1APRIL 2017

City of Keizer Keizer Rotary Amphitheatre

Application/Permit 

Keizer City Hall930 Chemawa Road NE 

Keizer, OR  97303 PO Box 21000, Keizer, OR 97307 

Phone: (503) 390‐3700 Fax: (503) 390‐3787

Permit Application/Permit Fee Schedule (All applicable fees are due at time of application. Use fees are charged from Access to Exit Times.)

Non-refundable Application Fee: $56.00

Deposit (Refundable): $150.00

Use fee for Non Profit Group or Private Party:

$39.00 per hour, with two (2) hour minimum rental. (Maximum of $390.00 per day)

Use fee for Ticketed/Concert Event:

$39.00 per hour, with three (3) hour minimum rental. -OR- Ten percent (10%) of ticketed sales whichever is greater. (Must provide proof of sales if requested by City.)

Electrical Use Fee: $11.00 (1/2 day) or $22 (full day)

Event Information 

Event Date(s):

Event Title:

Description of Event:

Initial Access Time: AM PM Final Exit Time: AM PM (First entrance to Park for set up.) (The time final cleanup and exit occurs.)

Event Start Time: AM PM Event End Time: AM PM

Estimated Group Size: Number of Vehicles:

Parking Areas Requested (See Parking Plan Map): Area A Area B Area C Area D Area E

Food Service: Yes No Caterer Name (or self-provided):

Will your event be using commercial cooking equipment and/or generators? Yes No

Alcohol Service: Yes No Alcohol Caterer:

Alcohol Service Times: Starting at: AM PM Ending at: AM PM

Event Contact Information (Responsible person will receive Permit correspondence) 

Group or Organization (if applicable):

Responsible Person:

Primary Phone: Secondary Phone:

Mailing Address:

Email Address:

Ordinance No. 2010-618 as amended establishes Keizer Parks Regulations. Provide on a separate sheet any activities proposed that require a permit under the regulations.

Activities not specifically listed or permitted in writing are not allowed.

2APRIL 2017

THIS APPLICATION/PERMIT IS SUBJECT TO THE FOLLOWING CONDITIONS:   This application by itself does not serve as an approved permit. All conditions must be complied with by the

deadline shown or the permit may be denied or withdrawn. 1. The Application Fee, the Deposit and the Use Fees are due at the time of Application submittal. The event dates will

not be calendared or held until this occurs. 2. Provide single limit liability insurance with minimum limits of $1,000,000 naming City of Keizer as additional

insured. The insurance policy is to be issued by an insurance company authorized to do business in the state of Oregon. “City of Keizer” includes its officers, agents, contractors, and employees. The evidence of insurance and additional insured endorsement must be provided to City 20 days prior to event.

3. No alcohol beverages are permitted on City owned property unless the appropriate OLCC permit/license has been issued for this event and all City requirements have been met. If serving alcohol, alcohol vendor must enter into a separate agreement with City, must provide single limit liability insurance with minimum limits of $1,000,000 and liquor liability insurance certificate with minimum limits of $1,000,000 naming City of Keizer as additional insured. The insurance policy is to be issued by an insurance company authorized to do business in the state of Oregon. “City of Keizer” includes its officers, agents, contractors, and employees. The agreement, evidence of insurance and additional insured endorsement must be provided to City 20 days prior to event. Alcohol vendor must provide all the necessary Oregon Liquor Control Commission (OLCC) licenses/permits to City 20 days prior to the event. Alcohol vendor must comply with all City regulations.

4. Food preparation vendors must have Food Handlers License (if applicable). 5. Permittee must restore Park areas used by said organization/party to original condition by the end of the event. 6. General Park users will be allowed to use other park facilities during the event. 7. Birdseed, confetti, glitter, rice, anything that sprouts, hay/straw, silly string, inflatable bounce houses/castles,

mechanical rides, party poppers, sky lanterns, trampolines, and aerial remote control devices (including drones) are strictly prohibited.

8. The City reserves the right to review and approve or deny any other requests that may be potentially hazardous, unsafe or cause damage that is not listed herein.

9. Entertainment/Music must adhere to City Noise Ordinance 2004-511. Permittee shall be responsible for the monitoring of sound at the top of the concourse. The City recommends that the noise level not exceed 80-85 DB during sound checks and concerts. However, Permittee is advised that the Keizer Noise Ordinance applies to sound levels measured at the property lines of adjoining residences. Permittee must comply with all applicable regulations and laws, including, but not limited to the requirements of the Keizer Noise Ordinance.

