SPECIAL PERMIT APPLICATION
(Street Solicitation)
Page 2 of 2
Special Permit Conditions:
1. Application must be submitted at least 48 hours in advance of the request.
2. The applicant, at the time the application is submitted, must submit a statement that neither the
applicant’s chief administrative officer nor any person designated to solicit on behalf of the applicant
has, within three years or less from the date of filing of the application, ever been convicted in any
jurisdiction of embezzlement, larceny, or other crime involving the obtaining of money or property by
false pretences.
3. Prior to the issuance of the Permit, the applicant is required to provide proof that the entity has and
will maintain in full force and effect during the term of the Permit a policy of insurance covering
general liability and property damage in the amount of at least Five hundred Thousand Dollars
($500,000.00) per occurrence. The insurance must not have a deductible in excess of Two Hundred
and Fifty Dollars ($250.00) per occurrence. The policy must include the City as an additional insured,
and must specify that the insurance is primary over any insurance carried by the City. The insurance
policy must be issued by a company authorized to do business in Virginia.
4. The applicant agrees to attach to the application a list of all staff members and volunteers with their
date of birth that participate in the solicitation activities at the identified designated locations with the
City limits of Norfolk.
5. The applicant agrees not to use persons under age eighteen (18) years of age to solicit.
6. Applicant understands that permit shall not be issued for more than one (1) year, but may be renewed
every year.
7. Return completed application to:
DEPARTMENT OF PUBLIC WORKS
RIGHT-OF-WAY MANAGEMENT DIVISION
810 UNION STREET
ROOM 201, CITY HALL BUILDING
NORFOLK, VA 23510
PHONE: (757) 664-7306 FAX: (757) 664-4696
The Permittee, its agents, employees, officers, volunteers and assign assume all responsibility and
liability for any injury to persons or damage to public or private property caused directly or indirectly, by
the performance of permitted work under this permit. Furthermore, the Permittee has reviewed the
provisions of the City of Norfolk’s Street Soliciting Ordinance and agrees to abide by them, and
understands and agrees that it will be held liable and its permit will be subject to revocation for any action
in violation of said ordinance done on its behalf by its agents, employees, officers, volunteers or assigns.
Furthermore, the Permittee, its agents, employees, officers, volunteers and assignees agree to save and
hold harmless the City of Norfolk, its agents, employees and officers from any and all claims, demands,
actions, judgments, executions, damages or proceeding for any and all personal actions, judgments,
executions, damages or proceedings for any and all personal injury, and injuries to property, real or
personal, public or private caused by or arising out of directly or indirectly, from the performance of
permitted work.
I certify that the above information is accurate.
________________________________________________ ______________________
Authorized Representative, Title Date
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