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SPECIAL EVENT PERMIT APPLICATION PLEASE TAKE TIME TO (City of Riverside, California)

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SPECIAL EVENT PERMIT
APPLICATION
PLEASE TAKE TIME TO REVIEW THE SPECIAL EVENT PERMIT APPLICATION AND
INSTRUCTIONS BEFORE
YOU BEGIN COMPLETING THE APPLICATION FORM.
The City of Riverside is proud to have its residents and visitors host a multitude of community events
in order to improve the quality of life and contribute to the economic vitality of the City. The
following pages include the City of Riverside’s Special Events Permit Application and
accompanying instructions developed to guide you through the permit process.
A Special Events Permit Application can be printed online or picked up at and submitted to:
Attn: Special Event Permits
Community & Economic Development Department
Arts & Cultural Affairs Division
3900 Main Street, 5
th
Floor
Riverside, CA 92522
For more information please contact (951) 826-2427 or specialevents@riversideca.gov
. On behalf
of the City of Riverside we thank you for contributing to the vitality of our community and offer you
best wishes for a successful event.
THERE ARE NO SHORTCUTS TO THE PROCESSING OF A SPECIAL EVENTS PERMIT
APPLICATION. PLEASE ALLOW A MINIMUM OF SIXTY (60) DAYS FOR THE
PROCESSING OF THE SPECIAL EVENTS PERMIT APPLICATION. A LATE FEE IN
ADDITION TO THE APPLICATION FEE WILL APPLY TO ANY SUBMITTAL RECEIVED
LESS THAN SIXTY (60) DAYS PRIOR TO THE EVENT DATE. FOR A
RESIDENTIAL/NEIGHBORHOOD BLOCK PARTY APPLICATION, PLEASE ALLOW A
MINIMUM OF THIRTY (30) DAYS FOR PROCESSING. A LATE FEE WILL APPLY TO
ANY SUBMITTAL RECEIVED LESS THAN THIRTY (30) DAYS PRIOR TO EVENT DATE.
A completed application must have all applicable sections of the application
complete and must include a detailed map of the event layout. Any
application that is submitted without a map of the event layout will be
deemed incomplete and returned to the applicant.
CITY OF RIVERSIDE SPECIAL EVENT PERMIT APPLICATION 2 of 26
TABLE OF CONTENTS
APPLICATION INSTRUCTIONS 3
SECTION I – CONTACT INFORMATION 5
SECTION II – EVENT INFORMATION 7
SECTION III – STREET CLOSURE(S) 9
SECTION IV – VENUE & STAGING DETAILS 12
SECTION V – CATERING/FOOD & VENDOR INFORMATION 13
SECTION VI – PARKING & SHUTTLE SERVICE(S) 14
SECTION VII – SANITATION & WASTE REMOVAL 16
SECTION VIII – SECURITY, POLICE & FIRE 17
SECTION IX – EMERGENCY SERVICES 18
SECTION X – SITE PLAN/MAP INSTRUCTIONS 19
SECTION XI – MISCELLANEOUS 19
INDEMNIFICATION AGREEMENT 20
APPLICANT AGREEMENT 21
APPENDIX 22
BLOCK PARTY PETITION FOR TEMPORARY STREET CLOSURE 23
NOTICE OF TEMPORARY STREET CLOSURE 24
NOTICE OF TEMPORARY PARKING ENCROACHMENT 25
PARTICIPATING VENDOR LIST 26
CITY OF RIVERSIDE SPECIAL EVENT PERMIT APPLICATION 3 of 26
INSTRUCTIONS
Completed Special Events Permit Applications must be received no later than sixty (60) days prior
to the event start date and may be submitted as early as six (6) months prior to the event start
date. In general, any organized activity involving the use of, or having impact upon public
property, street areas or the temporary use of private property in a manner that varies from its
current land use, requires a permit. Residential/Neighborhood Block Party Permit Applications must
be received no later than thirty (30) days prior to the event start date.
It is our goal to assist event organizers in planning safe and successful events that create a minimal
impact on the communities and residents surrounding the events.
COMMUNITY CALENDAR
The City of Riverside provides a calendar of upcoming events on the internet. Information from
your Permit Application is considered public information and may be used in developing the
calendar of community events. The City of Riverside Community Calendar can be accessed at
www.riversideca.gov/calendar. Please contact communitycalendar@riversideca.gov for more
information.
PERMIT APPLICATION PROCESS
The Permit Application Process begins when the Event Organizer submits a completed Special
Events Permit Application and Non-Refundable Permit Fee. During the initial application screening
process you will be allowed time to provide all pending documents (e.g. Liability Insurance,
secondary permits, etc.). Upon receipt of your completed Permit Application, a representative
from the City will contact you. Thereafter, this person will serve as your City Liaison and will be your
primary point of contact for the processing of your permit.
A completed application must have all applicable sections of the application complete and must
include a detailed map of the event layout. Any application that is submitted without a map of
the event layout will be deemed incomplete and returned to the applicant.
Your City Liaison will distribute, for review, copies of your Permit Application to all City Departments
affected by your event. You may be contacted individually by these departments only if they
have specific questions or concerns about your event. Please be aware that in some cases you
may need to contact federal, state or county agencies in addition to the City of Riverside.
Throughout the Permit Application Process you will be notified if your event requires any additional
information, permits, licenses or insurance. Delays in providing the requested items often delay the
ability to finish the Permit Application Process and approve a Permit Application in a timely manner
and could result in denial of the application.
Note: Keep in mind that acceptance of your Permit Application should in no way be construed as
final approval or confirmation of your Permit Application.
CITY OF RIVERSIDE SPECIAL EVENT PERMIT APPLICATION 4 of 26
NON-REFUNDABLE PERMIT FEE
Fees are determined taking into consideration the status of the Host Organization. The Fee is
established by resolution of the City Council and may not be waived. Payments must be made by
check or money order made payable to the “City of Riverside” or by credit card. Cash payments
will not be accepted. A late fee will be applied if the application is submitted less than sixty (60)
days from the date of the special event. For Residential/Neighborhood Block Permits, the late fee
will be applied if application is submitted less than thirty (30) days from the date of the event.
Residential/Neighborhood Block Party Permits
Permit Fee
Late Fee*
$25.00
$30.00
Non-Profit Organizations
Permit Fee
Late Fee*
$75.00
$300.00
Professional Corporation/Business/Organization
Permit Fee
Late Fee*
$100.00
$300.00
*Late Fee is in addition to Permit Fee.
CANCELLATION POLICY
Should Event Organizer, for any reason, need to cancel their event they must first notify their City
Liaison. Written notice of cancellation must be received in our office no later than thirty (30) days
prior to the event start date. Cancellations must be in written form; verbal cancellations will not be
accepted.
Please keep in mind that Permit Fees are non-refundable. It is also possible that fees related to
Police Services will still be incurred. Please contact your City Liaison for more details.
SUBMISSION
Please submit your completed Special Events Permit Application to the City of Riverside –
Community & Economic Development Department, Arts & Cultural Affairs Division (address below)
or via email to specialevents@riversideca.gov
.
You may also mail your Application to: Attn: Special Event Permits
Community & Economic Development Department
Arts & Cultural Affairs Division
3900 Main Street, 5
th
Floor
Riverside, CA 92522
Please review the Special Event Permit Application Packet in its entirety. If you have additional
questions please contact (951) 826-2427 or specialevents@riversideca.gov
.
CITY OF RIVERSIDE SPECIAL EVENT PERMIT APPLICATION 5 of 26
SECTION I – CONTACT INFORMATION
*Required information. Please complete entire section
Host Organization*
Host Organization is the organization accepting all financial responsibility for the event and provides
the required insurance.
Organization Name:
Type of Organization: Corporation LLC Non-Profit
(Non-Profit must provide copy of determination letter)
Mailing Address:
(Street Address) (City) (State) (Zip)
Physical Address:
(If different) (Street Address) (City) (State) (Zip)
Primary Phone Number: ( ) Fax Number: ( )
Website Address: http://
Event Organizer*
Event Organizer is the applicant given authorization by the host organization to apply for the Special
Event Permit.
Name: Title:
Mailing Address:
(Street Address) (City) (State) (Zip)
Phone Number: ( ) Cell Phone Number: ( )
E-Mail address:
Secondary Organizer*
It is recommended that Event Organizer provide contact information for a Secondary Organizer.
Name: Title:
Mailing Address:
(Street Address) (City) (State) (Zip)
Phone Number: ( ) Cell Phone Number: ( )
E-Mail address:
Only those authorized as event organizer and secondary organizer will be able to make
changes to the application.
CITY OF RIVERSIDE SPECIAL EVENT PERMIT APPLICATION 6 of 26
On-Site Contact
Contact information for the person who will be on-site and will be the primary contact on the day(s)
of the event.
Name: Title:
Check if same as above for Event Organizer or Secondary Organizer
Mailing Address:
(Street Address) (City) (State) (Zip)
Phone Number: ( ) Cell Phone Number: ( )
E-Mail address:
CITY OF RIVERSIDE SPECIAL EVENT PERMIT APPLICATION 7 of 26
SECTION II – EVENT INFORMATION
*REQUIRED INFORMATION. Please complete entire section.
Event Details*
Event Name:
Type of Event: 5k or 10k Runs Bike Races Block Party Celebration
Ceremony Concert Festival Fundraiser
Farmers Market Marathon Half-Marathon Parade
Procession Street Fair Walkathons Car Show
Other:
Detailed Event Description (50-Word Minimum):
Is this an annual event? Yes No
Is this a multi-day event? Yes No If so, how many days?
Is there an admission fee? Yes No If yes, please include admission fee(s) $
What is the anticipated attendance? Overall: Daily:
Previous year’s attendance (if applicable): Overall: Daily:
Event Set-Up & Tear-Down*
If you will be utilizing street closures please refer to the next section to provide all street closure
information.
How many days will your organization require to: Set-Up: Tear Down:
Event Set-Up Date: Event Set-Up Time: to
(Day of Week) (Date)
Event Start Date: Event Start Time: AM/PM
(Day of Week) (Date)
Event End Date: Event End Time: AM/PM
(Day of Week) (Date)
Event Tear-Down Date: Event Tear-Down Time: to
(Day of Week) (Date)
■
CITY OF RIVERSIDE SPECIAL EVENT PERMIT APPLICATION 8 of 26
If your event is a multi-day event, please complete the following information for each separate
date. Space is provided for five (5) additional entries. If your event is longer than five (5) days,
please attach an additional sheet of paper with the requested information.
Additional Day One:
Event Set-Up Date: Event Set-Up Time: to
Event Start Date: Event Start Time: AM/PM
Event End Date: Event End Time: AM/PM
Event Tear-Down Date: Event Tear-Down Time: to
Additional Day Two:
Event Set-Up Date: Event Set-Up Time: to
Event Start Date: Event Start Time: AM/PM
Event End Date: Event End Time: AM/PM
Event Tear-Down Date: Event Tear-Down Time: to
Additional Day Three:
Event Set-Up Date: Event Set-Up Time: to
Event Start Date: Event Start Time: AM/PM
Event End Date: Event End Time: AM/PM
Event Tear-Down Date: Event Tear-Down Time: to
Additional Day Four:
Event Set-Up Date: Event Set-Up Time: to
Event Start Date: Event Start Time: AM/PM
Event End Date: Event End Time: AM/PM
Event Tear-Down Date: Event Tear-Down Time: to
Additional Day Five:
Event Set-Up Date: Event Set-Up Time: to
Event Start Date: Event Start Time: AM/PM
Event End Date: Event End Time: AM/PM
Event Tear-Down Date: Event Tear-Down Time: to
CITY OF RIVERSIDE SPECIAL EVENT PERMIT APPLICATION 9 of 26
SECTION III – STREET CLOSURE(S)
Block Party Event/Petition for Temporary Street Closure
The City of Riverside requires signatures from all affected residents/businesses both on and/or
adjacent to a proposed street closure. Signatures and addresses will be cross-checked, with the
completed map, by the Riverside Police Department prior to final approval. If any affected
residents/businesses have not signed this petition, indicate the address and reason(s) below (i.e.
resident on vacation, unable to connect with resident, disapproves of street closure, etc.)
Please use the “Block Party Petition for Temporary Street Closure” form located in the Appendix as
proof of notice of the proposed street closure.
This “Block Party Petition for Temporary Street Closure” document may be reproduced as needed.
Notice of Temporary Street Closure*
The City of Riverside requires that all affected residents/businesses both on and adjacent to a
proposed street closure be notified of such a street closure.
Please use the “Notice of Temporary Street Closure” form located in the Appendix as proof of
notice of the proposed street closure. This “Notice of Temporary Street Closure” document may
be reproduced as needed.
Street Closure(s)
Closure Start Date: Closure Start Time: AM/PM
(Day of Week) (Date)
Closure End Date: Closure End Time: AM/PM
(Day of Week) (Date)
If your event requires multi-day street closures, please complete the following information for each
separate date. Space is provided for five (5) additional entries. If your event requires street closures
longer than five (5) days, please attach an additional sheet of paper with the requested
information
.
Additional Day One:
Closure Start Date: Closure Start Time: AM/PM
Closure End Date: Closure End Time: AM/PM
Additional Day Two:
Closure Start Date: Closure Start Time: AM/PM
Closure End Date: Closure End Time: AM/PM
Additional Day Three:
Closure Start Date: Closure Start Time: AM/PM
Closure End Date: Closure End Time: AM/PM
CITY OF RIVERSIDE SPECIAL EVENT PERMIT APPLICATION 10 of 26
Barricade Equipment*
Does Host Organization have its own barricade equipment? Yes No
If not, please indicate how Host Organization will meet all barricade requirements.
Host Organization will rent barricade equipment from a private company. Host
Organization will set-up and tear-down barricade equipment.
Host Organization will rent barricade equipment from a private company. Private
Company will set- up and tear-down barricade equipment.
If renting from or hiring a private company, please provide the following information.
Company Name:
Contact Name:
Mailing Address:
(Street Address) (City) (State) (Zip)
Physical Address:
(If different) (Street Address) (City) (State) (Zip)
Primary Contact Number: ( )
Secondary Contact Number: ( )
Email:
INSURANCE
Host Organization and/or Event Organizer must provide a General Liability Insurance Certificate
providing evidence of general liability insurance coverage in the minimum amount of $1,000,000
combined single limit, $2,000,000 aggregate AND $1,000,000 Auto Liability if the event includes any
moving vehicles including golf carts AND an additional insured endorsement naming the City of
Riverside, its officers, employees and agents’ as additional insured. $1,000,000 Liquor Liability if the
event is selling alcohol. $1,000,000 Liquor Host if the event is distributing alcohol at no charge. All
vendors participating in the event and service providers must provide insurance as well as all
contracted services for the event i.e. Security services, rentals, traffic management, etc. This
document must be submitted no later than fifteen (15) days prior to the event start date.
CITY OF RIVERSIDE SPECIAL EVENT PERMIT APPLICATION 11 of 26
Traffic Plan*
It may be necessary for the Event Organizer to obtain a Professional Traffic Plan.
Please keep in mind that streets must be closed from intersection to intersection; streets cannot be
closed mid-block. Event Organizer is responsible for posting Temporary “No Parking” Signs
according to requirements on page 15.
Please list the streets, from intersection to intersection, which will be closed for your event. Space is
provided for up to five (5) entries. If you need more space please attach an additional sheet of
paper with the requested information. Your Site Plan/Map must show all streets, street closures,
and must include a designated 12-foot wide emergency lane.
1) Street Name:
From (cross street):
To (cross street):
Type of Closure: Street Closure Sidewalk Closure Lane Closure
2) Street Name:
From (cross street):
To (cross street):
Type of Closure: Street Closure Sidewalk Closure Lane Closure
3) Street Name:
From (cross street):
To (cross street):
Type of Closure: Street Closure Sidewalk Closure Lane Closure
4) Street Name:
From (cross street):
To (cross street):
Type of Closure: Street Closure Sidewalk Closure Lane Closure
5) Street Name:
From (cross street):
To (cross street):
Type of Closure: Street Closure Sidewalk Closure Lane Closure
CITY OF RIVERSIDE SPECIAL EVENT PERMIT APPLICATION 12 of 26
SECTION IV – VENUE & STAGING
PARKS, RECREATION & COMMUNITY SERVICES EVENTS
If you plan to hold your event at a City park it is your responsibility to contact the appropriate
division or facility manager within the Parks, Recreation and Community Services Department to
coordinate the schedule of your event. Rules, regulations and restrictions unique to each
site/facility may apply. For more information please contact the Parks, Recreation & Community
Services Department at (951) 826-2000.
Facility Use Permit
Will this event take place at a City park? Yes No
Note: Please attach a copy of the Facility Use Permit Application.
Venue Details*
Venue Name:
Venue Address:
(Street Address) (City) (State) (Zip)
Venue Description (Please attach your Site Plan/Map to your Application Packet):
Staging Details*
The following items will be used at the event (Please mark all that apply):
Amplified Music Bleacher(s) Dance Floor(s) Live Entertainment* Jumper
Loud Speaker(s) Microphone(s) Disk Jockey (DJ) Moving Vehicles (Including golf
carts)
Stage(s) Number & Size:
Provide by: ________________________________________________________________________________
EZ Up Number & Size:
Canopy Number & Size:
Please indicate location of EZ Ups/canopies and size on Site Plan/Map.
Other:
*If Live Entertainment is selected, please describe: ___________________________________________
Note: If any of the above items will be used, please indicate their location on your attached Site
Plan/Map with Legend. Use of the above items may require the Event Organizer to meet Fire
Department, ADA regulations, and insurance requirements.
CITY OF RIVERSIDE SPECIAL EVENT PERMIT APPLICATION 13 of 26
SECTION V – CATERING & FOOD VENDORS
Catering/Food Vendor Details*
Event Organizer must obtain a health permit for the event including all food providers. If alcoholic
beverages will be provided or sold at the event, an ABC Permit is required. ABC Permit application
must be submitted to the city for approval a minimum of 30 days prior to the event. Police services
may be required.
Event will include the following (Please mark all that apply):
Alcoholic Beverages Non-Profit Food Vendors Pot Luck Items
Professional Catering Pre-Packaged Food/Beverage Items Retails Food Vendors
If a professional caterer will be hired for this event, please provide the following information and attach
copies of the company’s Business Tax Certificate, Liability Insurance Certificate and Health Certificate.
