Fillable Special Event Application Public Property ATTACHEMENTS CHECKLIST

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Special Event Application Public Property ATTACHEMENTS CHECKLIST

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Rev. 04/02/2020 1
CITY OF HICKORY SPECIAL EVENTS/ACTIVITIES APPLICATION
PUBLIC PROPERTY EVENTS
Submit to Planning & Development Permit Center
The purpose of this application is to provide information about your event or activity for various departments and
agencies to determine if they need to be involved in the approval and/or permitting process. City staff may contact you
with specific questions. Any City staff may require a pre-planning meeting with appropriate staff and the applicant. The
applicant is responsible for notifying the Planning & Development Permit Center of any changes to this application.
Incomplete applications will not be accepted. A complete and accurate application must include and meet the
following:
• Att
ached detailed site plan from a GIS or Google map
• Submitted at least 90 days prior to the planned event to allow for sufficient review time from staff, as well as
approval from City Council.
• Depending on the specific event, a permit application and/or fee(s) from individual departments may be required.
Eve
nt date availability:
• Applicant should contact permit center to verify date availability prior to submission of application
• Applications and events are prioritized based on a first come-first served basis.
• 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.
APPLICANT INFORMATION
Name of Event: _____________________________________________________________________________________
Applicant Name & Title: ______________________________________________________________________________
Organization: _______________________________________________________________________________________
Mailing (Billing) Address: _____________________________________________________________________________
City / State / Zip: ____________________________________________________________________________________
Daytime Phone: _________________ Cell: _________________ Email:_________________________________________
Description of the Event: _____________________________________________________________________________
__________________________________________________________________________________________________
APP
LICANT’S SIGNATURE ____________________________________________ DATE: _________________________
Event Address:
Date of Event: Rain Date (if applicable):
Event Start Time: Event End Time:
Set-Up Begins: Clean-Up Ends:
Preferred Date & Time of Inspection:
Estimated Attendance:
The Event is:
Private (by invitation only); Open to General Public; City brand partner/sponsored event
City of Hickory
PO Box 398
Hickory, NC 28603
Phone 828-323-7410
click to sign
signature
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Rev. 04/02/2020 2
TENTS & MEMBRANE STRUCTURES
POWER SOURCES
HAZARDOUS MATERIALS
Will there be any portable heaters?? Yes No
Will there be any deep fat fryers?? Yes No
Will the event have any hazardous materials such as propane, butane, gasoline, diesel tanks, helium cylinders, or
other upright tanks?
Yes No
If yes, all tanks must be secured in a manner to prevent accidentally being knocked over. All helium tanks not
being used shall have their caps in place.
Will there be any fireworks, lasers, torches, candles or pyrotechnics? Yes No
If yes, contact the Hickory Fire Department Division of Fire and Life Safety at (828) 323-7522 for more information.
MECHANICAL RIDES
** Tent is a structure, enclosure, or shelter, with or without sidewalls or drops **
Will tent(s) be used for the event? Yes No If so, number of tent(s) planned: _______________
Size of Tent(s) planned:________________________________________________________________
Percentage of side walls, if any, to be used for each tent: ______________________________________
Detail tent location, size, percentage of side walls and spacing for each on required site plan.
** Membrane structure is an air-inflated or air supported structure **
Will membrane(s) structures be used for the event? Yes No If so, number of membrane structures planned: ____
Size(s) air inflated/air supported membrane structures planned: ________________________________
Detail membrane structure location(s), size, and spacing for each on required site plan.
Will you use electric generators? Yes No If yes, will Power Distribution boxes be used? Yes No
Prov
ide contact information for contractor supplying generator power:
Name: __________________________Phone:_______________ Email:________________________
Will you use electric power from an existing structure? Yes No
If yes, will direct wiring to breakers be required? Yes No
Pro
vide contact information for person responsible for setup of power:
Name:___________________________Phone:_______________Email:________________________
Does the event include mechanical rides, or other similar attractions? Yes No
If yes, please describe attractions: ____________________________________________________________
Applicants contracting with amusement ride companies are required to provide the City of Hickory with a
certificate of insurance, naming the applicant and the City of Hickory (if applicable) as additional insured on general
liability. Please contact the NC Department of Labor to determine what requires inspection.
