Fillable Special Event Application

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Special Event Application

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1
***Due to the restrictions of the COVID-19 pandemic, we are requesting that all applicants abide
by the guidelines set forth by the Governor and the State to maintain social distancing,
in order to continue to protect the health and safety of our community***
Special Event Application
Special Event: An event such as a block party (see separate block party form), parade, festival, race, carnival,
exhibition or other public or private organized gathering of a short duration, lasting less than 3 days, which is proposed
to take place on Cheltenham Township-owned property, parks, private property and/or the public right(s) of way.
The Township of Cheltenham’s Special Event Application Policy is designed to ensure that reasonable preparations are
made to ensure a safe, successful Special Event.
Submitting Your Application
1. Event applicants will be responsible to provide the application fee, site fee, security deposit, staff costs, and
insurance indemnification required in advance to receive permission to hold an event.
2. All event applications must be submitted to the Cheltenham Township Manager’s Office. Applications must be
submitted at least ninety (90) days prior to the event. The application fee of $50.00* (waived only for block
parties) and all other required documentation must accompany the application. If the application is submitted less
than 90 days before the event, the fee is $75 and if submitted less than 30 days before the event, the fee is $125,
which must accompany the application. Only completed applications submitted to Cheltenham Township will be
reviewed. Applications must be mailed or hand-delivered. Faxed or emailed applications will NOT be accepted
unless it is a block party application, which can be emailed to specialevents@cheltenham-township.org.
3. Submitting an application does not grant the applicant permission to hold the event. Once a completed
application and the $50.00 fee are received, the Township will contact the applicant to acknowledge receipt of the
application, request more information for an extended review, issue or deny the application.
4. Within 30 days of submitting the completed application and $50.00 fee, the applicant should receive permission or a
denial letter with the application returned.
5. Once the signed application and all required payments, certificate of insurance and additional documentation are
received, the Township will execute and issue the approved application.
6. Acceptable forms of payment for all fees, deposits and costs are a cashier’s check, money order (made payable to
Cheltenham Township) or cash. Credit card payments or personal checks will not be accepted.
7. Special Events attended with larger attendance (over 500 people anticipated to be in attendance) may require
additional planning time, so please submit the application with as much lead time as possible. Applications
submitted less than 30 days in advance of such Special Event may be declined.
8. Arrangements for the Special Event should not be finalized until you have received permission. No Special Events
shall take place without an authorized application.
9. The Township may require you to provide commercial liability insurance for the Special Event as determined by the
Township Solicitor. The Insurance Certificate must be submitted in accordance with the enclosed Insurance
Requirements section.
Cheltenham Township
8230 Old York Road Elkins Park PA 19027
www.cheltenhamtownship.org
(215) 887-1000
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10. Adjoining property owners and neighbors must be notified at least 2 weeks in advance of the size and date(s) of
your Special Event. Please copy the Township Manager’s Office with this communication at alupino@cheltenham-
township.org.
11. The assigned permit is good only for the date(s) of the Special Event plus any designated rain date(s).
Special Event Application
Rules and Regulations for a Special Event Application
1. All applications must be completed and submitted to the Township as specified in the Submitting Your
Application section above.
2. A copy of the application must remain on site for review at all times.
3. Applications fees are non-transferable.
4. Parking or driving on grass, service roads or athletic fields is strictly prohibited. Applicants shall ensure that their
guests, vendors, concessionaries and exhibitors shall not park or drive vehicles on grass, service roads, or athletic
fields.
5. Fastening or attaching any rope, sign, banner, flyer or other object to any tree, shrub, or natural amenity in any
Township park area is strictly prohibited.
6. No refunds will be granted for any cancelled Special Events 30 days prior to event date.
7. All cancellations must be made in writing and addressed to the Township. Cancellations made less than 30 days
prior to the event date will forfeit any fees submitted.
8. The certificate of insurance for the Special Event must show evidence of general commercial liability coverage with
a minimum $1,000,000 per occurrence limit of liability, specifically naming Cheltenham Township as an additional
insured. Cheltenham Township reserves the right to require higher limits and/or special insurance coverage if the
Special Event so warrants.
9. Failure to obey the above rules and regulations will result in the forfeiture of all or part of the Special Event.
10. Recycling is mandatory during all Township events and community activities.
Amenities
1. Cheltenham Township does not provide amenities such as sound systems, tables, chairs or other support materials
and services.
