Event Permit Application

*Permit required for events located on, or impacting Lewis County Roads, Parcels or Trails, as set forth in Lewis County Local Law No. 5- 2020.

Event Name*

Sponsor: (Provide Individual name and name of partnership, corporation or association) (If corporation or partnership, provide names and addresses of directors, partners and/or associates*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Contact Person ( Person Authorized to arrange event and receive service of notices and summons from the County of Lewis: (If entity is not from Lewis County or does not have a place of business in Lewis County, provide name of natural person who resides in Lewis County who is authorized to accept service on behalf of the Sponsor)*

First NameLast Name

Age*

Phone Number*

Area CodePhone Number

Email*

example@example.com

Co-Sponsor: Name, Address, Telephone, Email

Event Description:*

*

Location:*

Staging Area:*

Parking Locations:*

County Roads*

County Parcels*

County Trails*

Town(s) in which event is propsed:*

Attach Map of event description and area:

Browse Files

If you need a screenshot, go to lewiscountyny.giscloud.com

Is the event open to the public?*

Is the event open to those under 18 years of age? If so, name and address of legally responsible adult:*

Name and address of legally responsible adult

Is there a fee to participate? If so, amount:

Estimated number of participants:

Minimum*

Maximum*

If over 5,000 participants, has NYS Department of Health been contacted? (Provide documentation and any approvals/conditions set forth by New York State Department of Health.)

Describe Security for Event:*

Describe Bathroom Facilities for Event: Port-a-potties and wash stations? If so, how many, locations, and anticipated methods of placement and removal of same:*

Workers Compensation and Disability Insurance as required by NYS for all employees/volunteers.

Commercial General Liability Insurance. The applicant shall maintain an occurrence form of commercial liability policy or policies insurance against liability from premises, personal injury or death, advertising injury, liability under an insured contract, negligence, occurring on or in any way related to the premises or occasioned by reason of the operations of the applicant. Such coverage shall be written on an ISO occurrence form (CG 0001 12 07 or equivalent) in an amount not less than $1,000,000.00 per occurrence and not less than $2,000,000.00 aggregate. The insurance must be endorsed to provide primary insured coverage to the County of Lewis and all of its Departments, and any other local municipality in which the event is conducted.

Automobile and/or other motorized vehicle insurance. The applicant shall maintain automobile, other vehicle and equipment policy(s) insurance against liability for bodily injury, death, damage to property and other coverages relating to the use, operation, loading or unloading of any automobiles, motorized vehicles and other equipment on an around the event site, in an amount not less than $1,000,000.00. If the event involves participants’ use of motorized vehicles (autos, ATVs, UTVs, motorcycles, motorbikes, snowmobiles, etc.) it is the applicant/permittees’ responsibility to assure that all participants motorized vehicles are properly licensed, registered and insured, as may be required under the law.

Notices: Lewis County with the approval of the County Attorney, may adjust the required insurance coverages and amounts, depending upon the nature of the event, i.e., activities, size, duration.

Do you have Insurance?*

YesNo insurance at this time

Insurance (please attach copies of all that apply):

Browse Files

Explanation for no insurance

Please allow 30 day for a review of the materials provided. You may be asked for additional information.

At the time a permit may be issued, applicant will be required to read and sign a statement of responsibilities and obligations together with insurance requirements and documents and to execute a hold harmless/indemnification statement in favor of the County similar to the following terms: “the County shall not be liable for any damage or injury to the applicant, employees, event organizers, volunteers, participants, or any other person, or to any property, occurring on the event site covered by the permit. The applicant/permittee agrees to defend, indemnify and hold harmless the County of Lewis, and its agents from and against all claims, damages, losses and expenses including but not limited to attorneys’ fees, arising out of any claim for personal injuries, property damage or wrongful death associated in any way with the applicant’s or participants’ use of the permitted site/property, or in any way related to the event, no matter how caused.”

The County, through the DRFP, shall have the right, in its sole discretion, at any time to terminate the permit, or any portion thereof, should it be necessary due to county operations, conditions, or other circumstances which may arise. Any termination of the permit shall not constitute a breach of the permit, and no liability shall be incurred by or arise against the County, its agents and employees for loss of profits or any other damages.

In addition applicant/permittee agrees to provide event information and any changes to the event or unusual circumstances or conditions of the event to the County as soon as possible. The applicant/permittee agreed to provide the County with actual number of participants who attended the event. 2. Immediately during and after the event, notify the Department of Recreation, Forestry and Parks of any unsafe conditions and any accidents that occurred during the event immediately upon discovery of same.

Other Information and conditions to which the County should be aware:

Signature*

Clear

Application fee:

250 participents or less : $0.00
More than 250 participents: $20.00
(unless over 10,000 participents, than additional fees may apply)

If paying by credit card please call the Treasure's Office Monday - Friday during the hours of 9:00AM until 4:00PM. (315)376-5324

Checks should be made out to:

Lewis County
Attn: Recreation, Forestry and Parks
7660 N State St
Lowville, NY 13367

Payment Options*

CheckCredit Card

Check #

Fee:

Please verify that you are human*

Please click the submit button to submit your application. You may print the document for your files, if you choose.