Special Events Application & Permit

Special Events Application & Permit

Haverford Police Department
Applicant Information
Legal Name of the Permit Application (Company or Individual):
Enter company name or individual name
Date

MonthDayYear
Date
Contact Person for Permit Application:

First NameLast Name
Contact Person Phone Number:
Please enter a valid phone number.
Contact Person Email:
example@example.com
Contact Person's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Permit Applicant Phone Number:
Please enter a valid phone number.
Permit Applicant Email:
example@example.com
Is Permit Applicant an Authorized Agent of Applicant to execute legally binding contracts?

YESNO
Is organization a Non Profit Tax exempt 501(c)(3)?

YESNO
If yes, provide tax exempt Number:
Event Information
Name of Event
Please enter Name of Event
Event Date:

MonthDayYear
Date
Location of Event
Is Location Reserved?

YESNO
Rain Date

MonthDayYear
Rain Date
Hours of Event
Start Time

Hour Minutes

AM/PM Option
Finish Time

Hour Minutes

AM/PM Option
Event Description:
Please enter event description
Event Information
Does the Street Have:
Septa Routes:

YESNO
Parking Meters:

YESNO
Parking Lots:

YESNO
Hospital/Nursing Home:

YESNO
Residences:

YESNO
Will there be:
Barricades (Block Party):

YESNO
Food Served:

YESNO
Merchandise Sold:

YESNO
Sound/ Music System:

YESNO
Live Music:

YESNO
No Parking Signs Required:

YESNO
Township Services

Police and Fire/Medical are for Internal Use Only. **The use of Township Services will be determined by the Township Manager. **
Police
# Of Officers
Date(s) Required
Enter dates required
Hours Needed
(i.e. 8am- 5pm)
The final number of Haverford Township Regular‐Off‐Duty Police Officers required for an event will be determined by the Haverford Township Police Department upon the approval of all required permits for this event
Fire/Medical
Is Fire Company Needed

YESNO
Is Medical Services Needed

YESNO
*One Medic and Ambulance is required up to 5,000 people and if additional attendees additional medics and ambulances will be required.
Trash
Trash: Who will be responsible for the collection of trash pick‐up during the event?
Enter trash collection information
Hours per day needed
Enter hours per day needed
Township Equipment
Barricades Yes Amount Amount Required (Determined by Police & Public Works)
Road Closed Signs Yes Amount Amount Required (Determined by Police & Public Works)
Codes Department
Will Structures be assembled needed to be inspected by Codes?

YESNO
Will Food Be Sold at Venue?

YESNO
Township Facilities
Location
If Using a Park are you the current Township Field Permit Holder?

YESNO
Other
Please list any other requests for Township Services (be specific)
**All booths, stands, trash, signs/banners must be removed immediately following event. All items left behind will be disposed of by the Township and owner/permit holder subject to fine & cost of removal.
Road Closures

State/Township
Please List All State Roads that will be closed during the event:
All State Road closed
The closure of State Roads requires PennDot Permit & certificate of Insurance to be completed.Was PennDot permit completed?

YESNO
Please List All Township Roads that will be closed during the event:
All State Road closed
The closure of Township Roads requires Township Approval and may require a certificate of insurance to be completed. Was Certificate of Insurance obtained?

YESNO
Please describe in detail the Parade Route and estimated amount of participants involved:
Parade Route Information
Vendor Information
Number of FOOD Vendors #Vendors Vendors list provided to the Township? YES NO
Number of OTHER Vendors #Vendors Vendors list provided to the Township? YES NO
Will there be alcohol at this event?

YESNO
If yes, has liquor license been issued?

YESNO
Additional Event Features
Temporary FencingInflatableMusic (Recorded)Signs/BannersOpen FlamesMusic Live EventPort‐A‐JohnFireworksAmplifying Devices/Loud SpeakersTent or CanopiesCarnival/Amusement Rides
Indemnification: For and in consideration of the Township of Haverford consent to allow the Applicant to hold a Special Event, Parade or Public Assembly (as defined by Township Ordinance) within the limits of Haverford Township, the Applicant agrees as follows:

The Permit Applicant jointly and severally, hereby hold harmless, indemnify and defend the Township of Haverford, its representatives, officers, agents, affiliates, employees, the administration and elected and appointed officials from and against all liability, suits, actions, claims, costs, expenses or demands (including, without limitation, suits, actions, claims, costs, expenses or demands resulting from death, personal injury and property damage) or expenses of every kind and character, including reasonable attorney’s fees, costs and appeals, arising or resulting in whole or in part, as a result of any tort, intentional action, negligent acts or omissions on the part of the Permit Applicant or any of the participants of the Event outlined in this application. This indemnification provision shall survive the termination of this contract and shall be in full force and effect beyond the term or termination of this contract, however, terminated.
Signature

Clear
Date

MonthDayYear
Date
Name

First NameLast Name
Fees for Services/Permit Fees
Permit Fees

Block Party Permits‐$35.00
Music Permits‐$10.00
Event/Race Permits‐$50.00
Large Events Permits (250 or more people)‐$150.00

Township Service Fees

Police Detail Fee‐$105.00 per hour
Township Medic Fee‐$50.00 per hour
Township Public Works Employee Fee‐$50.00 per hour
Township Trash Vehicle‐$47.00 per hour (plus employees per hour) Street Sweeper Fee‐$125 (plus employee per hour)
Should be Empty:

Special Events Application & Permit

Applicant Information

Event Information

Event Information

Township Services

Road Closures

Vendor Information

Additional Event Features

Fees for Services/Permit Fees