Company Name:
Contact Name:
Mailing Address:
(Street Address) (City) (State) (Zip)
Physical Address:
(If different) (Street Address) (City) (State) (Zip)
Primary Phone Number: ( ) Fax Number: ( )
Email:
Vendor Information Requirements
If event will include food vendors, a complete list of all food vendors must be provided a minimum
of 15 working days prior to the event. All participating food vendors must have a valid Permit from
the County of Riverside Department of Environmental Health, City of Riverside Business Tax
Certificate, and Liability Insurance.
Number of Food Vendors:
Number of Non-Food Vendors:
NOTE: Non-food vendors must also be included on the list and must provide a Business Tax
Certificate and Liability Insurance. See appendix for sample vendor list.
CITY OF RIVERSIDE SPECIAL EVENT PERMIT APPLICATION 14 of 26
SECTION VI – PARKING & SHUTTLE SERVICES
Parking Details
Please describe Public Parking arrangements. (Please indicate location(s) on Site Plan/Map) If
parking is located on private property, please provide a copy of written authorization.
Shuttle Service Details
Will a shuttle service be provided from parking areas to the event site? Yes No
If yes, please describe the shuttle plan. (Please indicate pick-up and drop-off location(s) on Site
Plan/Map)
If providing a private shuttle service, please provide the following information and attach copies of
the company’s Business Tax Certificate, Liability Insurance Certificate and California State License.
Company Name:
Contact Name:
Mailing Address:
(Street Address) (City) (State) (Zip)
Physical Address:
(If different) (Street Address) (City) (State) (Zip)
Primary Phone Number: ( ) Cell Phone Number: ( )
Fax Number: ( ) E-Mail address:
Parking Encroachment Details
POST “NO PARKING” SIGNS 72 HOURS BEFORE ENCROACHMENT FOR EVENTS
Garage: Yes No Location:
Meters On- Street: Yes No Location:
Parking Lot: Yes No Location:
On-Street
Parking (not marked): Yes No Location:
Marked Stalls: Yes No Location:
Impacts ADA/Disabled Parking Stall(s) or Pedestrian Access Ramps: Yes No
CITY OF RIVERSIDE SPECIAL EVENT PERMIT APPLICATION 15 of 26
How do you plan to utilize the parking space? Provide specific details:
Date/Time Meter Encroachment Begins: AM/PM
Date/Time Meter Encroachment Ends: AM/PM
For Metered Areas- List the meter numbers or space numbers located on the street. Please note
that meter rates may apply.
Meter #s:
Be advised that no parking zones, disabled parking and loading zones may not be reserved.
• Temporary “No Parking” approved in conjunction with special event
permits.
• Temporary No Parking Signs must indicate the Date and Time of
Restriction AND the RMC 10.52.100 and CVC 22651 (l), (n).
• Temporary No Parking Signs must be posted by the permittee a
maximum of 72 hours and a minimum of 24 hours before the date and
time they are to take effect. Per California Vehicle Code Section
22651 (l) and (n).
• Temporary No Parking Signs SHALL NOT cover or obscure existing signs or parking meter heads.
• Temporary No Parking Signs must be unobstructed and clearly visible by drivers on the street or
affected parking patrons. Post the Temporary No Parking Signs:
o Facing oncoming traffic, directly below the existing signage, and at a 45 degree angle
to the street
o Fastened at both top and bottom
o Signs must include “Entire Parking Lot” if an entire parking lot will be closed
o Signs must include “Entire Block” if an entire block will be closed
• All Temporary “No Parking Signs” must be removed by the permittee upon the expiration of the
signs or at the end of the event, whichever comes first.
CITY OF RIVERSIDE SPECIAL EVENT PERMIT APPLICATION 16 of 26
SECTION VII – SANITATION & WASTE REMOVAL
Restroom Facility Details*
Some events will require the presence of portable restrooms and/or hand-washing stations. Use of
these items will require the Event Organizer to meet ADA regulations. Please contact your rental
company for attendance to restroom ratios. A copy of the rental company’s City of Riverside
Business Tax Certificate and Liability Insurance must be attached to Permit Application. Please
indicate location(s) on your Site Plan/Map.
Will Event Organizer provide portable restroom facilities? Yes No
If so, please provide the following information. (Please indicate location(s) on Site Plan/Map)
Company Name:
Contact Name:
Address:
(Street Address) (City) (State) (Zip)
Primary Phone Number: ( ) Cell Phone Number: ( )
E-Mail address:
Waste Removal Details*
Event Organizer is responsible for arranging for the removal of all waste related to the event. This
includes, but is not limited to emptying of trash bins and the removal of waste from the event site
and other affected areas. A copy of the sanitation company’s City of Riverside Business Tax
Certificate and Liability Insurance must be attached to Permit Application. If not hiring a
professional sanitation company, please provide the following information for the person(s)
responsible for waste removal.