2. Cheltenham Township reserves the right to invoice for the abnormal consumption of excessive electricity during the
Special Event.
3. Provisions for parking are not included in the issuance of any Special Event.
4. Township does not provide portable restrooms or disposable trash containers for Special Events. These amenities
must be procured by the applicant.
5. Any tent or canopy measuring over 50 square feet requires permission from the Township.
6. The Township may request reimbursement for the provision of additional Emergency Services such as Police, Fire
Department and EMS as necessitated (in the township’s discretion) by the size and type of Special Event.
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Special Event Application
1
Event Information
Title of Event:
Start Date:
Location and Street Address:
Brief Description of Event:
Daily Start Time and End Time of Event:
2
Event Sponsor
Sponsor Name:
Sponsor Address:
Sponsor Phone Number:
Sponsor E-mail:
3
Applicant
Applicant Name:
Title (if applicable):
Applicant Address:
Applicant Cell Phone Number:
Applicant E-mail:
4
Special Event Application
4
Property Owner (if not the Applicant)
Owner Name:
Title (if applicable):
Owner Address:
Owner Cell Phone Number:
Owner E-mail:
Signature of Property Owner:
Date:
6
Indemnification Agreement (Liability Release)
By signing and submitting this Special Event Application, the Sponsor intending to be legally bound agrees to indemnify, defend and hold
harmless the Township of Cheltenham and its elected and appointed officials, agents, employees, and authorized volunteers from and
against any and all losses, costs (including, but not limited to litigation and settlement costs and attorneys’ fees), claims, suits, actions,
damages, liability and expenses, arising out of or in any way connected to and occasioned wholly or in part by the Sponsor’s act, omission,
negligence, fault or the act, omission, negligence or fault of the Sponsor’s agents, subcontractors, suppliers, employees or servants in
connection with the Special Event, except for any claims, liability, demands, damages, suits or loss arising from the willful or grossly
negligent acts of the Township of Cheltenham, its elected and appointed officials, agents, employees and authorized volunteers.
Signature of Responsible Party:
Title:
Date:
7
Permit Conditions (Township Use Only)
List additional permit conditions here:
Applicant Signature (Signature indicates agreement
with permit conditions)
Date:
5
Person in Charge on Day of Event (must be on site)
Name:
Title (if applicable):
Cell Phone Number:
E-mail:
5
Special Event Application
8
Additional Information
1. What is the estimated daily attendance at this event? _________ Persons
2. Will you require road closures? Yes No
3. Do you anticipate traffic interruptions? Yes No
4. POLICE: Will you require Police assistance? (additional fees may apply) Yes No
5. AMPLIFIED SOUND: Will you be using amplified sound? Yes No
6. If so, what times will the amplified sound occur? ______ to ______
7. STAGING: Will staging be used? Yes No
8. Will the staging be prefabricated or built on site? A building permit may be required. Prefabricated Built on Site
9. TENTS: Will tents or canopies be erected? Yes No
How many? _______ How large? _______ sq. ft.
If tents are over 50 square feet, they will require inspection by Building and Zoning and the Fire Department.
Building and Zoning: (215) 887-1000 ext. 217
Fire Marshal’s Office: (215) 887-1000 ext. 235
10. FOOD: Will you require a license to vend food, merchandise or product samples? Yes No
If yes, please contact the Montgomery County Health Department at (610) 278-3000.
11. ALCOHOL: Do you intend to sell alcoholic beverages? Yes No
(NOTE: Alcohol is not permitted in Township Park facilities)
LCB Special occasion permit applications are available by calling the Board’s Licensing Information Center at (717) 783-8250 or by
logging onto www.lcb.state.pa.us, clicking on “Licensing”, then “Special Permits” and then choosing the special occasion permit packet.
The application must be made thirty (30) days prior to the event and the Police Department must be notified of the times and place where alcohol
is to be served.
No alcohol is permitted without the prior written approval of the Liquor Control Board.
12. SECURITY: Will private security be used at this event? Yes No
If security is armed, the Police Department must be advised.
13. EVENT ROUTE: Will the event be mobile, such as a parade? Yes No
If so, submit a map of the proposed route with this application.
(special insurance coverage maybe required)
14. EVENT PLAN: Larger events will require a diagram depicting temporary structures, First Aid stations, sanitary facilities, entry control (if
applicable), food and beverage areas and parking arrangements.
