Fillable Form 4695 Special Events Permit Application (City of Celina)

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Form 4695 Special Events Permit Application (City of Celina)

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The Form 4695 Special Events Permit Application (City of Celina) form is 6 pages long and contains:

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City of Celina
142 N. Ohio Street, Celina, Texas, 75009 www.celina-tx.gov
SPECIAL EVENTS APPLICATION
PERMIT NUMBER:
PERMIT FEE: $50
APPLICATION DATE:
APPLICANT INFORMATION:
Organization Name:
Phone:
Email or Website:
Type of Organization:
Charitable
For Profit
Political
Non-Profit
Applicant Name:
Applicant Phone:
Applicant Address:
Additional Point of Contact:
Phone:
EVENT INFORMATION:
Official Event Name:
Event Location and Address:
Property Owner:
Property Owner Address:
Property Owner Phone:
Property Owner Email:
Event Purpose:
Event Set-up Date:
Set-up Time:
Day 1 Event Date:
Start Time:
End Time:
Day 2 Event Date:
Start Time:
End Time:
Day 3 Event Date:
Start Time:
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 (please describe
Is this a first time event?
Yes
No
If no, were you the chairman of the last event?
Yes
No
If no, has this event been held in Celina in the past?
Yes
No
If this event has been held in Celina in the past, when was the last event?
Est. total number in attendance:
Est. peak number in attendance:
Attach site plan with location of booths, stages, other structures, and parking
Attach route plan, if applicable
EVENT OPERATIONS – TRAFFIC CONTROL:
Describe the areas of uses (open land, streets, alleys, etc.)
Will you be requesting that roads be closed?
Yes
No
Will you be requesting the use of golf carts, gators or ATVs on public
roadways?
Yes
No
Notes:
•
All events that require a lane or road closure must submit an engineered traffic control plan
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• TXDot controlled roadways require a separate approval from TXDot and it is the responsibility of the event
coordinator to obtain this approval
• The event coordinator is responsible for the rental (or purchase) of any traffic control devices that will be used,
such as cones or barricades
•
The event coordinator is responsible for acquiring any additional permits or permissions
EVENT OPERATIONS – PARKING:
Indicate on site plan the location of parking and the number of spaces provided
Provide an entry and exit plan to the parking area
Describe the area to be used for parking, including any modifications to the site
Describe the process of parking, moving to registration area or gate, and entering the event
Provide verification from the property owner that parking is allowed on the site
EVENT OPERATIONS – PUBLIC SAFETY:
Event criteria may warrant the need for police personnel to be on site to be used for security and traffic control. The
rate for off-duty police officers is $45/hour per officer. Events with more than 3 officers per shift will require 1
supervisor to be present at the rate of $50/hour.
Does the event coordinator agree to pay the costs of police services, if
needed?
Yes
No
Event criteria may warrant the need for fire and EMS personnel to be on site to be used in emergencies. The rate for
off-duty fire/EMS personnel is $45/hour per officer. Events with more than 3 fire/EMS personnel per shift will
require 1 supervisor to be present at the rate of $50/hour.
Does the event coordinator agree to pay the costs of fire/EMS personnel, if
needed?
Yes
No
EVENT OPERATIONS – RESTROOMS:
Identify the number of permanent restroom facilities at the event location
Males:
Females:
Identify the number of portable restroom facilities being provided at the event location
Portable Restroom Contractor:
Contractor contact information:
Indicate the location of restrooms (permanent and/or portable) on the site plan
Indicate the number of staff per shift provided to clean and restock restrooms
Will water supply be needed for restrooms or any other non-concession
facility?
Yes
No
EVENT OPERATIONS – TRASH REMOVAL:
Number of dumpsters/trash containers needed:
Delivery date:
Pick-up date:
The City of Celina may provide the use of a dumpster or trash container at the
event. Does the event coordinator wish to secure a City-provided dumpster?
Yes
No
Indicate the number of staff who will be responsible for trash removal per shift:
HEALTH/FOOD SAFETY/CONCESSIONS/ALCOHOLIC BEVERAGES:
Will food be prepared at the event?
Yes
No
Will alcohol be served at the event?
Yes
No
Notes:
• 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 on City streets in
accordance with City ordinances (contact City Secretary at 972-382-2682 for the process to allow alcoholic
beverages at these locations)
• A special event permit for alcohol on private property could be permitted with a TABC license
• Food vendor applications and concessions information concerning temporary event health permits may be
obtained from the Permits Department at City Hall
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Number of Non-food Vendors/Booths:
Number of Food Vendors/Booths:
Food vendors must obtain a temporary health food permit
Do the concessionaires require water?
Yes
No
How will electrical service be supplied?
Public utilities
Generator
NOISE AND MISCELLANEOUS ISSUES:
What types of sound amplification will be used at the event?
None
Recorded music
Live music
Other (explain)
Will Celina residents likely be affected by the event? If yes, how will
residents be notified of the event?
Yes
No
Will signs or banners be used to advertise your event?
Events using signs or banners must obtain a separate permit from Development Services
Department.
Yes
No
Will this event have any pyrotechnic (fireworks) display?
If yes, provide the vendor and details of the display
Yes
No
If this event is a parade, please complete the following information:
• Assembly location
• Number of participants
• Number of animals
•
Number of vehicles
Will tents or other structures be used?
If yes, list number, type of structure, and sizes
Yes
No
INSURANCE, SAFETY PLAN, AND DISCLAINER INFORMATION:
The event must carry property, bodily injury, and municipal liability insurance of at least $1,000,000 per occurrence.
Proof of these documents must be attached to this application and the City of Celina must be shown as a named
insured party on the insurance declaration.
Proof of insurance must be submitted to the City a minimum of 30 days in advance of the event.
All event applications 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. Contact the Celina Fire Department at 972-382-2653 for detailed
information regarding the requirements of the safety plan.
Payment of the $50 nonrefundable event application fee is required prior to the processing of the application.
Submit the application and all additional documents and exhibits to the Building Department at City Hall.
Various City departments will review the application and additional information may be requested.
The City reserves the right to cancel or shut down the event if:
• It is in violation of any City ordinance;
• The event deviates from this application or site plan;
•
The event is deemed to be unsafe by public safety personnel.
Once the event application is approved, one or more meetings between the event coordinator and City staff will be
scheduled
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 shall be thrown from floats or vehicles in the parade.
Applicant’s signature:
Date:
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APPLICATION CHECKLIST
Please use the following checklist to help you plan your special event:
Master Site Plan
Event Activity Schedule
Emergency Plan
Expected Attendance
Radio Communication Plan
Gators, Golf Carts, ATVs
Parking Plan
Emergency Contact List
Traffic Plan
Daytime Security
Cash Collection and Transfer Plan
Nighttime Security
Water Plan for Concessions
Number of Vehicles, animals, pedestrians, and bikes
to be used in parade, if applicable
Water Plan for Restrooms
Electrical Plan for Concessions
Electrical Plan for Other Items
Information Tent/Location Plan
Trash Pick-up Plan
Lighting Plan
Vendor List
Insurance
Entertainment List and Schedule
Celina’s Special Events Ordinance can be found on the City website, www.celina-tx.gov
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CITY
OF
CELINA
A
GREE
M
E
N
T
INDEMNIFICATION
AND COST
RE
I
M
BU
RSE
M
E
N
T
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 _ , 20 _
_ _
NOTARY PUBLIC
NOTARY SEAL
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EVENT APPROVAL PROCESS
This page for City use only
PERMIT NUMBER:
EVENT NAME:
PUBLIC WORKS DEPARTMENT
APPROVED
DENIED
PENDING ADDITIONAL DOCUMENTS
Describe additional documents needed:
Supervisor approving the Public Works portion of application:
Signature:
Date:
POLICE DEPARTMENT
Officers required at event?
Number of Officers required per day:
Yes
No
Police vehicles required?
Yes
No
APPROVED
DENIED
PENDING ADDITIONAL DOCUMENTS
Describe additional documents needed:
Supervisor approving the Police Department portion of application:
Signature:
Date:
FIRE/EMS DEPARTMENT
Fire/EMS personnel required at event?
Number of Fire/EMS personnel required per day:
Yes
No
Ambulances required?
Yes
No
APPROVED
DENIED
PENDING ADDITIONAL DOCUMENTS
Describe additional documents needed:
Supervisor approving the Fire Department portion of application
Signature:
Date:
ENGINEERING DEPARTMENT
APPROVED
DENIED
PENDING ADDITIONAL DOCUMENTS
Describe additional documents needed:
Supervisor approving Engineering Department portion of application
Signature:
Date:
PARKS DEPARTMENT
APPROVED
DENIED
PENDING ADDITIONAL DOCUMENTS
Describe additional documents needed:
Supervisor approving the Parks Department portion of application
Signature:
Date:
OVERALL EVENT APPLICATION IS:
APPROVED
DENIED
Date:
Reason for denial:
Permits Department Signature:
Date:
City Manager Signature:
Date:
FILE: Public/Planning/Development Handbook/Individual Pages/Building Dept/SPECIAL EVENTS APPLICATION
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Form 4695 Special Events Permit Application (City of Celina)

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Completed 14 July 2020

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