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Otsego County Parks & Recreation Department Special Event Permit Application 315 S. Center Street, Gaylord, Mi. 49735 Telephone: (989) 732-6521 Name of Individual or Address: State___ Daytime Phone: Eve. Mobile Fax: Email Address: *Any change in the above information, please notify the parks department immediately. Type of Organization: Government for Profit County Resident ___Non-Profit – Tax _____Non-County Resident SPECIAL EVENT INFORMATION complete all data as required for event of any size Type of Event: ______Run/Walk ____Parade ____Wedding Ceremony/Photos ____Fair Concert Picnic ____Other Event Title: Event Estimated Attendance (peak) Requested Event Location: Park Name: (Community Center; Irontone Springs; Libke Fields; Louis M. Groen Nature Preserve; Otsego Lake County Park; Wah Wah Soo;) Area of Park (Describe Physical Boundaries): Are you planning on charging for the event: yes no Actual Hours of Event:__________AM/PM - Set up Times:_____ AM/PM - Take Down Times:_____AM/PM - Description of Event Set Please attach additional sheets as necessary, including plans, drawings, maps, etc. EXPENSE/REVENUE INFORMATION REQUIREMENTS ---PAGE BREAK--- Funds raised at the Louis M. Groen Nature Preserve must be used to offset expenses, with any profits deposited with the Otsego County Parks and Recreation Department for use at the Groen Nature Preserve. Organizers of events permitted at the Louis M. Groen Nature Preserve are required to submit a tentative budget including expected expenses, revenues and profit. In addition, a profit and loss report will be required at completion of the event. All activities at the Louis M. Groen Nature Preserve must be in compliance with the Conservation Easement recorded on Liber 1271 Page 786 at the Otsego County Register of Deeds Office. Insurance Requirements: During the performance, any and all events when there is a charge for participation, the applicant shall provide a certificate of insurance meeting the following requirements: a. General Liability Insurance, with a minimum combined single limit of $1,000,000 for each occurrence and aggregate. b. Motor Vehicle Liability Coverage and Michigan No-Fault Coverages including all owned, non-owned, and hired vehicles. c. Workers Compensation and Employers’ Liability , Michigan Statutory Limits of Liability. d. Otsego County, and Otsego County Parks and Recreation Department will be named as Additional Insured on all insurance coverage, with the exception of Workers Compensation and Employers’ Liability Insurance. e. A Waiver of Subrogation is required on the certificate of liability insurance. Otsego County, and the Otsego County Parks & Recreation Department, is not responsible for any accidents or damages to persons or property resulting from the issuance of this permit. IDENNITY AGREEMENT to the fullest extent of the (hereinafter described as “LESSEE” agrees to defend, pay on behalf of, indemnify and hold harmless the Otsego County Parks and Recreation Department (hereinafter referred to as “the OCPR”) its elected and appointed officials, employees and volunteers and any others working on behalf of the OCPR, against any and all claims, demands, suits, or loss, including all costs and any fees connected therewith, bought by anyone and for any damages which may be asserted, claimed or recovered against or from the OCPR, its elected and appointed officials, employees, volunteers or others working on behalf of the OCPR, by reason of personal injury, including bodily injury and death and/or property damage, including loss of use thereof, brought by anyone which arises out of the sole, comparative or partial negligence, error, omission or commission or any party including the OCPR, its agents or employees and is in any way connected or associated with this contract between LESSEE and the OCPR for the lease of the described premises. LESSEE agrees to guarantee that the following rules will be observed by all individuals in attendance at the event. LESSEE accepts responsibility for assuring the following; orderly behavior; financial responsibility for any damage due to use of the facilities; responsiveness to all directives of staff/personnel; that the program is of a nature suitable for presentation on public property; that the activity is lawful and in conformity with regulations of State and Federal laws and the OCPR; that LESSEE with not remove, change, rearrange or revise anything in or on the property without the specific approval from the OCPR. Intoxicated persons will not be allowed to enter; those found intoxicated will be removed. Failure by LESSEE to honor these requirements could result in forfeiture of use of the property. LESSEE shall not deny participation in any event of LESSEE or membership LESSEE because of race, creed, color, national origin or handicap. LESSEE understands and agrees that if at any time the OCPR determines that a person’s activities pose a danger to persons or property, the OCPR shall have the right to close down all or part of the property to remove offending persons or groups from the property. AFFIDAVIT OF APPLICANT: Everything I have stated on this application is correct to the best of my knowledge. I have read, understand and agree to abide by the policies and rules and regulations listed on this form as they pertain to the requested usage. By signing this application, the applicant agrees to follow all the rules and regulations. The permit, if granted, is not transferable and is not revocable at any time at the absolute discretions of the Otsego County Parks and Recreation Department. MISCELLANEOUS RULES 1. Trash Removal: You are responsible for securing additional receptacles or having your trash hauled away if facility containers won’t accommodate the needs for your event. 2. Portable Toilets: You are responsible for securing the appropriate number of portable toilets for your event. They should be delivered at the latest delivery date at time possible prior to your event and removed from the facility no more than 24 hours after your event ends. 3. Tent/Displays: The Otsego County Parks and Recreation Department are not responsible for any tents or displays set up for your event. Tent staking is not allowed without previous approval by Otsego County Parks and Recreation staff as to location. 4. It is the applicant’s responsibility to be familiar with the Otsego County Parks and Recreation Department rules to ensure their event complies with such. ---PAGE BREAK--- Name of Applicant: (Print) OFFICE USE ONLY: Approved Denied