Fillable Form 5733 Use Of Town Property Application (Town of East Longmeadow)

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Form 5733 Use Of Town Property Application (Town of East Longmeadow)

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TOWN OF EAST LONGMEADOW
USE OF TOWN PROPERTY APPLICATION
60 Center Square
East Longmeadow, MA 01028
413-525-5400
June 2019 rev.
2
USE OF TOWN PROPERTY APPLICATION – TOWN OF EAST LONGMEADOW
Thank you for considering the Town of East Longmeadow for your event! The Town of East Longmeadow is
pleased to welcome a variety of special events, from community festivals to concerts and athletic competitions. It
is the goal of the Town of East Longmeadow to work with event managers and organizers to help ensure that the
events taking place in our community are both safe and successful, while minimizing the impact on our residents
and businesses. Completing this form is the first step in your application process. This is not your permit.
Completing and submitting this application does not confirm your date or signify any intention by the Town to
approve this application.
A special event is any activity that occurs upon public or private property that affects the ordinary use of parks,
playgrounds, fields, buildings, public streets, right-of-ways or sidewalks. Special Events may include festivals, fairs,
concerts, carnivals, holiday celebrations, parades, athletic tournaments, road or bicycle races, etc.
The Town of East Longmeadow may permit the temporary use of public properties and/or roadways for special
activities. The Town coordinates the review of these events with various Town Departments to ensure that the
events are conducted safely.
Individuals or organizations wishing to hold events on public property, or on private property but with an impact
on public property such as roads within the Town limits, including Town parks, must obtain a Use of Town
Property Permit from the Town of East Longmeadow.
The Authorized User is required to demonstrate that adequate provisions have been made for security, parking,
insurance, set-up, maintenance and clean-up, emergency services, and safety of operations.
Use of Town Property Applications are to be submitted to the Town Manager’s Office not less than 90 days prior
to the event date. All components of the event are subject to approval by the Town Manager’s Office and may
also require approval by and/or permit(s) from other Town agencies/departments and boards. It is the
responsibility of the applicant to secure all necessary Town of East Longmeadow permits, and submit payments
required for permits.
The primary contact for Authorized Users during the review process will be the Town Manager’s Office. Once the
completed application is received, it will be distributed to the necessary Town Departments to be reviewed.
Approval for the use of Town Property for an organized event is required. To determine if a facility is available for
use ON THE DATE OF YOUR EVENT, you should contact the following departments:
□ School Buildings and Athletic Fields/Superintendent of Schools: (413) 525-5450
□ Pine Knoll and Athletic Fields/Recreation Department: (413) 525-5400 ext. 1300
□ Pavilion at Heritage Park/Department of Public Works (413) 525-5400 ext. 1200
□ Public Library: (413) 525-5400 ext. 1500
□ Senior Center: (413) 525-5400 ext. 1400
USE OF TOWN PROPERTY APPLICATION – TOWN OF EAST LONGMEADOW
3
□ Licensing Authority/Town Clerk: (413) 525-5400 ext. 1000
□ Town Manager’s Office: (413) 525-5400 ext. 1100
□ Building Department: (413) 525-5400 ext. 1150
□ Health Department: (413) 525-5400 ext. 1103
□ Police Department: (413) 525-5440 (non-emergency phone number)
□ Fire Department: (413) 525-5430 (non-emergency phone number)
Town Offices, all public streets and town sidewalks: Contact the Town Manager’s Office at (413) 525-5400 ext.
1100
If you are scheduling a large and/or complicated event, you may be required to obtain approval from several
Town Departments (Building, Board of Health, Recreation, Police and Fire, School) as well as one day alcohol
and/or entertainment licensing. You will be notified as to which approvals are necessary depending on the
size/scope of your event. These approvals must be obtained prior to the date of your event.
You must secure and submit a Certificate of Liability Insurance to the Town of East Longmeadow 14 days prior to
your event. The Town of East Longmeadow must be named as additional insured for the date and location of
your event with a minimum amount of 1 million dollars ($1,000,000) in liability per occurrence/2 million
($2,000,000) aggregate. This is required for all special event permits. Your permit will not be issued without the
certificate.
Your Use of Town Property permit will be mailed, emailed and/or faxed to you. Due to the many changing
components of an event, Use of Town Property Permits are often issued only a few days in advance of your event.
Use of Town Property permitting shall run with the original applicant. If there is a change in property ownership
or applicant then a new application shall be submitted.
All event publicity, printed materials and communications with your participants shall state “Town of East
Longmeadow” in the title when referring to your event location.
Alcohol Policy: NO alcohol is allowed without approval from the East Longmeadow Town Council-Licensing
Authority. If seeking Licensing Authority approval, this form must be submitted with the application for a one-day
special alcohol license.
All non-profit organizations must submit a copy of your 501 (c) (3)non-profit determination letter.
The Town of East Longmeadow reserves the right to deny request due to prior disrespect of facilities, property,
equipment, personnel and/or rules and regulations, back taxes or overdue bills to the Town of East Longmeadow.
USE OF TOWN PROPERTY APPLICATION – TOWN OF EAST LONGMEADOW
4
Event Summary
Event Title:
Description:
Event Categories:
□ Carnival/Circus □ Fair/Festival □ Special Attraction
□ Concert/Performance □ Fundraiser □ Family Gathering □ Sports/Recreation
□ Dance □ Outdoor Market □ Game □ Practice
□ Exhibits/Miscellaneous □ Parade/March □ Other
Day of the Week
Date
Time
Set up Starts
Event Starts
Event Ends
Dismantle Ends
Anticipated number of attendees?
Is this an annual event?
Is there a fee associated with event? (Admission fee, collection, dues, etc.) □ Yes □ No
Location (In order of preference, if applicable)
Note: Most park areas cannot be reserved for the exclusive use of the groups, and access to the area by the
general public must be available at all times. This means that areas cannot be roped off or otherwise secured.
5
USE OF TOWN PROPERTY APPLICATION – TOWN OF EAST LONGMEADOW
Site Plan & Route Map
To ensure appropriate review of your event, it is preferred that you submit one or more of the following:
Blueprints or computer assisted drawings of your event site plan or a hand drawing of your site plan. Be sure to
include the placement of receptacles (bins, dumpsters) for both trash and recycling in your plan/map.
Temporary structures, including stages built by private parties shall conform to all applicable building codes and
other Town regulations, and the Authorized User shall obtain any required building permits from the Building
Department (413) 525-5400 ext. 1150 and Fire Department (413) 525-5430. If a tent is erected, the Fire
Department shall complete a safety inspection prior to the event. Health Department must be contacted for safe
food handling and Food Permit (413) 525-5400 ext. 1105.
Your event site plan/route map should be submitted and include but not limited to:
o An overview of the event venue, including the names of all streets or areas that are part of the
surrounding area. If the event involved a moving route of any kind, indicate the direction of the travel
and all street or lane closures.
o The provision of minimum twenty-foot (20’) emergency access lanes throughout the event venue.
o The location of first aid facilities.
o The placement of dumpsters and/or trash & recycling bins
o The location of all stages, bleachers, grandstands, canopies, tents, portable toilets, booths, cooking areas,
trash containers and dumpsters, and other temporary structures.
o A detail of the food booth(s) and cooking area(s), including identification of all vendors cooking with
flammable gases or barbecue grills.
o Locations of generator(s) and/or source of electricity.
o Placement of vehicles and/or trailers.
o Exit locations for outdoor events that are fenced and/or locations within tents and ten structures.
o Identification of all handicapped accessible areas that meet 521 CMR Architectural Access Board (ADA)
Standards.
o Other event components not listed above. Please describe:
USE OF TOWN PROPERTY APPLICATION – TOWN OF EAST LONGMEADOW
6
Contacts/Organization Information
This section will allow the Town Departments and agencies that have an interest in your event, to
contact the appropriate individuals for any further information regarding your event. It will enable the
Town to ensure all your needs are met, and that the interest of the Town’s venue(s) are considered. Please
feel free to write-in or attach any further information that you feel would be important in this matter.
Applicants’ Name Phone/Cell Email (Required)
Organization Name Address Street City State Zip
Web Address Organization Phone Email
Emergency Contacts:
In case of an emergency during the event, a person must be available to be contacted during the hours of the
event. Please identify:
Name Cell Phone Phone
Name Cell Phone Phone
Orgination Status
TAX EXEMPT, NON-PROFIT: This refers to an organization that has been recognized as tax exempt
by the Internal Revenue Service at least six (6) months prior to your event date and is in good standing with
the IRS. If you are a bona fide tax exempt, non-profit organization, a copy of your current tax
exemption letter is required.
1. Is the Authorized user a commercial entity: □ Yes □ No
2. Is the Authorized User a bona fide tax exempt, non-profit entity? □ Yes □ No
If yes, you must attach to this application a copy of your IRS tax exemption letter providing proof and
certifying your current tax exempt status.
3. Are fees for admission, entry or participation required? □ Yes □ No
If yes, please provide amount
4. Are fees for vendor or other required? □ Yes □ No
Attach a copy of the most recent financial statement for this event.
