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157 N Broadway St Blackfoot ID 83221 [PHONE REDACTED] opt 0 Application For Special Event Permit Definition: Special Event shall mean any organized nonroutine activity on public and/or private property that may impact or affect neighboring property owners, residents, and/or businesses, which may require more parking spaces than the sponsor’s property can accommodate. Incomplete or unreadable applications will not be considered for approval. Application Requirements: A Special Event Permit must be filed with the City Clerk not less than 45 days prior to the proposed date. Attach to this Application for Special Event Permit are the following: • This event must meet all the requirements of the currently adopted International Fire Code, and any other life safety concerns as deemed necessary by the Fire Marshal. A separate inspection may be required by the Fire Marshal prior to the even. Fees for inspections are due before inspection can be scheduled. • A copy of the Reimbursement and Indemnification Agreement. Applicant Information Applicant Name and Date of Organization Promoting/Sponsor of the Event Contact Name (if other than Physical Mailing Telephone Email Is this a non-profit organization with a 501 c3 status YES NO Federal Taxpayer ID State of Idaho Sales Tax City of Blackfoot Non-Property Sales Tax ---PAGE BREAK--- 157 N Broadway St Blackfoot ID 83221 [PHONE REDACTED] opt 0 General Information Event Estimated Event Setup Cleanup Begin End Event Description & Vendors Additional Permits Vendor lists must be turned in before application is approved. Number of Food If food, beverage products are being sold, or given away during the event, the organizer is responsible for verifying proper permits, including a food handlers license or exemption certificate, health certificate, and a current year mobile vending permit. Number of Non-Food All vendors must follow policies set forth and stated on Special Event Use Policy, Park Rules, and City Codes. Selling Beer/Wine: Beer/Wine permits required from City Clerk, will also require security and ID Checkers. Serving Beer/Wine permits required from City Clerk, will also require security and ID Checkers. Beer/Wine sales are permitted only as local, state laws, and policies allowed for the actions of the participants, and who may be held liable for park damage, restoration, and/or cleanup costs. ---PAGE BREAK--- 157 N Broadway St Blackfoot ID 83221 [PHONE REDACTED] opt 0 Event Information Please include a comprehensive written plan of how the event takes place, including: • Type of event, date hours of operation. • Number of Event personal. • Estimated number of spectators. • Do you need off-site parking? • Set up and break down schedule, and what time the Event Site will be vacated. • If participants are charged how much? • Amount of vendors allowed will be based on approval from the Park Superintendent. • Will there be vendors at the event? Vendor permits are $20.00 per vendor, per day. Collected by the event planner, then paid to the City. • Do you plan on serving alcohol beverages? • Will you need any water or electrical connections, surcharges will apply. • Will you provide on-site medical services? • Have you made any provisions for on-site security? • Do you plan to have amplified sound? • Do you plan to use a banner or street signage? • Do you plan on any live animal exhibits or presentations? • Do you plan on having a parade? • Will there be pyrotechnics? Special Requests: (any exceptions to the guidelines as outlined herein): No Special Events Permits shall be issued until the application has been filed with the Assistant to the City Administrator: • Applicable permit fee $100.00 • Applicable permit fee for non-profit • Surcharge for water and power • Alcohol Permit • A refundable deposit equal to 125 % of the City anticipated expenses which shall be deposited to the City no later than 48 hours before the commencement of the Event. • A liability insurance policy in the amount of not less than one million dollars ($1,000,000) in the aggregate naming the City, its employees, volunteers, officers, agents, or officials as an additional name insured and providing for adequate notice of cancellation if the policy is cancelled prior to the event. ---PAGE BREAK--- 157 N Broadway St Blackfoot ID 83221 [PHONE REDACTED] opt 0 • A duly executed Reimbursement and Indemnification Agreement setting forth the promise of payment of any actual costs incurred for increased fire or police protection, street or bike path cleaning, litter and signage removal, or other extraordinary City services, which shall be reimbursed to the City Services, which shall be reimbursed to the City within twenty (20) days after the invoice. Which shall be Indemnified with officials for any and all claims for personal injury, damages, or losses resulting or arising from the Event, which was not caused by the gross negligence of the City. The undersigned makes these statements and provide said information for application for the event. By signing this application for Special Event Permit, the applicant agrees to comply with all the laws and ordinances of the City of Blackfoot, Idaho. Applicable to the subject matter thereof. This Special Event Permit is non-transferable. The City reserves the right and power to cancel this Special Event Permit due to inclement weather or other events which in the City’s sole discretion materially and adversely affect the health, safety, and welfare of the public. Signature of Authorized Representative/ Printed Title: Please submit completed application via hand-delivery or mail to above listed address.