CITY OF POULSBO SPECIAL EVENT PERMIT PACKET SUBMISSION

CITY OF POULSBO SPECIAL EVENT PERMIT PAPERWORK
On January 22, 2020 the Poulsbo City Council adopted a new ordinance creating section 5.30 Special Event Permits to the Poulsbo Municipal Code.

A Special Event is defined as: Any activity on public property and or public right-of-way; or any event held on private property which would have a direct significant impact to city services (ex. police, streets, etc.) that involves an open invitation to the public or attendance is by private invitation that exceeds our public space capacity.

Click to review these FAQs

Once the special event is approved by the City, of Poulsbo A Special Event Permit will be sent to the Event Organizer that must be retained on-site at the event.

REQUIRED PROCESSING TIME:
- All Special Event Permit Packets must be received a minimum of 90 days prior to the event start date.
- No Applications that require special arrangements for road closures, barricades, traffic control or public safety will be accepted for events within 90 days of the event date.
- No Applications will be accepted for events within 45 days of the event date.
- Application Packets are to be reviewed in person or by zoom consultation with Lin Hino, Special Events Coordinator in a 30-45 minute meeting, shedule now: https://calendly.com/poulsboevents/60min
While occasional exceptions can be made, the consequences of a late submission may include any or all the following:
- Permit may be denied due to insufficient processing time
- An expedited fee of $50 fee
- Jeopardizes historical date/location for recurring events
- Jeopardizes future events you may request
- Police staffing or other City services may not be available
- You will not receive a preliminary permit document (only the final permit document will be issued)
HOW TO SUBMIT THIS SPECIAL EVENT PACKET DIGITALLY: You must complete ALL questions and are asked to attach the following forms for this special event packet to be considered. You can save your progress, but the submission will not be reviewed until all required questions are completed and you hit the submission button.
1. Application of Special Event - this form and only accepted Application
2. Site Map
3. Certificate of Insurance and Additional Insured Endorsement

As applicable to your event, click for the quicklinks to the additional forms that may be need to be submitted.
Special Event Additional Forms (based on what your event includes):
- Certificate of Insurance Requirements with Examples
- Municipal Park Use Application - as operated with the Poulsbo Parks and Recreation department
- Burning Permit - as operated with the Poulsbo Fire department
- Route or Street Map - to be discussed with the Poulsbo Police Department
  --Anderson Parkway Parking Lot Map Template Fillable
- Vendor list
- Non-city owned property use form
- Rent a City Dumpster - as operated with the Poulsbo Fire department
- Community Signboard Application - as operated with the Poulsbo Parks and Recreation department
  --Signbboard requirements

Application for Special Event Permit
APPLICATION FOR SPECIAL EVENT PERMIT
- Applications need to be submitted 90 calendar days in advance of event.
- If an Application contains no road closures and is submitted within 90 days prior to the event, a $50 expedite fee will apply.
- No Applications will be processed for events falling within 45 calendar days of the event.
- An Application will not be accepted prior to one year of the event date.
- All Application questions must be answered before the paperwork can be completed.
  Completing this Application will provide City staff with the information necessary to address public safety and compliance with local policies, regulations and laws.
- Submittal of this Application to the Parks and Recreation Department does not indicate or guarantee approval of the Application or the dates requested.
- A meeting with City personnel may also be required prior to event approval.

1. Event Overview:
Event Name:
Your Event date(s) should be at least 90 days from today. This Application will not be accepted if it is less than 45 days away. Check here: https://www.timeanddate.com/date/duration.html
Is the event location fully or partially held at a city park?

YesNo
Municipal Park Use Application – to ensure your date is available, we recommend that you call Parks & Recreation (360) 779-9898 to double check
Select what Poulsbo Park(s)

Raab Park Picnic ShelterNelson Park Picnic ShelterAustin-Kvelstad Pavilion at Muriel Iverson Williams Waterfront ParkBonfire at Muriel Iverson Williams Waterfront ParkMuriel Iverson Williams Waterfront Park (entire park use)Other
Quick Link: Google Maps can help determine your event location
Event Location:
Describe event location, address, and neighborhoods:
Event Website:
If applicable
Event Description:
Please give a general overview of the event, including purpose

2. Event Contact Information:
Hosted by Organization/Business:
Event Organizer/Main Contact

Name must match the signature on this application
Full Name:
Title:
Organization:
Phone:
Cell:
Email:
example@example.com
Mailing Address: the Special Event Permit will be sent to this address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Public Contact: this will be published on the Special Events Website Calendar

Same as Event Organizer/Main ContactDifferent
On-Site Contact: s/he is available and at the event

Same as Event Organizer/Main ContactSame as Public ContactDifferent

3. Event Date(s), Times(s) and Attendees
Set Up Start Date:

MonthDayYear
The date you will start event operations (event staff)
Set Up Start Time:

Minutes

AM/PM Option
Take Down Completed Date:

MonthDayYear
The date you will be done with all event operations (event staff)?
Take Down Completed Time:

Minutes

AM/PM Option
How many days is your event?

1 Day2 Days3 Days4 or more Days

1 Day Event: Open to the Public
1 Day Event: Start Date

MonthDayYear
The date the event is open to public
1 Day Event: Start Time

Minutes

AM/PM Option
1 Day Event: End Time

Minutes

AM/PM Option
# of Participants:
For ticketed or vendor booth events, include specifically the maximum #
# of Spectators:
# of the public that is projected to join the event
# of Staff/Volunteers:
How many is part of the event staff (this can include volunteers)
Additional operational details and timelines
Attach additional pages as needed for additional days or details

Cancelof

2 Day Event: Open to the Public
Day 1 Date:

MonthDayYear
The date the event is open to public
Day 1 Start Time:

Minutes

AM/PM Option
Day 1 End Time:

Minutes

AM/PM Option
Day 2 Date:

MonthDayYear
The date the event is open to public
Day 2 Start Time:

Minutes

AM/PM Option
Day 2 End Time:

Minutes

AM/PM Option
# of Participants:
For ticketed or vendor booth events, include specifically the maximum #
# of Spectators:
# of the public that is projected to join the event
# of Staff/Volunteers:
How many is part of the event staff (this can include volunteers)
Additional operational details and timelines
Attach additional pages as needed for additional days or details

Cancelof

3 Day Event: Open to the Public
Day 1 Date:

MonthDayYear
The date the event is open to public
Day 1 Start Time:

Minutes

AM/PM Option
Day 1 End Time:

Minutes

AM/PM Option
Day 2 Date:

MonthDayYear
The date the event is open to public
Day 2 Start Time:

Minutes

AM/PM Option
Day 2 End Time:

Minutes

AM/PM Option
Day 3 Date:

MonthDayYear
The date the event is open to public
Day 3 Start Time:

Minutes

AM/PM Option
Day 3 End Time:

Minutes

AM/PM Option
# of Participants:
For ticketed or vendor booth events, include specifically the maximum #
# of Spectators:
# of the public that is projected to join the event
# of Staff/Volunteers:
How many is part of the event staff (this can include volunteers)
Additional operational details and timelines
Attach additional pages as needed for additional days or details
Attach additional pages as needed for additional days or details

Cancelof

Open to the Public 4 Days or longer event
Provide the Start Time and End Time open to the public for each day of your event
# of Participants:
For ticketed or vendor booth events, include specifically the maximum #
# of Spectators:
# of the public that is projected to join the event
# of Staff/Volunteers:
How many is part of the event staff (this can include volunteers)
Additional operational details and timelines
Attach additional pages as needed for additional days or details
Attach additional pages as needed for additional days or details

Cancelof

5. City of Poulsbo Public / Park Use
- Events held in a City of Poulsbo Park require completion of the Municipal Park Use Application.
  - To ensure your date is available, we recommend that you call Parks & Recreation (360) 779-9898 to double check.
  - Additional fees apply.
  - For regulations, see Section D: Municipal Park Use.
- A Site Map is required to be submitted
  - See Park Example Site Maps
  - See Section C: Street Closure/Site Map/Route Map
Select what Poulsbo Park(s) your event is fully or partially held at

Raab Park Picnic ShelterNelson Park Picnic ShelterAustin-Kvelstad Pavilion at Muriel Iverson Williams Waterfront ParkBonfire at Muriel Iverson Williams Waterfront ParkMuriel Iverson Williams Waterfront Park (entire park use)Other
Park Reservation was made prior to submital of Special Event Application

YesNo
Complete the Municipal Park Use Application:
- To ensure your date is available, we recommend that you call Parks & Recreation (360) 779-9898 to double check.
- Additional fees apply.
- For regulations, see Section D: Municipal Park Use.
- A Site Map is required to be submitted
  - See Park Example Site Maps
  - See Section C: Street Closure/Site Map/Route Map
Attach the Municipal Park Use Form and Site Map:

Cancelof

7. Insurance Requirements
- The City will need to recieve the required insurance coverage within 90 days of the event. The Application will not be accepted if it is less than 45 days away. Check the your dates here: https://www.timeanddate.com/date/duration.html
- The City of Poulsbo does not maintain insurance that will respond to claims against the Applicant arising out of the use of facilities by the Applicant, its members, vendors or those attending the event.
- The Applicant must provide a certificate of liability insurance prior to the event in the minimum amount of $ 1 Million Per Occurrence / $2 Million General Aggregate, and $1 Million Products-Completed Operations
- The Applicant must name the City of Poulsbo as an Additional Insured using an additional insured endorsement at least as broad as ISO form CG 20 12 or CG 20 26.
- Starting in 2025, insurance minimum for events will move to $2 Million Per Occurrence / $2 Million General Aggregate for all events. This update comes from recommendations and special event audits conducted with the City’s insurance agency WCIA as nationally the averages have increased.
- Higher risk activities (such as beer gardens, carnivals/amusement rides/inflatables, fireworks, large gatherings, events on/over water, etc. require additional amounts of insuance as outlined in the of insurance: Insurance Worksheet with Example
- As a helpful resource, here is a resource that shows a list of previously used insurance companies for past social events. This is intended to be used as an informational reference and does not signify any recommendations by the City. Note that this is not comprehensive: Poulsbo Insurance Companies use for Special Events
Certificate of Insurance Policy Effective Dates
(MM/DD/YYY - MM/DD/YYY) state typical renewal date if not secured for event date coverage
The Certificate of Insurance with the additional insured endorsement, meets the above-mentioned minimum City requirements?

YesNo
Please provide when you will be able to secure it
MM/DD/YYYY
The City will need to recieve the required insurance coverage within 90 days of the event. The Application will not be accepted if it is less than 45 days away. Check the your dates here: https://www.timeanddate.com/date/duration.html
Attach The Certificate of Insurance

Cancelof

8. Condition of Approval
City of Poulsbo Indemnification/Hold Harmless Agreement: I, Applicant, certify that I am authorized to enter into this Special Event Permit Application on behalf of Organization, that the event for which this permit is to be used will not be in violation of any City of Poulsbo ordinance and the statements made on this Application are true and correct to the best of my knowledge. I, as the Event Applicant/Organizer on behalf of Organization, agree to the terms and conditions of this permit.

The Applicant/Organization, shall defend, indemnify and hold harmless the City of Poulsbo, its officers, officials, employees and volunteers from and against any and all claims, suits, actions, or liabilities for injury or death of any person, or for loss or damage to property, which arises out of the acts or omissions of the Applicant/Organization, its employees, volunteers, representatives or vendors, or from any activity, work or thing done, permitted, or suffered by Applicant/Organization, related to the permitted activity, except only such injury or damage as shall have been occasioned by the sole negligence of the City.
Applicant has read and understands the conditions of the Special Events Permitting Indemnification/Hold Harmless Agreement?

YesNo
Application Packets are to be reviewed in person or by zoom consultation with Lin Hino, Special Events Coordinator in a 30-45 minute meeting:

Schedule Now: https://calendly.com/poulsboevents/60min
Name
First and Last Name
Title
Date

MonthDayYear
Date
Signature will be aquired during the required City Review

9. Contacts & FAQ
If you have any questions please reach out to:

Lin Hino – Special Events Coordinator
- Email: lhino@cityofpoulsbo.com
- Phone Direct: 360-394-9771
- Phone Office: 360-779-9898
- Adress at Poulsbo Parks and Recreation: 19540 Front Street NE, Poulsbo, WA 98370, Monday-Friday 8:00 AM to 7:00 PM and Saturday from 9:30am-1:30pm; closed for lunch from 11-12pm
City of Poulsbo Public Works:
- Email: publicworks@cityofpoulsbo.com
- Phone Office: (360) 779-4078
- Website: https://cityofpoulsbo.com/police-department/
- Adresss at Public Works Office: 22097 Viking Ave NW, Monday-Friday 8:00 AM to 4:30 PM
City of Poulsbo Police Department:
- Email: Police-Admin@cityofpoulsbo.com
- Phone Office: 360-779-3113
- Website https://cityofpoulsbo.com/police-department/
- Address at City Hall Police Department (located on 1st floor): 200 NE Moe Street, Monday-Friday 8:00 AM to 4:30 PM; closed for lunch from 12:15-1:15pm
Application Packets are to be reviewed in person or by zoom consultation with Lin Hino, Special Events Coordinator in a 30-45 minute meeting:

Schedule Now: https://calendly.com/poulsboevents/60min

Frequently Asked Questions
Should be Empty:

CITY OF POULSBO SPECIAL EVENT PERMIT PAPERWORK

APPLICATION FOR SPECIAL EVENT PERMIT

1. Event Overview:

2. Event Contact Information:

Event Organizer/Main Contact

Public Contact:

On-Site Contact:

3. Event Date(s), Times(s) and Attendees

4. Event Equipment / Set Up:

4. Event Vendors / Services

5. City of Poulsbo Public / Park Use

6. Street Use and Police Services

7. Insurance Requirements

8. Condition of Approval

Schedule Now: https://calendly.com/poulsboevents/60min

9. Contacts & FAQ

Lin Hino – Special Events Coordinator

City of Poulsbo Public Works:

City of Poulsbo Police Department:

Schedule Now: https://calendly.com/poulsboevents/60min

Frequently Asked Questions