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HomeMy WebLinkAbout11-72FEBRARY 22, 2011 11 -72 RESOLUTION (CARRIED 6 -0 LOST LAID OVER WITHDRAWN ) PURPOSE: APPROVAL OF SPECIAL EVENT / THE BOAT DOC — MERCURY MARINE —TRITON BOATS / UTILIZE MENOMINEE PARK FOR THE BOAT DOC WALLEYE INVITATION (FISHING TOURNAMENTS) / MAY 15 & 29, 2011, JUNE 26, 2011 & JULY 10, 2011 INITIATED BY: CITY ADMINISTRATION NOW, THEREFORE, BE IT RESOLVED by the Common Council of the City of Oshkosh that approval is granted to The Boat Doc, Mercury Marine & Triton Boats (Josh Wiesner) to utilize Menominee Park (Miller's Bay & Parking Lot), on Sunday, May 15, 2011, from 7:00 a.m. to 5:00 p.m.; Sunday, May 29, 2011, from 7:00 a.m. to 5:00 p.m.; Sunday, June 26, 2011, from 7:00 a.m. to 5:00 p.m. and Sunday, July 10, 2011, from 7:00 a.m. to 5:00 p.m. for their Boat Doc Walleye Invitation (fishing tournaments), in accordance with the municipal code and the attached application, with the following exceptions /conditions: BE IT FURTHER RESOLVED that as a condition of approval, the Event Organizer shall pay the City's actual costs for extraordinary services. Cost Estimates for Extraordinary Services Parks Department -- Electrical / power usage — preliminary estimate — unknown at this time APPLICATION FOR SPECIAL EVENT PERMIT – TO BE RETURNED TO CITY CLERK GENERAL EVENT INFORMATION Official Name of Special Event: Start Date: �! % End Date: .� Briefly describe your event. Be sure to include the purpose of the event and all EVENT DATE SUN MON TUE WED THUR FRI SAT SETUP TIME START TIME STOP TIME TEAR DOWN / CLEAN UP COMPLETED /,`?rl Location of Event: Estimated Attendance (daily & total): r Number of Booths: Organize on s) Sponsoring Event: d. — Alm _ &44,4 , � (includ i>I. - :FjjA j 5 JAN 03201! APPLICATION FOR SPECIAL EVENT PERMIT - TO BE RETURNED TO CITY CLERK Primary Contact: b 1 Daytime Telephone: ` Cell Phone: a ` Fax: L ,2 w - 717Y Emai iAia a ate' Address: City: __ Secondary Contact: Daytime Telephone: Cell Phone: Fax: Email: Address: City: _ State: Onsite Primary Contact: 5N!n&e ra.S 0-a-' Cell phone: Fax: Email: Address: City: _ Onsite Secondary Contact: Cell phone: Fax: Email: State: Zip Code: Zip Code: Address: City: _ State: Zip Code: NOTE Either the primary or secondary onsite contact must be present onsite at all times during the event. APPLICATION FOR SPECIAL EVENT PERMIT— TO BE RETURNED TO CITY CLERK SPECIAL EVENT CHECKLIST (please check all boxes that apply) Is Your event a: ❑ Festival / Music Concert • Religious / Educational • Rally / Memorial • Street / Block Party ❑ Parade I Fun Run / Walk- a -Thon • March utilizing any Public Property • Public Assembly for Political Purpose �c Sport Tournament (Fishing, Soccer, etc.) ❑ Other Location of event: ,' Park or other public property o Public street, sidewalk, alley, or right of way ❑ Private property Will you have ❑ Alcoholic beverages (Additional permit required from City Clerk) ❑ Food & non - alcoholic beverages (Additional permit required from Health Dept.) ❑ Non -food related sales and /or display booths (No additional permits required) Tent and/or Canopy pe%; y (Additional permit required from Inspections Dept.) (Digger's Hotline must be contacted minimum of 3 days before digging) Generator(s) and /or additional electrical facilities (Additional permit required from Inspections Dept.) ❑ Fires or Candles (Additional permit required from Fire Dept.) ❑ Fireworks (Additional permit required from Fire Dept.) ❑ Activities in a park outside of normal operating hours (Waiver required from City Council) ❑ Barricades (Approval from City Clerk's office if in right of way) APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNED TO CITY CLERK Amplified Sound ❑ Animals included or allowed in event (animals must be licensed and have proof of vaccination) ❑ Cooking Equipment (Fire Department approval required) We have made arrangements for • Restroom and hand washing facilities • Solid waste and recycling services • Event insurance • Public safety & security / EMS services ❑ Electricity / Generators ❑ Fire extinguishers Advertising with banners or signs • Drinking water • Grey water and grease removal • Weather contingencies • LP Gas • Tent Heating Space Intentionally Left Blank APPLICATION FOR SPECIAL EVENT PERMIT - TO BE RETURNED TO CITY CLERK Special Event Public Safety and Security Plan Name of Event: 1 L &%* `I)" U),I