10. Amplified sound is strictly prohibited after 9:00 p.m. 11. Signage for the event must comply with the Keizer Sign Regulations. Call 503-856-3441 for further information. 12. Provide a fire prevention plan reviewed and approved by the Keizer Fire District Fire Marshall or his/her designee for

all anticipated cooking operations and/or generator uses 20 days prior to event (if applicable). 13. Provide standard chemical toilets. The size of event determines number of toilets. (Call 503-856-3408 for clarification

on number) 14. 600 guests is the maximum capacity allowed by this event permit, unless Applicant requests for an increase in the

maximum capacity and approval is granted in writing by City. Requests for an increase to the maximum guest capacity must be submitted to the City of Keizer 20 days prior to the event.

15. If over 40 guests or not using parking Area A, a parking plan must be submitted 20 days prior to event. Including documentation of necessary equipment/volunteer staff for well delineated event parking. If any Shuttle buses will be used for the event then they must have a spotter when backing or maneuvering in the park.

16. If a Public Event, Ticketed Event or Concert Event submit to the City of Keizer a crowd control/security plan 20 days prior to event.

17. In the event of a cancellation less than thirty (30) days before the event, 50% of the Use Fees will be forfeited. 18. Should the event be cancelled by the City due to any reason, Permittee agrees and understands that other than refund of

all use fees, the City of Keizer shall not be liable for any damages or charges whatsoever. Acceptance of the full refund will fully release and satisfy any and all claims, damages or charges, direct or indirect, against the City of Keizer.

19. Should the event be cancelled for any other reason beyond the control of the City, e.g. weather conditions, Permittee agrees and understands that the application fee and use fees will be forfeited.

20. A late fee of $150.00 shall be imposed if all applicable documentation noted above and on the application/permit are submitted less than 20 days prior to the event.

3APRIL 2017

It is the Permittee’s responsibility to contact our Parks Department at least one week prior to your event date. Please call 503-856-3569 to discuss the following if applicable to your event:

PARKING: 165 marked paved parking spaces at the park amenities must remain open for general park users. Aparking plan, including number of parking attendants, must be established to ensure parking instructions given by the City are followed. Access to the Event Parking Access Gate will be arranged by the City. Parking instructions and a map will be provided with the approved permit.

ELECTRICAL USE: If electrical use fee is paid for limited power it will be made available only at the KeizerRotary Amphitheatre stage and the western end of the concrete apron entrance.

**NOTICE** Permittee agrees to defend, indemnify and hold harmless the City of Keizer, its officers, agents and employees, against any claim, demand, suit or action for property damage, personal injury or death arising in connection with this event. Permittee agrees to comply with all the conditions set forth herein and to provide at Permittee’s own expense the insurance set forth above.

Facsimile or electronic transmission of any signed original document, and retransmission of any signed facsimile or electronic transmission, shall be the same as delivery of an original. At the request of either party, the parties shall confirm facsimile or electronic transmitted signatures by signing an original document.

I hereby certify that I am the authorized representative of the above group, that the above statements are true to the best of my knowledge, and that I will abide by all restrictions, administrative rules and applicable City Ordinances.

Authorized Signature: Date:

EXPIRATION: The application expires one year from submitted date. ** PERMIT REVOCATION**

The City Manager or his designee may revoke the permit if circumstances reasonably show that the event can no longer be conducted consistent with public safety or the Permittee does not meet the conditions set forth within the required time period.

Please return this form and payment to the City of Keizer by one of the following methods: 1) In person: 930 Chemawa Rd NE -or- 2) By Mail: City of Keizer, PO Box 21000, Keizer, OR 97307

If you have any questions call 503-856-3408 or email PC@keizer.org

************THIS SECTION MUST BE COMPLETED BY CITY OF KEIZER STAFF************

Date Application Submitted: Received by:

Total Fees Due as Submitted: Total Fees Paid: Date Paid:

Approved as Submitted Approved as Amended Denied

By: Title: Dated:

Copy to: Parks Manager Police Dept. Fire Dept. Reserving Group City File

Area C: 40 Parking Spaces (Head in Parking Only)

Area B: 50

Parking Spaces

Area A: 40 Parking Spaces

Area E: 150 Parking Spaces

Event Parking Access Gate (Vehicles are ONLY allowed to enter and exit from THIS gate.)

Amphitheater Event Parking NOT Allowed

Amphitheater Event Parking Allowed. Designate on your Permit Applica on which parking areas you will need.

Keizer Rotary Amphitheater Parking Plan Event Name:_______________________ Event Date: ______________

We will have _____ number of parking a endants. The cars will be directed through the “Event Parking Access Gate”

and not allowed to park in the exis ng parking area so those using the other park ameni es have sufficient parking.

We are expec ng _____ number of cars and will park the vehicles in the parking areas designated on our applica on.

Parking Areas: A B C D E