Fillable PARADE, EVENT OR PUBLIC ASSEMBLY PERMIT APPLICATION (City of Jesup)

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PARADE, EVENT OR PUBLIC ASSEMBLY PERMIT APPLICATION (City of Jesup)

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BROWSE CITY OF JESUP (GA) FORMS

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Revised November 1, 2018
Permit # __________________
PARADE, EVENT OR PUBLIC ASSEMBLY PERMIT APPLICATION
Name of Organization:
Street Address of Organization:
Name of Representative:
Street Address of Representative:
Phone Number:
Email Address:
I understand it shall be unlawful to conduct any parade or public assembly, either fixed or processional,
over, upon, or burdening the public properties of the City of Jesup, or employing facilities thereon, without
first receiving a permit from the City Manager.
Public assembly means any meeting, demonstration, picket line, rally, or gathering of 10 or more people
for a common purpose that interferes with the normal flow or regulation of pedestrian or vehicular traffic,
or that requires exclusive use of all or any part of public areas or facilities open to the general public.
If the applicant is an association of persons in fact or in law, the application shall contain a description of
the entity; the name of said entity, if named; the registered or recognized address of the entity; the name
of the person making the application on behalf of the entity; such person’s relationship to said entity; and
some demonstration or recitation of the authority of the person making the application to act on behalf of
the entity and the names, addresses and phone numbers of the Corporate or Executive Officers of said
entity.
Where a parade or public assembly is conducted on, over, or upon, or burdening public properties, or
employing the facilities thereon, which is also to substantially involve or take place partly or wholly upon
private property with the consent of the owner(s) thereof, such owner(s) or their authorized
representatives must join as an applicant for any permit for such event.
The person or persons associated in fact, whether or not legally recognized entity, who wish to conduct
such parade or public assembly shall apply to the City Manager for a permit. Together with any
supplementary information as may be required this application shall be filed with the City Manager not
less than 10 days prior to the parade or public assembly to ensure proper processing. The permit will be
issued only after approval by the concerned departments listed below. Such application shall at a
minimum include:
Event Plan:
A plan must be submitted and must include the following information about the parade or public assembly
event:
i.
The anticipated number of persons participating on foot, number of cars or other units, or number and
construction of floats:
ii. The date or dates:
iii. The hours of each day the event will be conducted:
Set-up Time:__________ Start Time:__________ End Time:__________ Area Cleared By:__________
iv.
The exact location, or, if the parade or public assembly is processional or mobile, the route, the
assembly area and the dispersal area. If the parade or public assembly is to pass thru, use or impact
the use of any city park or square please identify such park or square and describe the proposed
impact. If any street is to be closed or access restricted, please also describe. Please see xxi below.
Description of Location/Route (attach map) and Impact on Parks, Squares and Streets:
v.
Event will consist of the following activities:
vi.
Will sound amplification equipment be employed?
No ( ) Yes ( ) If yes, explain
viii.
Will alcoholic beverages be dispensed or sold?
Yes ( ) No ( )
ix.
Are sales or vendors being planned?
Yes ( ) No ( )
x.
Is the use of tents planned?
Yes ( ) No ( )
xi.
Will portable toilets be used?
Yes ( ) No ( )
xii.
Will dumpsters be used?
Yes ( ) No ( )
xiii.
Is electricity needed?
Yes ( ) No ( )
xiv.
Will sign or pennants be hung outside?
Yes ( ) No ( )
xv.
Will artificial lighting be employed?
Yes ( ) No ( )
xvi.
Will temporary static structures be employed?
Yes ( ) No ( )
If yes, provide a complete description (including measurements) of the structure:
xvii. Will vehicles be employed? Yes ( ) No ( )
If yes, provide a description of each vehicle that will be used and how it will be used:
vii. Does the applicant intend to provide event insurance? Yes ( ) No ( ) If yes, please complete
insurance data section on following page.
xviii.
Provide a description of the anticipated need for safety, police, medical, sanitation, and other required personnel
and equipment, with the anticipated needed numbers and posting by location and time of personnel needed:
xix.
Provide a description of provisions necessary to the safety and welfare of the participants in the parade or public
assembly and members of the public in the area where the parade or public assembly will be conducted and
routes of access thereto and there from:
xx.
Provide a description of measures that will be taken to ensure public health and sanitation:
xxi.
Will the parade or public assembly require that the public spaces or facilities to be used or burdened, or the routes
and means of access thereto and there from, be temporarily diverted from their dedicated or customary uses, or
the public or private users thereof by diverted or excluded from, or limited in their use or enjoyment of, or their
access to or through, said spaces or facilities, before, during or after the parade or public assembly?
Yes ( ) No ( )
If yes, please describe.
Permission is hereby requested to hold the above Parade or Public Assembly in the City of Jesup:
___________________
DATE SIGNED
APPLICANT’S SIGNATURE
________________________________
________________________________
APPLICANT’S ADDRESS
Return all applications to: City of Jesup, Georgia
Attn: City Manager
162 East Cherry Street
Jesup, Georgia 31545
(912) 427-1313
All fees and/or deposits shall be paid via cashier’s check or money order payable to “City of Jesup”.
Insurance Data Section (see Paragraph vii above):
Name of Insured: ___________________ Is City an additonal insured? Yes ( ) No ( )
Name of Insurer ___________________ Does the City have copy? Yes ( ) No ( )
Limits of Insurance ___________________
Effective Date of Policy ___________________
________________________________
APPLICANT’S TELEPHONE NUMBER
________________________________
APPLICANT’S E-MAIL ADDRESS
******************FOR INTERNAL USE ONLY*******************
APPLICATION REVIEW OF REQUEST TO HOLD THE ABOVE EVENT IN THE
CITY OF JESUP, GEORGIA:
THE APPROVED LOCATION / ROUTE OF EVENT:
THE EVENT IS TO CONSIST OF:
DATE: ______________
Beginning time:____________ Ending Time:____________
EXTRA DUTY OFFICERS NEEDED:____________ ARRIVAL TIME:____________
NOTE - EXTRA-DUTY OFFICERS WILL BE PAID THE AMOUNT AGREED UPON PRIOT TO THE EVENT,
AND ARE NOT RESPONSIBLE FOR ADVISING DIRECTIONS OR PROVIDING ANY DETAILS OF THE
EVENTS TO PARTICIPANTS IN RUNS, WALKS, RACES, ETC. THE POLICE DEPARTMENT PROVIDES
SECURITY FOR THE EVENTS.
THE INFORMATION CONTAINED IN THE PERMIT HAS BEEN SUBMITTED TO AND APPROVED BY THE
CITY OF JESUP. ANY CHANGES IN THE DATE, TIME, COMPOSITION, LOCATION AND/OR ROUTE OF
THE EVENT OR PARADE MUST BE APPROVED IN ADVANCE. THIS PERMIT IS TO BE CARRIED BY THE
ORGANIZER THE EVENT OR LEAD UNIT OF THE PARADE AND IS TO BE
SHOWN UPON REQUEST.
Signatures: Approvals: Additional Requirements or Conditions:
City Manager ___________________________ Yes ( ) No ( ) __________________________________
Chief of Police ___________________________ Yes ( ) No ( )
Fire Chief ___________________________ Yes ( ) No ( )
{ } IF CHECKED: INSURANCE REQUIREMENTS ARE APPLICABLE: THE CITY OF JESUP REQUIRES
THAT THE APPLICANT PROCURE AND PROVIDE PROOF OF VALID EVENT INSURANCE AS FOLLOWS:
THE FAILURE TO PROVIDE REQUIRED INSURANCE VOIDS THIS PERMIT.
EFFECTIVE DATES OF POLICY: ________________________
LIMITS OF POLICY: ________________________
*THE CITY MUST BE NAMED AS ADDITONAL INSURED.
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PARADE, EVENT OR PUBLIC ASSEMBLY PERMIT APPLICATION (City of Jesup)

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Completed 3 August 2020

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