Location of Event: ��flY�nnu��GyCc�1G Date of Event: Time the Event is to Open: 6 2 18 Sponsor of the Event: X24- lY— - fn, le_ iV-/ ftfj�� Estimated Attendance (daily and total): �d Emergency Contact Information: Name: h 1 Yl� Daytime Phone Number: 20 Cell Number: �) t - 5 Name: Daytime Phone Number: Cell Number: Name: Daytime Phone Number: Cell Number: Primary Location of Event Staff at Event Site: JJIJ�C/r ,3ex Y Emergency Notification of the Public The public will be notified of safety and /or security issues in the following manner: APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNED TO CITY CLERK Emergency Medical Services Name of Provider: d Contact Person / Telephone Number: Location of Provider at Event Site: Fire Protection Name of Provider: 7 0 Contact Person / Telephone Number: Location of Provider at Event Site: Number of Fire Extinguishers: Location of fire access roads: Security Name of Provider: d Contact Person / Telephone Number: Location of Provider at Event Site: Location of Missing Persons Station: Event Parking Locations: APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNED TO CITY CLERK Other Provide any other information that you feel should be considered Yes No 7 -( 1 have reviewed and have considered the Contingency Plan information provided by the City of Oshkosh along with this application (pages 11, 12) 1 have reviewed and understand the City's Insurance requirements for Special Events as described in this document (pages 13, 14, and 15) I am enclosing the event's Public Safety Site Plan (see page 9) I am enclosing other information that I believe is necessary or helpful to describe the planned event SIGNATURE I am allowed to sign this application on behalf of the event sponsor. The information contained in this application for a Special Event permit is true, correct, and complete to the best of my knowledge. If there are any changes to the Special Event, I agree that I will promptly notify the City of Oshkosh of these changes and request approval of them. Date (print name) (print title with organization) SPECIAL EVENT INDEMNIFICATION AND HOLD HARMLESS AGREEMENT (Medium and High Risk Events) EVENT: ORGANIZER: The event organizer agrees that it, and not the City, will be solely responsible for all incidents related to the event. This responsibility of the organizer to the City includes but is not limited to the actions of the event organizer, its officers, employees, agents, and volunteers, along with event vendors, contractors, subcontractors, participants, and visitors. In consideration for the City's approval of the Special Event, � p 0 J zS hC� � , the organizer of this event agrees to indemnify and hold harmless the City of Oshkosh, and its officers, council members, agents, employees, and authorized volunteers, from, for, and against and agrees to defend the same from and against, any and all suits, claims, grievances, damages, costs, expenses, judgments and /or liabilities, including costs of defense and reasonable attorneys fees, and further agrees to pay any settlement entered into or on behalf of, or judgment entered against, the foregoing individuals and /or entities. The event organizer shall abide by the City's insurance requirements for the event, including the addition of the City of Oshkosh, and its officers, council members, agents, employees, and authorized volunteers as additional insured's for the event. The individual(s) signing this agreement has the authority to enter into this agreement on behalf of the organizer(s) of the Special Event. EVENT ORGANIZER (print name of organizer) (date) (signature) (title) _ / 'Ax ` o u jt 'sAy 1�1/�U' (print name) (print title) (date) (signature) (title) (print name) (print title) Print - Maps Bing Maps ! My Notes ;a FREE! Use Bing 411 to find monies, businesses & more; 800-BING -411 Page 1 of 1 I I I • - -- /--- -- -- /.- . -:-4- ii Mlti 1 /7R /x(11() Bird's eye view maps can't be printed, so another map view has been substituted. Print - Maps Bing Maps My Notes t- FREE! Use Bing 411 to find movies, businesses & more; 800 -BING -411 Page 1 of 1 Bird's eye view maps can't be printed, so another map view has been substituted. APPLICATION FOR SPECIAL EVENT PERMIT - TO BE RETURNED TO CITY CLERK Severe Weather Contingency Shelter Locations: Have you confirmed that the locations will be open and available? Who will deterD;�Pe if your event is canceled or held? Phone number: t ) Dsh W ) CSi'ldl `' 30 q 1 ) y�) W -< Public Safety Site Plan Provide a schematic drawing of the event site location. The drawing must be legible and drawn to scale. The public safety plan must include the following items if they will be provided, or if they are required. 1. Location of booths, stages, and event structures 2. Location of first aid stations 3. Location of information / ticket booths 4. Boundaries of the event 5. Location of fences 6. Location of exits and gates (gates must be numbered) 7. Location of Fire extinguishers 8. Location of severe weather shelters 9. Location of Fire / EMS access road 10. Location of security staff 11. Location of emergency contact event personnel 12. Location of assembly area and approximate occupant amounts 13. Location of event parking 14. Location of barricades 15. Location of generators 16. Location of temporary roadways APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNED TO CITY CLERK GENERAL EVENT INFORMATION Official Name of Special Event: \ T� l�xz� 1 JD Wo Ih yL, ' T/1 t,>i Start Date: -- _�'-� End Date: Briefly describe your event. Be sure to include the purpose of the event and all ninnnarl nntivitiPc EVENT DATE SUN MON TUE WED THUR FRI SAT SETUP TIME 6 , START TIME STOP TIME TEAR DOWN /CLEAN UP COMPLETED Location of Event: Estimated Attendance (daily & total): %( Number of Booths: Organize Sponsoring Event: JAN O 201 (includ APPLICATION FOR SPE Primary Contact: —)D Daytime Telephone: Cell Phone: ) Fax: 20 - 26 - 5 7 Email: )",/ —* 10 Address: City: � Secondary Contact: Daytime Telephone: Cell Phone: r de. S� State: LAI Fax: Email: Address: City: _ State: Onsite Primary Contact: 3001K, aS GL6nJt, Cell phone: Fax: Email: Address: City: _ Onsite Secondary Contact: Cell phone: Fax: Email: Address: City: _ State: Zip Code: Zip Code: Zip Code: CIAL EVENT PERMIT — TO BE RETURNED TO CITY CLERK y � � 1v)a, CeaM State: Zip Code: NOTE Either the primary or secondary onsite contact must be present onsite at all times during the event. APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNED TO CITY CLERK SPECIAL EVENT CHECKLIST (please check all boxes that apply) Is your event a: • Festival / Music Concert • Religious / Educational • Rally / Memorial • Street / Block Party • Parade / Fun Run / Walk- a -Thon • March utilizing any Public Property • Public Assembly for Political Purpose Sport Tournament (Fishing, Soccer, etc.) ❑ Other Location of event: /' Park or other public property • Public street, sidewalk, alley, or right of way • Private property Will you have • Alcoholic beverages (Additional permit required from City Clerk) • Food & non - alcoholic beverages (Additional permit required from Health Dept.) • Non -food related sales and/or display booths (No additional permits required) Tent and /or Canopy pe`3 / , u y (Additional permit required from Inspections Dept.) (Digger's Hotline must be contacted minimum of 3 days before digging) Generator(s) and /or additional electrical facilities (Additional permit required from Inspections Dept.) ❑ Fires or Candles (Additional permit required from Fire Dept.) ❑ Fireworks (Additional permit required from Fire Dept.) • Activities in a park outside of normal operating hours (Waiver required from City Council) • Barricades (Approval from City Clerk's office if in right of way) APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNED TO CITY CLERK X Amplified Sound • Animals included or allowed in event (animals must be licensed and have proof of vaccination) • Cooking Equipment (Fire Department approval required) We have made arrangements for ❑ Restroom and hand washing facilities ❑ Solid waste and recycling services • Event insurance • Public safety & security / EMS services • Electricity / Generators • Fire extinguishers p Advertising with banners or signs ❑ Drinking water • Grey water and grease removal • Weather contingencies • LP Gas • Tent Heating Space Intentionally Leff Blank APPLICATION FOR SPECIAL EVENT PERMIT - TO BE RETURNED TO CITY CLERK Special Event Public Safety and Security Plan T � Name of Event: C &a* fle L 1,�• � C je , Xti u; Location of Event: 01 ?ak Date of Event: Time the Event is to Open: Sponsor of the Event: - 1 Estimated Attendance (daily and total): 1,57 Emergency Contact Information: Name: 7) M t5yl� Daytime Phone Number: Cell Number: e - Name: Daytime Phone Number: Cell Number: Name: Daytime Phone