Fillable SPECIAL EVENT PERMIT Processions, Assemblages and Special Activities, (City of Titusville Pennsylvania)

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SPECIAL EVENT PERMIT Processions, Assemblages and Special Activities, (City of Titusville Pennsylvania)

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The SPECIAL EVENT PERMIT Processions, Assemblages and Special Activities, (City of Titusville Pennsylvania) form is 4 pages long and contains:

  • 4 signatures
  • 32 check-boxes
  • 93 other fields

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U.S.A. forms for City of Titusville Pennsylvania

BROWSE CITY OF TITUSVILLE PENNSYLVANIA (PA) FORMS
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APPLICANT CONTACT INFORMATION
SPECIAL EVENT PERMIT
Processions, Assemblages and Special Activities, and Film Shoots
TE-300 (5-19)
www.penndot.gov
Contact Name:_________________________________________________________ Title:______________________________________________
Organization:___________________________________________________________ o Municipal Sponsor o Private
Sponsor Street Address:___________________________________________ City:________________________ State:______ Zip Code:_______
Phone:____________________ E-mail:________________________________ Hours:__________________________________________________
SPECIAL EVENT INFORMATION
1. Special Event Name:___________________________________________________________________________________________________
2. Special Event Type (Check all that apply): . . . . . . . . . . . . . . o Procession o Assemblage o Special o Activity o Film Shoot
3. Special Event Purpose/Description (Attach additional sheet if necessary):
4. Date of Special Event: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . From ______________ To ______________
a. Alternate Date of Special Event: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . From ______________ To ______________
5. Time of Special Event: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . From ______________ To ______________
a. Alternate Time of Special Event: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . From ______________ To ______________
6. County(ies):
7. Municipality(ies):
8. State Road(s) (List all state roads involved in the special event - Attach additional sheet if necessary):
State Route Number: State Road Name: Number of Lanes: Type of Highway:
___________________ __________________________________________________________________ __________________ __________________
___________________ __________________________________________________________________ __________________ __________________
___________________ __________________________________________________________________ __________________ __________________
___________________ __________________________________________________________________ __________________ __________________
___________________ __________________________________________________________________ __________________ __________________
___________________ __________________________________________________________________ __________________ __________________
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SPECIAL EVENT INFORMATION (CONTINUED)
9. Approximate number of vehicles in the special event: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _______vehicles
10. Approximate number of pedestrians involved in the special event: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _______ pedestrians
11. Highway will be (check all that apply): o Fully Closed o Partially Closed o Minor Encroachment o Other

12. Travel distance of road closure/encroachment:___________________________________________________________________________
13. Travel distance of the alternate route:_____________________________________________________________________________ o N/A
NOTE: Alternate route shall not be more than 5 miles longer or 5 times greater in length then the normal travel distance. An
alternate route is not required if one of the following conditions exists:
a. The highway to be closed is not a state route and is primarily used by local drivers who are familiar with an alternate route.

remainder of the highway.

14. Does the special event occur on a freeway: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . o Yes o No
o N/A
a. Please state the reason(s) why this event should use a freeway, including safety aspects to both motorists and event
participants. (Explain on a separate attached sheet)
o Yes o No
c. Will the special event move orderly and uniformly along the freeway: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . o Yes o No
d. Will the special event use a maximum of one lane of the highway and can the MPT Contractor safely
o Yes o No

o Yes o No
 
a. PSP Contact Name:____________________________________ Title:______________________________ Date:_______________
o N/A

b. MPT Contact Name:_________________________________________________________________ Phone:___________________
c. Date MPT requested:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . From____________________ To____________________
i. Alternate Date MPT requested: . . . . . . . . . . . . . . . . . . . . . . . . From____________________ To____________________
d. Time MPT requested:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . From____________________ To___________________
i. Alternate Time MPT requested: . . . . . . . . . . . . . . . . . . . . . . . . From____________________ To____________________
17. Vehicle Escort Service: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . o N/A

b. Vehicle Escort Contact Name:______________________________________________ Phone:____________________________
c. Date Vehicle Escort Service requested: . . . . . . . . . . . . . . . . . . . . . . . . From____________________ To____________________
i. Alternate Date Vehicle Escort Service requested: . . . . . . . . . . From____________________ To____________________
d. Time Vehicle Escort Service requested: . . . . . . . . . . . . . . . . . . . . . . . . From____________________ To____________________
i. Alternate Time Vehicle Escort Service requested: . . . . . . . . . . From____________________ To____________________
Page 2
APPLICANT CERTIFICATION, PERMIT CONDITIONS, & SIGNATURES
Page 3
The applicant shall indemnify, save harmless, and defend (if requested) the Commonwealth of Pennsylvania, the Department of






to cover any loss that might occur as a result of the permitted use of the state highways or that might otherwise arise out of or be
connected with the event; (b) occurrence-based coverage; and (c) the Commonwealth of Pennsylvania named as an additional

The event route shall be appropriately secured with proper security and safety measures taken to protect the event participants,




and written approval shall be obtained from each municipality granting the applicant permission to hold the event. The applicant

The Department reserves the right to re-open any closed road(s) at any time due to any emergency that may occur which require the

o 
o I have read, understand, and agree to the above terms and conditions.
o I attest that all information in the special event permit application is accurate to the best of my knowledge.
o 
Applicant
Contact Name (Print): __________________________________________ Title of Contact: _______________________________________
Contact Name (Signature): ______________________________________________________________________ Date: _________________
Attesting Witness (Print): _______________________________________ Title of Witness: ________________________________________
Attesting Witness (Signature): ____________________________________________________________________ Date: __________________
Pennsylvania Department of Transportation


District Executive (Print): _________________________________________________________________________
District Executive (Signature): _____________________________________________________________________ Date: ________________
Remarks:
Actions


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Page 4
APPLICANT CHECKLIST
o Complete TE-300: Special Event Permit Application (Submit Pages 1, 2, and 3).
NOTE: Application becomes permit once reviewed and signed.
o
o 
o 
o Coordination of a vehicle escort service (if applicable).
o 
Police/Fire, etc.
o 
o 
Municipal Sponsor
NOTE
criteria for own special event AND private sponsor criteria for the other municipalities that your special event enters.
If Special Event occurs on:
1. State Road(s)
o 
permit application (Pages 1, 2, and 3) to the Pennsylvania Department of Transportation.
2. Local Road(s)
o The Pennsylvania Deparatment of Transportation has no involvement with the special event on the Municipality's local
road(s). The Municipality coordinates its own criteria for special event involvement on its own local road(s).
Private Sponsor
If Special Event occurs on:
1. State Road(s)
o 
road(s).
o The Private Sponsor is required to obtain approval letter from each municipality for special event involvement on state
road(s).
o 
application (Pages 1, 2, and 3) to the Pennsylvania Department of Transportation.
2. Local Road(s)
o The Pennsylvania Deparatment of Transportation has no involvement with the special event on the Municipality's local
road(s). The Private Sponsor is required to submit appropriate documents to municipality according to the municipality's
requirements.
NOTE: If the involvement of the special event on a state road also requires requires involvement on a local road the private sponsor
should notify the municipality of the local road involvement at least eight (8) weeks prior to the date of the special event.
o Submit completed and signed permit application and the required documents to the appropriate Pennsylvania
(8) weeks prior to the date of the special event.
Page 5
GLOSSARY TERMS
The terms used in this package are dened as follows:
1. Applicant - An individual, group, municipal authority, or governing body that is applying for the special event permit.
2. Assemblage - An organized gathering of people without vehicles, or with vehicles that are stationary, which encroaches onto a

fairs, block parties, organized demonstrations and other recreational events.
3. Conventional Highway - A highway other than a low-volume road, expressway, or freeway.
4. Expressway - 

5. Film Shoot - All aspects of production of a video production at a set or location.
6. Freeway - A limited access highway to which the only means of ingress and egress is by interchange ramps.
7. Fully Closed Road - The roadway is closed to all road users except contractor's equipment or authorized vehicles.
8. Low-Volume Road - 
9. Maintenance and Protection of Trac (MPT) Contractor - A service used to provide such safety measures deemed necessary
to maintain alternate routes while safely guiding the traveling public through detours. These safety measures include, but are not


