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pinellascounty.org Special Event Application (Private Applicants)

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1 – Special Event Appv.8.14.15



SpecialEventApplication

Thisapplicationistobecompletedbytheindividualorauthorizedrepresentativeoftheorganizationregulatingtheeventandrequesting



permit. Submissionofanapplicationdoesnotguaranteetheeventwillbeapproved. Donotpublicizeorpromoteyoureventuntilyour



notificationofacceptancehasbeenissued.



NameofEvent:  Purpose: 

Date(s)ofEvent: 

EventStart/Endtime: 

Location(Facility/Park /Road):

(Parks‐includeParkName&

ShelterNumber)

SetupDate/Time&FinalWrap‐Up: 

FacilityorShelterReserved: Yes No N/A

RainorShineEvent:

Yes



 No



 

ChoosePublicorPrivateEvent: PublicPrivate



ExpectedAttendance(includeCrew,Participants,Spectators)



Overall: 



AtanyOneTime: 



(Thissectio nisforusebyindividualsonly)



Name:  Email:



Address:  City:  State/ZipCode: 

DaytimePhone:  Cell:  FaxNo: 

EventPointofContact:  POC:Phone# 



(Thissectio nisforusebyorganizationsregisteredwiththeStateofFloridaboth“ForProfitand“NonProfit”)



Company/OrganizationName: 

CharityOrganization:YesNo

(Copyof501(c)3Required)

TaxExempt: YesNo

(FloridaExemptionCertificateRequired)

Address:  City:  State/ZipCode: 



Email: 

OrganizationWebsite:

AuthorizedRepresentativeandTitle PointofContactName

Name: 

(ifdifferent): 

DaytimePhone:  CellNo:  FaxNo: 

EVENTINFORMATION 

APPLICANT(Complete only one of the following sections)

INDIVIDUAL

COMPANY/ORGANIZATION

2 – Special Event Appv.8.14.15



Hasthiseventbeenheldpreviously? YesNoIfyes,Date/Place/Attendance:



Pleaseselectallapplicableactivitiesand/orknownservicesforthiseventfromthechoicesbelow:

ActivityType Check Details

AnimalAct/Show



Beverage/Catering(withalcohol)



BicycleRacingEvent



BicycleRidingEvent



BlockParty



BoatingEvent



Camping(Adults)



Camping(Minors)



Catering(On‐SitePrep) 



CraftShow



Dance



Demonstration



Entertainment‐MusicBand



EquipmentRentals



EquipmentTesting

EventPlanner

ExerciseClass



Fair(Art/Craft/Other)



FishingEvent/Tournament



Fundraising

GeneratorUsage

Lighting(external)



MediaAttendance



MotorsportEvent



OtherPublicEntityUsage



Parade



Picket(Organized)



Pyrotechnics



Rally



Sales‐Beverage/Food/Merchandise



SportingEvent(Organized)



Stage/Risers



TentUse(>10X10)



Track/Field(NOA‐Thons)



UseofRoad/RightofWay



*ActivitiesareforadiverserangeofCounty‐ownedfacilities.NotallactivitiesarepermittedinCountyparks.



OtherActivity(notmentionedabove):



EVENTACTIVITIES

3 – Special Event Appv.8.14.15



Pleasecomplete thefollowingsectionof thisapplication. Provide as muchdetail as possible foractivities applicable

to your event. If any of the following sections do not apply to activities,  services, or needs for your event, please



writeN/A(fornotapplicable).



DescribeyourplansforEntertainment.



Pleasenameallvendorswhowillprovide



entertainmentandthetypeofentertainment



provided. Entertainmentlocationsmustbe



shownonthesitemap.



Describeyourplansforparking.



Includeparkingplanfordisabled,vendors,



spectators,participants,media,etc. Avisualof

parkingmustbeshownonsitemap.



Describeyourplansforallsignage,and/or

decorationsfortheevent.



Pleaseincludetypeofsignagetobeused,and

descriptionofverbiagebeingpostedonthe



signage.



Signagemustalsobemarkedonsitemap.



Section 1

4 – Special Event Appv.8.14.15



DescribeyourplansforWasteManagement.



Pleaseincludeplansfordisposalofvendor



waste,aswellasallotheraccumulatedwaste



product.

Namethecompanyselectedforwaste



management.

ProvidethenumberofpersonsyourEvent

Coordinatorhasdesignatedfordisposalof

wasteattheevent.



Describeyourplansforphysicalamenities.



Nameallvendorsbeingcontractedforphysical

amenityservices. Pleaseincludenumberof

waterstations,numberofport‐o‐lets,hand

washingstations,oranyotheramenitiesusedto

keepattendeescomfortable.



Describeyourplansforemergencyservices.



Pleaseincludetheagencynameandcontact



informationforeachemergencyservice(EMS

andFire)youhaverequested.



5 – Special Event Appv.8.14.15

Section 2



Provideasmuchdetailaspossibleforactivitiesapplicabletoyourevent.



DescribeyourplansforControllingIngress/



Egress.



Ingress/Egressisentryandexitofpersons,



vehicles,equipment. Pleasemarklocationson

thesitemap.



DescribeyourplansforVendor/Catererfood



preparation.



Includetypeoffoodandhowitwillbeprepared

onsite. Ifsmoking,orbarbecuingdescribe



methodfordisposalofflammablematerials.

Verifythecaterer/vendor hasavalid

food/beveragelicense. Furnishacopyofvendor



currentfood/beveragelicenseswiththis

application.



DescribeyourSecurity/LawEnforcementPlan.



Pleaseprovidecontactinformationforoff‐duty



lawenforcementagenciesusedfortheevent.

Includeofficercountandattendancetimes.



Placemarksonthesitemapwheresecuritywill

bestationed.Iffundswillbecollectedon‐site,



explaintheprocesssecuringthemoney



collected. Ifequipmentwillbeon‐site



overnight,providedetailsforpersonalproperty



safetyandsecurityofsite.



6 – Special Event Appv.8.14.15



DescribeanyotherPublic‐Entityaccessthat



mayoccurduringtheevent.



IncludeusageofStreet/Road/Park,etc.If other

municipalitieswillbeaccessed,provideproofof

permitapplicationorapprovedpermit



from

eachsuchentity. Approvalpermitsfrom



all

othermunicipalitieswillneedtobefurnished to

theCountynolaterthan30dayspriortothe



event.



Describeinfull detailthepurposeofyour

demonstration/rally/assembly.



Provideinformationontimesandlocationsand

expectedattendance. Ifanytypeof

demonstrationotherthansignswillbeused,



pleasedescribeinfulldetail.



Describeinfulldetailanyotheractivitiesnot



previouslyaddressed.



Pleaseincludetheuseofanyexternallighting

sources,electrical/generatorusage,(both

vendorandapplicant),athleticactivity(non‐

organized),and/ortentusage.



7 – Special Event Appv.8.14.15

Section 3



Provideasmuchdetailaspossibleforactivitiesapplicabletoyourevent.



DescribeStaging/Start‐FinishArea/Bleachers/

Equipment/Amusementsbeingused.



Includeband,vendor,supplier,setupandtear‐

downinformation,mediastaging,etc. Please



providedimensionsandlocationsonthesite



map.



DescribeyourneedforRoad/Street/Alley

closureanduseofsame.



Pleaseincludetheexactsectionrequestedfor



closurebynamingstreets/roads/avenue,etc. 

fromnorthtosouth,theneasttowest.Then

providevisualonthesitemap.



Describeindetailyourorganizedathletic

activity.



Provideinformationonallactivities,whois

overseeingeachactivity,whowillreceivethe



proceedsfromtheactivityandwhy.



8 – Special Event Appv.8.14.15



Describethepurposeofyourrequestfor

theuseofalcoholonCountyproperty.



Pleaseincludethetypeofbeverage(s),and

nameofthelocaldistributor. Namethe



organizationwhowillbeservingthe



beverage(s),andifabartendingserviceis

contracted,nametheindividualbartender.

Describethemethodofdistribution(walkup

tap,closedcanspurchase,barservice,etc.)



Providethestartandofficialclosetimesof

distribution,aswellasannouncementtimeof

“lastcall”.



Allpermitsforeventsinvolvingalcoholicbeverages

mustbepostedandvisibleduringtheentireevent.

TheApplicantNameontheSpecialEvent/Sp ecialuse

formmustbethesameasallotherappliedpermits.

Noexceptionswillbeallowed.



Describeinfulldetailanyotheractivitiesnot



previouslyaddressed.



Reminder:

Attachthefollowingdocumentsandsubmitwithyour application(Plans#1‐3canbeprovidedonthesameplan):

SITEPLAN

PARKINGPLAN

WASTEMANAGEMENTPLAN

INSURANCE–CERTIFICATE(FORAPPLICANTANDALLCOMMERCIALVENDORS)

REQUIREDPERMITSIFCURRENTLYAPPROVED

6. IFADDITIONALPAGESARENECESSARYTOEXPLAINTHEEVENT,PLEASEPROVIDEINADDITIONTOTHISAPPLICATION.

7. DOCUMENTATIONEVIDENCINGAUTHORITYTOSIGNONBEHALFOFYOURORGANIZATION.



ThankyouforcompletingthePinellasCountySpecialEventApplication. Submit applications to

specialevents@pinellascounty.org.  PinellasCountywillreviewtheapplicationand contactyouwith

ourresponse,orrequestadditionalinformation. PleaseproceedtotheTermsofAgreement.

9 – Special Event Appv.8.14.15



TERMSOFAGREEMENT



Astheapplicant,Iherebyacceptandunderstandtheresponsibilitytooverseeallcontractors,vendorsorpa rtiesaffiliatedwith

theeventandtoensurecompliancewithallpolicies,rulesandregulations,andguidelinesofPinellasCountyGovernment;

includingtherulesandregulationsofeachindividualdepartmentaspostedatwww.pinellascounty.org.

Thedutytodefend

underthisparagraphisindependentandseparatefromthedutytoindemnify,andthedutytodefendexistsregardlessofany

ultimateliabilityoftheapplicant,theCountyandanyindemnifiedparty.Thedutytodefendarisesimmediatelyupon

presentationofaclaimbyanypartyandwrittennoticeofsuch

claimbeingprovidedtotheapplicant.Iunderstandthatany

violationsmayresultinimmediatecancellationofthereservationand/orrevocati on ofthepermit. Iunderstandthepermitis

non‐transferableandnon‐refundable. Failuretoprovideallrequirementsandpaymentbytheduedatewillresultinno

issuance

ofapermitfortheevent. ThereareparkingfeesinplaceatFredHoward,FortDeSoto,andSandKeyParks. Parking

feesarealsoinplaceatboatramplocationsgovernedbyPinellasCountyParks&ConservationResources. Thesefeescannot

bewaived.



Basedupondetailsofthe

event,insurancerequirementsmaychangefromthebelowstatedrequirements. Youwillbenotified

ofanychangeintheserequirements.Acertificateofinsuranceasproofofinsuranceshallbesubmittedwiththisapplication.

Minimuminsurancerequirementsareasfollows:



CommercialGeneralLiabilityinsuranceincluding,butnotlimitedto,Bodily

Injury,PropertyDamage,andPersonalInjury.

Limits



GeneralAggregate $1,000,000

PersonalInjuryandAdvInjury $1,000,000

EachOccurrence $1,000,000

• The term "County" or "Pinellas County" shall include all Authorities, Boards, Bureaus, Commissions, Divisions, Departments and

Constitutional offices of County and individual members, employees thereof in their official capacities, and/or while acting on

behalfofPinellasCounty.

• Allpoliciesprovidingliabilitycoverage(s)tomeettherequirementsoftheAgreementshallbeendorsedtoincludePinellasCounty,a

politicalsubdivisionoftheStateofFloridaasanAdditionalInsured.AcopyoftheAdditionalInsuredendorsementmustbeprovided

withthecertificateofinsuranceasproofofcoverage.

• Allpoliciesshallbewrittenonaprimary,non ‐contributorybasis.

• PinellasCountyreservestherighttorequestacop yofallinsurancepolicies.

InconsiderationofthisagreementtoallowuseoftheCounty’sproperty,theapplicantshallanddoesagreetoindemnify,

defend,paythecostofdefense,includingattorney’sfeesandholdharmlessPINELLASCOUNTYandallofitsofficers,agents, and

employeesfromallsuits,actionsorclaimsofanycharacter,

includingallcosts,attorney’sfees,expenses,damages, judgments,

ordecrees,broughtonaccountofany injuriesordamagesreceivedorsustainedbyanyperson,persons, participants,

spectators,orpropertyarisingoutoforinanywayattributabletotheholding,performance,operationor maintenanceofthe

eventhereinpermitted. This

dutyofdefenseandindemnificationsp ec ific al l yincludesanyandallalleged negligencebyPinellas

Countyasrelatedtotheevent,includingbutnotlimitedtotheissuanceofthispermit,supervisionof theevent,conditionsator

adjacenttothesite,road,sidewalk,trafficsigns/signalconditions,

prov ided,however,thattheapplicantshallhavetherightto

seekcontributionfromPinellasCount yforanyjudgment,settlement,ordecreerenderediftheCountyisfoundsolely

negligent.



IagreetotheTERMSOFAGREEMENTassetforthinthisapplication,andIagreetoabidebyallrulesandregulationsas

providedbyseparatedocumentwiththisapplicationsresponse. Theapplicantrepresentsandwarrantsthatithasthefull

rightandauthorityandhasobtainedallnecessaryapprovals

toenterintothisAgreement,thatthepersonexecutingthis

AgreementonbehalfoftheOrganizationisauthorizedtodoso,andthatthisAgreementconstitutesavalidandlegallybinding

obligationoftheApplicant,enforceableinaccordancewithitsterms.

Applicant/AuthorizedRepresentative: Signature: 



PrintedName: 



Date: 

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pinellascounty.org Special Event Application (Private Applicants)

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Completed 26 September 2019

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