Permit No.
CITY OF BISBEE
PARK, FACILITY AND RIGHT -OF -WAY USE PERMIT
(This permit must be approved by City Council and/or by Parks staff prior to the event)
Permit must be submitted to and approved by the City Council prior to the event. City Council meetings are
the first and third Tuesday of each month. Please note: your permit application must be submitted to the
Public Works / Parks & Recreation Department at least four weeks prior to the next scheduled City Council
meeting (before your scheduled event) in order for it to be on the City Council's meeting agenda. If the
applicant is proposing to sell liquor at the proposed event, the applicant should allow an additional 10 days
for processing of the required State "Special Liquor License." Also: As per section 11.2.9 paragraph G -
"All permittees shall be responsible for returning the park, recreational facility or public right-of-way to the
same condition in which it existed upon issuance of the permit. If this responsibility is not met, the
permittee will be charged at a rate set forth by the City staff and approved by the Mayor and Council".
Refer to Section 11.2.9 - "Park and Facility Use" of the City Code for requirements regarding use of
City parks and facilities (a copy of the City Code is available at www.BisbeeAZ.gov , City Hall, or
the Copper Queen Library)
If you have any questions regarding this permit application, please contact Lorena Valdez, Public Works at
432-6002 or lvaldez@BisbeeAZ.gov
APPLICANT INFORMATION
1. Applicant Name: Date:
2. Organization Name:
3. Mailing Address:
Phone #: Contact name and phone # during event
4. Name and complete description of activity planned (attached separate letter to include breakdown of
event and activities and details if more than one activity or if more space is needed).
5. Approximate Number of Participants and/or Spectators:
6. Requested Location of Event:
7. Date(s) of Event:
8. Hours of Event:
9. Hours of Reservation (with set-up and breakdown)
10. Request Consumption of Alcohol: Yes No
11. Request Sales of Alcohol: Yes No
(Page 1 of 3)
SERVICES REQUESTED FROM THE CITY OF BISBEE
(Provide letter with all services that are needed with details of times and locations. City may require
services depending on nature of event) See attached service rate sheet.
$ ͹General Electricity access $10 (CITY, LOWER VISTA, & GRASSY PARKS ONLY),
Band Shell Access $50 (CITY PARK):
□ GENERATORS ARE PERMITTED…ALL JUMPING CASTLES MUST HAVE
INSURANCE AND GENERATORS
$ ͹Beer Permit (non-commercial permits only) $10
$ ͹Police (escorts, security, road closures, redirecting of traffic): for _
$ ͹Park Public Works staff (example: posting “no parking signs, access to facility/band
shell/restrooms, etc.) NOTE: ROAD CLOSED SIGNS/BARRIERS MUST BE
SUPPLIED BY APPLICANTS:
$
͹
Other - any additional requests made by applicant or any other conditions set by the
City Council, City Code, ordinance or resolution.
CONDITIONS APPLICANT MUST MEET THAT ARE REQUIRED BY THE CITY OF
BISBEE:
$25 non-commercial or $50 commercial permit fee paid before permit is processed.
$50.00 refundable deposit paid before permit is processed (if a check is issued, must be "Written
separately from other charges) This deposit will be refunded at the completion of the event, provided
that the facility has been left in the same, or better, condition as it was at the start of the event. The
City will deduct from this deposit any expenses that may be incurred for cleaning or repairing the
facility following the event prior to refunding any remaining balance.
͹Fees for above service requests in the amount of $ before permit is processed or
event can take place.
͹Business License/Special Event License Fee of $32.50 paid before permit is processed- where there
is a promoter sub-letting booth space to vendors, the promoter will pay a fee of $32.50 and $4.00 per
vendor per day. The promoter is required to supply a list of vendors which describes the items or
service the vendor will be selling and pay all applicable fees prior to the event. Sales tax on all items
sold at the City rate will be collected by the City for all sales made by the promoter and all
vendors via their State tax forms.
͹Vendor Fee of $4.00 per vendor, per day (must be submitted prior to the event).
͹Certificate of insurance required showing City of Bisbee as additional insured - $1,000,000
minimum for high risk functions.
͹County Health Department Food Permit must be attached if serving food or having food vendors.
