Fillable SPECIAL EVENT APPLICATION (City of Kingsport)

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SPECIAL EVENT APPLICATION (City of Kingsport)

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SPECIAL EVENT APPLICATION
City of Kingsport, Tennessee
225 W. Center Street Kingsport, TN 37660
(423) 224-2821
Special Event Meetings are held on the third Wednesday of every month at 1:00 PM at the City Hall Council Room. You are
encouraged to attend the meetings as you will be placed in direct contact with representatives of various City services to assist
with your event. Special Event Applications must be submitted at least 30 days prior to the event (90 days for road races).
All events held on
city property will require liability insurance. The minimum requirement will be based upon your event.
Section 1: General Information
Event Name: _____________________________________________________________________________
Event Date (s): ___________________________________________________________________________
Name of
event organizer (person): ____________________________________________________________
Presenting Organization: ____________________________________________________________________
Address:_________________________________________________________________________________
Cell/home phone:_________________________Business phone:_________________
Email:__________________________________________________________________________________
Has this event been held in the past? ______If yes, how many years__________________________________
Event Description (Please provide specific details:)
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Will this event be held on City Property? Yes □ No If no, please skip to section 3
If yes, pl
ease list all city property involved below:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Please note some locations (Allandale Mansion, Bays Mountain Park, Renaissance Arts Center & Theatre, Civic
Auditorium, V.O. Dobbins, Sr. Complex, Farmers Market, parks, etc.) require additional information and
contracts/permits along with rental fees. Please contact each location for specific rental requirements.
Section 2: Event Information
A. Event Times:
Set up
start time: _____________________________________
Event start time: _____________________________________
Event end time: _____________________________________
Break down/clean up finish time: _________________________
B.
Attendance:
Estimated attendanc
e: ____________________________________
Is the event open to the public? □ Yes □ No Will tickets be sold to the event? □ Yes □No
Is the event by invitation only? □ Yes □No
C. Sound:
Will any sound amplification be used? □ Yes □No If no, please skip to section D.
If yes, please provide details regarding the purpose of use, the type of sound amplification (DJ, Band, Speaker,
etc), and the time frame for amplification. IF for entertainment, please specify the type of music (along with the
entertainment line-up), amp wattage, etc:
___________________________________________________________________________________________
___________________________________________________________________________________________
Who is providing sound? _______________________________________________________________________
What time will they be setting up?________________________________________________________________
Will there be a stage erected? □ Yes □No
D.
Alcohol:
Will ther
e be alcohol at the event? □ Yes □No If no, please skip to section E.
If alcohol is served/sold on city property the event liability insurance must include liquor liability
Will alcohol be sold? □ Yes □No If yes please check with the City Clerk’s office as a permit may be necessary.
Also note an officer may be required for the times alcohol is being sold, the cost will be at the organizer’s expense.
Who will be serving alcoholic beverages?
____________________________________________________________________________________
E. Tents:
Will you have tents at your event? □ Yes □No If no, please skip to section F.
Will there be commercial tents? □ Yes □No
Who is providing tents? ________________________________________________________________
When will the tents be erected? Removed? ________________________________________________
Note some tents will require a tent permit from the City of Kingsport building dept, please check with the dept.
for requirements.
F. Portable Restrooms:
Will there be portable restrooms on site? □ Yes □No If no, please skip to section G.
How many portable restrooms will be on site? __________________________________________
Who is providing this service? ________________________________________________________
When will the portable restrooms be delivered/picked up?__________________________________
G. Inflatables and other entertainment rentals (please check with the facility manager to determine whether the
rentals can be placed on property):
Will the event have inflatables (bounce houses, etc)? □ Yes □No note additional liability insurance will be
required for inflatables and all inflatables must be secured
Will there be a stage erected? □ Yes □No
Will there be any amusement attraction, amusement rides or any other entertainment rentals not listed be on site?
□
Yes □No
Approximately what time will the rentals arrive?________________________________________
Name of rental company? __________________________________________________________
Applicant must list specific details as to the location and type of games/activities, i.e. inflatables, horseshoes, relay
races, stages, etc. along with the name of the company providing the stage and/or activities. Applicant must also
include a copy of applicant’s or providing company’s insurance certificate naming the City of Kingsport as additional
insured as well as a copy of the policy for review and verification of coverage. Any stages, tents, inflatables or other
items that require specific set up and take down times must be erected/installed during the specified set up time and
removed during the specified break down time.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
If yes, please list _____________________________________________________________
______________________________________________________________________________________
H. Vendors:
Will any vendors be present (this includes food, beverages, merchandise and other items): □ Yes □No
If no, please skip to section I.
Please provide a detailed list of the vendors and the items to be sold:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Will your vendors need access to power? □ Yes □No
(Not all locations will have access to power, also please notify your vendors they are responsible for their own
extension cords, the cords must be a minimum of 12 gage)
What time will your vendors be setting up? ________________________________________________
Will you be charging a vendor fee? □ Yes □No
I. Road Race:
Does this event involve a road race? □ Yes □No If no, please skip to section 3
If yes, please attach the following to this application:
Detailed course map with written turn by turn route from start to finish
An alternate route for this race (Note: Application without contingency plans will not be approved)
List of road guard locations
Are you hiring an outside organization to manage aspects of the road race? □ Yes □No
If yes, please provide the following:
Name of organization: _______________________________________________________________
Name of responsible person: __________________________________________________________
Address: __________________________________________________________________________
Phone #: __________________________________________________________________________
Email: ____________________________________________________________________________
Applications
for ROAD RACES should be submitted no later than 90 days in advance to allow proper
time to be processed. Routes for these races should NOT be announced or advertis
ed in advance of
their approval. Applications for road races that do not include an alternate route and a list of road
guards will not be approved.
Section 3: Special
Requests and Feedback
Please list any special requests:
Anything to note about past experiences, whether they are positive or negative, and/or suggestions:
NOTE: Events that include deep frying cooking oil operations are required to have a grease pit on-site and contract with a grease
waste hauler to handle the grease waste and removal of the grease pit. The primary event sponsor is required to remove all cooking
grease from the site immediately after the event. Illegal dumping of cooking grease, or its’ introduction into the sanitary or storm
sewer systems is prohibited and will be prosecuted
Kingsport Fire Dept:
All medical standbys will be a minimum of 3 hours at a rate of $25/hr.
Races 5K or less will require one bike team. Races great than 5K or more than 450 participants will require a minimum of two
bike teams. Each bike team will consist of one paramedic and EMT, they must carry basic and advanced life support equipment
(AED, heart monitor, cardiac drugs, and advanced airway equipment (i.e.; ET and king type airway). Bikes with emergency lights
and siren for responding to emergencies and safety lighting for night operations.
CITY SERVICES
Final decisions will be determined by departmental managers. There may be a cost associated with some city services.
Please indicate which of the following services are requested and for what days/times:
Kingsport Police Department: Note – off duty police officers cost $25/hr with a 3 hour minimum.
Traffic Control: _____________________________________________________________________________________
Security:___________________________________________________________________________________________
Kingsport Fi
re Department: Please indicate Yes or No in the following spaces:
Outdoor cooking: Yes No
Use of Propane: Yes No
Proper Fire Extinguisher at each site: Yes No 
Any cooking with Grease must have Class K Fire Extinguisher. All others must be a 5lb ABC or larger. Set up Diagram
must be provided. All compressed gas cylinders must be secured.
Fire watch may be required for any event at the discretion of the Fire Marshal. If set up is on the weekend, it may
require a weekend inspection by the Kingsport Fire Marshal’s office at a rate of $25/ hr with a 3 hour minimum.
Any event involving fireworks and/or more than 5 cooking vendors and/or when outside capacity exceeds indoor capacity
at any venue will require a Fire Watch to be on duty. The cost for a Fire Watch is $25/hr with a 3 hour minimum.
Food trailers cooking with grease must have an approved hood with Fire Prot. System. No propane tanks allowed under tents
or in Farmer’s Market building & relief valve must be directed away from tent. Propane tanks must be separated from
cooking appliances. Inflatables & tents must be properly secured. Hay and other combustible materials are not allowed in the
Farmer’s Market building. Vehicles are allowed in the building only for load in/out purposes.
Kingsport Public Works & Facilities:
Traffic Signage: ________________________________________________________________________________________________________
(Type and number requested)
Are you requesting street closures? Yes No
If y
es, please list any requests for street closures, including times required for closure and purpose of closure. Attach
additional sheet with map and contingency plan.
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
Are you requesting any of the following:
Electric (if available): □Yes □ No
Requests for use of electric must be determined on a case by case basis as each location has specific limitations,
event organizers are responsible for their own extension cords, the cords must be a minimum of 12 gage
Barri
cades: □
Yes
□ No
Con
es: □Yes □ No
Trash Bins: □Yes □ No
Recycling Bins: □Yes □ No
How many? ______________
How many? ______________
How many? ______________
How many? ______________
Submit completed application to:
Kristie Leonard
City of Kingsport, Community Services
225 W. Center Street
Kingsport, TN 37660
(423) 224-2821 office (423) 229-9350 fax
KristieLeonard@KingsportTN.gov
Please read all documents prior to signing application. Some facilities and rentals will require an additional contract.
1. I/We, , agree to abide by all
ordinances and regulations of the City of Kingsport, including all requirements and/or
conditions that may be placed particular to my event.
2. I/WE do swear or affirm that all of the information given in this application is true and
complete.
3. I/We do hereby agree to assume the defense of and indemnify and hold harmless the City
of Kingsport, its officials, employees, agents, representatives, insurers, sureties and
assigns, or anyone acting on their behalf from all actions, causes of actions, claims,
demands, damages, torts, any other relief of any nature whatsoever, whether known or
unknown, whether absolute, fixed or contingent, whether in law, in equity or that I/we
have ever had, now have or hereafter can, shall or may have, arising out of or as a
consequence of the event to which this document is attached and the activities permitted
in connection there with.
4. I/We agree to provide proof of insurance, up to and including a copy of the actual
insurance policy, as required by the City of Kingsport.
5. I/We agree to provide a copy of this signed Event Application to any vendors, planners,
and related parties associated with the event to ensure they are familiar with the guidelines
set forth herein.
6. I/We understand that receiving approval under this Special Event application does not
grant or waive other permit(s) that might be separately required.
7. The application for an event shall be filed not less than 30 days (90 days for road races)
nor more than 180 days prior to the scheduled date of the event. Events should not be
advertised or promoted until an event application has been approved by the city of
Kingsport. Failure to file the Special Event Application in a timely manner may result in
the rejection of the application.
8. The City of Kingsport reserves the right to require one or more City of Kingsport Police
Officers, Fire fighters or other emergency or supervisory personnel as deemed necessary
by the City of Kingsport to be present at any and all events that occur within the City
limits. The Event Sponsor, signatory of this document, is responsible for paying
reasonable expenses related to this requirement, with a minimum of three hours
equivalent expenses paid.
Printed Name and Title of Special Event Sponsor (if organization, must be official or officer)
Signature Date
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Completed 23 January 2021

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