USE OF TOWN PROPERTY APPLICATION – TOWN OF EAST LONGMEADOW
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Security Plan
Have you made arrangements for security? □ Yes □ No If yes, check all that apply:
□ Town of East Longmeadow Police Department (413) 525-5440
□ Licensed Professional Security Company**
□ Other* Please describe:
*Certain activities require heightened security. The type of security will be determined by local, state and or
federal officials.
**If using licensed Security Company, please complete the following:
Company Phone
Street City State Zip
Private Operating License #
Licensed Professional Security Company shall provide the Town with an insurance certificate naming the Town of East Longmeadow as
“Additional Insured.” A copy of such must be submitted no later than 14 days prior to the event date.
Medical Services/Safety Plan
EMS Plan
Due to the vast number of different types of events, along with the anticipated crowd sizes, any Authorized User
shall contact the Town of East Longmeadow Fire Department at (413) 525-5430 to determine the adequate
resources needed for your event.
At a minimum, all events should have knowledge of 911 Access and someone who is certified in First Aid/CPR.
Also, basic First Aid stations and/or kits SHALL be on site.
The following is the number of ambulances needed for the number of people in attendance:
1,000 to 10,000 people - 1 ambulance 10,001 to 20,000 people – 2 ambulances 20,001+ people – 3 ambulances
Have you made arrangements for Emergency Medical Services/Safety Arrangements? □ Yes □ No If yes,
check all that apply:
□ Town of East Longmeadow Fire Department (413) 525-5430
□ Licensed Professional Medical Services/Safety Company**
□ Other* Please describe:
**If using licensed Medical Services/Safety Company, please complete the following:
Company Phone
Street City State Zip
Private Operating License #
8
USE OF TOWN PROPERTY APPLICATION – TOWN OF EAST LONGMEADOW
Fire Safety Plan
Will your event include any of the following?
Tents □ Yes □ No Other Temporary Structures □ Yes □ No
Bonfires □ Yes □ No Fireworks Displays □ Yes □ No
Propane Use □ Yes □ No Any Open Flames (i.e. candles, other) □ Yes □ No
Above service is being provided by:
The Fire Department shall be contacted in advance for any event that will include, but not limited to the
items listed above. Permits are not transferable, and any change in use, operation or tenancy shall require
a new permit.
527 CMR 1:04: The Chief of the Fire Department may revoke a permit or approval issued under the provisions
of 527 CMR, if there is any violation of the Fire Code, or there have been any false statements or
misrepresentations. Certain special events may require a fire watch detail. A Fire Inspector shall inspect the
site of the event and determine the need for a fire watch detail. Please contact the Fire Department for
guidelines and associated costs for fire watch details.
o The Fire Department requires that the permit applications be filed at the Fire Prevention Bureau.
o Any inspection that is conducted after hours would require overtime for the inspector.
o Fireworks displays require a Fire Inspector and Police officer to be present from the time that the
fireworks arrive in the town until the end of the fireworks show.
o The fireworks permit is required to be in 15 days before the date of the show.
Accessibility Plan
1. Will there be a clear path of travel throughout your event venue? □ Yes □ No
If no, please explain:
2. Have you developed a Disabled Parking and/or Transportation plan (including use of public
transportation or shuttle services) for your event? □ Yes □ No
If no, please explain:
3. Will there be accessible rest rooms at your event? □ Yes □ No
If no, please explain:
4. Will all food, beverage and vending areas be accessible? □ Yes □ No
If no, please explain:
*Any Tent 400 sq. ft. or more requires a permit from the Building Department 413-525-5400 ext. 1150
*
USE OF TOWN PROPERTY APPLICATION – TOWN OF EAST LONGMEADOW
9
Entertainment and Related Activities
o Will you be erecting and using any tents or other temporary facility? □ Yes □ No
o Will sound checks be conducted prior to the event? □ Yes □ No When?
o Will sound amplification be used? Start date/time: End date/time:
o Will there be fireworks? □ Yes □ No Fireworks require a Fire Inspector and Police Officer to be
present from the time the fireworks arrive in the Town until the end of the show. They may also require
the erection of crowd control fencing.
o Will inflatable items, Hot air balloons or similar devices be used? □ Yes □ No
o If yes, please explain:
o Do your event plans include any casino games, bingo games, drawings or lottery opportunities?
□ Yes □ No If yes, please explain:
Contact the Town Clerk’s Office for Raffle & Bazaar Permit Application (413) 525-5400 ext. 1000
Amusement Rides
Will you have amusement rides? □ Yes □ No
If yes, please answer the following:
Number of rides
Dates of operation
Amusement Vendor (name, address & phone#):
License#
Amusement/Carnival Vendor shall carry liability insurance naming the Town of East Longmeadow as “Additional Insured.” A
copy of such must be submitted not later than 14 days prior to the event date. Include safe ride operator certificate with
application. Vendor must coordinate with State Inspectors for ride compliance.
Restrooms
Have you determined any facilities in the immediate area of your event which will be available to the public
during the entire event? □ Yes □ No
If yes, please explain where they are located and how you have determined their availability during the entire
event:
o Are the restrooms owned by the Town of East Longmeadow? □ Yes □ No
o Are you providing portable restrooms? □ Yes □ No
o How many portable restrooms?
Name of Portable Restroom Company
Address:
Phone# Name of Contact person:
Set up time: Pick up time:
USE OF TOWN PROPERTY APPLICATION – TOWN OF EAST LONGMEADOW
10
Alcohol
Will there be any alcoholic beverages at your event? □ Yes □ No
If yes, please check all that apply:
□ Free/host alcohol □ Alcohol sales □ Beer
□ Beer & Wine □ Beer, Wine & Distilled Spirits
Will there be a licensed bartender/caterer to serve the alcoholic beverages? □ Yes □ No
If yes, please provide company name, address, phone:
Liquor Liability License#
Please explain your plan to ensure the safe sale or distribution of alcohol at your event:
o Will you be using wristbands? □ Yes □ No
o Will you be supplying police detail? □ Yes □ No
o Who will be responsible for checking I.D.’s?
o Who will be responsible for making sure alcohol does not leave restricted areas?
o Has anyone who will be serving or dispensing alcohol received TIPS certification or any other type of
alcohol intervention training? □ Yes □ No
If yes, please provide their names(s) along with evidence of their certification:
Servers must be certified as trained in alcohol service safety such as “TIPS”, “ServeSafe”, or other alcohol service
safety program. Proof of certification required. See Addendum #6 for One-day Liquor License Application
Waste Management
It is the responsibility of the Authorized User to ensure that all waste is properly disposed of during and after the
term of the event. For multiple day events, all trash barrels must be emptied and waste removed from the site as
needed and at the end of the day.
If the area is not properly cleaned, or if there is any damage to town property as a result of your event, you will be
billed for the full cost of recovery, which will include rates for cleanup and repair. Further, failure to
properly clean may result in disapproval of any future requests for a Use of Town Property Permit, or may
require a cash deposit and/or surety bond.
o You are required to supply your own trash barrels
o If the Town of East Longmeadow is supplying your trash barrels, you must supply your own plastic linings
for the trash barrels. Call the Department of Public Works to coordinate.
o Should the proper disposal of waste at your event require a dumpster, the Authorized User is responsible
to supply such item(s) at its own cost.
o Number of dumpsters
o If cooking on site you must arrange for proper disposal of cooking oil.
11
USE OF TOWN PROPERTY APPLICATION – TOWN OF EAST LONGMEADOW
Recycling
Recycling is mandatory at your event. Contact the Health Department 413-525-5400 ext. 1103 with any
questions. You are required to provide receptacles for trash & recycling. The following items are
banned from being disposed of in the trash according to the Massachusetts Department of Environmental
Protection: recyclable paper (clean paper and cardboard), glass containers, metal containers, narrow necked
plastic bottles leaves and yard waste, lead acid batteries, white goods, whole tires, CRT’s (computer monitors
and television) as well as construction and demolition debris.
Trash & recycling bins must be set up next to each other to encourage event goers to recycle and to
assist collection accessibility.
Please submit your plan for recycling:
Food Concession or Preparation
You may be required to apply for a health permit if food or beverages are sold or given away during your special
event.
The Health Department will determine if your event requires a food permit. If a licensed caterer will be serving
food at the event the caterer must submit a copy of its food license to the Town’s Health Department, along with a
copy of the menu and a notification form. Also, in the Commonwealth of Massachusetts a certified food
protection manager certification and allergen certification is required. Guidelines for food facilities are provided
by the Town of East Longmeadow’s Board of Health. These guidelines should assist you in planning for food
handling, preparation and serving in the most responsible and legal matter.
Any questions, please contact the Health Department at 413-525-5400 ext. 1103.
1. Does your event include food concession and/or preparation areas? □ Yes □ No
Please describe how food will be served and or prepared
2. Will there be food vendors on site? □ Yes □ No
If yes, how many?
