Temporary Event Application

Name of Event

Sponsoring Organization (if any)

Applicant’s Name

Address

City

State

Zip

Phone #

Email

Event Type Parade Festival Concert Sales Event Block Party Other

Date(s) of event

Starting Time

Estimated attendance per day

List Streets to be blocked/closed List each street (and indicate cross streets between), Closing Date, and Closing Hours

Do you intend to use a Village owned parking lot?

Is a County or State owned street or road affected by your event?

Will Food be served at your event?

Will Food be prepared at your event?

Will Alcoholic beverages be available at your event?

Will there be any live entertainment or music at your event?

If so, what times will the performances take place each day? Include the date, start time, and finish times for each performance. Note: Regardless of your plans for music or entertainment, you are required to describe what you intend to do at this event. The Police Department will determine if variance is required.

Will additional electrical wiring be installed for your event?

Will your event require restroom facilities?

Have you arranged for security at your event?

If so, who will be providing security?

Describe your plans for trash minimization and removal. Include number, types and locations of all trash receptacles, a schedule for monitoring and emptying trash, and plans for cleaning up debris not placed in trash. Include any persons or entities who will be providing trash related services if any.

Does your event involve the use of a park or Village Facility?

If so, what is the name of the park or facility and where is it located?

CLEAN UP Applicant agrees to promptly clean up all paper or debris caused by applicant’s use of the area and understands 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 Applicant agrees to provide a policy of liability insurance. This insurance shall provide coverage for not less than $1,000,000 for personal injury to each person, $1,000,000, $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. The limits of the insurance shall be subject to statutory changes as to maximum limits of liability imposed on municipalities of the State of New York. This insurance shall be without prejudice to coverage otherwise existing and shall name as additional insured The Village of Trumansburg and its officers, agents, and employees. The sponsor agrees to maintain continuous

CONDUCT/NUISANCES Applicant understands that if the outdoor activity is conducted in such a way as to create a nuisance for any business or resident of the area, future permits may be denied for that reason alone. Applicant will be notified as soon as practical that the activity engaged in created a nuisance and may ask for review of such determination.

VILLAGE CODES/PERMITS Applicant agrees to obtain all Village permits and licenses that may be required, and shall comply with all other Village laws and other conditions that the Village and its agents determine necessary. The Village of Trumansburg Police Department will determine if a noise variance is necessary after reviewing this application.

Applicant Name

Applicant Signature Typing your name here indicates that you agree to the text below.

I, the applicant, herby acknowledge that I understand and agree that any error, misstatement or misrepresentation of material fact, whether or not deliberate, that might or would otherwise cause this application to be denied, or any changes made subsequent to the issuance of a permit relating to this application, without the approval of the Village of Trumansburg, shall constitute sufficient ground for the immediate revocation of such permit.

I have read through all provided information and agree to all terms and conditions. I, being dully sworn according to law, hereby swear and attest that the attached application is accurate and complete to the best of my knowledge.

Indemnification Agreement for Temporary Event Permit

**Note: All applicants must sign this Indemnification Agreement.

Grantee acknowledges and agrees as follows:

In consideration of the Village of Trumansburg’s approval of this application for a temporary event permit, applicant accepts responsibility for the event and agrees to indemnify, defend, waive the rights of subrogation, and hold harmless the Village of Trumansburg, New York, its officials, employees, agents, volunteers, and assigns from and against any and all claims, suits, liabilities and expenses (including but not limited to, damages, attorney fees, and costs) that may be asserted against the Village of Trumansburg , New York arising out of or in any way related to the temporary event for which permission is sought.

Applicant acknowledges that applicant has carefully read the foregoing and understands its contents. Applicant warrants that applicant is authorized to sign this document and does so freely without reservation.