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Special Event Permit Application

2. Special event permit applications are subject to Council approval

   Special event permit applications are subject to Council approval

4. Council meetings are held twice a month; therefore, all items listed below must be completed/provided at least one month prior to the requested event date in order to be placed on a Council agenda. Applications turned in less than one month prior to the event date are not guaranteed to be processed in time.

   Council meetings are held twice a month; therefore, all items listed below must be completed/provided at least one month prior to the requested event date in order to be placed on a Council agenda. Applications turned in less than one month prior to the event date are not guaranteed to be processed in time.

6. To be considered complete, the following items must be received at City Hall: Fee payment ($20 for a single event or $75 for a seasonal event), insurance certificate ($1 million in liability listing the City as an additional insured), and map of the City property to be used

   To be considered complete, the following items must be received at City Hall: Fee payment ($20 for a single event or $75 for a seasonal event), insurance certificate ($1 million in liability listing the City as an additional insured), and map of the City property to be used

8. Name of event*

10. Event description*

12. COVID-19 precautions in place*

    Describe the precautions that will be in place during this event to ensure adherence with guidelines issued by the Iowa Department of Public Health and Centers for Disease Control to prevent the spread of COVID-19

14. Event location*

16. Event promoter*

17. Event promoter's street address*

19. Point of contact*

20. Email address*

21. Phone number*

23. Event date and time range*
    Event date and time range Start Date

    Event date and time range Start Time

    —

    Event date and time range End Date

    Event date and time range End Time

    Applications must be submitted at least one month prior to the requested event date

25. Additional dates*

    Does the event occur on more than one date?

    1. No
    2. Yes
27. Additional dates and times

29. Rain date (if applicable)
    Rain date (if applicable)

    If rain date is not provided, and inclement weather affects your event, a new application will need to be submitted

31. Set-up begins at...*
    Set-up begins at...

    Set-up begins at...

33. Take down complete by...*
    Take down complete by...

    Take down complete by...

35. Street closures*

    Does event involve street closures?

    1. No
    2. Yes
37. Street closure location

38. Start and end time
    Start and end time Start Time

    —

    Start and end time End Time

39. # of barricades requested

41. Parking space closures*

    Does event involve parking space closures?
    (Only check yes if the parking spaces are not within a previously identified street closure)

    1. No
    2. Yes
43. Parking space closure location

44. Start and end time
    Start and end time Start Time

    —

    Start and end time End Time

45. # of cones requested

47. Event map

    Map must include event location and any street or parking space closures

49. Police officers*

    Are police officers needed during the event?

    1. No
    2. Yes
51. Number of officers

    Please also contact the Police Chief at 641.628.4921

52. Time frame
    Time frame Start Time

    —

    Time frame End Time

    $30/hour per police officer

54. Vendor sales*

    Will vendors be selling during the event?

    1. No
    2. Yes
56. Vendor name(s) and location(s) where sales will occur

58. Signage*

    Will signage be placed before or during the event?

    1. No
    2. Yes
60. Type of signage
    -- Select One --A-frameBannerPortableSandwich BoardTraffic DirectionalWindowOther (please describe)

62. Other (please describe)

64. Size of signage

66. Colors and materials used on signage

68. Location of signage

70. Date & time of signage placement
    Date & time of signage placement Start Date

    Date & time of signage placement Start Time

    —

    Date & time of signage placement End Date

    Date & time of signage placement End Time

    Signs should not create a traffic hazard or impede vehicle or pedestrian traffic
    Signs in the public right-of-way are prohibited unless expressly authorized by the special event permit
    The City reserves the right to require additional signage, as determined for the safety and well being of the public
    Temporary signs associated with a special event permit must be removed immediately when the event ends

72. Electricity*

    Will electricity be needed during the event?

    1. No
    2. Yes
74. Date & time requested for hook-up
    Date & time requested for hook-up

    Date & time requested for hook-up

75. Date & time for disconnect
    Date & time for disconnect

    Date & time for disconnect

77. Electrical details

79. Other City services*

    Are any other City services requested that have not been covered on this application?

    1. No
    2. Yes
81. Please explain what other City services are requested

83. Private property*

    Is any part of the event held on private property?

    1. No
    2. Yes
85. Property owner name(s) and address(es)

    Event promoter must provide written authorization from property owners prior to approval of this application

87. Certificate of insurance

    An insurance certificate with $1,000,000 in liability coverage listing the City as an additional insured for this specific event must be provided for this application to be considered complete
    The certificate can be provided by uploading using this form, or by email to msmith@cityofpella.com

89. Notifications

    Would you like to receive an email confirming when the application has been placed on a Council agenda?

    1. No
    2. Yes
91. Email address for notifications

93. E-Signature*

    By signing, I acknowledge I have reviewed and understand requirements of special events under City Code chapter 123. After submitting your application, the applicable fee of $20 for a single event or $75 for a seasonal event must be sent to:

95. City Hall (Attn: City Clerk) 825 Broadway Street Pella, IA, 50219

    City Hall (Attn: City Clerk) 825 Broadway Street Pella, IA, 50219

97. If you have questions regarding this process, contact Mandy Smith at 641.628.4173 x231 or msmith@cityofpella.com

    If you have questions regarding this process, contact Mandy Smith at 641.628.4173 x231 or msmith@cityofpella.com

Leave This Blank:


98. 1. Receive an email copy of this form.
99. Email address

    This field is not part of the form submission.

100. Submit