Docstoc

New%20Bedford%20Special%20Event%20Request%20for%20City%20Services

Document Sample
New%20Bedford%20Special%20Event%20Request%20for%20City%20Services Powered By Docstoc
					                                       SPECIAL EVENT
CITY OF NEW BEDFORD                   REQUEST FOR CITY
                                         SERVICES




     Special Event Permit Application | City of New Bedford
                        Special Event Request for City Services- City of New Bedford


Welcome. The City of New Bedford appreciates your efforts in contributing to the heart and vitality of
the City through your Special Event.

New Bedford Parks, Recreation & Beaches will be the primary contact for Authorized Users during the
review process. Once the completed application is submitted, Parks, Recreation & Beaches Office will
work closely with the Department of Public Facilities to expedite your requests. After you complete
the Request for City Services, please return it to the office of Parks, Recreation & Beaches located at
181 Hillman Street, Building #3, New Bedford, MA 02740.

REQUEST FOR CITY SERVICES APPLICATIONS SHALL BE SUBMITTED TO PARKS, RECREATION &
BEACHES OFFICE NOT LESS THAN NINETY (90) DAYS PRIOR TO THE EVENT DATE.

**IMPORTANT** REVIEW ALL ADDENDUMS AT THE BACK OF THIS APPLICATION PACKAGE FOR
INFORMATION REGARDING POLICIES, PERMITS AND FINANCIAL CHARGES FOR CERTAIN CITY
SERVICES THAT MAY BE APPLIED TO YOUR SPECIAL EVENT.




        City of New Bedford ∙ 181 Hillman Street, Building 3, New Bedford, MA 02740 ∙ 508-961-3015
                                                 2|Page
                              Special Event Request for City Services- City of New Bedford

                                                      Event Summary

EVENT TITLE:


Description:




Event Categories:
   Sports/Recreation                   Concert/Performance                   Fundraiser                  Carnival/Circus
   Fair/Festival                       Special Attraction                    Parade/March                Family Gathering
   Exhibits / Miscellaneous            Outdoor Market                        Dance                       Other

                       Day of the Week         Date                   Time                             Anticipated number of
                                                                                                        attendees? ______
Set-up Starts

Event Starts
                                                                                                   Is this an annual event?
Event Ends
                                                                                                            Yes No
Dismantle Ends



                                          Contacts/ Organization Information                     How many years has this
                                                                                                   event run? ______
In this section will allow the City departments and agencies that have an interest in your event, to contact the appropriate
individuals for any further information regarding your event. It will enable the City to ensure all your needs are met, and
that the interests of the City’s venue(s) are considered.
Please feel free to write-in or attach any further information that you feel would be important in this matter.


Applicant Name                                  Phone                                 E-Mail


Organization Name                               Address Street               City              State              Zip


Web Address                                     Organization Phone                    E-Mail

Emergency Contacts: In case of an emergency during the event, a person must be available to be contacted during the
hours of the event. Please Identify:

Name                                            Cell Phone                          Phone


Name                                            Cell Phone                          Phone



          City of New Bedford ∙ 181 Hillman Street, Building 3, New Bedford, MA 02740 ∙ 508-961-3015
                                                   3|Page
                                 Special Event Request for City Services- City of New Bedford

                                                     Organization Status


TAX EXEMPT, NON-PROFIT: This refers to an organization that has been recognized as tax exempt by the Internal Revenue
Service at least six (6) months prior to your event date and is in good standing with the IRS. If you are a bona fide tax exempt,
nonprofit organization, a copy of your current tax exemption letter is required.

   Yes     No
                    Is the Authorized User a commercial entity?
                    Is the Authorized User a bona fide tax exempt, non profit entity? If yes, you must attach to this application a copy
                    of your IRS tax exemption letter providing proof and certifying your current tax exempt status.
                    Are fees for admission, entry or participation required? If yes, please provide amount?__________
                    Are fees for vendor or others required? If yes, please provide amount(s):____________________



                                                        City Stage Rental

    Will you require use of a city stage? Yes    No
      There is a $50 holding fee per stage
      Stage fees vary depending upon size required

                                SHOWMOBILE, BANDSTAND AND SECTIONAL STAGE RENTAL
                                 AGREEMENT RELEASE AND INDEMNIFICATION DOCUMENT
   Renter Information

   Individual or Organization:______________________________________________________________________
   Address of Individual or Organization:_____________________________________________________________
   Contact Person (if organization) :_______________________________________Contact Phone: ____________


            I/We wish to utilize the show mobile and/or bandstand and/or sectional staging owned by the City of
   New Bedford on (date/s requested) _______________________________. Delivery and set up will occur
   between (DPF will complete) _______________the day of the event and removal will occur on the first business
   day following the event, at the discretion of the City.

           In accord with this request, I/we as the renting party do hereby request and authorize the City of New
   Bedford and/or its agents, employees, officials and contractors to enter upon the premises listed above which is
   either owned, operated or rented by the party above, for the purpose of delivering, erecting, installing,
   maintaining and thereafter removing a show mobile, bandstand or sectional staging and appurtenances
   (equipment) used for entertainment or public address.

            I/We further agree that no attachments of any auxiliary lighting, materials, items or appliances used for
   the purpose of entertainment or public address either by nail, screw, tack, tape, or clamp shall be made by the
   renter, its agents, employees, officials, contractors or volunteers to the City equipment without the express
   written consent by the City acting by and through an authorized official of the Department of Public Facilities.



                City of New Bedford ∙ 181 Hillman Street, Building 3, New Bedford, MA 02740 ∙ 508-961-3015
                                                         4|Page
                           Special Event Request for City Services- City of New Bedford


        In consideration of the aforementioned rental and service, I/we do hereby release and agree to
indemnify and to hold harmless the City, its agents, servants, employees, officials and contractors hired by it,
from any and all claims, liability, loss or damage (including defense costs and attorneys fees) which may arise
from the use or misuse of said equipment, from claims for personal injury and to promptly reimburse the City
for any damage to City equipment which may occur during the use/rental of said equipment by the renting
party.

        I have read and fully understood the above rental, release and indemnification agreement and agree to
the terms included on behalf of myself and/or the organization which I represent. If this document is executed
by me on behalf of an organization rather than individually, I hereby covenant and represent to the City of New
Bedford that I am authorized to execute this document on behalf of the organization and I further agree in my
individual capacity to indemnify and hold the City harmless from any and all damages which may arise out of any
unauthorized execution of this document by me.

Name of organization or individual renter: ___________________________________________

Name of authorized individual or renter (please print clearly): ____________________________

Signature: _____________________________________________________________________

Name of witness (please print clearly): ______________________________________________

Signature of witness: ____________________________________________________________

Approved on behalf of the City of New Bedford acting by and through its Department of Public Facilities:

Date of Agreement: _____________________________

_____________________________________________

Kenneth F. Blanchard
Superintendent of Public Works
Department of Public Facilities
City Yard
309 Smith Street
New Bedford, MA 02740




          City of New Bedford ∙ 181 Hillman Street, Building 3, New Bedford, MA 02740 ∙ 508-961-3015
                                                   5|Page
                              Special Event Request for City Services- City of New Bedford

                                                           Insurance

The Authorized User shall to secure general liability insurance from an approved insurance company listing the City of New
Bedford and the Park Board or other applicable department as additional insured, and providing coverage of $1 million per
occurrence. Evidence of said insurance must be submitted to the Mayor’s (or other applicable Department) no later than

Insurance Agency                                               Phone

Street                               City                            State                      Zip


Contact Name                     Policy Type                                 Policy Amount         Policy Number
ten (10) working days prior to the Special Event.


                                                    Applicants Affidavit


Event Title                                         Event Date(s)                                     Time

Location

I, on behalf of the organization I represent, certify that all the foregoing pages in this Special Event Permit Application have
been completed, and for those pages for which are not applicable, it has been so noted on the appropriate sections. I
attest that the information contained herein is accurate, to the best of my knowledge and belief.

I attest that I have read all the rules, regulations and guidelines specified herein and that which is included in the
addendums to this Application.

I, acting on behalf of the organization I represent, am authorized to commit that organization to agree to abide by the rules,
regulations and guidelines specified herein, and that I will accept all responsibilities for any payments for municipal services
and/or resources as they have been outlined and as they may be utilized by me and the organization whom I am
representing and the patrons who will be served by this Special Event.

Name of Applicant                                            Title

Organization Name

E-mail address

Signature                                                                        Date

                    This Affidavit MUST BE SUBMITTED, signed and mailed to the following:
                                               City of New Bedford
                                    c/o Special Event Request for City Services
                              Parks, Recreation & Beaches- Administrative Offices
                                          181 Hillman Street, Building #3
                                             New Bedford, MA 02740
   FAILURE TO RETURN THIS SIGNED AFFIDAVIT WITH THE COMPLETED REQUEST APPLICATION SHALL CAUSE THIS
                                     REQUEST TO BE DEEMED INCOMPLETE

            City of New Bedford ∙ 181 Hillman Street, Building 3, New Bedford, MA 02740 ∙ 508-961-3015
                                                     6|Page
                                 Special Event Request for City Services- City of New Bedford
                                                City Permits and Fee Association

 Special Event Permit, Administrative Costs                                                                  $25.00
 City Clerk’s Office*
 Theatrical exhibitions, public shows, public amusements and exhibitions of every description, to which      See City Clerk for Fees and more
 payment of money for such amusement is given (MGL 140 Section 181)                                          information
 - Carnival, concert, circus, dance license                                                             See City Clerk
 Sunday License (if running rides on a Sunday)                                                          See City Clerk
 Inspectional Services
 Temporary Devices – (requires annual renewal – fees dependent on the device. See Building Dept. for other fees)
 -Circus, carnival, amusement or concession units (to include temporary tents).                           $10.00
 Electricians must obtain a permit and schedule an inspection of the property for code compliance. The electrician shall be in attendance for the
 inspection.
 Health Department
 Temporary Food Establishment Permit                                                                      $60.00
 Licensing Board
 Special All Alcoholic Beverages License (MGL 138, Section 14)                                            $100.00/day
 Special Wines and Malts Beverages License (MGL 138, Section 14)                                          $75.00/day
 Fire Department
 Fire Prevention Permit (for vendors)                                                                     $10.00
 Permit to Erect and Use Tents                                                                            $10.00
 Permit for Supervised Display of Fireworks (MGL 148, Section 39A & 527 CMR 2.04)                         $10.00

All applicable city permits, applications and fees associated are due no later than 10 working days prior to the event, unless
otherwise noted for any specific department.
If there will be any fees for admission and/or to purchase tickets for any type of entertainment at your event, you must contact the
City Clerk’s Office to determine if a special license is required. Failure to do so may result in that portion of your event being closed.

                                                City Services with Cost Association
                                                      Fees subject to change
 Water / Wastewater Department
 Street Sweeping                                                                $65.00/hour
 Generator Set                                                                  $35.00/hour; $130.00/day
 Water Hose Set Up                                                              $1.50/linear foot
 Water Connections                                                              $80/day
 Lights                                                                         $50/day
        ***General Labor
        Foreman                                                                 $24.30/hr
       Operator                                                                 $24.86/hr
       Laborer                                                                  $21.38/hr
 Department of Public Works (D.P.W.)

 Clean up                                                                       General Labor/per hour***
 Sink Set-ups                                                                   General Labor /per hour
 Plumber                                                                        $22.84/hr∙ $34.26 overtime (3 hr min)
 Electrician                                                                    $22.84/hr∙ $34.26 overtime (3 hr min)
 Custodian                                                                      $16.37/hr ∙ $24.56 overtime (3 hr min)
 Dumping of Material                                                            $75.00/ton
 Health Department
 Sanitarians (Minimum: 3 hours call back at time & ½) $27.52/hr x 3             $82.56 (for minimum 3 hrs)
 Fire Department
 Fire Inspectors                                                                Contact Fire Dept. @ 508-991-6124 for overtime* rates.
 *Overtime refers to any hours outside regular time. Regular hours are
 Monday through Friday and the times vary by department.
             City of New Bedford ∙ 181 Hillman Street, Building 3, New Bedford, MA 02740 ∙ 508-961-3015
                                                      7|Page

				
DOCUMENT INFO
Categories:
Tags:
Stats:
views:0
posted:11/13/2012
language:Unknown
pages:7
PermitDocsPrivate PermitDocsPrivate http://
About