City Event Permit Application For events, block parties, walks, runs, and public gatherings. Event Name*Contact/Producer First Last Applicant &/or Producer/Planner to be contacted regarding event.PhoneEmail Event Location Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Event Start Date Date Format: MM slash DD slash YYYY Event Start Time : HH MM AM PM Event End Date Date Format: MM slash DD slash YYYY Event End Time : HH MM AM PM Total Attendance ExpectedRain Date Note: Contact/Producer is to present event to City Event Planning board monthly meeting prior to event date. Please read and adhere to all rules and regulations listed on page 2 of this permit application. Permit Fee $150 to be paid at the time of the meeting, made payable to Jeffersonville Parks Department. Other fees may apply. Contact/Producer is to present event to City Event Planning board monthly meeting prior to event date at least 60 days in advance.Event Type Block Party Parade Motorcade Public Gathering Other If you selected "Other" as the event type, please describe the event.Additional Information REQUIRED from event producer/planner/contact: • Provide a map showing streets to be blocked, route map if run/walk, and site plan layout of the requested area • Notify affected business and residents of the planned event and applicable street closures • Provide a Certificate of Insurance listing the City of Jeffersonville as an Additional Insured for $1,000,000 • Provide a cleanup plan. Producer/Planner is required to leave City property and surrounding area clean and litter-free after the event HOLD HARMLESS AND IDEMNIFICATION CLAUSE The applicant/Event Producer/Planner shall indemnify, hold harmless and defend the City of Jeffersonville and the Jeffersonville Parks & Recreation Department, their elected and appointed officials, employees, agents, and successors in interest from all claims, damages, losses, and expenses including attorneys’ fees, arising out of or resulting, directly or indirectly, from the Applicant/Event Producer’s (or Applicant/Event Producer’s subcontractors, if any) performance or breach of the contract provided that such claim, damage, loss of expenses is:(1) attributable to personal injury, bodily injury, sickness, death, or to injury or destruction of property, including the loss of use resulting therefrom, or breach of contract, and (2) not caused by the negligent act or omission or willful misconduct of the City of Jeffersonville or the Jeffersonville Parks & Recreation Department, their elected and appointed officials and employees acting within the scope of their employment. This Hold Harmless and Indemnification Clause shall in no way be limited by any financial responsibility or insurance requirements and shall survive the termination of the Small Event Permit Application. Only applicants in good standing with the City of Jeffersonville will be considered for Approval. Any misrepresentation in this application or deviation from the final approval specifications and activities described herein or failure to abide by all Federal, State, and City of Jeffersonville laws, ordinances, policies, and procedures may result in the immediate revocation of the approved permit and/or refusal to issue a permit in the future. Electronic SignatureWhen providing this electronic signature, you are agreeing to the Hold Harlmess and Indemnification Clause. If you have not read this clause, please do so at https://jeffparks.org/city-event-permit/. For Personnel Use Only Police: ________________________________________ Fire: ___________________________________________ Public Works/ Street: ____________________________ Parks: _________________________________________ Safety: ________________________________________ CITY EVENT PERMIT APPLICATION RULES AND REGULATIONS Revised 7.17.2020 1. Applicant will be held to mean the contact/producer, director, chaperone, or representative of the organization in its use of facilities. 2. The use of facilities will be confined to areas designated or included in the permit. The applicant will be held responsible for the compliance of these rules by all persons participating in or pertaining to the activity for which the facility is being used. 3. Alcoholic beverages or their possession must be approved by the City Events Planning Board. 4. No furniture or equipment shall be used or moved without expressed approval on the permit. 5. The City of Jeffersonville and/or board of Parks & Recreation and its employees shall not be responsible for injuries, damage to, or loss of property upon park premises sustained by the applicant, participants, or patrons of any program or event. 6. No nails, screws, tape, or other materials may be used in or on floors, walls, curtains, woodwork, blinds, window glass, shelter/pavilion, or equipment without written approval on the permit. Fires or open flames prohibited. 7. Smoking inside city buildings or facilities or within 8 feet of entry or on sport field is prohibited. 8. No organization may use facility for special rehearsals or any other use except on the exact date and hours contracted. No public parties, by party promotion companies or event services, applicant cannot charge admission at the door or sell tickets and no promotion or fundraiser usage without prior approval of the City Events Planning Board. 9. If the nature of the event demands special police, special parking attendants, or security, any expense and liability involved is the obligation of the applicant. 10. All properties or equipment brought in to the facility or park property by the applicant must be removed the same date unless otherwise approved by the City Events Planning Board. 11. All concession rights are retained by Jeffersonville Parks and Recreation Department unless otherwise arranged. 12. Damage or misuse of the facilities and equipment shall be paid for in full by the organization and/or applicant. The appraisal of the Park Director, or his agent, shall be the final determinant in all cases. 13. Food or drinks shall be confined to designated concession areas. 14. No refunds shall be granted due to inclement weather or failure to comply with rules and regulations. 15. Applicant allowed possession of premises 15 minutes prior to the event for set up and 15 minutes after for cleanup, unless otherwise approved. 16. Gambling is not permitted on Park property.