Number: Cell Number: Primary Location of Event Staff at Event Site: 1��(/rj ,x Emergency Notification of the Public The public will be notified of safety and /or security issues in the following manner: APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNED TO CITY CLERK Emergency Medical Services Name of Provider: n Contact Person / Telephone Number: Location of Provider at Event Site: Fire Protection Name of Provider: Contact Person / Telephone Number: Location of Provider at Event Site: Number of Fire Extinguishers: Location of fire access roads: Security Name of Provider: Contact Person / Telephone Number: Location of Provider at Event Site: Location of Missing Persons Station: Event Parking Locations: APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNED TO CITY CLERK Other Provide any other information that you feel should be considered Yes No I have reviewed and have considered the Contingency Plan information provided by the City of Oshkosh along with this application (pages 11, 12) I have reviewed and understand the City's Insurance requirements for Special Events as described in this document (pages 13, 14, and 15) I am enclosing the event's Public Safety ite Plan see page 9 Y ( p 9 ) I am enclosing other information that I believe is necessary or helpful to describe the planned event SIGNATURE am allowed to sign this application on behalf of the event sponsor. The information contained in this application for a Special Event permit is true, correct, and complete to the best of my knowledge. If there are any changes to the Special Event, I agree that I will promptly notify the City of Oshkosh of these changes and request approval of them. Date (print name) (print title with organization) SPECIAL EVENT INDEMNIFICATION AND HOLD HARMLESS AGREEMENT (Medium and High Risk Events) EVENT: �/1t �L'Z,'� c WC,�> � �J ORGANIZER: The event organizer agrees that it, and not the City, will be solely responsible for all incidents related to the event. This responsibility of the organizer to the City includes but is not limited to the actions of the event organizer, its officers, employees, agents, and volunteers, along with event vendors, contractors, subcontractors, participants, and visitors. In consideration for the City's approval of the Special Event, the organizer of this event agrees to indemnify and hold harmless the City of Oshkosh, and its officers, council members, agents, employees, and authorized volunteers, from, for, and against and agrees to defend the same from and against, any and all suits, claims, grievances, damages, costs, expenses, judgments and /or liabilities, including costs of defense and reasonable attorneys fees, and further agrees to pay any settlement entered into or on behalf of, or judgment entered against, the foregoing individuals and /or entities. The event organizer shall abide by the City's insurance requirements for the event, including the addition of the City of Oshkosh, and its officers, council members, agents, employees, and authorized volunteers as additional insured's for the event. The individual(s) signing this agreement has the authority to enter into this agreement on behalf of the organizer(s) of the Special Event. EVENT ORGANIZER os W) e (print name of organizer) 12Z& (date) (signature) (title) / tTAr uk-sny t') ),.0 (print name) (print title) (date) (signature) (title) (print name) (print title) Print - Maps Bing Maps . ........... ..... .._ ........... ......... My Notes FREE! Use Bing 411 to find monies, businesses & more; 000 -BING -411 >a`f r' 4 F Page 1 of 1 ........................... . 7R>v_1,RT , =dd M( 1 7/7R/7.n1 (1 Bird's eye view maps can't be printed, so another map view has been substituted. Print - Maps Bing Maps My Notes ,w.: FREE! Use Bing 411 to find movies, businesses & more: 800-BING-411 Page I of I 13 245--- 12/28/2010 Bird's eye view maps can't be printed, so another map view has been substituted. APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNED TO CITY CLERK Severe Weather Contingency Shelter Locations: Have you confirmed that the locations will be open and available? A Who will detergaane if your event is canceled or held? Phone number: Public Safety Site Plan Provide a schematic drawing of the event site location. The drawing must be legible and drawn to scale. The public safety plan must include the following items if they will be provided, or if they are required. 