BOROUGH OF SCHWENKSVILLE
SPECIAL EVENT PERMIT APPLICATION
In order to ensure the safety of our residents and visitors, while also minimizing the impact of special events on the flow of pedestrians, traffic, and commerce within Schwenksville Borough, the following permit process must be completed by all persons and organizations who wish to host a special event within Schwenksville Borough.
SUBMITTING AN APPLICATION DOES NOT GRANT PERMISSION TO HOLD AND EVENT.
APPLICATION MUST BE SUBMITTED
14 DAYS
PRIOR TO THE EVENT.
APPLICANT INFORMATION
Name of Applicant/Organization:
Main Contact Name:
Main Contact Mailing Address:
Main Contact Phone Number:
Main Contact E-Mail:
example@example.com
EVENT DAY CONTACT INFORMATION
Point of Contact Name:
Point of Contact Phone Number:
EVENT INFORMATION
Name of Event:
Date of Event:
-
Month
-
Day
Year
Date
Event Start Time:
Hour Minutes
AM
PM
AM/PM Option
Event End Time:
Hour Minutes
AM
PM
AM/PM Option
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TYPE OF EVENT
TYPE OF EVENT
Walk/Run
Parade
Block Party
Festival
Filming
March
Public Rally
Other
Number of Participants:
Number of Workers:
DESCRIPTION OF EVENT
LOCATION OF EVENT
LIST OF ALL STREET CLOSURES (IF APPLICABLE)
FOOD VENDORS, FOOD TRUCKS, AND CATERERS
Will your event have food vendors, food trucks, or caterers?
Yes
No
If YES, please provide a list of all food vendors, along with a copy of that vendor's Montgomery County Health Department license, or a temporary event license specific to this event. Food vendors must also provide a Certificate of Insurance naming "Schwenksville Borough" as additionally insured.
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CRAFTERS, NON-CRAFTERS, OR INFORMATION BOOTHS
Will your event have crafters, non-crafters, or information booths?
Yes
No
If YES, how many vendors or outside crafters will be attending?
ANY NON-FOOD VENDOR WILL HAVE TO SUBMIT A WAIVER AND RELEASE FORM TO PARTICIPATE IN THE EVENT.
SUBCONTRACTORS AND THIRD-PARTY COMPANIES
List all sub-contractors and third-party companies hired for this event. Examples include porta-potties, trash removal, fencing, inflatables, etc. Attach a separate sheet of paper to the application is necessary.
1:
2:
3:
4:
5:
ALL SUB-CONTRACTORS MUST PROVIDE A PROPERLY ENDORSED CERTIFICATE OF INSURANCE NAMING "SCHWENKSVILLE BOROUGH" AS ADDITIONALLY INSURED.
ACKNOWLEDGEMENT
1: Upon receipt of the completed Special Event Permit Application, the Application will be reviewed by the Borough
2: If approved, a Special Event Permit will be issued within five (5) days of receipt of the application.
3: The Certificates of Insurance shall be provided to the Borough prior to the event.
4: All applicable fees are due prior to the event.
5: The Borough reserves the right to withdrawal he Special Event Permit if the Certificates of Insurance and any applicable fees are not received prior to the event.
6: I/We acknowledge and agree to the terms and conditions set forth herein.
Signature of Applicant:
Date:
-
Month
-
Day
Year
Date
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Schwenksville Borough
300 Main Street, Schwenksville, PA 19473
Telephone:
610-287-7442
Email:
info@schwenksville-pa.org
Website:
www.schwenksville-pa.org
Meadow Park & Main Street Plaza Address
300 Main Street, Schwenksville, PA 19473
Special Event Risk Release and Waiver of Liability
In consideration of the use of Schwenksville Borough property for an event in accordance with the Special Event Permit (the "Event"). I/We recognize and acknowledge that there may be certain risks of personal injury and property loss arising from the Event, and I/We agree to assume full risk of any illnesses, injuries, including death, loss or damage of property from conducting the Event and use of any Borough property or facilities for the Event.
I/We hereby specifically acknowledge, understand, and agree that the Borough does not sanitize, disinfect, clean or otherwise treat outdoor seating areas, pavilion, playground equipment and/or surface of any kind with which Event participants may come in contact.
I/We agree to waiver and relinquish all claims I/We may have as a result of hosting the Event.
I/We agree and covenant to indemnify, defend, and hold harmless the Borough of Schwenksville and its officials, members, supervisors, employees, attorneys, successors and assigns, against and from any loss, damage, cost, charge, expense, liability claims, demand or judgement of whatsoever kind or nature whether to persons or property, arising out of, resulting from or caused by, in whole or in part, any negligent act, error, omission or willful misconduct on part of Applicant, its agents, employees or sub-contractors in connection with the Applicant pursuant to the Special Event Permit, including but not limited to, those in connection with loss of life, bodily injury, personal injury, damage to property, contamination or adverse effects on the environment, any liability for fines, fees, or penalties for violations of any statues, ordinances, codes, rules, regulations or standards applicable to activities or services provided by Applicant, its agents, employees or sub-contractors at the Event (herein after "Acts and/or Omissions").
In case of suit or cause of action brought against the Borough on the account of any Acts and/or Omissions, I/We hereby agree and covenant to appear and assume the defense thereof and to pay all costs, charges, reasonable attorney fees and other expenses, and all judgements that may be incurred against the Borough to which this release and waiver applies. The indemnification provisions have been mutually negotiated between the parties.
I HAVE READ THE ABOVE AND AGREE TO ABIDE BY ALL TERMS AND CONDITIONS SETFORTH IN THE RISK RELEASE AND WAIVER OF LIABILITY.
I HAVE READ THE ATTACHED USE OF BOROUGH FACILITIES POLICY AND RULES THAT APPLY AND AGREE TO THE TERMS, CONDITIONS, RESPONSIBILITIES AND UNDERSTANDINGS STATES THEREIN.
I UNDERSTAND THAT A CERTIFICATE OF INSURANCE NAMING SCHWENKSVILLE BOROUGH AND ITS EMPLOYEES, ELECTED AND APPOINTED OFFICIALS AS ADDITIONA INSURED IS REQUIRED FOR USE OF THE COMMUNITY ROOM, PUBLIC TOILETS, MAIN STREET PLAZA, AND MEETING ROOM.
I UNDERSTAND THAT ALL MINORS MUST HAVE ADULT SUPERVISION AND THAT CONTACT INFORMATION FOR THE RESPONSIBLE ADULTS BE PROVIDED TO THE BOROUGH.
Printed Name:
Signature:
Cell Phone:
Email:
example@example.com
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