Fillable Special Event Application (City of El Mirage)

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Special Event Application (City of El Mirage)

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U.S.A. forms for City of El Mirage

BROWSE CITY OF EL MIRAGE (AZ) FORMS

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Special Event Application
1 Revised September 2019
Please complete all information. Do not leave any spaces blank. Write N/A in spaces that do not pertain to your event.
Incomplete applications will not be processed. Applications for a one-time event involving no more than 50 people with no
sale of goods or services and conducted completely on private property may skip page 2, but require a site plan. Full
review typically requires 30 days. Applications submitted less than 30 days prior to an event may not be accepted.
1. Event Information
Name of Event:
Describe Event:
Date(s) of Set-up: Hour(s) of Set-up:
Date(s) of Event: Hour(s) of Event:
Location of Event/Street Address:
Please complete “FACILITY USE APPLICATION & PERMIT FORM” if the event is proposed in a City facility, see pages 6-7
Name of property owner where event is to be held (if private property, a letter authorizing use by the owner must be attached):
Will there be:
Live entertainment?
Yes
No
Description:
Any items or services sold?
Yes
No
Vendor Information:
Food Truck(s)
Yes
No
Quantity:
Description:
a Stage?
Yes
No
Quantity:
Dimensions:
Tents or Canopies?
Yes
No
Quantity:
Dimensions:
Open flames or cooking?
Yes
No
Explain:
Fireworks?
Yes
No
Temporary Fencing?
Yes
No
Dimensions:
Electric Generators?
Yes
No
Quantity:
kW Size:
Carnival/Amusements?
Yes
No
Quantity:
Spotlights?
Yes
No
Quantity:
Traffic Control Plan?
Yes
No
Fire Watch (Emergency Medical)
Yes
No
Private Security
Yes
No
Contact Information:
Description of any other activities at the event:
Do you plan to have alcohol at
the event?
Yes No
Will you need electrical
connections?
Yes No
2. Applicant Information
Contact Person and Organization Sponsoring the Event:
Address:
Phone #: Alternate Phone #:
Email Address: _______________
Special Event Application (cont.)
2 Revised September 2019
3. Parades, Motorcades, Running/Walking/Cycling/Skating Events
Assembly Area: Assembly Time:
Disassembly Area:____ Disassembly Time:
Number of Units:
Description of Units (vehicles, marching bands, pedestrians, animals, inflatables, floats, sound amplification, special effects)
Closure of Public Access – A separate plan indicating vehicle/pedestrian traffic control, detour routes, directional
signs, and
street closures must be submitted for the proposed closure of any streets, sidewalks, alleys, rights-of-way,
parking lots or any other
public access area. Please note: Street closures are primarily intended for parades, races, and
events which must take place within
the street. Signatures of affected residents may be required in residential areas, see page 5.
Parade or Race Routes – A separate plan indicating the proposed parade or race route, including assembly and
disassembly
areas, must be submitted with this application.
Business License - Any person, partnership, syndicate, firm, association, or corporation, before engaging in any of the
businesses, callings, or professions, hereinafter collectively called “business” or “businesses”, within the corporate limits
of the
city or who conducts a business outside the corporate limits of the city and who solicits, canvasses, advertises, or
delivers products
or performs services within the city limits shall procure from the Finance Department a license for the carrying on of the business,
upon payment of the license tax, as provided by the fee schedule adopted in the City Code.
If any of your activities meets the criteria identified above please contact the Finance Department or visit their website
at
http://www.elmirageaz.gov/343/Business-Licensing-Tax-Information to obtain the proper business license(s) for your
business(es).
4. Insurance
For events occurring on City-owned property or other major commercial events on private property, the applicant must
provide a
certificate of insurance for commercial general liability, auto liability, and liquor liability (if applicable) naming the
City of El
Mirage as additional insured. The certificate must indicate the dates, times, and location of event. The person
or organization listed
on the certificate must be the applicant. Please have your insurance provider address the certificate
to the attention of Parks and
Recreation, at least 15 days prior to the event date. The minimum limits are as follows:
$ 1,000,000 per occurrence
$ 2,000,000 aggregate
$ 1,000,000 automobile liability (or non-owned automobile liability)
$ 1,000,000 Liquor liability insurance
Additional limits may be required after review. Providing the above-listed insurance does not in any way reduce or
eliminate any
responsibility assumed under the indemnity agreement statement.
5. Site Plan
A bird’s eye view of the area indicating the location(s) of equipment and activities must be submitted with this application.
Please draw the plan or attach plans on 8-1/2” x11” or larger paper. The site plan should include all items that apply:
- Dimensions of the site (in feet)
- Carnival or amusement rides
- Existing or temporary water service
- Controlled access or admission areas
- Parking spaces for participants
- Trash &/or recycling receptacles
- Merchandise/Food/Service vendors
- Activity & amusement areas
- Existing and/or temporary fencing
- Open flames/Cooking/Eating areas
- Transportation transfer areas
- Emergency access and fire lanes
- Tents/canopies or other structures
- Electrical service or generators
- Liquor distribution & control areas
- Permanent and/or portable restrooms
- Electrical cord layout and protection
- In and out access to the property
Special Event Application (cont.)
3 Revised September 2019
- First aid/Emergency/Security stations
- Stage & amplified sound equipment
- Handicap parking & access areas
6. Certification
Applicant agrees to hold the City of El Mirage harmless and will indemnify the City of El Mirage for damages sustained as
a result of
an injury or property damage for which the City of El Mirage may be held responsible, resulting from the event
identified in this
agreement for the use of City property. I have read and understand all of the attached policies and will
abide by all policies, rules,
regulations, and conditions of use as written. I understand that the special event permit is not
transferable to any other individual or
group.
Applicant’s Signature: Date:
7. Department Approval
Approval of the application does not constitute final approval for the event. Final approval will depend upon an inspection of the
event set up prior to opening to the public. It is the applicant’s responsibility to comply with the requirements for each City division:
Building Safety, Fire, Police, Public Works, and Zoning.
YES
NO
Date:
Building Official (or designee)
YES
NO
Date:
Fire Chief (or designee)
YES
NO
Date:
Police Chief (or designee)
YES
NO
Date:
Public Works Director (or designee)
YES
NO
Date:
Zoning Administrator (or designee)
For OFFICIAL USE only:
8. Follow-Up Instructions: _______________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
4 Revised July 2020
Special Event Fees
___
Special Event Permit Processing Fee
$ 25.00
Minor (No Street/Parking Lot Closure)
$ 50.00
Major (Street/Parking Lot Closure)
___
Special Event Business License
$ 65.00
/event
___
Temporary Membrane Structure &
Canopies (Tent Permit)
$ 340.00
<800 sq. ft. and $150.00 each add'l
$ 600.00
>800 sq. ft. and $150.00 each add'l
___
Carnivals & Fairs
$ 320.00
/submittal
___
Exhibits & Trade Shows
$ 250.00
1-5k sq. ft
$ 325.00
>5k sq. ft.
___
Amusement Building
$ 250.00
Permanent Structure
$ 380.00
Temporary Structure
___
Fire Inspection (After Hours)
$ 100.00
(Min. 2 hours) / request
___
Pyrotechnics/Fire Works Performance
$ 600.00
First display and $300.00 each add'l display
___
Fireworks Temporary Retail Sales
$ 195.00
/submittal
___
Fire Watch
$ 150.00
+ $32.00/ hr per # of personnel
___
Emergency Medical Standby
TOTAL $ __________________
___ Facility/Field Fees $ __________________
$ 150.00
+ $32.00/ hr per # of personnel
*
Mobile Food Vendor - Grease Producing Operation
(to be obtained by each mobile food vendor)
*
$50.00 Annually
(unless able to produce proof of passed fire inspection
conducted by fire department within the state within
the preceding twelve months.)
5 Revised September 2019
SPECIAL EVENT
CLOSURE OF PUBLIC ACCESS
Property Owner Signatures
Name of Event: ___________________________________________________________________________
Event Address: ___________________________________________________________________________
City: ________________________________, State: __________________ Zip: ___________
Time of Event
Start Time: ___________ am/pm End Time: __________ am/pm
(Include set-up & breakdown time)
Applicant (Name): _________________________________________________________________________
(Please print)
A
pplicant (Signature): ______________________________________________, Date: __________________
NAM
E ADDRESS
Corresponding map attached of area to be blocked.
V
erified by: __________________________________________ Date: _________________
Community Development Department / Planning & Zoning
FACILITY USE APPLICATION & PERMIT FORM
All requests for use of facilities must first be approved by the City at least 48 hours in advance
A COPY OF YOUR CERTIFICATE OF INSURANCE MUST ACCOMPANY THIS APPLICATION
City of El Mirage - Customer Service - 14406 N Alto St., El Mirage, AZ 85335
Date(s)
Requested
One-time use
Date:
Day:
Multiple dates use (List each date):
Time
Requested
Day:
Su
M
Tu W
Th F
Sa
Start time:
a.m.
p.m.
End time:
a.m.
p.m.
Ramada 1 Ramada 2
Ramada 3
Facility Requested
(Location: i.e., Gateway Park)
Ramada 4 Ramada 5 Ramada 6
Area Requested
(ie, Field #1)
Equipment Requested
Scoreboard
Base
Tables
#
Chairs
#
Other:
Set-up Requested
Classroom Theater Hollow Square
U-Shape
Conference
Other:
Special Instructions
Does activity service
El Mirage
Residents
Yes
# of Residents
Served:
Participant
Discount to
Fee: $
Residents
Request for Waiver of
Fees (Attach)
Any governmental or non-profit agency may request a waiver of fees for facility use. If requesting a waiver of fees, please include a
narrative explaining why the City of El Mirage should grant your request and how both the City and its residents will directly benefit from
the planned event. Upon review by the City Manager, a city representative will contact the applicant regarding the approval or denial.
Name of Organization
Designation
Non-profit
Profit
Commercial Government
Nature of Activity
Applicant Responsible
(Please Print)
Telephone
Work
Cell
Home
Mailing Address
City
Zip
Thank you for choosing the City of El Mirage for your rental needs. Your patronage is valued and your rental is important. Should you have any comments, questions or
concerns please phone (623)
935-6405, Monday through Friday, between 7:00am and 3:00pm. In the event that you incur a problem after 3pm on weekends and holidays,
please phone (623) 933-1341 and the Police Dispatcher will contact the appropriate personnel to assist you.
Indemnification: The applicant and organization identified above hereby
agree to indemnify, defend and hold harmless the City of El Mirage, and its employees, officers,
elected officials, agents and anyone acting on or for its behalf (hereinafter collectively "City”) from any and all liability, loss, claims, demands, litigation, causes of action,
court costs, attorneys’ fees and other expenses arising from or related to any loss, damage or injury (including death) to person or property in any way resulting from,
arising out of or alleged to result from or arise out of the use of the City of El Mirage facility(ies) by me, the above identified organization or any persons invited o
r
permitted by me or the organization to use the facility(ies), whether or not such loss, damage or injury is attribut
able, or alleged to be attributable, to the negligence of
others, including the City.
Assumption of Risk and Release: I and the organization know the risks and dangers, from both known risks and unanticipated risky, of usi
ng t
he facility(ies) described
above in the manner specified, and do so voluntarily and in reliance upon our own judgment and ability, not upon the property, equipment, facilities and existing conditions
furnished by others, including the City. As consideration for being permit
ted to use the facility, I and organization, on behalf of ourselves and those whom we invite or
permit to use the facility(ies), assume all risk of liability, and
agree to release and waive the City of El Mirage of liability, for any loss, damage or injury (including
death) to person or property from any cause whatsoever, whether or not attributable to the negligence of others including the City of El Mirage, arising out of the use
of the facility in the manner set forth above and during the dates and times specified. This Assumption of Risk and Release shall also apply to any minor under 18 years
of age whom we may bring or allow participating in any event or activity in, on or at the facility.
Signature of Applicant
Date
No
6
R
evised September 2019
Gateway Park
click to sign
signature
click to edit
7
Revised September 2019
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Special Event Application (City of El Mirage)

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Completed 3 August 2020

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