SPECIAL EVENTS APPLICATION FORM

                        FOR THE TOWN OF KENSINGTON

 

Event Name:  ___________________________________________________________

Purpose of Event:  _______________________________________________________

________________________________________________________________________

Organization/Sponsor Name:

________________________________

________________________________

Address: ________________________

________________________________________________________________________________________________

Phone: __________________________

E-mail: _________________________

 

Applicant/Contact Name:

________________________________

________________________________

Address: ________________________

________________________________________________________________________________________________

Phone: __________________________

E-mail: _________________________

 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Date of actual event: __________________    Time of actual event: _________________

Date of set-up: _______________________   Time of set-up: ______________________

Date of clean-up operations: ____________    Time of clean-up operations: ___________

Specific location of event: (Please attach site plan and/or map)_______________________________

________________________________________________________________________

 

1.  List any roads that may need to be closed, including specific dates and times plus time of re-opening:

 

ROAD NAME

CLOSING DATE

CLOSING TIME

DATE OF RE-OPENING

TIME OF RE-OPENING

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. List projected number of person attending the event.  Include the basis for projection:

________________________________________________________________________

________________________________________________________________________

 


3. Will any temporary structures be built?                                  Yes                  No

    If yes, describe in detail and include location:

________________________________________________________________________

________________________________________________________________________

 

4. Will any signs or pennants be hung?                                       Yes                  No

    If yes describe in detail and include location:

________________________________________________________________________

________________________________________________________________________

 

5. Will there be any entertainment or music?                              Yes                  No      

    If yes, describe performance, times and location:

________________________________________________________________________

________________________________________________________________________

 

6. Will additional utility services be used such as power and water beyond that which is available

     in the area?                                                 

                                                                                                Yes                  No

    Describe in detail specific utilities and location: (Any additional utilities must be provided by the applicant.)

________________________________________________________________________

________________________________________________________________________

 

7. Is a parade planned in connection with the event?                  Yes                  No

    State details, time and anticipated crowd; attach a map of route:

__________________________________________________________________________

__________________________________________________________________________

 


8. Are any street peddlers or vendors being planned?                Yes                  No

    Describe in detail:

__________________________________________________________________________

__________________________________________________________________________

 


9. Are food sales planned?                                                        Yes                  No

    Describe in detail: (Applicant should also contact the local health department for regulations governing food sales.)

 

___________________________________________________________________________

___________________________________________________________________________

 

10. Describe in detail how do you plan to remove refuse and garbage:  (Applicant must complete       

                                                                                                                                clean-up supplement for special events.)

 

__________________________________________________________________________

__________________________________________________________________________

 

11. Describe in detail how do you plan to provide security:

 

__________________________________________________________________________

__________________________________________________________________________

 

12. Describe parking areas and available transportation modes to and from the event:

 

__________________________________________________________________________

__________________________________________________________________________

 


13. Will existing bathroom facilities be adequate?                       Yes                  No

    Describe plans to augment available sanitary facilities:

 

__________________________________________________________________________

__________________________________________________________________________

 


14. Do you plan to sell beer, wine or alcohol for public consumption?  Yes                    No

    List any license presently held (section a.); provide evidence of liquor liability insurance.

a._________________________________________________________________________

    _________________________________________________________________________

b. List beverages and vendors, plus locations and times of sale.

 

 

BEVERAGE

 

VENDOR

TIME OF SALE

 

LOCATION

 

LICENSE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15. Explain the proposed controls for the sale of alcohol beverages where minors may be present:

 

________________________________________________________________________

________________________________________________________________________

 

16. Do you plan to publicize the event?                                     Yes                  No

      If yes, attach publicity plans.

________________________________________________________________________

________________________________________________________________________

 

Additional information questions:

A-1. ________________________________________        Yes                  No

________________________________________________________________________

________________________________________________________________________

 


A-2. ________________________________________        Yes                  No

________________________________________________________________________

 

Approval of this application will reserve for the applicant the requested event date/place providing all requirements outlined in this policy are met.  If the special event request is approved, the sponsor shall assume full responsibility for compliance with all conditions, fees, and charges and further agrees to pay any cost associated with damage to Kensington town property, lost barricades/signs, cleanup by Kensington town crews, or any other additional Kensington town expense caused by this event, over and above the security deposit.

 

Applicant’s Signature: _______________________________________________ Date: ____________

 

RETURN COMPLETED APPLICATION TO:  BOARD OF SELECTMEN’S OFFICE

 

                                 Approved                                       Denied

 

Authorized Signature: _______________________________________________ Date: ____________

 

 
________________________________________________________________________

 

 

 

          SPECIAL EVENTS LIABILITIES INFORMATION SHEET

 

Name of Event: ___________________________ Date(s) of Event: __________________

Entity: __________________________________ Event Coordinator: _________________

Starting time of Event: ______________________ Ending time of Event: _______________

Location of Event: _________________________ Estimated Attendance: _______________

 

                                                Contacts

Event Sponsor/Promoter(s): ______________________________     Phone: _____________

_____________________________________________________  Phone: _____________

Facility Maintenance Contact: _____________________________    Phone: _____________

Fire Department Contact: __________________________________ Phone: _____________

Police Department/Security Contact: __________________________ Phone: _____________

Medical Response/Ambulance Contact: _______________________ Phone: _____________

Utility Company Contact(s): ________________________________ Phone: _____________

Parking & Traffic Control Contact: ___________________________ Phone: _____________

Designated Media Spokesperson: ____________________________ Phone: _____________

Local Health Department Contact: ____________________________ Phone: _____________

 

Any other pertinent department(s): ____________________________ Phone: _____________

______________________________________________________ Phone: _____________

______________________________________________________ Phone: _____________

 

                                      Insurance Contacts

Property/Liability Insurer: __________________________________ Phone: _____________

Contact: _______________________________________________ Phone: _____________

 

Special Events Liabilities Coverage Insurer: _____________________ Phone: _____________

Contact: _______________________________________________ Phone: _____________

 

Workers’ Compensation Insurer: ____________________________ Phone: _____________

Contact: _______________________________________________ Phone: _____________

 

Claims Adjuster Company: ________________________________ Phone: _____________

Contact: __________________________________________________________________