3. Do you intend to cook food in the event area? □ Yes □ No
If yes, specify the method (i.e. gas, electric, charcoal, etc.) Use of propane requires contact with the
fire department.
4. Will you and/or the food concession vendor provide a sink to be used in the proper preparation of
food? □ Yes □ No
If yes, will you be supplying your own licensed plumbers and electricians to set up and connect the
sinks? □ Yes □ No
Food Vendor Name Phone#
Address
If more than one vendor, include a list of vendors with their address & phone number.
USE OF TOWN PROPERTY APPLICATION – TOWN OF EAST LONGMEADOW
12
Marketing – Advertisement
o Will this event be advertised? □ Yes □ No
o Please explain
o Will there be media coverage at the event? □ Yes □ No
Please explain
Insurance & Security Deposit
Insurance
The Authorized User shall secure general liability insurance from an approved insurance company listing the Town
of East Longmeadow and/or other applicable department as additional insured, and providing coverage of one
million dollars ($1,000,000) per occurrence, two million dollars ($2,000,000) aggregate. Evidence of said
insurance must be submitted to the Town Manager’s Office no later than 14 days prior to the Special Event.
Security Deposit
The Authorized User shall deposit the sum of $5,000.00 in cash, certified funds or money order, with the Town of
East Longmeadow (or other applicable Department), at least five (5) days prior to the Special Event. Said deposit
shall act as security that the premises will be returned to its original condition, immediately following the Special
Event, wear and tear expected. Rather than deposit said fund with the Town, the Authorized User may obtain a
surety bond in the amount of $5,000.00 securing its performance of its obligations hereunder. Said deposit held
by the Town will not bear interest and shall be released upon determination by the Town that the Authorized
User’s obligations hereunder have been satisfied.
The Town reserves the right to waive these requirements, depending upon the size and risk level of the event.
Insurance Agency Phone
Street City State Zip
Contact Name Policy Type Policy Amount Policy Number
Bonding Company Phone
Street City State Zip
Contact Name Policy Type Policy Amount Policy Number
USE OF TOWN PROPERTY APPLICATION – TOWN OF EAST LONGMEADOW
13
Applicant's Affidavit
Event Title
Event Date(s) Times
I, on behalf of the organization I represent, certify that all the foregoing pages in this Use of Town Property Permit
Application have been completed, and for those pages for which are not applicable, it has been so noted on the
appropriate sections. I attest that the information contained herein is accurate, to the best of my knowledge and
belief.
I, hereby attest under the Pains and Penalties of Perjury that all of the information contained in this application is
true and accurate to the best of my knowledge and understanding.
I attest that I have read all the rules, regulations and guidelines specified herein and that which is included in the
addendums to this Application.
I, acting on behalf of the organization I represent, am authorized to commit that organization to agree to abide by
the rules, regulations and guidelines specified herein, and that I will accept all responsibilities for any payments
for municipal services and/or resources as they have been outlined and as they may be utilized by me and the
organization whom I am representing and the patrons who will be served by this Special Event.
Name of Applicant Title
Organization Name
Email Address Phone
Signature Date
This Affidavit MUST BE SUBMITTED, signed and mailed (90 days prior to the event) to the following:
Town of East Longmeadow
Town Manager’s Office
60 Center Square
East Longmeadow, MA 01028
FAILURE TO RETURN THIS SIGNED AFFIDAVIT WITH THE COMPLETED PERMIT APPLICATION SHALL CAUSE THIS
USE OF TOWN PROPERTY APPLICATION TO BE DEEMED INCOMPLETE
USE OF TOWN PROPERTY APPLICATION – TOWN OF EAST LONGMEADOW
14
Town Approval
For Police Department Official Use Only
Approval Recommended
Approval Not Recommended
Police Officer Required: Yes No Other
Comments/Conditions:
Date: Signature:
For Fire Department Official Use Only
Approval Recommended
Approval Not Recommended
Fire Dept. Presence Required: Yes No
Comments/Conditions:
Date: Signature:
For Public Works Official Use Only
Approval Recommended
Approval Not Recommended
Comments/Conditions:
Date: Signature:
For Recreation Department Official Use Only
Approved
Not Approved
Comments/Conditions:
Date: Signature:
For Building Department Official Use Only
Approved
Not Approved
Comments/Conditions:
Date: Signature:
For Town Manager Official Use Only
Approved
Not Approved Comments/Conditions:
Required Not Required
Security Deposit
Date:
Signature:
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Form 5733 Use Of Town Property Application (Town of East Longmeadow)

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Completed 15 July 2020

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