Contact Name & Title:
Primary Phone Number: ( ) Cell Phone Number: ( )
E-Mail address:
If hiring a professional sanitation company, please provide the following information.
Company Name:
Contact Name:
Address:
(Street Address) (City) (State) (Zip)
Primary Phone Number: ( ) Cell Phone Number: ( )
E-Mail address:
CITY OF RIVERSIDE SPECIAL EVENT PERMIT APPLICATION 17 of 26
SECTION VIII – SECURITY, POLICE & FIRE
Security and/or Police*
If necessary, in case of emergency, the On-Site Contact will call 9-1-1.
Event Organizer is requesting assistance from the Riverside Police Department. The Riverside
Police Department will require a signed contract for services provided.
Event Organizer will provide a private security company.
If providing a private security company, please provide the following information and attach copies
of the company’s City of Riverside Business Tax Certificate, Liability Insurance and California State
License.
Company Name:
Contact Name:
Mailing Address:
(Street Address) (City) (State) (Zip)
Physical Address:
(If different) (Street Address) (City) (State) (Zip)
Primary Phone Number: ( ) Cell Phone Number: ( )
Fax Number: ( ) E-Mail address:
Fire
Event will require the use of electrical generators. How many: ________ Size: ____________________
A Fire Building & Safety Permit will be required if using generators that exceed 10,000KW
Event will host the use of fireworks, explosive devices, pyrotechnics, mock gunfire and/or the
use of weaponry for special effects.
Note: Please be advised that a police officer is required to be present any time weapons are
loaded and/or discharged. Please contact your City Liaison for more information.
If hosting the use of fireworks, explosive devices, pyrotechnics, mock gunfire and/or the use of
weaponry for special effects, please provide the following information.
Date and Time of Demonstration:
Company Providing Demonstration:
Demonstration & Location Description (Please indicate the location of the show and/or launching on
the Site Plan/Map):
CITY OF RIVERSIDE SPECIAL EVENT PERMIT APPLICATION 18 of 26
SECTION IX– EMERGENCY SERVICES
Medical Plan*
All events are required to have a First Aid Station on-site. Please indicate the location on the Site
Plan/Map.
If necessary, in the case of an emergency, the On-Site Contact will call 9-1-1.
Event Organizer will provide an ambulance company to be on site.
Event Organizer will provide a medical doctor, registered nurse, and/or EMT Staff to be on site.
If providing an ambulance company, please provide the following information and attach copies
of their City of Riverside Business Tax Certificate, Liability Insurance and California State License.
Company Name:
Contact Name:
Mailing Address:
(Street Address) (City) (State) (Zip)
Physical Address:
(If different) (Street Address) (City) (State) (Zip)
Primary Phone Number: ( ) Cell Phone Number: ( )
E-Mail address:
If providing a medical doctor, RN, and/or EMT Staff, please provide the following information and
attach a copy of their identification credentials.
Company Name:
Contact Name:
Mailing Address:
(Street Address) (City) (State) (Zip)
Physical Address:
(If different) (Street Address) (City) (State) (Zip)
Primary Phone Number: ( ) Cell Phone Number: ( )
E-Mail address:
Evacuation Plan
Please provide a detailed description of your emergency evacuation plan.
CITY OF RIVERSIDE SPECIAL EVENT PERMIT APPLICATION 19 of 26
All site plans/maps must be submitted using 8 ½” x 11” or 8 ½” x 14” white paper. All
applicants are required to submit a detailed Site Plan/Map.
Site plans/maps must also include a key showing the use of symbols for people, vehicles,
first aid station(s), cooking station(s), food tables, stage(s), platform(s), barricades, 12 foot
fire lane, etc.
If using Computer Assisted Generation (CAG) for the site plan/map please ensure the use
of Arial Fonts no smaller than size 10.
Animals
If animals will be present, food service canopies/tents must be at least fifty (50) feet away. It will
also be required that Event Organizer provides portable hand-washing stations.
Will there be any kind of animals at this event (e.g. petting zoo, pony rides, etc.)? Yes No
If yes, please list type of animal(s):
_______________________________________________________________
If so, please indicate the location of the animals on the Site Plan/Map. Additional permitting may
be required.
Balloons/Balloon Launching
It is required that the Event Organizer contact the Riverside Airport at (951) 351-6113 to obtain
information regarding weather and timing of air flights in the direction of the launch. Mylar
balloons, string, ribbon and/or valves are not permitted when launching balloons.
Will Mylar and/or latex helium-filled balloons be launched/sold at the event? Yes No
If so, please indicate launch site on Site Plan/Map. How many balloons will be launched?
SECTION X – SITE PLAN/MAP INSTRUCTIONS
SECTION XI – MISCELLANEOUS
CITY OF RIVERSIDE SPECIAL EVENT PERMIT APPLICATION 20 of 26
Host Organization and/or Event Organizer agree, in consideration of the granting of this
Application and Special Event Permit for:
to be held on ,
Event Name Event Date(s)
by of .
Event Organizer/Primary Applicant Host Organization
Host Organization and/or Event Organizer(s) agree to defend, indemnify and hold harmless the
City of Riverside, and the City of Riverside’s employees, officers, managers, agents, council
members, and volunteers harmless from any and all losses, damages, claims for damage, liability,
lawsuits, judgment expense and cost(s) arising from any injury or death to any person or damage
to any property including all reasonable costs for investigation and defense thereof (including, but
not limited to, attorney fees, costs and expert fees) arising out of or attributed to the issuance of
Applicant’s Special Event Permit regardless of where the injury, death or damage may occur,
unless such injury, death or damage is caused by the sole negligence or willful misconduct of the
City.
Host Organization and/or Event Organizer agree to provide satisfactory evidence of, and shall
thereafter maintain during the specified special event, such insurance policies and coverages in
the types, limits, forms and ratings required by the City’s Risk Manager or City Attorney or their
designee.
Host Organization and/or Event Organizer hereby requests waiver of insurance under the
prohibitive cost exemption. Note: This waiver is offered only to Block Party/Neighborhood Event
Applicants.
Print Name Title
Signature Date
INDEMNIFICATION AGREEMENT
CITY OF RIVERSIDE SPECIAL EVENT PERMIT APPLICATION 21 of 26
Please read each statement. Initialing next to each statement indicates your understanding and
agreement to the statement.
Host Organization and/or Event Organizer agrees, upon request, to provide a General Liability
Insurance Certificate providing evidence of general liability insurance coverage in the minimum amount of
$1,000,000 combined single limit, $2,000,000 aggregate AND $1,000,000 Auto Liability if the event includes
any moving vehicles including golf carts AND an additional insured endorsement naming the City of
Riverside, its officers, employees and agents’ as additional insured. This document must be submitted no
later than fifteen (15) days prior to the event start date.
Host Organization and/or Event Organizer agrees, upon request, to submit a Security Plan setting
forth the proposed security measures to be taken to protect the health, safety and welfare of the
participants, spectators, bystanders and passersby. This plan may be reviewed by the Police Department
who may require alterations to the plan. Security measures may include but are not limited to the hiring of a
private security or Riverside Police Officers at the expense of the Event Organizer.
Host Organization and/or Event Organizer agrees, upon request, to provide a copy of their Determination
Letter, as issued by the Internal Revenue Service of the United States or State of California, if the application is made
on behalf of any organization representing itself as a tax-exempt, non-profit and/or charitable organization.
Host Organization and/or Event Organizer agree, upon request, to pay a refundable Cleaning Deposit no
later than ten (10) days prior to the event as a condition of the issuance of the Special Event Permit. Applicant also
agrees to pay any clean-up costs, in excess of the deposit, incurred by the City as a result of additional clean-up
required to return the event location and surrounding area to its previous condition.
Host Organization and/or Event Organizer agree to notify all residents and businesses that will be
affected by street/sidewalk closures and/or amplified sound. Notification also includes the posting of official
temporary “No Parking” signs on streets involved in closures for the event.
Host Organization and/or Event Organizer agree to supply warning signs and/or barricades and to
situate them in such a position that the road closure may be maintained in a safe and orderly manner.
Barricades must be manned at all times during street closures.
Host Organization and/or Event Organizer agree that any false statement or material
misrepresentation made in support of this application and permit is cause for denial of issuance of a Special
Event Permit. Applicant also agrees that failure to adhere to the policies and procedures established by the
City of Riverside ordinance number 6102, known as the “Special Events Ordinance”, or any conditions or
restrictions imposed upon the permit by the Riverside Police Department or the Community and Economic
Development Department, is cause for revocation of the Special Event Permit. Applicant further agrees that
the Special Event Permit may be revoked at any time by any supervisor of the Riverside Police Department
or the Community and Economic Development Department.
By signing below, Host Organization and/or Event Organizer indicate understanding and
agreement to the above statements.
Print Name Title
Signature Date
APPLICANT AGREEMENT
CITY OF RIVERSIDE SPECIAL EVENT PERMIT APPLICATION 22 of 26
This section provides you with documents that you may need to complete the application
process. This section includes:
Block Party Petition for Temporary Street Closure
Notification of Temporary Street Closure
Insurance Sample
Notice of Temporary Parking Encroachment
Participating Vendor List
For more information please contact (951) 826-2427 or specialevents@riversideca.gov.
APPENDIX
CITY OF RIVERSIDE SPECIAL EVENT PERMIT APPLICATION 23 of 26
BLOCK PARTY PETITION FOR TEMPORARY STREET CLOSURE
The City of Riverside requires that all affected residents/businesses both on and adjacent to a proposed
street closure sign this petition. Therefore, this document serves as a petition for the following proposed street
closure.
Name of Person Responsible for Initiating this Petition:
A temporary street closure has been requested for the following date(s)/time(s) for the streets listed.
Closure Start Date: Closure Start Time: AM/PM
(Day of Week) (Date)
Closure End Date: Closure End Time: AM/PM
(Day of Week) (Date)
Street Name(s):
The purpose of the proposed street closure is (Event Description):
By signature of this “Petition for Temporary Street Closure,” the undersigned hereby agrees to defend,
indemnify and hold harmless the City of Riverside, its officers, employees and agents from any and all losses,
damages, claims for damages, liability, expense or cost arising from any accident or occurrence causing
any injury or damage of any person or property arising out of or attributed to the closure of the above-noted
street(s) or the authorization therefore.
1.
Print Name Signature
( )
Address Phone Number
2.
Print Name Signature
( )
Address Phone Number
3.
Print Name Signature
( )
Address Phone Number
4.
Print Name Signature
( )
Address Phone Number
CITY OF RIVERSIDE SPECIAL EVENT PERMIT APPLICATION 24 of 26
NOTICE OF TEMPORARY STREET CLOSURE
The City of Riverside requires that all affected residents/businesses both on and adjacent to a proposed
street closure be notified of such a street closure. Therefore, this document serves as proof of notice of the
proposed street closure listed.
A temporary street closure has been requested for the following date(s)/time(s) for the streets listed.
Closure Start Date: Closure Start Time: AM/PM
(Day of Week) (Date)
Closure End Date: Closure End Time: AM/PM
(Day of Week) (Date)
Street Name(s):
The purpose of the proposed street closure is (Event Description):
Host Organization Name:
Contact Name:
Mailing Address:
(Street Address) (City) (State) (Zip)
Acknowledgement:
By signing below, the undersigned acknowledges receipt of the above “Notice of Temporary Street Closure.”
1.
Print Name Signature Title Date
( )
Business Name Address Phone Number
2.
Print Name Signature Title Date
( )
Business Name Address Phone Number
CITY OF RIVERSIDE SPECIAL EVENT PERMIT APPLICATION 25 of 26
NOTICE OF TEMPORARY PARKING ENCROACHMENT
The City of Riverside requires that all affected residents/businesses both on and the adjacent to a proposed
parking encroachment be notified. Therefore, this document serves as a template of proof of notice of the
proposed parking encroachment listed.
A temporary parking encroachment has been requested for the following date(s) and time(s) at the
location listed below:
Parking Encroachment Start Date: ___________________ Parking Encroachment Start Time: _______AM/PM
(Day of Week and Date)
Parking Encroachment End Date: ___________________ Parking Encroachment End Time: ________AM/PM
(Day of Week and Date)
The purpose of the proposed parking encroachment is (Description):
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Host Organization Name:
__________________________________________________________________
Contact Name:
__________________________________________________________________________
Email Address:
__________________________________________________________________________
Acknowledgement:
By signing below, the undersigned acknowledges receipt of the above “Notice of Temporary Parking
Encroachment.”
Signature: _______________________________________ Print Name: _______________________________________
Title: ____________________________________________ Date: _____________________________________________
Business Name: ______________________________________________________________________________________
Address: _____________________________________________________________________________________________
Phone Number: ______________________________________________________________________________________
Garage: YES □ NO □
Location (Address, Lot or Garage):
Meters On-Street: YES □ NO □
Parking Lot: YES □ NO □
On-Street Parking (not marked)
:
YES
□
NO
□
Marked Stalls: YES □ NO □
Impacts ADA/Disabled Parking Stall(s) or Pedestrian
Access Ramps: YES □ NO □
CITY OF RIVERSIDE SPECIAL EVENT PERMIT APPLICATION 26 of 26
PARTICIPATING VENDORS
Please list all participating vendors. List of all vendors must be provided a minimum of 15
working days prior to the event. All participating food vendors must have a valid Permit from the
County of Riverside Department of Environmental Health, City of Riverside Business Tax Certificate,
and Liability Insurance.
Vendor Name
Type of
Vendor
Address Phone Number
FOR OFFICE USE ONLY
Health
Permit
Business Tax
Certificate
Insurance
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Completed 24 January 2021

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