Town of Boones Mill Special Event Permit Request Form

Town of Boones Mill Special Event Permit Request Form

Online Submission
Complete this application in its entirety before submitting, and retain a copy for your records. Depending on the scale of your event, the processing time for your application will vary.

Note: Submission of your application does not constitute final approval of your event, nor does it exempt you from other required application and reservation procedures. The Town of Boones Mill reserves the right to request additional information and, if deemed necessary, an in-person meeting to review event details.
Applicant
Applicant:*
Applicant Email:*
example@example.com
Main Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Event Details
Event Name:*
Description of Event:*
Event Sponsors:*
Start Date:*

MonthDayYear
Date
End Date:*

MonthDayYear
Date
Rain Start Date:*

MonthDayYear
Date
Rain End Date:*

MonthDayYear
Date
Please indicate if this event will take place on a recurring schedule. (Events may be permitted for one calendar year. Please list additional dates or "every Saturday from 9am-12pm", "every 4th Friday".*
Event Category:*

Music ConcertCommunity FestivalParade or RaceNeighborhood Block Party or PicnicOther
Admission Fee:*

In AdvanceDay of EventNo Fee
Event Site Plans:*

Regardless of venue, please attach a site map for your event. A clear, hand-drawn or computer-drawn map is recommended. Please use the Event Name and Date as your file name (ex: holiday parade_dec15). Site maps should include the following information: (1) An outline of the entire venue area, (2) Entrance/exits for attendees, (3) Location of vendors/sponsors including loading areas, (4) Emergency access points and first aid stations, (5) ADA areas, (6) Restroom Facilities
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Event Personnel Plan: Provide a detailed description of the number of staff, volunteers, and private security you have assigned to work your event.*
Public Safety
All events with attendance of 100 or more people, and events determined by staff, must procure on-site police, fire, and EMS services.
Will your event require police, fire or EMS services per the criteria at the link above?*

YesNo
Alcohol Served and Sold
Will your event have alcohol served or for sale?*

YesNo
What types of alcohol will be at your event?*

WineBeerMixed Beverages
Will there be retail vendors of alcohol? (bottles of wine, etc)*

YesNo
Total number of alcohol vendors:*
Please upload a list/description of alcohol vendors including contact information.*

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Food Vendors
Will there be food and/or retail vendors at your event?*

YesNo
Will there be food trucks at your event?*

YesNo
Total Number of Food/Retail Vendors and Food Trucks:*
Please upload a list of all Food/Retail Vendors and Food Trucks, including contact information:*

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Parking
Where will attendees park?*

On-Site Public ParkingPrivate Property (must acquire written permission of property owner)Satellite Parking LocationOther
Restrooms and Waste Removal
Please describe your waste removal (number of trash cans & locations, clean-up timeline, etc) AND restroom plan (number of public restrooms, number of portapotties and locations).*
All Special Events using Virginia Department of Transportation (VDOT) right-of-way within the Town must obtain official State approval and required VDOT permits before the event. Event Organizers should work directly with VDOT staff during this process to get all permits and approvals.
Will this event require a street closure?*

YesNo
If requiring a street closure, please describe in detail the streets and cross streets that would be closed.*
Liability Insurance Information
A certificate of insurance for this event must be presented to the Town of Boones Mill Town Manager no later than fifteen (15) calendar days before the start date of the event. If the information requested below is not available when this application is submitted, it can be added later, but not later than the fifteen (15) day deadline previously noted.
Insurance Agency:*
Agents Name:*
Business Phone:*
Please enter a valid phone number.Format: (000) 000-0000.
Email:
example@example.com
Policy Number:*
Policy Limits:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Attach copy of COI here. (Event permit will not be issued without proof of insurance.)*

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Community Engagement
The event applicant is responsible for coordinating all communication efforts to include residents, civic associations, and businesses affected by the event at least 2 weeks before the event.*

By checking this circle, I acknowledge that it is my/the event organizers responsibility to notify impacted residents, organizations, and businesses of my event.
Indemnity Agreement
In consideration for the Town of Boones Mill granting the undersigned Event Organizer representative permission to hold the proposed event on public property and to display, sell, or offer for sale wares, services, and/or food or merchandise within the perimeters of their event venue, the undersigned agrees to assume the defense of and indemnify and save harmless the Town, it's employees, offices, and agents against any and all claims, liabilities, judgments, costs, causes of action, damages, expenses, and shall pay all attorney's fees, court costs, and other cost incurred in defending such claims, which may accrue against, be charged to, be recovered from, or sought to be removed from the Town, its employees, officers, and agents by reason of or on account of any personal injury or death or damage to property arising from the undersigned's event and associated activities, if such personal injury or death or damage of property is caused by the acts or omissions or negligence of the undersigned, or the undersigned's employees and agents or by such acts, omissions, or negligence of any other person subject to the undersigned's control. The Town, its employees, officers, and agents shall not have to give the undersigned any specific types of notices of such claims.
Certification by Applicant
By signing below, I certify that the information contained in this Special Event Application is true and correct to the best of my knowledge and belief. I understand and agree to abide by all regulations, provisions, and rules governing Special Events as set forth by the Town of Boones Mill. I understand this application is made subject to the rules and regulations established by the Boones Mill Town Council. I agree to abide by these rules and further certify, on behalf of the organization, that I am authorized to commit said organization, and therefore agree to be financially responsible for any costs and fees which may be incurred by or on behalf of the Event to the Town of Boones Mill.
Signature:*
Please verify that you are human*
Should be Empty:

Town of Boones Mill Special Event Permit Request Form

Applicant

Event Details

Public Safety

Alcohol Served and Sold

Food Vendors

Parking

Restrooms and Waste Removal

Liability Insurance Information

Community Engagement

Indemnity Agreement

Certification by Applicant