Name of Event:
Sponsoring Organization (if any):
Applicant's Name:
Address:
Phone:
Email:
Date(s) of Event:
Type of Event: Please select...ParadeFestivalConcertSales EventBlock PartyOther (please describe)
If Other, please describe:
Starting Time:
Ending Time:
Estimated attendance per day:
List Streets to be blocked/closed: Please include cross-street names and times of closure.
Do you intend to use a Village-owned parking lot?: Please select...YesNo
Is a County or State-owned street or road affected by your event?: Please select...YesNo
Will Food be served and/or prepared at your event?: Please select...YesNo
Food License Information: If food will be served, proof/copy of food handlers license, caterer license, or permit from the Tompkins County Health Department must accompany this application.
Will Alcoholic beverages be available at your event?: Please select...YesNo
Liquor License Information: If alcoholic beverages will be served, proof of liquor license/permit allowing sale off premises of your establishment must accompany application or permit.
Will there be any live entertainment or music at your event?: Please select...YesNo
Entertainment Performance Times: If so, what times will the performances take place each day?
Clean Up Agreement: I agree to promptly clean up all paper or debris caused by applicant's use of the area and understand that if such clean up is not promptly undertaken the Village reserves the right to do the cleaning itself and to charge the applicant for the actual time and expense incurred.
Insurance Agreement: I agree to provide a policy of liability insurance with coverage for not less than $1,000,000 for personal injury to each person, $1,000,000 for each occurrence involving property damage; or a single limit policy of not less than $2,000,000 covering all claims per occurrence.
Applicant is responsible for obtaining all additional permits, licenses, and insurance certificates required upon the issuance of the Temporary Event Permit. Please fulfill all of the obligations listed below before submitting this application.
By submitting this form, I hereby swear and attest that this submission is accurate and complete to the best of my knowledge, and I agree to the terms and conditions stated above.