1. Location of booths, stages, and event structures 2. Location of first aid stations 3. Location of information / ticket booths 4. Boundaries of the event 5. Location offences 6. Location of exits and gates (gates must be numbered) 7. Location of Fire extinguishers 8. Location of severe weather shelters 9. Location of Fire / EMS access road 10. Location of security staff 11. Location of emergency contact event personnel 12. Location of assembly area and approximate occupant amounts 13. Location of event parking 14. Location of barricades 15. Location of generators 16. Location of temporary roadways APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNED TO CITY CLERK GENERAL EVENT INFORMATION Official Name of Special Event: )lam )) K� tip &yc :z.� �v���� f Start Date: End Date: EVENT DATE SUN MON TUE WED THUR FRI SAT SETUP TIME START TIME STOP TIME ' ° P TEAR DOWN / CLEAN UP COMPLETED Location of Event: AACM6 Rai Estimated Attendance (daily & total): Number of Booths: Organiz 'on(s) Sponsoring Event: JAN 0 3 2010 (includ Briefly describe your event. Be sure to include the purpose of the event and all APPLICATION FOR SPE Primary Contact: �-)b Daytime Telephone: Cell Phone: Fax: Email: iAZO Address: City: —� Secondary Contact: Daytime Telephone: Cell Phone: Fax: CIAL EVENT PERMIT — TO BE RETURNED TO CITY CLERK Email: Address: City: _ State: Zip Code: Onsite Primary Contact: 5aeM< as 0 Cell phone: Fax: Email: Address: City: _ State: Onsite Secondary Contact: Cell phone: Fax- Email: Address: City: _ Zip Code: State: Zip Code: NOTE Either the primary or secondary onsite contact must be present onsite at all times during the event. APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNED TO CITY CLERK SPECIAL EVENT CHECKLIST (please check all boxes that apply) Is vour event a: ❑ Festival / Music Concert ❑ Religious / Educational ❑ Rally / Memorial ❑ Street / Block Party • Parade / Fun Run / Walk- a -Thon • March utilizing any Public Property • Public Assembly for Political Purpose Sport Tournament (Fishing, Soccer, etc.) ❑ Other Location of event: Park or other public property ❑ Public street, sidewalk, alley, or right of way ❑ Private property Will you have • Alcoholic beverages (Additional permit required from City Clerk) • Food & non - alcoholic beverages (Additional permit required from Health Dept.) • Non -food related sales and /or display booths (No additional permits required) Tent and/or Canopy Pe-_3;V y (Additional permit required from Inspections Dept.) (Digger's Hotline must be contacted minimum of 3 days before digging) Generator(s) and /or additional electrical facilities %j (Additional permit required from Inspections Dept.) ❑ Fires or Candles (Additional permit required from Fire Dept.) ❑ Fireworks (Additional permit required from Fire Dept.) ❑ Activities in a park outside of normal operating hours (Waiver required from City Council) ❑ Barricades (Approval from City Clerk's office if in right of way) APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNED TO CITY CLERK Amplified Sound ❑ Animals included or allowed in event (animals must be licensed and have proof of vaccination) ❑ Cooking Equipment (Fire Department approval required) We have made arrangements for • Restroom and hand washing facilities • Solid waste and recycling services ❑ Event insurance • Public safety & security / EMS services • Electricity / Generators • Fire extinguishers Advertising with banners or signs ❑ Drinking water • Grey water and grease removal • Weather contingencies ❑ LP Gas ❑ Tent Heating Space Intentionally Lett Blank APPLICATION FOR SPECIAL EVENT PERMIT- TO BE RETURNED TO CITY CLERK Special Event Public Safety and Security Plan Name of Event: Vii Jloa f Z. Or Location of Event: plypw'- � 24'.1k Date of Event: Time the Event is to Open: ��/►'i Sponsor of the Event: / �L - 1'�{�C Y'tr� fiJ1•Z� Estimated Attendance (daily and total): ,57 Emergency Contact Information: Name: ��5� �J ►c'Yl Daytime Phone Number: 26 ��' Cell Number: p - 0 1 - �;) 9J _ Name: Daytime Phone Number: Cell Number: Name: Daytime Phone Number: Cell Number: Primary Location of Event Staff at Event Site: milks gck y Emergency Notification of the Public The public will be notified of safety and/or security issues in the following manner: APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNED TO CITY CLERK Emergency Medical Services Name of Provider: a Contact