Health Department can be contacted at 520- 432-9472 for more information (This is not a food
handler's certificate)
͹Special Event Liquor License Application submitted to the City Clerks office- required in order to
serve or sell liquor from the State of Arizona (Department of Liquor Licenses & Control, Phoenix
Office). The sale of or consumption of alcoholic beverages must be approved by the City Council.
͹Copy of flyers or promotional material associated with this event.
NOTES: 1-THERE IS NO WATER USAGE AT ANY PARK AT ANY TIME.
2-IF YOU ARE HAVING A PARTY WITHOUT A PERMIT WITH MORE THAN 50
PEOPLE, CITY STAFF WILL COLLECT THE PERMIT FEE AT THE TIME OF
YOUR PARTY AND PROVIDE YOU WITH A RECEIPT.
APPLICANT CERTIFICATION
ANY PERSON VIOLATING ANY PROVISION OF THIS ARTICLE SHALL BE GUILTY OF A MISDEMEANOR
AND, UPON CONVICTION THEREOF, SHALL BE PUNICHABLE BY A FINE OF NOT LESS THEN FIFTY
DOLLARS NO MORE THAN FIVE HUNDRED DOLLARS.
I, certify that I am authorized to sign this agreement and agree to abide by the
conditions set forth herein and in the City Code.
Signature of Applicant/Authorized Party Date
(Page 3of 3)
Please print or type:
HOLD HARMLESS AGREEMENT
In consideration of any services rendered and the use of the City of Bisbee facilities or
Right-of-Way during the (print event) event the period from
(date & time) to ,the permittee
agrees to the following:
1.
That the permittee shall defend, indemnify and save harmless the City of
Bisbee, its officers, employees, agents and representatives from and against all
losses, claims, demands, payments, suits, actions, recoveries and judgments of
every nature and description arising by reason of any act or commission of the
permittee, his agent(s), employees or participants during the event or in
consequence of any negligence or carelessness regarding the same.
If Permittee is required to provide insurance:
2.
The Permittee's insurance shall be primary.
3.
The City of Bisbee shall be named as an additional insured on the
permittee's liability insurance coverage for the referenced event, and
the Hold Harmless Agreement be endorsed onto said insurance policy.
4.
Said liability insurance shall be in an amount no less than $1,000,000.00
per occurrence.
5.
Said insurance shall not be canceled or expired during the term of the
event unless a minimum of ten (10) days written notice is given to the
Finance Director of the City of Bisbee.
Signature of Permittee or Authorized Representative
Print Name Date
COUNCIL ACTION:
Recommended to: Approve: Deny:
With conditions as noted:
Mayor's Signature: Date:
(Page 4 of 4)
click to sign
signature
click to edit
CITY OF BISBEE PUBLIC WORKS DEPARTMENT
915 S. Tovreaville Road
BISBEE, AZ 85603
(520) 432·6002
APPLICATION FOR SPECIAL EVENT LICENSE
(Please print firmly or type)
(1)
Applicant's Name: _
(2)
Mailing Address, City, State & Zip:
(3)
Business Name:
(4)
Business Address:
(5)
City: State: Zip:
(6)
Business Phone No.: Resident Phone No.:
(7)
Name of Special Event: Date:
Specify date(s) License needed:
(8)
Will you be serving food: YES NO
If yes, do you have a Health Dept. Food Certificate: YES NO
(A copy of the Cochise County Health Dept. Certificate MUST
accompany this application otherwise it will not be accepted)
~
Fees: Permit fee: $32.50
Vendor fee of: $4.00 per day. (When promoter subletting to other vendors)
Total submitted: $
I, being first duly sworn upon oath hereby declare, under penalty of perjury. that I am the
licensee making the foregoing application and that said application has been read and that the contents thereof and all
statements contained therein
are true, correct, and complete.
Signature of Applicant Date
Make checks payable to: City of Bisbee
915 S. Tovreaville Road
Bisbee, Arizona 85603
click to sign
signature
click to edit
SPECIAL EVENT LICENSED PREMISES DIAGRAM
(This diagram must be completed with this application)
Special Event Diagram: (Show dimensions, serving areas, and label type of enclosure and security
positions)
NOTE: Show nearest cross streets, highway, or road if location doesn't have an address.
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome