1 Special Event Appv.8.14.15
SpecialEventApplication
Thisapplicationistobecompletedbytheindividualorauthorizedrepresentativeoftheorganizationregulatingtheeventandrequesting
permit. Submissionofanapplicationdoesnotguaranteetheeventwillbeapproved. Donotpublicizeorpromoteyoureventuntilyour
notificationofacceptancehasbeenissued.
NameofEvent: Purpose:
Date(s)ofEvent:
EventStart/Endtime: 
Location(Facility/Park /Road):
(Parks‐includeParkName&
ShelterNumber)
SetupDate/Time&FinalWrapUp:
FacilityorShelterReserved: Yes No N/A
RainorShineEvent:
Yes
 No
 
ChoosePublicorPrivateEvent: PublicPrivate
ExpectedAttendance(includeCrew,Participants,Spectators)
Overall:
AtanyOneTime:
(Thissectio nisforusebyindividualsonly)
Name: Email:
Address: City: State/ZipCode:
DaytimePhone: Cell: FaxNo:
EventPointofContact: POC:Phone#
(Thissectio nisforusebyorganizationsregisteredwiththeStateofFloridaboth“ForProfitand“NonProfit”)
Company/OrganizationName:
CharityOrganization:YesNo
(Copyof501(c)3Required)
TaxExempt: YesNo
(FloridaExemptionCertificateRequired)
Address: City: State/ZipCode:
Email:
OrganizationWebsite:
AuthorizedRepresentativeandTitle PointofContactName
Name:
(ifdifferent):
DaytimePhone: CellNo: FaxNo:
EVENTINFORMATION
APPLICANT(Complete only one of the following sections)
INDIVIDUAL
COMPANY/ORGANIZATION
2 Special Event Appv.8.14.15
Hasthiseventbeenheldpreviously? YesNoIfyes,Date/Place/Attendance:
Pleaseselectallapplicableactivitiesand/orknownservicesforthiseventfromthechoicesbelow:
ActivityType Check Details
AnimalAct/Show

Beverage/Catering(withalcohol)

BicycleRacingEvent

BicycleRidingEvent

BlockParty

BoatingEvent

Camping(Adults)

Camping(Minors)

Catering(OnSitePrep)

CraftShow

Dance

Demonstration

EntertainmentMusicBand

EquipmentRentals

EquipmentTesting
EventPlanner
ExerciseClass

Fair(Art/Craft/Other)

FishingEvent/Tournament

Fundraising
GeneratorUsage
Lighting(external)

MediaAttendance

MotorsportEvent

OtherPublicEntityUsage

Parade

Picket(Organized)

Pyrotechnics

Rally

SalesBeverage/Food/Merchandise
SportingEvent(Organized)

Stage/Risers

TentUse(>10X10)

Track/Field(NOAThons)

UseofRoad/RightofWay

*ActivitiesareforadiverserangeofCountyownedfacilities.NotallactivitiesarepermittedinCountyparks.
OtherActivity(notmentionedabove):
EVENTACTIVITIES
3 Special Event Appv.8.14.15
Pleasecomplete thefollowingsectionof thisapplication. Provide as muchdetail as possible foractivities applicable
to your event. If any of the following sections do not apply to activities, services, or needs for your event, please
writeN/A(fornotapplicable).
DescribeyourplansforEntertainment.
Pleasenameallvendorswhowillprovide
entertainmentandthetypeofentertainment
provided. Entertainmentlocationsmustbe
shownonthesitemap.
Describeyourplansforparking.
Includeparkingplanfordisabled,vendors,
spectators,participants,media,etc. Avisualof
parkingmustbeshownonsitemap.
Describeyourplansforallsignage,and/or
decorationsfortheevent.
Pleaseincludetypeofsignagetobeused,and
descriptionofverbiagebeingpostedonthe
signage.
Signagemustalsobemarkedonsitemap.
Section 1
4 Special Event Appv.8.14.15
DescribeyourplansforWasteManagement.
Pleaseincludeplansfordisposalofvendor
waste,aswellasallotheraccumulatedwaste
product.
Namethecompanyselectedforwaste
management.
ProvidethenumberofpersonsyourEvent
Coordinatorhasdesignatedfordisposalof
wasteattheevent.
Describeyourplansforphysicalamenities.
Nameallvendorsbeingcontractedforphysical
amenityservices. Pleaseincludenumberof
waterstations,numberofportolets,hand
washingstations,oranyotheramenitiesusedto
keepattendeescomfortable.
Describeyourplansforemergencyservices.
Pleaseincludetheagencynameandcontact
informationforeachemergencyservice(EMS
andFire)youhaverequested.
5 Special Event Appv.8.14.15
Section 2
Provideasmuchdetailaspossibleforactivitiesapplicabletoyourevent.
DescribeyourplansforControllingIngress/
Egress.
Ingress/Egressisentryandexitofpersons,
vehicles,equipment. Pleasemarklocationson
thesitemap.
DescribeyourplansforVendor/Catererfood
preparation.
Includetypeoffoodandhowitwillbeprepared
onsite. Ifsmoking,orbarbecuingdescribe
methodfordisposalofflammablematerials.
Verifythecaterer/vendor hasavalid
food/beveragelicense. Furnishacopyofvendor
currentfood/beveragelicenseswiththis
application.
DescribeyourSecurity/LawEnforcementPlan.
Pleaseprovidecontactinformationforoffduty
lawenforcementagenciesusedfortheevent.
Includeofficercountandattendancetimes.
Placemarksonthesitemapwheresecuritywill
bestationed.Iffundswillbecollectedonsite,
explaintheprocesssecuringthemoney
collected. Ifequipmentwillbeonsite
overnight,providedetailsforpersonalproperty
safetyandsecurityofsite.
6 Special Event Appv.8.14.15
DescribeanyotherPublicEntityaccessthat
mayoccurduringtheevent.
IncludeusageofStreet/Road/Park,etc.If other
municipalitieswillbeaccessed,provideproofof
permitapplicationorapprovedpermit
from
eachsuchentity. Approvalpermitsfrom
all
othermunicipalitieswillneedtobefurnished to
theCountynolaterthan30dayspriortothe
event.
Describeinfull detailthepurposeofyour
demonstration/rally/assembly.
Provideinformationontimesandlocationsand
expectedattendance. Ifanytypeof
demonstrationotherthansignswillbeused,
pleasedescribeinfulldetail.
Describeinfulldetailanyotheractivitiesnot
previouslyaddressed.
Pleaseincludetheuseofanyexternallighting
sources,electrical/generatorusage,(both
vendorandapplicant),athleticactivity(non‐
organized),and/ortentusage.
7 Special Event Appv.8.14.15
Section 3
Provideasmuchdetailaspossibleforactivitiesapplicabletoyourevent.
DescribeStaging/StartFinishArea/Bleachers/
Equipment/Amusementsbeingused.
Includeband,vendor,supplier,setupandtear‐
downinformation,mediastaging,etc. Please
providedimensionsandlocationsonthesite
map.
DescribeyourneedforRoad/Street/Alley
closureanduseofsame.
Pleaseincludetheexactsectionrequestedfor
closurebynamingstreets/roads/avenue,etc.
fromnorthtosouth,theneasttowest.Then
providevisualonthesitemap.
Describeindetailyourorganizedathletic
activity.
Provideinformationonallactivities,whois
overseeingeachactivity,whowillreceivethe
proceedsfromtheactivityandwhy.
8 Special Event Appv.8.14.15
Describethepurposeofyourrequestfor
theuseofalcoholonCountyproperty.
Pleaseincludethetypeofbeverage(s),and
nameofthelocaldistributor. Namethe
organizationwhowillbeservingthe
beverage(s),andifabartendingserviceis
contracted,nametheindividualbartender.
Describethemethodofdistribution(walkup
tap,closedcanspurchase,barservice,etc.)
Providethestartandofficialclosetimesof
distribution,aswellasannouncementtimeof
“lastcall”.
Allpermitsforeventsinvolvingalcoholicbeverages
mustbepostedandvisibleduringtheentireevent.
TheApplicantNameontheSpecialEvent/Sp ecialuse
formmustbethesameasallotherappliedpermits.
Noexceptionswillbeallowed.
Describeinfulldetailanyotheractivitiesnot
previouslyaddressed.
Reminder:
Attachthefollowingdocumentsandsubmitwithyour application(Plans#13canbeprovidedonthesameplan):
1.
SITEPLAN
2.
PARKINGPLAN
3.
WASTEMANAGEMENTPLAN
4.
INSURANCECERTIFICATE(FORAPPLICANTANDALLCOMMERCIALVENDORS)
5.
REQUIREDPERMITSIFCURRENTLYAPPROVED
6. IFADDITIONALPAGESARENECESSARYTOEXPLAINTHEEVENT,PLEASEPROVIDEINADDITIONTOTHISAPPLICATION.
7. DOCUMENTATIONEVIDENCINGAUTHORITYTOSIGNONBEHALFOFYOURORGANIZATION.
ThankyouforcompletingthePinellasCountySpecialEventApplication. Submit applications to
specialevents@pinellascounty.org. PinellasCountywillreviewtheapplicationand contactyouwith
ourresponse,orrequestadditionalinformation. PleaseproceedtotheTermsofAgreement.
9 Special Event Appv.8.14.15
TERMSOFAGREEMENT
Astheapplicant,Iherebyacceptandunderstandtheresponsibilitytooverseeallcontractors,vendorsorpa rtiesaffiliatedwith
theeventandtoensurecompliancewithallpolicies,rulesandregulations,andguidelinesofPinellasCountyGovernment;
includingtherulesandregulationsofeachindividualdepartmentaspostedatwww.pinellascounty.org.
Thedutytodefend
underthisparagraphisindependentandseparatefromthedutytoindemnify,andthedutytodefendexistsregardlessofany
ultimateliabilityoftheapplicant,theCountyandanyindemnifiedparty.Thedutytodefendarisesimmediatelyupon
presentationofaclaimbyanypartyandwrittennoticeofsuch
claimbeingprovidedtotheapplicant.Iunderstandthatany
violationsmayresultinimmediatecancellationofthereservationand/orrevocati on ofthepermit. Iunderstandthepermitis
nontransferableandnonrefundable. Failuretoprovideallrequirementsandpaymentbytheduedatewillresultinno
issuance
ofapermitfortheevent. ThereareparkingfeesinplaceatFredHoward,FortDeSoto,andSandKeyParks. Parking
feesarealsoinplaceatboatramplocationsgovernedbyPinellasCountyParks&ConservationResources. Thesefeescannot
bewaived.
Basedupondetailsofthe
event,insurancerequirementsmaychangefromthebelowstatedrequirements. Youwillbenotified
ofanychangeintheserequirements.Acertificateofinsuranceasproofofinsuranceshallbesubmittedwiththisapplication.
Minimuminsurancerequirementsareasfollows:
CommercialGeneralLiabilityinsuranceincluding,butnotlimitedto,Bodily
Injury,PropertyDamage,andPersonalInjury.
Limits
GeneralAggregate $1,000,000
PersonalInjuryandAdvInjury $1,000,000
EachOccurrence $1,000,000
The term "County" or "Pinellas County" shall include all Authorities, Boards, Bureaus, Commissions, Divisions, Departments and
Constitutional offices of County and individual members, employees thereof in their official capacities, and/or while acting on
behalfofPinellasCounty.
Allpoliciesprovidingliabilitycoverage(s)tomeettherequirementsoftheAgreementshallbeendorsedtoincludePinellasCounty,a
politicalsubdivisionoftheStateofFloridaasanAdditionalInsured.AcopyoftheAdditionalInsuredendorsementmustbeprovided
withthecertificateofinsuranceasproofofcoverage.
Allpoliciesshallbewrittenonaprimary,non contributorybasis.
PinellasCountyreservestherighttorequestacop yofallinsurancepolicies.
InconsiderationofthisagreementtoallowuseoftheCounty’sproperty,theapplicantshallanddoesagreetoindemnify,
defend,paythecostofdefense,includingattorney’sfeesandholdharmlessPINELLASCOUNTYandallofitsofficers,agents, and
employeesfromallsuits,actionsorclaimsofanycharacter,
includingallcosts,attorney’sfees,expenses,damages, judgments,
ordecrees,broughtonaccountofany injuriesordamagesreceivedorsustainedbyanyperson,persons, participants,
spectators,orpropertyarisingoutoforinanywayattributabletotheholding,performance,operationor maintenanceofthe
eventhereinpermitted. This
dutyofdefenseandindemnificationsp ec ific al l yincludesanyandallalleged negligencebyPinellas
Countyasrelatedtotheevent,includingbutnotlimitedtotheissuanceofthispermit,supervisionof theevent,conditionsator
adjacenttothesite,road,sidewalk,trafficsigns/signalconditions,
prov ided,however,thattheapplicantshallhavetherightto
seekcontributionfromPinellasCount yforanyjudgment,settlement,ordecreerenderediftheCountyisfoundsolely
negligent.
IagreetotheTERMSOFAGREEMENTassetforthinthisapplication,andIagreetoabidebyallrulesandregulationsas
providedbyseparatedocumentwiththisapplicationsresponse. Theapplicantrepresentsandwarrantsthatithasthefull
rightandauthorityandhasobtainedallnecessaryapprovals
toenterintothisAgreement,thatthepersonexecutingthis
AgreementonbehalfoftheOrganizationisauthorizedtodoso,andthatthisAgreementconstitutesavalidandlegallybinding
obligationoftheApplicant,enforceableinaccordancewithitsterms.
Applicant/AuthorizedRepresentative: Signature:
PrintedName:
Date:
click to sign
signature
click to edit
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