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Page 1 of 4 (Initials) ROAD RACES, PARADE, OR PUBLIC ASSEMBLY1 PERMIT APPLICATION FOR COLUMBIA COUNTY, GEORGIA PERMIT # Type of Event: 5K 10K Half Marathon Walkathons Bike Races Public Assembly Ceremonies, Grand Openings, Street Fairs Parades _______Other (Please identify: Name of Applicant/Organization: Street Address of Applicant/Organization: Name of Representative (if Organization): Street Address of Representative: Phone Email Address: I understand to not conduct any road race, parade or public assembly, either fixed or processional, over, upon, or burdening the public properties of Columbia County, Georgia or employing facilities thereon, without first receiving a permit from the necessary parties within this application and approved according to the requirements set out. This application, and any supplemental information required, shall be submitted not less than 45 days prior to the road race, parade or public assembly to ensure proper processing. Once the application is received, please allow two weeks for Columbia County to review and provide any estimated costs for the applicant. If there are costs associated with this event, it is the responsibility of the applicant and said payment is due 24 hours before the date of the event. The permit will be issued only after approval by the concerned departments listed below. When approving road closures for routes, the county will consider various impacts on residents, occupants, businesses, and emergency lanes (whether lane closures, local streets, or major/secondary streets).2 If the applicant is an association of persons in fact or in law, the application shall contain a description of the entity; the name of said entity, if named; the registered or recognized address of the entity; the name of the person making the application on behalf of the entity; such person’s relationship to said entity; and some demonstration or recitation of the authority of the person making the application to act on behalf of the entity and the names, addresses and phone numbers of the Corporate or Executive Officers of said entity. 1 Public assembly means any meeting, demonstration, picket line, rally, or gathering of people for a common purpose that interferes with the normal flow or regulation of pedestrian or vehicular traffic or that requires exclusive use of all or any part of public areas or facilities open to the general public. 2 Please note: Plans that involve crossing, encroaching, traveling along or otherwise directly impacting State Routes will require an additional review and approval process by the Georgia Department of Transportation. Their review and approval process can only be initiated two to four weeks prior to the event. ---PAGE BREAK--- Page 2 of 4 (Initials) Event Plan: A plan must be submitted and include the following information about the road race, parade or public assembly event: 1. Anticipated number of persons participating on foot, number of units, number and construction of floats: 2. 3. Hours of each day the event will be conducted: Set-up Time Start Time End Time: Area Cleared By: 4. Exact location, or, if the road race, parade or public assembly is processional or mobile, the route, the assembly area and the dispersal area: Location/Route (attach map): 5. Event will consist of the following activities: 6. Will sound amplification equipment be employed? No ( ) Yes ( ) If yes, explain: 7. Will alcoholic beverages be dispensed or sold? Yes ( ) No ( ) 8. Are sales or vendors being planned? Yes ( ) No ( ) 9. Is the use of tents planned? Yes ( ) No ( ) 10. Will portable toilets be used? Yes ( ) No ( ) 11. Will dumpsters be used? Yes ( ) No ( ) 12. Is electricity needed? Yes ( ) No ( ) 13. Will sign or pennants be hung outside? Yes ( ) No ( ) 14. Will artificial lighting be employed? Yes ( ) No ( ) 15. Will temporary static structures be employed? Yes ( ) No ( ) If yes, provide a complete description (including measurements) of the structure: 16. Will vehicles be employed? Yes ( ) No ( ) If yes, provide a description of each vehicle that will be used and how it will be used: 17. Provide a description of the anticipated need for safety, police, medical, sanitation, and other required personnel and equipment, with the anticipated needed numbers and posting by location and time of personnel needed: 18. Provide a description of provisions necessary to the safety and welfare of the participants in the parade or public assembly and members of the public in the area where the parade or public assembly will be conducted and routes of access thereto and there from: 19. Provide a description of measures that will be taken to ensure public health and sanitation; ---PAGE BREAK--- Page 3 of 4 (Initials) 20. Will the road race, parade or public assembly require that the public spaces or facilities to be used or burdened, or the routes and means of access thereto and there from, be temporarily diverted from their dedicated or customary uses, or the public