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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 non-routine activity on public or private property that may impact or affect neighboring property owners, residents, and businesses. Which may require more parking spaces than the sponsor’s property can accommodate. Please select the appropriate category for your event: Minor Event-Less than 1,500 attendees Major Event-more than 1,500 attendees Application Requirements: A Special Event Permit must be filed with the City Clerk not less than 45 days before the date is proposed. Attached to this Application for Special Event Permit are the following: • Excerpts from the 2003 International Fire Code: Chapter 4- Emergency Planning and Preparedness and Chapter 24- Tents, Canopies, and other Membrane Structures. This event must meet all requirements of the 2003 International Fire Code and any other life and safety concerns as deemed necessary by the Fire Chief or his/her representative. • A copy of the Reimbursement and Indemnification Agreement. Applicant Name and Title: Date of Application: Organization Promoting/Sponsoring the Event: Event Contact Name (if other than above): Physical Address: Mailing Address: Telephone Email Address: 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 Identification Number: APPLICANT INFORMATION ---PAGE BREAK--- 157 N Broadway ST Blackfoot ID 83221 [PHONE REDACTED] OPT 0 Please include a written comprehensive 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 time Event Site will be vacated. • If participants are changed how much? • Will there be vendors at the event? If so, what, if any, is the vendor permit fee? • Do you plan on serving alcoholic beverages? • Will you need water or electrical connections? • 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 Event Permit shall be issued until the applicant has filed the following with the Assistant to the City Administrator: • Applicable permit fee of $100.00 • A liability insurance policy in an amount not less than one million dollars ($1,000,000) in the aggregate naming the City, its employees, volunteers, officers, agents, assigns, or officials as an additional name insured and providing for adequate notice of cancellation if the policy is cancelled prior to the Event. • 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 invoice, and which agreement also indemnifies the City, its employees, volunteers, officers, agents, assigns, or EVENT INFORMATION ---PAGE BREAK--- 157 N Broadway ST Blackfoot ID 83221 [PHONE REDACTED] OPT 0 • officials for any and all claims for personal injury, damages, or losses resulting or arising from the Event not caused by the gross negligence of the City. • Verification of Certification by the Southeastern District Health ([PHONE REDACTED]) relating to food preparation and/or handling. • Sign Permit (if required) • Liquor License or Temporary Catering Permit (if required) Dependent on the nature of the proposed Event, the Applicant may also be responsible for: A cash deposit equal to 125 % of the City anticipated expenses which shall be deposited to the City no later than forty-eight (48) hours before the commencement of the Event. The undersigned makes these statements and provided said information for Application for 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 valid for the undersigned, and only for the dates and locations set forth in the Special Event Permit. This Event Permit is not transferable. The City reserves the right and power to cancel this Special Event 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/ Sponsor Printed Name: Dated day of 20___ Title: Please submit completed application via hand-delivery or mail to above listed address. other-membrane-structures ---PAGE BREAK--- 157 N Broadway ST Blackfoot ID 83221 [PHONE REDACTED] OPT 0 The signature lines below will be executed during the internal event permit approval process by City of Blackfoot officials. Once the Application for Event Permit has been approved and signed off by each official, a copy of this application will be returned to the applicant and the document will be the applicant’s authorized City of Blackfoot Event Permit. Verification of conformance to traffic management plan to be signed off by Blackfoot Police Department Blackfoot Police Chief: Date: [PHONE REDACTED] Verification of conformance to the 2003 International Fire Codes to be signed off by Blackfoot Fire Department Blackfoot Fire Chief: Date: [PHONE REDACTED] Verification of conformance to the 2003 International Building Codes to be signed off by The Building Department Blackfoot Building Official: Date: [PHONE REDACTED] Verification of conformance to traffic management plan to be signed off by Blackfoot Street Department Blackfoot Superintendent: Date: [PHONE REDACTED] Date of Application for Event Permit received: Fee: Date Paid: Deposit: Date Paid: Approval of Event Permit for: City Clerk: Date: Mayor: Date: