARTMENTS AND THE EVENT COORDINATOR.
MULTIPLE MEETINGS MY BE NECESSARY TO COORDINATE THIS EVENT.
• THE CITY RESERVES THE RIGHT TO CANCEL OR SHUT DOWN THE EVENT IF:
a) IT IS IN VIOLATION OF ANY CITY ORDINANCE
b) THE EVENT DEVIATES FROM THIS APPLICATION OR SITE PLAN
c) THE EVENT IS DEEMED UNSAFE BY PUBLIC SAFETY PERSONNEL.
PARADE DISCLAIMER
• THE SAME RESPONSIBILITY OF LITTER / TRASH CONTROL APPLIES TO THE ENTIRE STAGING SITE AND/OR THE PARADE ROUTE.
• RESTROOMS MUST BE PROVIDED FOR PARADE PARTICIPANTS DURING FLOAT PREPARATION AND STAGING.
•
ABSOLUTELY NO OBJECTS WILL BE THROWN FROM FLOATS OR VEHICLES IN THE PARADE.
APPLICANT SIGNATURE:
X
DATE:
APPLICATION CHECKLIST
PLEASE USE THE FOLLOWING CHECKLIST TO HELP YOU PLAN YOUR SPECIAL EVENT.
☐
MASTER SITE PLAN
☐ EMERGENCY PLAN
☐ RADIO COMMUNICATION PLAN
☐ PARKING PLAN
☐ TRAFFIC PLAN
☐ CASH COLLECTION / TRANSFER PLAN
☐ WATER PLAN FOR CONCESSIONS
☐ WATER PLAN FOR RESTROOMS
☐ ELECTRICAL PLAN FOR CONCESSIONS
☐ ELECTRICAL PLAN FOR OTHER ITEMS
☐ INFORMATION TENT / LOCATION PLAN
☐ TRASH PICKUP PLAN
☐ LIGHTING PLAN
☐ VENDOR LIST
☐ INSURANCE
☐ ENTERTAINMENT LIST AND SCHEDULE
☐
EVENT ACTIVITY SCHEDULE
☐ EXPECTED ATTENDANCE
☐ GATORS / GOLF CARTS / ATV’S
☐ EVENT EMERGENCY CONTACT LIST
☐ SECURITY DAY AND OVERNIGHT
☐ NUMBER OF VEHICLES, ANIMALS,
BIKES INVOLVED IN PARADE
☐ ______________________________________
☐ ______________________________________
☐ ______________________________________
☐ ______________________________________
☐ ______________________________________
☐ ______________________________________
☐ ______________________________________
☐ ______________________________________
☐ ______________________________________
OUR SPECIAL EVENTS ORDINANCE CAN BE FOUND AT OUR WEBSITE AT WWW.CELINA-TX.GOV
55
Page 4 of 5
PERMITS DEPT. SIGNATURE:
X
DATE:
CITY MANAGER SIGNATURE:
X
DATE:
CITY OF CELINA - DEPARTMENT APPROVAL / DENIAL
THIS PAGE IS FOR CITY USE ONLY
PERMIT #
EVENT NAME:
PUBLIC WORKS
THIS SECTION IS COMPLETED BY THE CELINA PUBLIC WORKS DEPARTMENT ONLY:
DOES THE PUBLIC WORKS DEPARTMENT REQUIRE ADDITIONAL DOCUMENTS?
☐
YES
☐
NO
DESCRIBE:
☐
APPROVED
☐
DENIED ☐ PENDING ADDITIONAL DOCUMENTS
SUPERVISOR APPROVING PUBLIC WORKS PORTION OF APPLICATION:
SIGNATURE:
X
DATE:
POLICE
THIS SECTION IS COMPLETED BY THE CELINA POLICE DEPARTMENT ONLY:
OFFICERS REQUIRED AT EVENT?
☐
YES
☐
NO
NUMBER OF OFFICERS REQUIRED PER DAY:
POLICE VEHICLES REQUIRED?
☐
YES
☐
NO
DOES THE POLICE DEPT. REQUIRE ADDITIONAL DOCUMENTS?
☐
YES
☐
NO
DESCRIBE:
☐
APPROVED
☐
DENIED ☐ PENDING ADDITIONAL DOCUMENTS
SUPERVISOR APPROVING POLICE PORTION OF APPLICATION:
SIGNATURE: X DATE:
FIRE / EMS
THIS SECTION IS COMPLETED BY THE CELINA FIRE DEPARTMENT ONLY:
FIRE / EMS REQUIRED AT EVENT?
☐
YES
☐
NO
NUMBER OF PERSONNEL REQUIRED PER DAY:
AMBULANCE REQUIRED?
☐
YES
☐
NO
DOES THE FIRE DEPT. REQUIRE ADDITIONAL DOCUMENTS? ☐YES ☐NO
DESCRIBE:
☐
APPROVED
☐
DENIED ☐ PENDING ADDITIONAL DOCUMENTS
SUPERVISOR APPROVING FIRE / EMS PORTION OF APPLICATION:
SIGNATURE:
X
DATE:
CITY ENGINEER
THIS SECTION IS COMPLETED BY THE CELINA CITY ENGINEER DEPARTMENT ONLY:
DOES THE CITY ENGINEER REQUIRE ADDITIONAL DOCUMENTS?
☐
YES
☐
NO
DESCRIBE:
☐
APPROVED
☐
DENIED ☐ PENDING ADDITIONAL DOCUMENTS
SUPERVISOR APPROVING CITY ENGINEER PORTION OF APPLICATION:
SIGNATURE:
X
DATE:
OVERALL EVENT APPLICATION IS:
☐
APPROVED
☐
DENIED
DATE:
REASON FOR DENIAL:
$50.00 FEE PAID ON:
FEE PAID BY:
☐
CASH
☐
CHECK #
RECEIPT #
Page 5 of 5
CITY OF CELINA AGREEMENT
INDEMNIFICATION AND COST REIMBURSEMENT
I, THE UNDERSIGNED APPLICANT, HAVING AUTHORITY TO EXECUTE THIS AGREEMENT ON BEHALF OF
MYSELF AND/OR THE ORGANIZATION, AGREE TO INDEMNIFY AND HOLD HARMLESS, THE CITY OF CELINA,
ITS OFFICERS, EMPLOYEES, AGENTS, AND REPRESENTATIVES AGAINST ALL CLAIMS OF LIABILITY AND
CAUSES OF ACTION RESULTING FROM INJURY OR DAMAGE TO PERSONS OR PROPERTY ARISING OUT OF
THE SPECIAL EVENT.
I FURTHERMORE AGREE TO REIMBURSE THE CITY OF CELINA FOR ANY ADDITIONAL COST INCURRED AS A
RESULT OF THE SPECIAL EVENT WITHIN TEN (10) DAYS OF NOTICE FROM THE CITY OF SUCH COST.
_____________________________________
PRINTED NAME OF APPLICANT
_____________________________________ ____________________
APPLICANT SIGNATURE DATE
_____________________________________
PRINTED NAME OF NOTARY
ACKNOWLEDGED BEFORE ME THIS _________ DAY OF ___________________, _________
_________________________________________
NOTARY PUBLIC
NOTARY SEAL
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Form 133 Special Events Application (City of Celina)

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Completed 14 July 2020

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