Page 1 of 2 Revised: 04/17/2019
Public Event Permit
16345 Sixth Street | PO Box 2460 - La Pine, Or 97739 | ph. (541) 536-1432 |
City Facilities (add'l deposit)
City Parking Required/Possible
Organizational Name:
(Last, First, Middle)
Mailing Address:
Daytime Telephone: ( )
Cell Number:(
Nature of the Event:
(e.g. concert, race, festival)
Event Location:
Date(s) of Event:
Time(s) of Event:
Expected Attendance:
Attached Site Plan/Traffic Plan/Event Narrative:1 or 2 paragraphs describing the event.
Attached OLCC Temporary License Application (If Applicable /Additional Fees Apply - See Fee Schedule)
The applicant must be at least 18 years of age (21 if alcohol will be served) and must assume financial responsibility for
payment of fees, any clean up required by city employees, and any damages to equipment and/or property which may be
incurred. Abuse of facilities or violation
of regulations shall result in subsequent denial of use of city facilities. Applicant must
provide adequate supervision
of scheduled event. The City of La Pine nor Deschutes County are responsible for the
security of personal items of the applicant or
attendees/guests of the event. The City and County also reserve the right to
deny use of facilities/roadways to the applicant. Parking
allowed only in designated areas, unless other arrangements have been
The City of La Pine reserves the right to charge an extra fee for special services rendered. Example: location/rental of
barricades, any clean-up not done as required by this agreement, damage of city property.
I, and/or the organization I represent understand that any violation of these agreements or City Code will result in
immediate termination of event, and jeopardize future use of City of La Pine facilities. User
agrees to indemnify, defend,
and save and hold City of La Pine, its affiliates and their respective directors, officers,
and employees, and agents of the
City of La Pine harmless from and against any claims (including without limitation,
third party claims for personal injury or
real or personal property damage), actions, administrative proceedings,
judgments, damages, punitive damages,
penalties, fines, cost, liabilities, (including sums paid in settlement of claims),
interest, or losses, including reasonable
attorney’s and paralegal’s fees and expenses (including without limitation,
any such fees and expenses incurred in
enforcing this agreement or City Code, or collecting any sums due
hereunder),costs, consultants’ fees, together with all
other costs and expenses of any kind or nature that arise directly
or indirectly from the use of the facilities by user.
As a condition of use of the City of La Pine facilities, the applicant agrees that it will not discriminate or permit
discrimination at or in relation to applicant’s event against any person on the basis of race, color, creed, national
age gender or disability.
Additional Fees
Alcohol Service: Yes No
per Ordinance No. 2019-05
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Page 2 of 2 Revised: 4/17/2019
Public Event Permit
16345 Sixth Street | PO Box 2460 - La Pine, Or 97739 | ph. (541) 536-1432 |
Additional Items and Information:
PERMIT FOR PUBLIC EVENT: Permission for the above-named applicant to conduct the Public Event
specified herein is hereby granted:
City Manager Date
Application Received Date:
Cash Receipt Number:
1. Event organizer is responsible for clean-up of debris. Note: if the city facility/roadway is not cleaned up after a sponsored event that lack of action
may serve as a basis for future permit denial.
2. All proposed directional and event signage must be submitted for approval. Signage is to be removed within 24 hours of the event ending. The city
shall be notified of signage changes or organizers inability to remove signs on time.
3. A parking plan and/or traffic plan must be submitted with application. Flow of traffic based on signage directing attendees as well parking that might
overflow into city right-aways due to displaced parking spots on non-city property should be noted.
4. I/We acknowledge paint and other permanent markings are not permitted on City, County or State roads.
5. I/We acknowledge the need to follow all local ordinances (e.g., noise control). Note: permit holders are not exempt from any fines or penalties
imposed as a result of noncompliance.
6. I/We agree to publicly notify all residents and/or businesses of any contemplated road closures or delays. Provide the City a copy of the public notice
for review [if applicable].
7. I/We consent to allowing law enforcement, public health and fire control officers to come on the premises of any property we control for purposes of
assuring the terms and conditions of the permit are met.
8. Permit applicants must obtain and maintain special event liability insurance concerning the special event with limits of not less than $2,000,000.00 for
injury to one person, $2,000,000.00 for any one accident or occurrence, and $2,000,000.00 for property damage. If alcohol will be served at the
special event, liquor liability insurance will also be obtained and maintained by the applicant with minimum limits approved by the manager. Each
liability insurance will (1) be the primary insurance policy for all covered losses, (2) name City and City's representatives as additional insureds, and
(3) apply to, and provide coverage for, all injuries, claims, demands, actions, suits, proceedings, damages, liabilities, losses, costs, and expenses of
any kind, including, without limitation, bodily injury and property damage, arising out of the special event. The liability insurance policy(ies) (and
endorsements) required under this Section 5.2(d) will be in form and content satisfactory to City and will be provided to the City for inspection at the
time the application is submitted. Notwithstanding anything contained in this Ordinance to the contrary, the minimum insurance required under this
Ordinance (a) will provide coverage in amounts sufficient to meet the minimum tort claim liability limits under applicable law, and (b) may be
increased at any time and from time to time through council resolution or manager determination.
Please note: Deschutes County may also require being named as an additional insured, see item 9 below for clarification.
9. If you are using Deschutes County Roads or Land as part of a route or parking area you must also name them as an additional insured on your
insurance policy.
10. An OLCC Temporary License is required to serve alcohol at an event. You must provide the application and fee w/ your event application.
11. Please provide payment at the time of submittal. Current fees are available on our Master Fee Schedule.