10. Minor Encroachment - 
11. Partially Closed Road - 

12. Procession - 

walks, foot races, parades, and marches.
13. Special Activity - An organized vehicle race, speed competition or contest, drag race or acceleration contest, test of physical
endurance, exhibition of speed or acceleration, or other planned event held within the right-of-way of a public roadway. The term

14. Special Event - A procession, assemblage, or special activity held within the right-of-way of a public roadway.
15. State Designated Highway/State Road/State Route (SR) - A highway or bridge on the system of highways and bridges over

14. Vehicle Escort Service - An automobile used to guide vehicle(s), bicycle(s), and/or pedestrian(s).
Page 6
PENNSYLVANIA DEPARTMENT OF TRANSPORTATION DISTRICT ENGINEERING OFFICES
Click on District to visit website (e.g. "District 1-0")
District 1-0
 
Oil City, PA 16301-0398
Phone: 814.678.7154
Counties: Crawford, Erie, Forest, Mercer, Venango,
Warren
District 2-0
 
Phone: 814.765.0400
 

District 3-0
 
Montoursville, PA 17754-0218
Phone: 570-368-8686
 

District 4-0
Address: 55 Keystone Industrial Park
Dunmore, PA 18512
Phone: 570.963.4061
Counties: Lackawanna, Luzerne, Pike, Susquehanna,
Wayne, Wyoming
District 5-0
Address: 1002 Hamilton Street Allentown, PA 18101
Phone: 610.871.4100
 
Schuylkill
District 6-0
 
King of Prussia, PA 19406-1525
Phone: 610.205.6700
 
Philadelphia
District 8-0
Address: 2140 Herr Street Harrisburg, PA 17103-1699
Phone: 717.787.6653
Counties: Adams, Cumberland, Dauphin, Franklin,
Lancaster, Lebanon, Perry, York
District 9-0
Address: 1620 North Juniata Street
Hollidaysburg, PA 16648
Phone: 814.696.7250
 
Somerset
District 10-0
 
Indiana, PA 15701-0429
Phone: 724.357.2800
 
District 11-0
 
Phone: 412.429.5000
 
District 12-0
Address: 825 North Gallatin Avenue Ext.


Phone: 724.439.7315
Counties: Fayette, Greene, Washington, Westmoreland
Central Oce
 
Harrisburg, PA 17120
Phone: 717.787.2838
Page 7
EXHIBIT A - FILM SHOOT REQUIREMENTS
District 8-0
Address: 2140 Herr Street Harrisburg, PA 17103-1699
Phone: 717.787.6653
Counties: Adams, Cumberland, Dauphin, Franklin,
Lancaster, Lebanon, Perry, York
District 9-0
Address: 1620 North Juniata Street
Hollidaysburg, PA 16648
Phone: 814.696.7250
 
Somerset
District 10-0
 
Indiana, PA 15701-0429
Phone: 724.357.2800
 
District 11-0
 
Phone: 412.429.5000
 
District 12-0
Address: 825 North Gallatin Avenue Ext.


Phone: 724.439.7315
Counties: Fayette, Greene, Washington, Westmoreland
Central Oce
 
Harrisburg, PA 17120
Phone: 717.787.2838
1. Prior to the installation of any temporary structures to any bridges, the Applicant shall submit a detailed plan prepared by
a professional engineer for each installation and shall obtain acceptance of the Commonwealth's District Engineer or
designee. The Applicant shall be fully responsible for the design and proper installation of its temporary structures. The
acceptance of a detailed plan by the District Engineer or their designee will not relieve the Applicant of the responsibility for its
work. This written acceptance shall constitute authorization to the Applicant to proceed with the installation of the temporary
structure in accordance with the accepted plans. The Applicant shall remove the temporary structure after it no longer needs
the temporary structure and shall restore the bridge in a manner deemed acceptable to the Commonwealth. The installation of

permit.
 
the Applicant shall submit a written request to the Commonwealth. The Commonwealth will issue a letter signed by a duly
authorized Commonwealth representative specifying a new termination date, which letter shall become part of this permit and
operate as a supplement to it.
3. Actual road or lane closures are permitted only for the time required to set up staging, remove all staging or props and conduct

 






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SPECIAL EVENT PERMIT Processions, Assemblages and Special Activities, (City of Titusville Pennsylvania)

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Completed 9 February 2021

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