HomeMy WebLinkAboutTUPType of Event:
_ Public Concert
Parade
_ Motion Picture
Event Title:
Actual Event Hours:4•,OC) am/ to 1 .0 6 ame
Setup/assembly/construction Date: 02
Fair
_ Demonstration
_ Grand Opening
X. Festival
Community Event
Circus Block Party
Other66d �tv>
lnuul T&�re Viama1 C
Event Location: bra.. 4)1T @V1f-$.Q. , t+ `1' "' : , 4 192
Event Date(s): From 05 • + i to Orlon 1tI Total Anticipated Attendance: 30c�
M.nth/Day/Yea ( 50 Participants)
(Z60 Spectators)
Start time:
Please describe the scope of your setup/assembly
work (specific details):
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Dismantle Date: OS`ZSu411 Completion Time: Q1.3
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List any street(s) requiring closure as a result of this event. Include street name(s), day and
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Sponsoring Organization:( 1 �,�( Cry For Profit
)( Not -for -Profit
Chief Officer of Organization (Name) "IkV AA1;1,9 L: !Y
Applicant (Name): Q101\M" L.Ikuil(van
Address: `1�\ \��j`(1 UhA lLC\YNa.! VL , 11c0
Daytime Phone: a) q�1 0,-syk Evening Phone: (t3)Fax: () (Mi
Contact Person "on site" day of the event: %c.
Pager/Cellular:(tIkelt)
NOTE: THIS PERSON MUST BE IN ATTENDANCE FOR THE DURATION OF THE EVENT
AND IMMEDIATELY AVAILABLE TO CITY OFFICIALS
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Is your organization a "Tax Exempt, nonprofit" organization? YES _ NO
Are admission, entry, vendor or participant fees required? YES _ NO
If YES, please explain the purpose and provide amount(s):�a QJ' rQZ k tSr T5�4t Q111 J
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$ 1 , 6z6 Estimated Gross Receipts including ticket, product and sponsorship sales from
this event.
$ �� 6 66 Estimated Expenses for this event.
What is the projected amount of revenue that the Nonprofit Organization will
receive as a result of this event?
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Please provide a DETAILED DESCRIPTION of your event. Include details regarding any
components of your event such as the use of vehicles, animals, rides or any other pertinent
informa ion abou the event.
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YES
NO If the event involves the sale of cars, will the cars come exclusively from
National City car dealers? If NO, list any additional dealers involved in the
sale: I I 1
2
YES % NO Does the event involve the sale or use of alcoholic beverages?
_ YES X NO Will items or services be sold at the event? If yes, please describe:
_ YES /A NO Does the event involve a moving route of any kind along streets, sidewalks or
highways? If YES, attach a detailed map of your proposed route indicate the
direction of travel, and provide a written narrative to explain your route.
XYES _ NO Does the event involve a fixed venue site? If YES, attach a detailed site map
� ( showing all streets impacted by the event.
' ` YES _ NO Does the event involve the use of tents or canopies? If YES:
Number of tent/canopies Cc} Sizes (b )( (Q
NOTE: A separate Fire Department permit is required for tents or canopies.
K_ YES _ NO Will the event involve the use of th ity stalDorET system)
In addition to the route map required above, please attach a diagram showing the overall layout
and set-up locations for the following items:
➢ Alcoholic and Nonalcoholic Concession and/or Beer Garden areas.
➢ Food Concession and/or Food Preparation areas
Please describe how food will be served at the event:
If you inteng to cook food in the event area please specify the method:—
GAS ELECTRIC CHARCOAL OTHER (Specify):i�i
O➢ Portable and/or Permanent Toilet Facilities
Number of portable toilets: 2, (1 for every 250 people is required, unless the
applicant can show that there are facilities in the immediate area available to the public
during the event)
Tables and Chairs (i-Fd0 Z cha irs ?DJ( tomlk 21r-a-T% �z 1 -(-ot(01) a iC6l1-s.)
Fencing, barriers and/or barricades
Generator locations and/or source of electricity
Canopies or tent locations (include tent/canopy dimensions)
Booths, exhibits, displays or enclosures (741 bl1,8j
Scaffolding, bleachers, platforms, s ges, g andstands or related structures
Vehicles and/or trailers [.CAA\S Sr i 113\4d)
Other related event components not covered above
Trash containers and dumpsters
(Note: You must properly dispose of waste and garbage throughout the term of your
event and immediately upon conclusion of the event the area must be returned to a clean
co
ndition.) Number
t 1 TT `
Number of trash cans: '1'V Trash containers with lids: Z dJ�
Describe your plan for clean-up and removal of waste and garbage during and after the event:
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Please describe your procedures for both Crowd Control and Internal Security:
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YES
NO Have you hired any Professional Security organization to handle security
arrangements for this event? If YES, please list:
Security Organization:
Security Organization Address:
Security Director (Name):
Phone:
YES _ NO Is this a night event? If YES, please state how the event and surrounding area
, ill be illuminate to ensur ety of th particip is nd •ec tors:
Please indicate what arrannement you h ve made forrproviding First Aid Staffing and Equip ent.
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Please describe your Accessibility Plan for access at your event by individuals with disabilities:
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Tc!) pro de a detailed description of your P KI G pl n:
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ease describe your plan for DISABLED PARKING:
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Please describe your plans to notify all residents, businesses and churches impacted by the
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NOTE: Neighborhood residents must be notified 72 hours in advance when events are
scheduled in the City parks.
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YES NO
Are there any musical entertainment features related to your event? If YES,
please state the number of stages, number of bands and type of music.
Number of Stages: 0 Number of Bands: 2
Type of Music: UonostV, e1 T\ l U '\- y1 ,Q11.
YES NO Will sound amplification be used? If YES, please indicate:
Start time: `i % 00
amFinish Time `i '\ 06 am.X._ �m
YES _ NO Will sound checks be conducted prior to the event? If YES, please indicate:
Start time: c> :00 am/' Finish Time 3 , SO ame
Please describe the sound equipment that will be used for your event:
AN t LU
_ YES NO Fireworks, rockets, or other pyrotechnics? If YES, please describe:
X__ YES _ NO Any signs, banners, decorations, special lighting? If YES, please describe:
Revised 08/10/05
--\11 QM -601A:
5
Event:
,for Office 'Use Only
Department Date
Approved? Yes No Initial
Specific Conditions of Approval
Council Meeting Date:
Approved: Yes No
Vote:
Kathleen Trees, Director
Building & Safety Department
6
City of National City
PUBLIC PROPERTY USE HOLD HARMLESS AND
INDEMNIFICATION AGREEMENT
Persons requesting use of City property, facilities or personnel are required to
provide a minimum of $1,000,000 combined single limit insurance for bodily
injury and property damage which includes the City, its officials, agents and
employees named as additional insured and to sign the Hold Harmless
Agreement. Certificate of insurance must be attached to this permit.
Organization 4'.1-Mal (1\144y e ThU
Person in Charge of Activity ` (ICWIl,\\1 L.�
Address R6\ 1ViIr A`V 1it;A�� 1_1(6
Telephone 6\96-11-1-133" 1 Date(s) of Use -Ran 14 ( 1 0i1 y
Uu tbt9)Vo-VA
HOLD HARMLESS AGREEMENT
As a condition of the issuance of a temporary use permit to conduct its activities
on public or private property, the undersigned hereby agree(s) to defend,
indemnify and hold harmless the City of National City and the Parking Authority
and its officers, employees and agents from and against any and all claims,
demands, costs, losses, liability or, for any personal injury, death or property
damage, or both, or any litigation and other liability, including attorneys fees and
the costs of litigation, arising out of or related to the use of public property or the
activity taken under the permit by the permittee or its agents, employees or
contractors.
Signature of Applicant
Official Title Date
For Office Use Only
Certificate of Insurance Approved Date
7
REQUEST FOR A
WAIVEROF FEES
Non-profit organizations, which meet the criteria on page v of the instructions, will
be considered for a waiver. If you would like to request a waiver of the
processing fees, please complete the questionnaire below.
1. Is the event for which the TUP is sought sponsored by a non-profit
organization?
Yes (proceed to Question 2)
No (Please sign the form and submit it with the TUP
Application)
2. Please state the name and type of organization sponsoring the event
for which the TUP is sought and then proceed to Question 3.
Name of the sponsoring orga i tion
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p.
Type of Organization bUl.0.3 ,''(t j QrUY\\)111-Frieli.
(Service Club, Church, Social Service Agency, etc.) J
3. Will the event generate net income or proceeds t the sponsoring
organization?
Yes (Please proceed to Question 4)
No (Please sign the form and submit it with the TUP
Application)
4. Will the proceeds provide a direct financial benefit to an individual
who resides in or is employed in the city, and who is in dire financial
need due to health reasons or a death in the family?
Yes (Please provide an explanation and details.
No (Please proceed to Question 5)
8
5. Will the proceeds provide a direct financial benefit to city
government such as the generation of sales tax?
Yes lease pro ide a e planation and details.
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LAMA 1\1
No (Please proceed to Question 6)
6. Will the proceeds provide a direct financial benefit to a service club,
social services agency, or other secular non-profit organization
located within the city such as Kiwanis, Rotary, Lions, Boys and
Girls Club?
Yes (Ple�se pr�ie_,ta-n exp�n tion and details.
i1Wil )X Q ��S 01,\ MORS
No (Please proceed to Question 7)
7. Will the proceeds provide a direct financial benefit to an
organization, which has been the direct recipient of Community
Development Block Grant (CDBG) funding?
Yes Year funds were received:
Funds were used to:
No (P lease sign the form and submit it with the TUP
Application)
Signature Date
9