Person / Telephone Number: Location of Provider at Event Site: Fire Protection Name of Provider: Contact Person / Telephone Number: Location of Provider at Event Site: Number of Fire Extinguishers: Location of fire access roads: Securi Name of Provider: Contact Person / Telephone Number: Location of Provider at Event Site: Location of Missing Persons Station: 7 d Event Parking Locations: APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNED TO CITY CLERK Other Provide any other information that you feel should be considered Yes No I have reviewed and have considered the Contingency Plan information provided by the City of Oshkosh along with this application (pages 11, 12) I have reviewed and understand the City's Insurance requirements for Special Events as described in this document (pages 13, 14, and 15) I am enclosing the event's Public Safety Site Plan (see page 9) am enclosing other information that I believe is necessary or helpful to describe the planned event SIGNATURE I am allowed to sign this application on behalf of the event sponsor. The information contained in this application for a Special Event permit is true, correct, and complete to the best of my knowledge. If there are any changes to the Special Event, I agree that I will promptly notify the City of Oshkosh of these changes and request approval of them. Jv h ,JiC-5, yv/ /O wtx/ - Date (print name) (print title with organization) APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNED TO CITY CLERK Severe Weather Contingency Shelter Locations: /y1i /Ias&Y Have you confirmed that the locations will be open and available? /l2) Who will deterrpuae if your event is canceled or held? Phone number: Public Safety Site Plan Provide a schematic drawing of the event site location. The drawing must be legible and drawn to scale. The public safety plan must include the following items if they will be provided, or if they are required. 1. Location of booths, stages, and event structures 2. Location of first aid stations 3. Location of information / ticket booths 4. Boundaries of the event 5. Location of fences 6. Location of exits and gates (gates must be numbered) 7. Location of Fire extinguishers 8. Location of severe weather shelters 9. Location of Fire / EMS access road 10. Location of security staff 11. Location of emergency contact event personnel 12. Location of assembly area and approximate occupant amounts 13. Location of event parking 14. Location of barricades 15. Location of generators 16. Location of temporary roadways SPECIAL EVENT INDEMNIFICATION AND HOLD HARMLESS AGREEMENT (Medium and High Risk Events) EVENT: � �►�, J �-,�' ���C, ink, l +I' Uf-I G� ORGANIZER: The event organizer agrees that it, and not the City, will be solely responsible for all incidents related to the event. This responsibility of the organizer to the City includes but is not limited to the actions of the event organizer, its officers, employees, agents, and volunteers, along with event vendors, contractors, subcontractors, participants, and visitors. In consideration for the City's approval of the Special Event, the organizer of this event agrees to indemnify and hold harmless the City of Oshkosh, and its officers, council members, agents, employees, and authorized volunteers, from, for, and against and agrees to defend the same from and against, any and all suits, claims, grievances, damages, costs, expenses, judgments and /or liabilities, including costs of defense and reasonable attorneys fees, and further agrees to pay any settlement entered into or on behalf of, or judgment entered against, the foregoing individuals and/or entities. The event organizer shall abide by the City's insurance requirements for the event, including the addition of the City of Oshkosh, and its officers, council members, agents, employees, and authorized volunteers as additional insured's for the event. The individual(s) signing this agreement has the authority to enter into this agreement on behalf of the organizer(s) of the Special Event. EVENT ORGANIZER (print name of organizer) (date) (signature) (title) �- (print name) (print title) (date) (signature) (title) (print name) (print title) Print - Maps Bing Maps My Notes FREE! Use Bing 411 to find movies, businesses & more; SQU- BING-411 Page 1 of 1 ��ny? mkt= Pn_�icR>�= 17R�.c= hk -rn =44 n7.Fi... 19)28/2010 Bird's eye view maps can't be printed, so another map view has been substituted. Print - Maps Bing Maps My Notes y FREE! Use Bing 411 to find movies, businesses & more; OOO- BING-411 Page 1 of 1 httn: / /www.hin g. com /mans/nrint. asnx ?mkt= en -us &z =19.3 2611603313245 ... 12/28/2010 -'A - Bird's eye view maps can't be printed, so another map view has been substituted. A ---L APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNED TO CITY CLERK GENERAL EVENT INFORMATION Official Name of Special Event: Start Date: ^ a _ End Date: Briefly describe your event. Be sure to include the purpose of the event and all planned activities. ^ _ j , i _ _ --j --- . 1 _, 1 - 1 k t�o , EVENT DATE SUN MON TUE WED THUR FRI SAT SETUP TIME START TIME 7hiO STOP TIME ` TEAR DOWN 1 CLEAN UP COMPLETED Location of Event: r� Estimated Attendance (daily & total): /' Number of Booths: Organize on(s) Sponsoring Event: (includ JAN 0 3 201? APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNED TO CITY CLERK Primary Contact: Jb k l.Jt Y1U/� ( — f C- - °b Daytime Telephone: I. �� Cell Phone: ` — / Fax: Tt lq Emai J` 10 & A ,.-t, , _, _ da Address: City: --.J Secondary Contact: Daytime Telephone: Cell Phone: Fax: Email: Address: City: _ State: Zip Code: Onsite Primary Contact: &, a a6)fe -" Cell phone: Fax: Email Address: City: _ Onsite Secondary Contact: Cell phone: Fax: Email: Address: City: _ State: Zip Code: State: Zip Code: NOTE Either the primary or secondary onsite contact must be present onsite at all times during the event. APPLICATION FOR SPECIAL EVENT PERMIT— TO BE RETURNED TO CITY CLERK SPECIAL EVENT CHECKLIST (please check all boxes that apply) Is your event a: ❑ Festival / Music Concert ❑ Religious 1 Educational ❑ Rally / Memorial ❑ Street / Block Party ❑ Parade / Fun Run / Walk- a -Thon • March utilizing any Public Property • Public Assembly for Political Purpose Sport Tournament (Fishing, Soccer, etc.) ❑ Other Location of event: f ( Park or other public property ❑ Public street, sidewalk, alley, or right of way ❑ Private property Will you have ❑ Alcoholic beverages (Additional permit required from City Clerk) ❑ Food & non - alcoholic beverages (Additional permit required from Health Dept.) ❑ Non -food related sales and /or display booths (No additional permits required) �d Tent and /or Canopy peS�,ly (Additional permit required from Inspections Dept.) (Digger's Hotline must be contacted minimum of 3 days before digging) Generator(s) and /or additional electrical facilities ? /� (Additional permit required from Inspections Dept.) ❑ Fires or Candles (Additional permit required from Fire Dept.) ❑ Fireworks (Additional permit required from Fire Dept.) ❑ Activities in a park outside of normal operating hours (Waiver required from City Council) ❑ Barricades (Approval from City Clerk's office if in right of way) APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNED TO CITY CLERK Amplified Sound ❑ Animals included or allowed in event (animals must be licensed and have proof of vaccination) ❑ Cooking Equipment (Fire Department approval required) We have made arrangements for ❑ Restroom and hand washing facilities ❑ Solid waste and recycling services ❑ Event insurance • Public safety & security / EMS services • Electricity / Generators • Fire extinguishers Advertising with banners or signs • Drinking water • Grey water and grease removal ❑ Weather contingencies • LP Gas • Tent Heating Space Intentionally Leff Blank APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNED TO CITY CLERK Special Event Public Safety and Security Plan T Name of Event: � Z (� " ma c• L" raI k;ic, I y z% oti Location of Event: p%32 ►.6LJ PAlk Date of Event: r Time the Event is to Open: Sponsor of the Event: Estimated Attendance (daily and total): Emergency Contact Information: Name: , — h J► Daytime Phone Number:✓ — ' Cell Number: 'b t _ Name: Daytime Phone Number: Cell Number: Name: Daytime Phone Number: Cell Number: Primary Location of Event Staff at Event Site: Emergency Notification of the Public The public will be notified of safety and /or security issues in the following manner: APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNED TO CITY CLERK Emergency Medical Services Name of Provider: ° Contact Person / Telephone Number: Location of Provider at Event Site: Fire Protection Name of Provider: 7 It Contact Person / Telephone Number: Location of Provider at Event Site: Number of Fire Extinguishers: Location of fire access roads: Securit Name of Provider: Contact Person / Telephone Number: Location of Provider at Event Site: Location of Missing Persons Station: Event Parking Locations: APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNED TO CITY CLERK Other Provide any other information that you feel should be considered Yes No 1 have reviewed and have considered the Contingency Plan information provided by the City of Oshkosh along with this application (pages 11, 12) I have reviewed and understand the City's Insurance requirements for Special Events as described in this document (pages 13, 14, and 15) I am enclosing the event's Public Safety Site Plan (see page 9) I am enclosing other information that I believe is necessary or helpful to describe the planned event SIGNATURE am allowed to sign this application on behalf of the event sponsor. The information contained in this application for a Special Event permit is true, correct, and complete to the best of my knowledge. If there are any changes to the Special Event, I agree that I will promptly notify the City of Oshkosh of these changes and request approval of them. `)05h L�iLSn / (�l•�nc� Date (print name) (print title with organization) SPECIAL EVENT INDEMNIFICATION AND HOLD HARMLESS AGREEMENT (Medium and High Risk Events) EVENT: ORGANIZER: The event organizer agrees that it, and not the City, will be solely responsible for all incidents related to the event. This responsibility of the organizer to the City includes but is not limited to the actions of the event organizer, its officers, employees, agents, and volunteers, along with event vendors, contractors, subcontractors, participants, and visitors. Inconsideration for the City's approval of the Special Event, the organizer of this event agrees to indemnify and hold harmless the City of Oshkosh, and its officers, council members, agents, employees, and authorized volunteers, from, for, and against and agrees to defend the same from and against, any and all suits, claims, grievances, damages, costs, expenses, judgments and /or liabilities, including costs of defense and reasonable attorneys fees, and further agrees to pay any settlement entered into or on behalf of, or judgment entered against, the foregoing individuals and/or entities. The event organizer shall abide by the City's insurance requirements for the event, including the addition of the City of Oshkosh, and its officers, council members, agents, employees, and authorized volunteers as additional insured's for the event. The individual(s) signing this agreement has the authority to enter into this agreement on behalf of the organizer(s) of the Special Event. EVENT ORGANIZER t} h (�; P (print name ) of organizer) /ld (date) ( (title) (print name) (print title) (date) (signature) (title) (print name) (print title) APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNED TO CITY CLERK Severe Weather Contingency Shelter Locations: Have you confirmed that the locations will be open and available? / -p Who will deterQ;+Ae if your event is canceled or held? Phone number: Public Safety Site Plan Provide a schematic drawing of the event site location. The drawing must be legible and drawn to scale. The public safety plan must include the following items if they will be provided, or if they are required. 1. Location of booths, stages, and event structures 2. Location of first aid stations 3. Location of information / ticket booths 4. Boundaries of the event 5. Location offences 6. Location of exits and gates (gates must be numbered) 7. Location of Fire extinguishers 8. Location of severe weather shelters 9. Location of Fire / EMS access road 10. Location of security staff 11. Location of emergency contact event personnel 12. Location of assembly area and approximate occupant amounts 13. Location of event parking 14. Location of barricades 15. Location of generators 16. Location of temporary roadways Print - Maps Bing Maps Page 1 of 1 htt„- /hxnx7w hind c,.nm /manrn /nrint_a.,nx ?mkt= en- us &z= 17 &s =b &c-o= 44.026... 12/28/2010 A.— Bird's eye view maps can't be printed, so another map view has been substituted. Print - Maps Bing Maps My Notes FREE! Use Bing 411 to find movies, businesses 8, rnore: 800- BING Page 1 of 1 http: / /www.bing.com/ maps /print.aspx ?mkt= en -us &z= 19.32611603 313245... 12/28/2010 `$ - - -= Bird's eye view maps can't be printed, so another map view has been substituted.