MISCELLANEOUS
15. PERMITS/LICENSES: Copies of all permits/licenses must be posted and available for inspection at all times.
16. SANITATION and SAFETY: The applicant is required to secure port-a-johns/portable washrooms, chairs, trash boxes and appropriate medical
First Aid stations for the event at the Sponsor’s expense. Failure to provide such amenities could result in future Special Event applications being
declined by the Township.
17. EVENT CANCELLATIONS: Event cancellations or cancellation of requested services must be made in writing no less than 24 hours prior to the
Special Event. Failure to provide written notice may result in the Sponsor being required to reimburse the Township for the agreed upon
services.
6
Special Event Application
9
Insurance Requirements
INDEMNIFICATION
To the fullest extent permitted by law, the Sponsor agrees to defend, indemnify, pay on behalf of, and save harmless the Township of Cheltenham, its
elected and appointed officials, agents, employees, and authorized volunteers against any and all claims, liability, demands, damages, suits or loss,
including attorneys’ fees and all other related costs, arising out of or in anyway connected to the Sponsor’s proposed use or occupancy of the
premises and/or right away of the Township of Cheltenham except for any claims, liability, demands, damages, suits or loss arising from the willful or
grossly negligent acts of the Township of Cheltenham, its elected or appointed officials, agencies, employees and authorized volunteers.
INSURANCE
Most large events will require an additional Insurance Rider provided by the Sponsor. Please check with the Township to see if additional insurance is
required for your Special Event. Depending on the type of event, special insurance may be required by the Township.
COMPLIANCE WITH THE TERMS OF THIS SECTION IS:
REQUIRED SUGGESTED WAIVED
1. MINIMUM REQUIREMENTS: The Sponsor shall purchase and maintain through the term of this agreement or its use of occupancy of Township
of Cheltenham premises commercial general liability insurance or its equivalent with a minimum of:
$1,000,000 for each occurrence;
$1,000,000 personal and advertising injury;
$2,000,000 general aggregate; and
$1,000,000 products/completed operations aggregate
2. SPECIFIC COVERAGE TYPES: This commercial general liability insurance or its equivalent shall include coverage for all of the following:
a. Liability arising from premises and operations;
b. Liability arising from products and completed operations;
c. Contractual liability including protection for the Sponsor from bodily injury and property damage claims arising out of liability assumed under
this agreement;
d. Liability arising from explosion, collapse, or underground hazards;
e. Liability arising from athletic sports or sports participation; and
f. Liability arising from bodily injury to spectators.
3. ADDITIONAL INSURED PARTY: Cheltenham Township and its elected and appointed officials, officers, agents, employees, and authorized
volunteers shall be named as additional insured on the commercial general liability insurance policy as respects to Sponsor’s use or occupancy
of the premises of Cheltenham Township. The following manuscript wording must be utilized on the additional insured endorsement issued by
the general liability insurer and shown on the insurance certificate submitted by the Sponsor to evidence its purchase of commercial general
liability insurance:
“The policy is amended to include as additional insured the Township of Cheltenham and it’s elected and appointed officials, officers, agents,
employees, and authorized volunteers, but only for liability arising out of your operations on, at or adjacent to the premises of Cheltenham
Township, [Sponsor’s Special Event] or [Sponsor’s merchandise or work product] “
4. VEHICLES: If the Sponsor has any owned autos, the Sponsor shall purchase and maintain through the term of this agreement or its use or
occupancy of the premises of Cheltenham Township Business Auto Liability Insurance, or its equivalent, with a minimum limit of $1,000,000 per
accident and including coverage for liability arising out of the ownership, maintenance or use of any auto and for automobile contractual liability.
5. WORKER’S COMPENSATION INSURANCE: If the Sponsor has any employees, the Sponsor shall purchase and maintain throughout the term
of this agreement or its use or occupancy of Cheltenham Township premises Worker’s Compensation Insurance or its equivalent with statutory
benefits as required by any Pennsylvania or Federal Law, including standard “other states” coverage, and Employers’ Excess Liability Insurance,
or its equivalent, with minimum amounts of:
$100,000 each accident for bodily injury or accident;
$100,000 each employee for bodily injury by disease;
$500,000 policy limit for bodily injury by disease
7
Special Event Application
6. UMBRELLA EXCESS LIABILITY INSURANCE: The Sponsor shall purchase and maintain throughout the term of this agreement or its use or
occupancy of Cheltenham Township premises Umbrella Excess Liability Insurance, or its equivalent, with minimums of:
$5,000,000 per occurrence;
$5,000,000 aggregate for other than products/completed operations and auto liability; and
$5,000,000 products/completed operations aggregate
and including all of the following coverages on the applicable schedule of underlying insurance:
a. Commercial General Liability;
b. Business Auto Liability; and
c. Employers’ Liability.
d. The Township shall be listed as an additional insured.
7. ALCOHOL: If the sponsor has a license or receives a permit from the LCB to serve alcohol, then the sponsor shell obtain all special insurance
coverage’s to insure for risks associated with the scale and/or distribution of alcohol and the township shall be listed as the additional insured.
8. WAIVER OF SUBROGATION: To the fullest extent permitted by law, the Sponsor and its employees, officials, volunteers, agents and
representatives waive any right of recovery against the Township of Cheltenham and its elected and appointed officials, officers, volunteers,
consultants, agents and employees for any and all claims, liability, loss, damages, costs or expense (including attorneys’ fees) arising out of the
Sponsor’s proposed use or occupancy of the premises of Cheltenham Township or arising out of the Sponsor’s operations on, at or adjacent to
any premises of Cheltenham Township. The Sponsor shall advise its insurers of the foregoing and such waiver shall be provided under the
Sponsor’s Commercial Property and Liability insurance policies and the Sponsor’s Worker’s Compensation Insurance Policy, if any.
9. DAMAGE TO THE PROPERTY OF THE SPONSOR AND ITS INVITEES: The Sponsor and its employees, officials, volunteers, and agents shall
be solely responsible for any loss or damage to property of the Sponsor or its invitees, employees, officials, volunteers, agents and
representatives while such property is on, at or adjacent to the premises of Cheltenham Township.
10
Additional Documentation Check Sheet
Applicant: Ensure the below documentation is enclosed (if applicable):
Enclosed Verified
1. PA Liquor Control Board permit (if applicable)
2. Insurance certificate (original)
3. Application fee (waived for block parties only)
4. Municipal Services fee (if applicable)
5. Event Site Plan enclosed with the following:
6. Designated parking areas
7. Security/monitor locations
8. Food/beverage/alcohol serving areas
9. Water and First Aid stations
10. Sanitary facilities, rest rooms and portable toilets
11. Event route map (if applicable)
8
Special Event Application
12
Police Department Approval (PD use only)
Approved: The above application was reviewed and approved with the following modifications:
Denied: The above application was reviewed and denied for the following reason(s):
No modifications
John Frye, Chief of Police
Date:
13
Fire Marshal Department Approval (FD use only)
Approved: The above application was reviewed and approved with the following modifications:
Denied: The above application was reviewed and denied for the following reason(s):
No modifications
Scott Lynch, Fire Marshal
Date:
14
EMS Department Approval (EMS use only)
Approved: The above application was reviewed and approved with the following modifications:
Denied: The above application was reviewed and denied for the following reason(s):
No modifications
Kenneth Hellendall, EMS Director
Date:
11
Parks and Recreation Department Approval (P&R use only)
Approved: The above application was reviewed and approved with the following modifications:
Denied: The above application was reviewed and denied for the following reason(s):
No modifications
Brian Hinson, Director P&R
Date:
9
Special Event Application
15
Public Works Department Approval (PW use only)
Approved: The above application was reviewed and approved with the following modifications:
Denied: The above application was reviewed and denied for the following reason(s):
No modifications
Approved by:
Christopher Clewell, PW Superintendent
Date:
16
Township Manager’s Office Approval
Approved: The above application was reviewed and approved with the following modifications:
Denied: The above application was reviewed and denied for the following reason(s):
No modifications
Approved by:
Township Manager
Date:
DISCLAIMER
By completing and submitting this Application, the Applicant agrees and acknowledges that
Cheltenham Township disclaims all liability for injuries and damage to property, during the event
which is the subject of this Application, which occurs on, over or in, or involves, private property.
Copy to:
□ Township Manager’s Office
□ Fire Marshal’s Office
□ EMS Director
□ Public Works Department
□ Chief of Police
□ Parks and Recreation Department
□ Public Information Office
***Due to the restrictions of the COVID-19 pandemic, we are requesting that all residents abide
by the guidelines set forth by the Governor and the State to maintain social distancing,
in order to continue to protect the health and safety of our community***
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Special Event Application

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Completed 31 August 2021

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