OAKLAND POLICE DEPARTMENT
Special Events Permit Application
TF-807-3 (Jul 10)
APPLICANT INFORMATION
Applicant Name Date of Birth Contact No. Alternate Contact No.
Applicant’s Address City Oakland Zip Code
EVENT INFORMATION
Date of Application Type of Event
Select one
Other Event (Describe)
Location/ Address of Event Date of Event Time/ Start-End
No. Persons Expected Persons Allowed
Select one
Ticket Sales
Select One
No. of Monitors/ Security Security Company Telephone No.
Type of Music
Select one
Other Music (Describe) Will food/drink be sold
Yes No
PERMIT INFORMATION
HAVE YOU EVER BEEN DENIED A PERMIT? Yes No
Applicant agrees to abide by Oakland Municipal Code Dance Hall Regulations, Section 5-4.03
HOLD HARMLESS AGREEMENT
The Special Event applicant or president of designee of the sponsoring organization(s) (hereafter called “permittee”)
agrees to reimburse the City of Oakland (hereafter called “City”) for all losses incurred by it in repairing or replacing
damage to City Property proximately caused by the permittee, its officers, employees, agents, monitors, or any other
persons or forming the special event, who were, or should have been, under the permittee’s control. Persons who merely
attend or join in a special event are not considered by that reason alone to be “under the control” of the permittee.
The permittee further agrees to defend without costs, indemnify, and hold harmless the City, its officers, agents, and
employees from any liability to any persons, damages, losses, or injuries arising out of or alleged to arise out of the
permitted special events, which was proximately caused by the actions of the permittee, its officers, employees, agents,
including monitors, or any other persons attending or joining in the special event who were, or reasonably should have
been under the control of the permittee. Persons who merely attend or join in a special event are not considered by that
reason alone to be “under the control” of the permittee.
I have read and I understand the Hold Harmless Agreement and I declare under penalty of perjury that the information
provided in this application is true and correct.
Permittee’s Signature ________________________________________ Date ________________
Police Overtime cost Attached: Yes No Application Fees Paid: Yes No
ABC Endorsement: Approved Denied
Verified By:
________________________________________ _____________
Special Events Personnel Serial No.
Pursuant to OMC §9.52.080, a Special Events Permit is conditionally approved in order for the applicant to obtain additional
required documentation.
_____________
__________________________________ ______________ ___________________
Signature of Special Events Coordinator Serial No. Date Signed
A Permit is Hereby Approved
Denied – Pursuant to OMC Section 9.52.090 Subsection (Select Appropriate Subsection)
_____________
__________________________________ ______________ ___________________
Signature of Chief of Police Designee Serial No. Date Signed
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