or private users thereof be diverted or excluded from, or limited in their use or enjoyment of, or their access to or through, said spaces or facilities, before, during or after the road race, parade or public assembly? Yes ( ) No ( ) If yes, please describe: Insurance Requirements: Applicant shall purchase and maintain insurance with a company acceptable to Columbia County and authorized to do business in the State of Georgia insuring against all loss or damages, including personal injury and property damage which may arise out of or result from the Applicant's, its agents', employees', volunteers' and participants' actions pursuant to this permit. This insurance shall be written for not less than the limits of liability specified below, or required by law. The Applicant shall provide Columbia County with a certificate of insurance certifying that the foregoing insurance is presently in force. Applicant shall also provide appropriate endorsements to its liability policies which provide: that such insurance shall not be cancelled, allowed to expire or be materially changed without giving Columbia County thirty (30) days advance notice by registered mail; and that Columbia County, its employees, and agents shall be named as additional insured under the Applicant’s general liability policies. Automobile – Automobile Liability will be required if a mobile unit is placed on the County’s property as part of the Applicant's setup. Bodily injury and property damage liability covering all owned, non-owned, and hired automobiles for limits of not less than $1,000,000.00 minimum for bodily injury of each person/each accident and $1,000,000.00 property damage, or $1,000,000.00 combined single limit - Bodily injury and property damage combined. Comprehensive General Liability – This coverage shall be on an “Occurrence” basis. Coverage shall include Premises and Operations; Products and Completed Operations; and Medical Expense in reference to General Liability and cover bodily injury and personal property damages. The amounts of such insurance shall not be less than $1,000,000.00 per occurrence / personal & advertising injury; $1,000,000.00 general aggregate; $100,000.00 damages to County premises, and $5,000.00 medical expense (any one person) in reference to General Liability. Liquor Liability - Liquor Liability will be required if the Applicant will be selling alcohol during the event, or an event being held on County premises. The amounts of such insurance shall not be less than $1,000,000.00. If any insurance required to be provided by the Applicant should be canceled or changed by the insurance company or should any such insurance expire during the period of this contract, the Applicant shall be responsible for securing other acceptable insurance to provide continuous coverage during the life of this contract. Failure of the Applicant to provide and maintain continuous coverage as specified herein will result in the event/individual vendor being shut down until such time acceptable insurance is presented / restored. This would be in addition to any legal recourse open to Columbia County under breach of contract. Cleanup after the Event: The applicant must remove all debris that results from the event. The areas will be inspected after the event and an invoice will be sent for any required cleaning that is performed by Columbia County Roads & Bridges. If the areas are deemed unsatisfactory, the organization may not be able to host future events in Columbia County. Permission is hereby requested to hold the above Road Race, Parade or Public Assembly in Columbia County, Georgia: APPLICANT’S SIGNATURE DATE SIGNED APPLICANT’S ADDRESS ---PAGE BREAK--- Page 4 of 4 (Initials) Return all applications 45 days prior to the event to: Columbia County Community Events Attn: Rachael Enfinger P.O. Box 498 Evans, GA 30809 Or Fax to [PHONE REDACTED] APPLICATION REVIEW OF REQUEST TO HOLD THE ABOVE EVENT IN COLUMBIA COUNTY, GEORGIA: THE APPROVED LOCATION / ROUTE OF THE ROAD RACE, PARADE OR PUBLIC ASSEMBLY: EVENT IS TO CONSIST OF: DATE(S): Beginning time Ending ASSOCIATED COSTS (RESPONSIBILITY OF APPLICANT): Extra Duty Officers Needed ARRIVAL TIME: _ NOTE: EXTRA-DUTY COLUMBIA COUNTY DEPUTIES WILL BE PAID THE AMOUNT AGREED UPON PRIOR TO THE EVENT, AND ARE NOT RESPONSIBLE FOR ADVISING DIRECTIONS OR PROVIDING ANY DETAILS OF THE EVENTS TO PARTICIPANTS IN RUNS, WALKS, RACES, ETC. THE COLUMBIA COUNTY SHERIFF’S DEPARTMENT PROVIDES SECURITY FOR THE EVENTS. ANY CHANGES IN THE DATE, TIME, COMPOSITION, AND/OR ROUTE OF THE ROAD RACE OR PARADE MUST BE APPROVED IN ADVANCE. COMMUNITY EVENTS MANAGER Recommended Approved YES / NO DATE CLS DIVISION DIRECTOR Recommended Approved YES / NO DATE TRAFFIC OPERATIONS MANAGER Recommended Approved YES / NO DATE R&B DIVISION DIRECTOR Recommended Approved YES / NO DATE FIRE CHIEF OR DESIGNEE Recommended Approved YES / NO DATE SHERIFF OR DESIGNEE Recommended Approved YES / NO DATE COUNTY ADMINISTRATOR Approved YES / NO DATE ADDITIONAL APPROVERS COMMENTS: