Special Event Application

**FOR FULL PROVISIONS AND REQUIRED MATERIALS, COPY AND PASTE THIS LINK IN YOUR BROWSER: https://s3.amazonaws.com/iworq-upload/PENDLETON/5/19677443-Event_provisions.pdf

1. Event Information

* Event Name:

* Event Location:

* Where will this event be held?:

* Event Start Date:

* Event Start Time:

* Event Finish Date:

* Event Finish Time:

* Event Setup Date:

* Event Setup Time:

* Event Clean Up Date:

* Event Clean Up Time:

Event Website (if applicable):

Registration/Entry Fee (if applicable):

Date(s) of Event For Next Year (if applicable):

* Is Your Event:

* Brief description of Event:

2. Event Sponsor Information

* Event Sponsor :

* Contact Person:

* Phone Number:

* Email Address:

* Address:

* City, State, Zip:

Event Sponsor Website (if applicable):

3. Departmental Requests

Please indicate if you have any special requests for the following departments

Parks (extra trash containers, building/shelter use, etc):

Public Works (street closings, barricades, water, etc):

Water Turn-On Date:

Water Turn-Off Date:

Electric (electricity hook ups for vendors or booths, etc):

Electric Turn-On Date:

Electric Turn-Off Date:

Police (parade vehicles, hire off-duty officers for security or traffic control, etc):

Fire (parade vehicles, presence on site for event, etc):

Ambulance (parade vehicles, presence on site for event, etc):

4. Banner Over State Street

Preferred date(s) for banner to be displayed (if applicable):

5. Additional Permits, Licenses, and Approvals

Please submit copies of all permits, licenses, and approvals (if applicable)

Please indicate if your event will include the following:

A raffle. Please include copy of raffle license:

Fireworks display. Please include copy of permit from Indiana Department of Homeland Security:

Beer or alcohol sales. (Please complete section 7 below) :

The closure of a state or US highway. Please provide a copy of your permit (if required):

Temporary staging, outdoor stage equipment, canopies, or tents. Please provide a copy of your permit from the Indiana Department of Homeland Security (if required):

6. Insurance Information

Please submit an insurance binder and a certificate of insurance with "Town of Pendleton" (and "Pendleton/Fall Creek Township Park District" if applicable) listed as a certificate holder and additional insured at least 15 days prior to event start.

* Insurance Carrier Name:

* Amount of Coverage:

* Contact Person:

* Phone Number:

* Address:

* City, State, Zip:

7. Application to Serve Alcohol in a Controlled Environment

You must provide the following:

• Security

• Proof of compliance of Indiana Alcoholic Beverage Laws and Regulations (show on map controlled area location and information on how this area will be secured)

• Name of alcohol permit holder, copy of permit and license, and proof of insurance.

Security Information

Name of Agency Providing Security:

Contact Name:

Contact Email Address:

Contact Phone Number:

Address:

City, State, Zip:

Alcohol Permit Holder

Name of Business or Agency Serving Alcohol:

Contact Name:

Contact Email Address:

Contact Phone Number:

Address:

City, State, Zip:

Signature and Disclosures

By signing and submitting this event application, the sponsor agrees to indemnify, defend, and hold harmless the Town of Pendleton and the Pendleton/Fall Creek Township Park District, their agencies, employees, and volunteers from any liability (including reasonable attorney's fees and costs) due to loss, damage, injuries, or other casualties of whatever kind, to person or property arising out of the event for which this application is being submitted.

I have read and understand the attached set of regulations and agree to abide by these rules.

* E-Signature:

Items Required For Submission

Please note, the Event Permit will NOT be issued until all required documentation is provided

• Event Map - Please upload below. This is required at the time of submission

• Insurance Binder and Certificate of Insurance - due a minimum of 15 days prior to event.

• State of Indiana Permits (if applicable) - due a minimum of 15 days prior to event.

• Indemnification agreement - Please upload below. This is required at the time of submission and is located on the last page of the event provisions document.

• Please submit any post application documents to Jennifer Everitt at jeveritt@pendleton.in.gov

Required Files for Special Event Application

If submitted without file(s) listed below or with the wrong file type, application will not be accepted.

Event Map

(File Types: .docx, .jpeg, .jpg, .png, or .pdf ):

Indemnification agreement

(File Types: .docx, .jpeg, .jpg, .png, or .pdf ):

Other Files

Files

*The required uploads were not found