Use of Borough Property Permit Application - BLANK

Use of Borough Property Permit Application

Completed applications, with unexpired proof of insurance, must be submitted to the Borough Clerk, at least 30 days in advance of the event. All events must be in compliance with Executive Orders.

Please attach a Certificate of Insurance showing proof of liability insurance with a limit of at least $1,000,000 per occurrence naming the Borough of High Bridge as an additional insured with respect to the above-mentioned event. Alcoholic beverages are prohibited in any public park or facility without prior application and authorization by the Mayor and Council.
Type of Use*
Field(s) requested

Field 1Field 3Field 4
Other
Requesting Huskies field will be inclusive of fields 1 and northeast area.
ALL DATES REQUESTED MUST HAVE A START TIME AND END TIME SPECIFIED.
Date of Event (Start)*

MonthDayYear
Date
Date of Event (End)*

MonthDayYear
Date
Time of Event (Start) * Please include set up*

Minutes

AM/PM Option
Time of Event (End) * Please include clean up*

Minutes Minutes

AM/PM Option
Number of Persons Expected*
APPLICANT INFORMATION:
Please feel free to attach a document

specifying requested dates/times.
Authorized Contact name andor organization*
Address
Phone Number*
Fax Number
Email Address
example@example.com
Authorized Alternate Contact name
Address
Phone number
Email Address
example@example.com
INSURANCE INFORMATION (Fill out or attach):

Insurance Company Name: Insurance Company Address: Phone Number:
Insurance Company Name*
Insurance Company Address*
Phone Number*
Fax
Agent Contact Name
Requesting "Huskies Field" will be inclusive of fields 1 and3
Additional Supporting Information
Include any special requests or information not otherwise found in prior sections of this form.
I, hereby, agree that all information above is true to the best of my knowledge and understand that the Borough of High Bridge may require additional information on which to base a satisfactory approval. An event fee may be charged by the Borough of High Bridge for use of any of its recreational open space. All fees MUST be paid to the Borough of High Bridge prior to approval and issuance of the above Field Permit.
Certificate of Insurance*

Cancelof
Authorized Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

APPLICANT INFORMATION: