Fillable SPECIAL EVENT APPLICATION (City of Mineral Wells)

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SPECIAL EVENT APPLICATION (City of Mineral Wells)

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  • 33 check-boxes
  • 91 other fields

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BROWSE CITY OF MINERAL WELLS (TX) FORMS

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Page | 1 of 6 Form revision: 10/27/2020
City of Mineral Wells
PO Box 460 ● Mineral Wells, TX 76068
Telephone (940) 328-7701 ● Fax (940) 328-7732
SPECIAL EVENT APPLICATION
COMMUNITY EVENTS / ROAD CLOSURES / PARADES ONLY
The purpose of this application is to provide information about your event or activity in order for various departments and agencies to
determine if they need to be involved in the approval and/or permitting process. Depending on the specific event, a permit application and/or
fee(s) may be required. The applicant is responsible for providing complete and accurate information on the application, including an
attached detailed site plan. The applicant is also responsible for notifying the City Manager’s Office of any changes. Incomplete applications
will not be accepted.
A complete application should be submitted at least 15 days prior to the planned event to allow sufficient review time.
Public officials may contact you with specific questions and may require a pre-planning meeting.
Some activities will require verification of a Certificate of Liability Insurance for the organization (ie. any activity on a public roadway - See
Texas Transportation Code: Chapter 552 for more information) or additional permits/inspections as may be required by the City or other
agencies. Applications and events are prioritized based on a first come-first served basis and the City may approve or disapprove an
event’s requested date based on availability of resources. Events that occur on an annual basis will receive priority the following year.
Return the completed application to the City of Mineral Wells (City Manager’s Office) at
115 SW 1
st
Street, Mineral Wells, Texas 76067. For questions, please call (940) 328-7701.
APPLICANT INFORMATION N
Name of Event: ____________________________________________________________________
Applicant Name & Title: _____________________________________________________________
Name of Organization: ______________________________________________________________
Mailing Address: ______________________________ City / State / ZIP: _____________________
Daytime Phone Number: __________________ Email: ___________________________________
APPLICANT’S SIGNATURE: _______________________________ DATE: _______________________
If the event is to be held by or for any person/organization other than the applicant, the applicant shall attach a written statement from that
other person/organization showing authority to make this application. A pre-planning meeting may be required and will be scheduled to
include the appropriate staff. The event applicant must attend the meeting. The city reserves the right to require others to attend.
EVENT INFORMATION N
Type of Event: □ Parade □ Run / Walk □ Street Fair/Festival □ Other ________________________
Event Address: Is this address private property or public?
□ Private □ Public
Date(s) of Event: Is the event planned for Indoor or Outdoor?
□ Indoor □ Outdoor
Event Start Time:
Event Set-up time begins at:
Event End Time:
Event Tear-down time ends at:
Will this event require a road/street to
be closed/blocked?
□ Yes □ No
Road Closure Begins:
Road Closure Ends:
CLEAR FORM
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Page | 2 of 6 Form revision: 10/27/2020
EVENT SITE PLAN N
Please provide a detailed Site-Plan sketch of the event. Include maps, outline or diagram of
the entire event venue including the names of all streets or areas that are part of the venue
and the surrounding area. The plan should include the following information (if applicable):
• Location of the event/activity on the property with approximate distances from roads, fire hydrants, buildings, etc.
• Location of temporary structures that will be used during the event. Must indicate size of temporary
structures, distances between temporary structures and existing buildings.
• Identify how each temporary structure will be used. Example: type of vendor, food preparation, alcohol sales, etc.
• Location of all fencing, barricades, or other restrictions that will impair access to and from the event or property.
• Identify all designated parking areas.
• Identify location of any generators and fuel storage.
SITE PLAN SKETCH N
Event location/address: _________________________________________________________________________________
EVENT CITY RESOURCE NEEDS N
Will the event involve or require any of the following?
Parking arrangements:
□ Yes □ No
What type of parking will be utilized by this event?
□ On Site □ Off Site □ Both
Will the event require additional police security?
□ Yes □ No If “Yes”, how many officers? _____________
Is traffic control needed for road closures at this event?
□ Yes □ No If “Yes”, please indicate location on Site Plan
Does the event plan to have amplified sound?
□ Yes □ No If “Yes”, please indicate position on Site Plan
Will the event have food/beverages for sale?
□ Yes □ No
Will alcoholic beverages be sold at the event?
□ Yes □ No If “Yes”, must contact “TABC”
Will there be tents (tops with sides) at the event?
□ Yes □ No If “Yes”, will require Fire Inspection
Page | 3 of 6 Form revision: 10/27/2020
ROUTE AND TRAFFIC PLAN N
Please provide an estimate (number) for each of the following:
PARADE (Includes floats, vehicles, and persons) MARCH OR WALK (Persons only)
VEHICLES ONLY (Includes motorcycles) FOOT RACE BICYCLES
OTHER (Description:
)
Number of persons: % Children:
Number of vehicles: Vehicle Types:
Number of animals: Kinds:
DESCRIBE THE EVENT ROUTE IN THE SPACE BELOW. IF THERE IS MORE THAN ONE SEGMENT TO
AN EVENT, INCLUDE START AND FINISH TIMES FOR EACH SEGMENT.
GENERIC AWARENESS RUN
Page | 4 of 6 Form revision: 10/27/2020
ROAD CLOSURE / TRAFFIC / PEDESTRIAN IMPACT N
•
Use of TX and US highways will also require approval from the TXDOT. [Street Dept. can assist]
•
The proposed route to be traveled including the requested starting and termination
point.
Please also clarify the direction of movement of your event.
•
Routing plans for traffic. Illustrate a plan to include roads that you are requesting to be
closed to
vehicular or other traffic for your event. Include planned arrangements to resolve
conflicts with
people trying to reach businesses, their own residences, places of worship
and public facilities
including public transportation.
•
Whether the event will occupy all or a portion of the street(s) requested for use.
•
Proposed locations for barricades, signs and police/volunteers.
•
The provision of twenty foot (20’) minimum emergency access lanes throughout the event site.
•
White temporary water base paint can be used to mark the route on the street pavement.
Note: All road closure requests will be strictly reviewed by the City. Road closures will be limited to one block or
one cul-de-sac as determined by the City so as to not impede traffic and emergency routes for special events.
Exemptions to this limitation may be granted for approved parades, foot races, and bike races. Approval, denial,
or modification of all road closure requests lies in the sole discretion of the City. The City of Mineral Wells has
final discretion over your Route and Traffic Plan including, but not limited to the route, placement and number
of all barricades, signs and police/volunteer locations. Certificate of Liability Insurance may also be required.
DO NOT ASSUME, ADVERTISE, OR PROMOTE YOUR EVENT UNTIL YOU HAVE
AN APPROVED SPECIAL EVENT/PARADE PERMIT FROM THE CITY OF MINERAL WELLS.
CONFLICTS DO ARISE AND CHANGES TO THE REQUEST MAY BE NECESSARY.
Please attach a detailed map of the proposed route to this application or use the space below to sketch the proposed route.
If your event involves road closures, a parade, a foot or bike race, any other type of procession,
pedestrian impact in a roadway, or more than one location, please attach a Route and Traffic Plan.
Include the required information (listed below) and any additional information that you believe
apply to your event. When planning a moving route, the Mineral Wells Police Department is
available
to assist you in planning your route. You may also choose City pre-approved routes.
Page | 5 of 6 Form revision: 10/27/2020
WAIVER and HOLD HARMLESS AGREEMENT
In consideration of the _______________________________________________ (name of organization),
hereinafter the “Organization”, and its Members, employees, volunteers or guests, being allowed to participate
in _____________________________ (the “Activity”), the undersigned hereby recognizes and assumes any and
all risk pertaining to the Organization participation in the Activity.
To the fullest extent permitted by law, the Organization hereby agrees to defend, indemnify, and hold harmless
the City of Mineral Wells, its officials, agents, and employees, against all injuries, deaths, claims, suits, liabilities,
judgments, cost and expenses (including attorneys’ fees) which may in anywise accrue against the City of
Mineral Wells, its officials, agents, and employees, arising in consequence of the Organization participation in
the Activity, or which may in anywise result therefore, except that arising out of the sole legal cause of the City
of Mineral Wells, its agents, or employees. The Organization shall, at its own expense, appear, defend, and pay
all charges of attorneys and all costs and other expenses arising therefore or incurred in connections therewith,
and, if any judgment shall be rendered against the City of Mineral Wells, its officials, agents, and employees, in
any such action, the Organization shall, at its own expense, satisfy and discharge the same. The invalidity or
unenforceability of any of the provisions hereof shall not affect the validity or enforceability of the remainder of
this Agreement.
The undersigned represents it has full authority to execute this Waiver and Hold Harmless Agreement on behalf
of the Organization.
Agreed this ________day of__________________, 20_____.
Name of Organization
Print Name of Authorized Person
Signature of Authorized Person
Title
The Organization and the authorized signatory (Applicant) below agree to inform the City of Mineral Wells of any
changes in the application at least five (5) days prior to the event. Please note: Final approval of this event is
pending satisfactory completion of Certificate of Insurance requirements.
All applications must be signed and notarized.
I do solemnly swear (or affirm) that all answers given and statements made on the application are true and correct
to the best of my knowledge and beliefs.
By on behalf of
Signature of Applicant
Name of Organization
Printed Name of Applicant
Date
(Notary Public)
Signed and sworn to before me this ______ day of___________________, 20________.
After submitting all forms, your application will be reviewed by City staff. All departments that will be involved or
impacted in providing services or permits for the event will be notified. Please do not assume that all aspects of
the event will be approved. You may be asked to make some changes to your plan based on the availability of
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Page | 6 of 6 Form revision: 10/27/2020
services or scheduling of other events. The City of Mineral Wells reserves the right to cancel any event at any time
for reasons deemed necessary by the City Council and/or City Manager.
Deliver all completed items to:
City of Mineral Wells ● Attn: City Manager’s Office
115 S.E. 1
st
Street ● Mineral Wells, Texas 76067
THIS SECTION RESERVED FOR INTERNAL PURPOSES ONLY
Certificate of General Liability Insurance Verified: □ Yes □ No Policy #________________________
REVIEWED BY:
Police Department
□ Approved □ Denied Date: _______ Reviewer: ___________________
City Support requirements (if any): ________________________________________________________
Comments: ____________________________________________________________________________
Fire Department
□ Approved □ Denied Date: _______ Reviewer: ____________________
City Support requirements (if any): ________________________________________________________
Comments: ____________________________________________________________________________
Public Works □ Approved □ Denied Date: _______ Reviewer: ____________________
City Support requirements (if any): ________________________________________________________
Comments: ____________________________________________________________________________
Inspections/Health
□ Approved □ Denied Date: _______ Reviewer: ____________________
City Support requirements (if any): ________________________________________________________
Comments: ____________________________________________________________________________
Parks & Recreation
□ Approved □ Denied Date: _______ Reviewer: ____________________
City Support requirements (if any): ________________________________________________________
Comments: ____________________________________________________________________________
Based on the information submitted and reviewed, the request for a permit has been:
CITY MANAGER
□ Approved □ Denied Date: ___________ PERMIT #: ______________
Authorized Signature: ___________________________________________________________
Comments: _____________________________________________________________________________
Additional charges to be collected:
Nature of cost: _______________ # of Units ________ x $ ____________ / Unit = $ _____________ Cost
Nature of cost: _______________ # of Units ________ x $ ____________ / Unit = $ _____________ Cost
Total additional charges due prior to permit issuance: $ _________________________
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Completed 23 January 2021

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