Rev. 04/02/2020 3
VOICE/MUSIC AMPLIFICATION
ALCOHOL
VENDORS
Are there any musical entertainment features related to your event? Yes No If no, proceed to next section.
If yes, state the number of bands and type of music: Number of bands: ____________
Type(s) of music: __________________________________________________________
______________________
Will a portable or temporary stage be utilized? Yes No
If yes*, state the number of portable or temporary stages: _______________________________________________
Will stage have canopy with frame that supports equipment (lighting, etc.)? Yes No
If yes* state the size of canopy: _________________________________________________________
Provide contact information for contractor providing stage:
Name:__________________________________Phone:__________________Email:______________________
______
*A Temporary Stage Certification Form must be completed for Catawba County Building Services*
Will your event have amplified sound? Yes No
If yes, indicate times: Start time: ___________ Finish time: ____________
Will alcoholic beverages be served? Yes No (If yes, NC ABC permit required.)
Will alcoholic beverages be sold? Yes No (If yes, NC ABC permit required.)
What type of alcohol will be served?
Draft Beer Can/Bottle Beer Wine Liquor
Who will be serving the alcohol? ____________________________________________________________________
Times for alcohol to be served: ______________________________________________________________________
Locations within event site where alcohol will be served: _________________________________________________
__________________________________________________________
__________________________________
Upon approval of this application, applicant will provide their North Carolina ABC permit to the Permit Center.
If the event will have food vendors, please check the following that apply:
Served Sold Free Catered Prepared Outdoors
Does the event include food concession and/or cooking areas? Yes No
If yes, please list each vendor. Use additional sheet, if necessary.
VENDOR
COOKING METHOD
(gas, electric, charcoal, other)
FOOD ITEM
Fire Code requires a fire extinguisher at each cooking location. Food and beverages shall not be sold at an event
unless approved and licensed, if necessary, by the Catawba County Health Department.
Event organizers are responsible for arranging health inspections for their events.
An applicant having any food service must contact the Catawba County Health Department
Rev. 04/02/2020 4
EVENT SCHEDULE
Provide a detailed schedule of the event, including dates and times for entertainment, activities, hours of event, start
time, finish time, etc. If the event requires an extended time frame for set-up, include details with a timeline listing
the times and locations where streets or public property will be impacted and when dismantling will be completed.
(Use additional sheet of paper if necessary)
CITY SERVICES
The
City of Hickory does not provide amenities such as portable washrooms,
sound systems, tables, chairs, tents, canopies, or other equipment.
TRASH AND RECYCLING PLAN
How many trash bins are you requesting for trash? ______________________________________________
How many recycle bins are you requesting? ___________________________________________________
Delivery Location? _______________________________________________________________________
Date and Time for trash or recycling bins to be emptied\picked up: _________________________________
Applicants are responsible for cleaning and restoring the site after the event. The cost of any employee overtime
incurred because of an applicant’s failure to clean and/or restore the site following the event will be paid for by the
applicant. If you reasonably believe that no litter will be generated during your event, please state this in your plan.
PUBLIC PROPERTY CLEAN-UP
Contracted personnel or volunteers may be used if indicated below. What is the clean-up plan for the
event? _________________________________________________________________________________
If City personnel are needed to assist with event site clean-up the applicant will be required to hire off Duty personnel.
If needed, please list preferred date and time for clean-up staff to arrive: ____________________________
Will any of the following services be used for the event:
Water Service Portable Toilet Services Public Electric Power
Wastewater Service Public Restrooms
DATE TIME ACTION ADDITIONAL NOTES
Rev. 04/02/2020 5
SPECIAL EVENTS CONE/BARRICADE REQUEST:
Number of Cones Requested? ________________ Number of Barricades Requested? __________________
Drop-off/pick-up Location? _________________________________________________________________
Drop-off Date and Time: ________________________Pick-up Date and Time: ________________________
Drop-off/pick-up Contact: __________________________________________________________________
Phone Number: ________________________ Email: ____________________________________________
Drop-off/pick-up contact MUST be present for drop-off and pick-up.
If the contact person changes from above, please notify Chelsey Brooks at (828) 323-7500 or email at
cbrooks@hickorync.gov. If a contact person is not present or cannot be reached at the drop-off time, cones/
barricades will NOT be left.
For events on Saturdays, Sundays, or holidays, cones/barricades are typically dropped off on the last business day
before the event and picked up on the first business day after the event. Business hours are Monday through Friday
7 a.m. – 3:30 p.m. If the Traffic Division needs to adjust the number of cones/barricades to be provided or the drop-
off/pick-up dates or times, the applicant will be contacted at the phone number or email provided above.
SAFETY AND SECURITY (CHECK TYPES OF SECURITY REQUESTED):
Beer/Alcohol Security Stage Security Event Area Security Gate Security
Road Closure Security Money Handling Security Other __________________________________
Overnight Security From ______: ______ To ______: ______
Dates & Times security will be on site: ________________________________________________________
Security provided by: ____________________________ Number of Security Personnel: ________________
Applicant may be required to hire sworn off-duty City of Hickory police officers to provide security to ensure public
safety. The Hickory Police Department will determine the number of security personnel required on site.
FIRE AND EMS STANDBY (CHECK TYPE OF SERVICES REQUESTED):
FIRE WATCH/STANDBY MEDICAL STANDBY
Dates requested: _________________________________________________________________________
Times requested: From _______:_______ To _______:_______
The City of Hickory Fire Department will determine the number of personnel and apparatus required on site. The
applicant will be required to pay standby fees, as outlined in the City of Hickory Fee Schedule, for all personnel and
apparatus standby at events.
SITE PLAN/MAP
A detailed map and site plan of the event from either GIS or Google Maps is required. Included in the event map (if
applicable):
• 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.
• Location of the event/activity on the property with approximate distances from roads, fire hydrants, existing
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.
• Identify location of all cooking devices and open flames.
• 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.
Rev. 04/02/2020 6
ATTACHMENT CHECKLIST
In addition to the Special Event Application form, the following supporting documents are required to complete your
application package and begin the review process:
All Events:
Detailed Site Plan from GIS or Google Maps
Parking Plan for participants and volunteers (May be included in site plan)
Volunteer Plan for events with an anticipated attendance of 100 participants or more (how many, their duties)
All Public Property Events:
Certificate of Insurance listing the City of Hickory as certificate holder and additional insured.
-Public
Property Event at a Public Park:
Events held at a public park must contact the Recreation and Sports Tourism Department to discuss event details and
gain approval from Recreation staff prior to submitting this application to the Permit Center. The Recreation and Sports
Tourism Department may be reached at (828) 322-7046 or mseaman@hickorync.gov
.
Email from the Recreation and Sports Tourism Department indicating approval of the event date.
-Public Property Event at the Airport:
Events held at the Hickory Regional Airport must contact the Airport to discuss event details and gain approval from the
Airport Director prior to submitting this application to the Permit Center. The Airport Director may be reached at (828)
323-7408 or tclark@hickorync.gov
.
Email from the Airport Director indicating approval of the event date.
-Public Property Event at LP Frans Stadium (Hickory Crawdads):
Events held at LP Frans Stadium must contact the Hickory Crawdads to discuss event details and gain approval from the
General Manager prior to submitting this application to the Permit Center. The Hickory Crawdads General Manager may
be reached at (828) 322-3000 or dlocascio@hickorycrawdads.com
.
Email from the Hickory Crawdads General Manager indicating approval of the event date.
-Waiver Request
I am requesting a waiver from the section which prohibits animals from special events on city property. I have
included the required safety plan with the application.
Rev. 04/02/2020 7
USE OF UNION SQUARE AND OTHER PUBLIC PLACES
** THIS SECTION IS ONLY TO BE COMPLETED IF REQUESTING TO HOLD AN EVENT ON UNION SQUARE
COMMON, STREETS ADJOINING THERETO OR OTHER PUBLIC PLACES AND PARKS **
RULES
REGULATING THE USE OF UNION SQUARE COMMON, STREETS ADJOINING
THERETO AND OTHER PUBLIC PLACES AND PARKS FOR SPECIAL EVENTS
• Special events may be held in one or more of the following areas:
o Union Square Common, north of the Norfolk-Southern Railway tracks, east of Third Street, NW, and
west of Second Street, NW.
o Streets adjoining Union Square, including Third Street, NW, between the Norfolk-Southern Railway
tracks and the northern margin of First Avenue, NW; First Avenue, NW between Third Street, NW and
Second Street, NW; Second Street, NW from the Norfolk-Southern Railway tracks to the northern
margin of First Avenue, NW; and Trade Alley.
o Any other public building, park or property owned or possessed by the City of Hickory which, by its
nature, is suitable for any certain special event that may be applied for, provided that said event
remains open to the public at large.
• The City Council reserves the right to reject any application as to the use of any area described above for any
special event. If the City Council learns that the event or vendors participating were misrepresented to the City
Council or that the event in any way fails to comply with the rules regulating the use of Union Square Common
or fails to comply with any applicable local, state, or federal laws, it reserves the right to rescind any approved
application up to and during the course of the event. In the case of a special event being held at a City-owned
facility for which a rental fee is usually charged, the normal rental fee shall be charged to the applicant unless
the City Council waives such rental.
• Application must be filed in the City Manager’s Office at least ninety (90) days prior to the time that the
applicant desires to first take possession of the area to prepare for the special event. The applicant for a special
event must be a non-profit organization, organized and existing for the purpose of either some charitable or
public benefit or for the promotion of business in the Downtown Area of Hickory. In addition, said non-profit
organization may at the request of the Council be required to produce evidence of their non-profit corporation
status as defined by state and federal laws. In addition, procedures to be used for selecting participants and
vendors must be included with the application.
• The applicant shall provide to the City Manager at least two (2) weeks prior to the beginning of the public
participation in the special event a list of all the vendors or others having booths or display tables during the
special event. No other persons may sell merchandise or operate any booth or display tables during the special
event, unless the applicant, in writing, requests the City Manager to amend such list accordingly and permission
is granted.
• No motor vehicles or other large equipment or manufactured items or livestock will be permitted within the
area unless they are clearly identified and described, and the proposed location is stated in the application and
specific approval is given.
• The size, type of construction and location of display tables and booths must be described generally in the
application; all construction must be safe and self-sustaining; no spikes or other holding devices may be driven
into the ground of any street, sidewalk or tied to any tree.
• When food preparation, painting and/or pottery -making activities or similar activities are held, appropriate
protective materials must be placed over any paved or brick areas for protection.
• No tents may be placed in the area without being described and exhibited to the Fire Prevention Inspectors of
the Hickory Fire Department and special approval by the City Council.
• Public address systems can be used only if specifically requested in the application and special permission given,
including limitations as to use.
Rev. 04/02/2020 8
• Sufficient portable toilets shall be provided for the expected number of participants.
• A first-aid station shall be provided, staffed by competent Emergency Medical Technicians, unless a waiver is
requested and granted by the City.
• The applicant shall be responsible for providing trash receptacles of the number and size as the city shall require
in order to eliminate litter.
• If the applicant desires to sell alcoholic beverages, it shall specifically so state in its application and shall provide
a sketch of the area where the same will be sold and consumed. The area shall be delineated by barricades, with
the entrance to be clearly marked and so constructed as to allow ready control of patrons, including viewing of
identification to avoid underage persons being within the barricaded area. Signs shall be posted stating that no
one shall leave the barricaded area with alcoholic beverages.
• Application must be made to proper State authorities for special permit for sale of alcoholic beverages. Special
permit shall be available for inspection by the City at any time.
• The applicant shall assume full liability for all accidents or claims of accidents as a result of activities taking place
at the special event and during the time the area is being readied for the event and while it is being cleaned up
following the event. A copy of the insurance policy must be submitted to the City Manager’s office prior to the
event. The policy is to be one of comprehensive general liability in the amount of not less the Three Hundred
Thousand Dollars ($300,000.00) for bodily injury per person and One Million Dollars ($1,000,000.00) per
occurrence, Three Million Dollars ($3,000,000) aggregate, and not less than One Hundred Thousand Dollars
(100,000.00) for property damage per occurrence. Policy holder must also list the City of Hickory as additional
insured.
• The applicant will be responsible for the security or protection of any articles, items, merchandise, display
tables, booths or other property owned by the applicant or others participating in the special event.
• Applicants must obtain any special use permits required by the Hickory Fire Inspector, must comply with all
applicable provisions of the North Carolina Fire Code and must at all times ensure that all fire lanes in the area
to be used remain unobstructed.
• Applicants must comply with all applicable Health Department regulations pertaining to the scheduled event.
• Applicants must comply with the requirements of the Hickory Sign Ordinance.
• Applications must comply with any and all local, state, and federal laws pertaining to equal opportunity and
should make every effort to make events accessible to the disabled public. In addition, applicants shall not deny
access or a vendor’s booth to any group based on national origin, race, religion, age, sex, or disability.
Rev. 04/02/2020 9
NAME OF NON-PROFIT ORGANIZATION
______________________________________________________________________________
BRI
EFLY DESCRIBE THE PURPOSE OF THE NON-PROFIT ORGANIZATION:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
LIST ORGANIZATIONS OFFICERS:
___________________________________________ ____________________________
TELEPHONE
___________________________________________ ____________________________
TELEPHONE
___________________________________________ ____________________________
TELEPHONE
CHAIRPERSON OF THE SPECIAL EVENT:
___________________________________________ ____________________________
NAME TELEPHONE
_____________________________________________________________________________________________
ADDRESS
The u
ndersigned Applicant is aware of the rules regulating the use of Union Square Common, streets adjoining thereto
and other public places and parks for special events, and will abide with the same; and further understands that the
City of Hickory will not be responsible for the security or protection of any articles, items, merchandise, display tables,
booths or other property owned by the applicant or others participating in the special event. The undersigned
Applicant agrees to reimburse the City of Hickory for the additional cost of providing police department and/or fire
department personnel to supervise the event, including services rendered both before, during and after the event
itself, to ensure the compliance with all laws and ordinance, to direct traffic and to promote the safety and welfare of
participants and other citizens.
__________
______________________________
President
________________________________________
Non-Profit Organization
___________________________________________
_________________________
Date
Approved by:
__________________________________
CITY MANAGER OR DESIGNEE
DATE
DAT
E APPROVED BY HICKORY CITY COUNCIL: _____________________________________________________________
Rev. 04/02/2020 10
NORTH CAROLINA
RELEASE AND INDEMNITY AGREEMENT
CATAWBA COUNTY
THIS RELEASE AND INDEMNITY AGREEMENT, entered into by THE CITY OF HICKORY, a North Carolina Municipal
Corporation, party of the first part, and the _____________________________________________________________, a
non-profit organization with its principal place of operation being _____________ County, North Carolina, party of the
second part:
W I T N E SS E T H
WHEREAS, the party of the first part is desirous of allowing the party of the second part to conduct a special
event within the City Limits of Hickory, North Carolina, pursuant to the
Hickory City Code; and
WHEREAS, the party of the second part is desirous of conducting a special event within the City Limits of
Hickory, North Carolina; and
WHEREAS, to this end, said party of the second part has heretofore filed with the City of Hickory an application
for approval of said event, and wishes to enter into this Release and Indemnity Agreement pursuant to the Hickory City
Code and the administrative rules of the City of Hickory;
NOW, THEREFORE, for and in consideration of the mutual promises and covenants herein contained, and for
other good and sufficient consideration, the receipt of which is hereby acknowledged, the parties agree as follows:
1. That the party of the second part hereby completely and unequivocally releases the party of the first
part, the officials of the party of the first part, and all employees of said party of the first part, and their
families, from any and all claims, damages, injuries or rights of action which the party of the second part
may incur by reason of the special event being conducted by the party of the second part.
2. That the party of the second part hereby agrees to indemnify and hold harmless the party of the first
part for any liability, injury or claim which may arise to the benefit of the party of the second part as a
result of the special event being conducted by the party of the second part.
3. That the parties to this Release and Indemnity Agreement stipulate and acknowledge that there exists
sufficient consideration for the execution of this instrument.
This the ___________ day of _____________________________, 20________.
________________________________
President
_____________________________
Witness
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Special Event Application Public Property ATTACHEMENTS CHECKLIST

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Completed 13 July 2020

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