HomeMy WebLinkAboutAPPLICATIONType of Event:
Public Concert _ Fair Festival _ Community vent
_ Parade _ Demonstration ther ,,,>1, lA&)^1� I� S
Motion Picture Grand Opening Other
I' A—y
Event Title: � I Ax SE At S�%��/ D/ S �� s
Event Location: %to /s E. P 2A i 0) (or /4--,'74..'?
Event Date(s): From:, ,. af2, 3 to Y/1V' (m'c'
sz
Actual Event Hours: Le-n'`/pii to am/pm
Total Anticipated Attendance: ,U/4 ( Participants Spectators)
Setup/assembly/construction Date:/4i/3 Start time: S Arry\
Please describe the scope of your setup/assembly work (specific details):
Dismantle Date: (f-! IS () Completion Time: am
List any street(s) requiring closure as a result of this event. Include street name(s), day
and time of closing and day and time of reopening.
Sponsoring Organization:
Chief Officer of Organization (Name) � 6 Pc 1
Applicant (Name): 126 G
Address: C is- 045,241, 'LJ, l o f
Daytime Phone: I9.) 473
Fax: ( ) E-Mail:
Contact Person "on site" day of the event:
Evening Phone: ( ) I ��
ar: (v N9 4 67- 387E
NOTE: THIS PERSON MUST BE IN ATTENDANCE FOR THE DURATION OF THE EVENT
AND IMMEDIATELY AVAILABLE TO CITY OFFICIALS
YES NDoes the event involve the sale or use of alcoholic beverages?
YES _ NO Will items or services be sold at the event? If yes, please describe:
YES V 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.
YES 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 Sizes NOTE: A
separate Fire Department permit is required for tents or canopies.
YES _ NO Will the event involve the use of the City or your stage or PA system?
SPECIFY:
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 intend to cook food in the event area please specify the method:
GAS ELECTRIC CHARCOAL OTHER (Specify):
Portable and/or Permanent Toilet Facilities
Number of portable toilets: (1 for every 250 people is required, unless the applicant can
show that there re facilities in the i mediate area available to the public during the event)
Tables # and Chairs #_
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
Scaffolding, bleachers, platforms, stages, grandstands or related structures
Vehicles and/or trailers
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
condition.) Number of trash cans: Trash containers with lids:
es c u ibe your plan for clean - and removal of waste and garbage during and aft the event:
F� tf- I -��
Please describe your procedures for both Crowd Control and Internal Security:
_ YES VNO 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:
4ES __ NO Is this a night event? If YES, please state how the event and surrounding area will
be i urinated to ensue safety ofthe participants and spectators;
Please indicate what arrangement you have made for providing First Aid Staffing and Equipment.
Please describe your Accessibility Plan for access at your event by individuals with disabilities:
Please provide a detailed description of your PARKING plan:
Please describe your plan for DISABLED PARKING:
t -e
Please describe yow Vans to notify all residents, businesses and churches impacted by the
event: 'Y\
NOTE: Neighborhood residents must be notified 72 hours in advance when events are
scheduled in the City parks.
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:
Number of Bands:
Type of Music:
YES _ NO Will sound amplification be used? If YES, please indicate: Start time:
am/pm Finish Time am/pm
YES " NO Will sound checks be conducted prior to the event? If YES, please indicate: Start
time: amlpm Finish Time am/pm
Please describe the sound equipment that will be used for your event:
YES _ NO Fireworks, rockets, or other pyrotechnics? If YES, please describe:
YES NO Any signs, banners, decorations, special lighting? If YES, please describe:
Revised 02/29/12
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 :ElS2,\ vr-7`
Person in Charge of Activity
Address ��r Pt 7 �. 9 r 1.2, Tel
Telephone rs �� Date(s) of Use tiff 13 — 411-51,3
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 opplicant Official Title Date
For Office Use Only
Certificate of Insurance Approved Date
(
G-441„jo
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