special function - palmettodocsonline.palmettofl.org/palmetto/agendas/city/...piti 2 f cr f ls c i c...
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SPECIAL FUNCTION PE APPIdICATIN
EJJlH11VLW 11VH
APPLICANT l t
ADDZESSDD 1CONTACT y V t
D AILS O FUNC ION LOLCATION PARADE ROUTE ETCjG tN 41 LfG Q tocrnpl t2n c Se
fC 1B nG Ee
CITY SERVICES REQITIREDPOLICE Streets locked rcControl SecurityPUBLIC WORKS Barricades Cleanup Setup
XCe YSJU
tJ SPY C 5
Other
Other
Ifa temporary restroom is utilized for a period greater than five S days a Temporary Zse Permit is requiredApplication is available at eityHall
TEMORARY RESTROONIItII S ofututs
Proposed locationsofdays
INSITRAlICEREQUIREMENT Organized events open to the public require insurance naming the City ofPalmetto asanAdditional Insured and the insurance policy must be providito the City Cierk ten 10 daysprior to the event If yau have entered into a rental agreement for a City facility for a private evem noinsurance isretured Please review Ezhibit A for insurane coverage requirements
The Special Function Fermit Application must be suhmittedo City Commission for approval at least 30 daysprior to the event Sale or consumption ofaltoholic beverages an City progerty is strictly prohibited If yourevent will include the use af loudspeakers you may be required to apply for a Special Permit Exception tothe
CitysNoise Ordinance See Chapter5Amusements ofthe City ofPalmetto Code ofOrdinances
THIS PORTION OF TI3E PAGE INTENTIONALLY LEFIBLANK
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PLEASE CONTINUE TO PAGE 2
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almetto Histaorical Park hone s799I
POBox 1195 Fax 91981888
Palmetto Florida 3440119 Mail tcclcrkcam
PALMTIOIISTO1tCAiPARK RENTALAPPLICATION AG tT
lessecolete thisaplicatiaa with as much detail as possible Retean cvmpleted applicationwitjAZL ll8tltiritBl CCB diA mAtl to thE adtle88 AbovC or dD eison to 518 10Ave Wametto
Nme ofAppirnt Name ofOrganiaatioa
For Profit NotFor Profit
A c z3P one daytiztae Phone eveaing Phone cell Mail Addresa
Contsctiifother than applicant one da aPh hone evening
applzcantContact 5 ifotheF Phone day Phone evetaingOMacimumAaticipated attendance Mlns
late ofUse 1 Dysvfweek
tStatt time ineleoratingsetuptime ndectude cleanup time
Irhis afuadraising evenka Yes No
NoIs an entry fee ticket orregitrationfrequireda Y sCAre ny ocbetteawitb c1 Vent C r o
Ifyes to any of the abave pleaseelain how funds will beued
Pleaecheck all that applp to this event
BabyBridal Shower C aBithday Party Church FtinctionSocial FamrlyGatheringRemionCField Use Games ox Practicea FielUae Recreational MeetinccnicrClinic
CPolitical Fanction Tournament 1Wedding or Reception G aXoutk Leagve MeetmgEleetrie ifavailable Water ifavilable Otber describe
Ptaletto1to1Cp1TI RCntSI Fee3
Please check ALL facilities being requesteci for use and circle the application fees
CaxCiegie LibraryC ment Floor Oaly kES1300oFirat 3 Howsl4000each additionalhourBementF1r Grounds FEFS R4vooFirst s HourslSOOeach addatoealhour
ChapelooovSecurity depoait FEES500oan hour
N01FA SPECTALF1tCTiUN ANDADDFCCTYD ALSM F
AYS lN ANY 1DAY PERIOD SRALIiIRE12YCOIONkQMIOTIFCAPPROVAI FEFS FOgLONGRENTALU 11CIIsSIALLSE BASEDONiHEADDTIIQNAL
IId
ecura Deo500oper faciltyuxiless adiffretamounc is specified above hiamount is payabte at time of
xeservatxoa andirefimdblealpon the Completion ofafavorable inspectiou Up to loo9b of tbe secuxity deposittaayhc
retained far damage andorceanuif deemed necessary by maiaagement Insddition the appicant shall 6e
responsible fox payment ofcleaniz damage cbarges ineccess ofthe securitydewst
otaCesEncoCdtt V h CbeCC FOYIiOYA TCe8 OTDPOS1tBA Drivers License is requincifor eck for tlepeonwluse name is on the chee
State
wti O J v
Feescoilccted 5b 05 teceipt s
Palmetto Historical Cazuxuvon N1LV
or
Parks andReation
PALMETTOffiTORTCAL PARKAPPLICAN7CtCKNO DGEMENT
The Applicarit herebyacknowledges and a to theolowing
Allctafees and tacesmust be includedwththis applicationSubmittal of the appiictiondoes nat confirm reservation datesReservation requests are subject to City appcoval amd are pcocessed onafirst come firstserved basis
Applicarn has been provided with a copy vf the Palmetto Historical JPazk Facility RentalRules and Regulations andaees to abide by same
ApplicaztJhereby afuumstatthe infonmationcontained in this applicatlon is true and correctacknowledges receipt ofa coyofthe appication and agres to atl ofthe ternas and conditionss outlined in the acility Rerrtal Agreement includin how to proceed in the event ofan
emergecy during the evezkt
In the case oaaeznezgenCy cotactthe Palmetto Police Departxnentact 941723587
By
Pta e N ro l crlf o S
SPECIAL FUNCTION PERMIT APPLICATION
EVENT NAME C tF irvt
APPLICANT b it slL
aDUESS l tt CrqacP5
CQNTACT1d3
DETAILS OF FIINCTION LOCATION PARADE ROUTE ETCr n
EVENT DATE
EVEITTIMLrjuPHONE LPHONE j
Cz1cCc rC 3CITY SEtVICES REQUIREDPOLICE Streets Bloeked Traffic Control r Security OtherPUBLIC WORKS Barricades Cleanup Setup Other
If a tempoay restroom is utilized for a pefiod greateN than five S days a Temporary Use Permit is requiredApplication is available at City Hall
TEMPORARY RESTROOM FACILITIES ofunits of daysProposed locations
INSURANCE REQUIREMENT Organized events open to the public require insurance naming the City ofPalmetto as an Additional Insured and the insurance policy must be provided to the City Clerk ten 10 daysprior to the event If you have entered into a rental agreement for a City facility for a private event no
insurance is required Please review Exhibit A for insurance coverage requirements
The Special Function Permit Application must be submitted to City Commission for approval at least 30 daysprior to the event Sale or consumption of alcoholic beverages on City property is strictly prohibited If yourevent will include the use of lolidspeakers you may be required to apply for a Special Permit Exception to the
Citys Noise Ordinance See Chapter5Amusements ofthe City ofPalmetto Code ofOrdinances
THIS PORTION O TH PAGE INTENTIONALLY LEFT BLANK
PLEASE CONTINUE TO PAGE 2
Speciai Function Pezmit ApplicatioiiPaye 2
EVENT C lL L tr Event Date Cy r JC tcCSJ v i
INDEI2NITY
i 3t J11L Permzttee agrees to defeld indemnify and hald harmless the CITY OF
PALVIETTO its officer agents employees and volunteers fronall loss cost and expense arising out ofailyliability or claizn or lia ility for personal injury bodily injury to persons contractual liability and damage to
propert sustained or claimed ta llave beensistained arising out ofactivrties of the Permittee ar those ofaily ofits officers agents employees licensees or invitees whether sucl act is authorized by this pennit or not anciPenllittee shall pay for any and all damage to the property oftlie CITY OF PALMETTO or loss or theft ofsuclproperty ciolle or caused by such persans CITY OF PALiV1ETT0 assumes no responsibility vhatsoever forany property placed on the prelnises PenZlittee futther agrees to waive a11 rights ofsubrogation against CITYOF PALiVIETTQ The provisions ofthis paragraph clause do not apply to any damage or loss caused solely bythe negligence of the CITY OF PALMETTO or any ofits agents or employees
I HAVE RE4D AND UNDERSTAND THE ABOVE SPECIAL FUNCTION PERMIT APPLICATIONCONDITINSAND INDEi12NITY
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CITY APPF
Public Wor
Planning
Risk ManagParks DepatPolice DepartlzleztNorth River Fire
APPROVED BY COMVIISSION
CInternal use onlyDate Received
Date
Date
Date
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ISCLAIMER
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ACORD25i204id08 2 of 2 239575
STA7E OF FLORIDA aEPARTMENT OF TRANSPORTRTION 85
Q QCI er MAWTEidRNCE
03106
IrtruCtions 1 Ottain signatures ofi local lawenorcment anai ciiylcounty ofPscialspa orz
2 lhis form must besubmstedby the locaf govemmentat authoriiy fo FDflTtobta6n written appraval Aliow adequate time for Pheeeview
3 Attach any necsssary maps or supporting documents
NAME OF ORGANIZATION PERSNINCHARGE ATE5
F t il 5 lADDRESS OF ORGANIZATION TEIEPHONE NUMBER
TITLEOF EVENT
DATE OF EVENT STARTINt9IMEOF EVENT DURATION OF EYENF APPROX ACTUAL CLOSING TIME INCLUDING SETTING UP BARRIERS EfC
3 v2 e
PROPOSEDROUTE pNCLUDE STATE ROAD NUMBER SPECIFIC LOCATION ETC INCLUDE MAPS J
rt0 1ctV
1 i 1 tZ L itr
t c34a lir at vL l
cc1t t
DETOUR ROUTE INCLUDE ALTERNATE ROUTES INCLUDE MAPS
NAME OF DEPT RESPONSIBLE FOR TRAFFIC CONTROL ETC CIiY POLfCE SHERIFFS DEPTPORIDAHWY PATROL ETCJQNCLUDE PREClNCT NO
g q giC 1 C2l sc 1a LSlLZ9 L
SPECIAL GONDITIONS
THIS SECTION ISTO BE CORAPLETED WHEN PERMITTMG SPECIAL USE OF A S7ATE ROAD FOR FILMING
LiCENSED PYROTECHNICS OPERATOR
APPROVAL OF LOCAL FIRE DEPAR7MENT
UABILITY 1NSURANCE CARRIER
COVERAGE AMOUNT 9OimO MINIMUM
tENGTH OF COVERAGE DAYS
FEDERAL AVIATION ADMINISTRQTION APPROVAL FOR LOW FLYING FIIMINC
ADDITIONAL IIASWTY lNSURANCE AMOUNT
TYPED NAME AND TITLEINCLUDE BADGENO IF RPPROPRIATE
TYPED NAME AND TITLE OFCITYCOUNTYOFFICIAL
POLICY EFFEGTNE DATE
SW000MIM1IIMUM
SIGNATURE OF CHIEF OF LAW ENFORCEPAENT AGENCY I DA7E 51GNED
SIGNATURE OF CITYCOUNTYOFFICIAL DATE SIGNED
UCENSE NO
Al7THORITIES CHAP7ERid65FLORIflA AaM1NiSTRATIVE CODE RULES OF TFdE DcPARTR9ENT OF TRANSPORTA71C3N TEMPORARY CLOSiNG AND SPECIAL USE OFSTATE ROADS SECTIONS3374061406AND 316Q06 FLORIflASTATUTES
8500405
CeatractesoFslagaionto indmnify defna9aatdy for ttae defense or at the epartmen opt3on to partiipatean5scsci witt
tiearmment in th dsffeneand trial of aesy ciarnage claien orsuit and any rE6ated itiement resgafaonsstslibtrigercftsy t9e
egartzntsnotieoff 9aim for ins9emn6fatianto Cortractor ContractorsicbUity to vauate9iablis or i9 eua4tEon of Ibaa@shatl not xcuseortractors cluty to deend and indemnrfywithinsven days after such aatc y tts ae4ent as gven b
egisteredraaiJ On1ranajc9ication or judgeeenfi aferhihest appeal 6s exisausted specificlfy ndngtheprtmevatSOLiY
reglientshall xcuepeaFocmaeeof th6 provision by ontractor Corractorstall pay all cosl ans feesrlaedto t1tioliten
and its enforcemettayth epartreentepartmnts failure to notify Contrctor ofialaim hailrs6easeCoatrctrof the abov
duiy ta ciefnd
tis understood and agreed that the rights and privsleges herein set outare granedonly to theetent of the States right titi and irterest in
the tand to be entered upon and used by the Permittee and the Permittee will a all times assume all risk of and indemnify defend adsave
harmtess the State of Fiorida and the Department frarn nd against any and all ioss damage cost or expsnse arising in any manner on
accoun of the exercise ar afitempted exercases by said Rermittee of the aforesaid rights and privileges
C7urirgthe event ail safety regulations fi the Department shali be obsenrdand thehider must take measursinduding ptacing and disp6ayof afetydvices that may bencessary in order to safely conduct the public through the project area iea accordartce with theeeral Manuat
on tlriform TraffcCartrol Devices fVltlTCt aamended ardtheCepactmentsiaest fdoadvvay and TracEesign 4andards
in case ofnoncompliance with ttae Departmensrequirements in effect as of the approvddate of thi permit this peamit is void and th faciiityvvill havfo be brought into comp0iance orremved frorn the R1kVa no cost o the Department
Submitedby t Piace CorpartePertrritlee
1 cc1Signature nd T e Attesied
y
epartmettaf TcanspaRafiion Approval This equest is Hereby Apprved
t2ecomrnenderi for approva Title Date
Approved by C3ateDistrieY Secretary or Designse
DtSTRIl1T1flt Origtnal Permittcee
1st copy District Maintenance Offrce
2nd capy Loca6AaintenaneEnginer
Speczal FunctionPermilTemporary Use Perxnit Application
Stepping Out Against Domestic Violence
Hope Family Services Inc
Saturday October 25 2008
800am1IQ4am
Sutton Park Walking from Sutton Park over Green Bridge to Bradenton and back to
Sutton Park map attached Walkers will register at Suttfln Park pzior ta walk
COSTS associated with Hope aznity Services Stepping Out Against Domestic Violence
beginning at Sutton Park
Overtime hours 2 employee 4 houxs @2900 23200
Salaried staff employees NC23200
InKind Services requestedSutton Paxk Renal 6500
150 Cones
extra trash cans
cxo
oPECIAL FUNCTION PERifeku3t c
EVENT NAMEvh1Se CL S tAPPLICANT ChfltttADsGCONTACT ytJ itpti1
MIT APPLTCATIOlY 9EVEN DATE
EVENTTNIEtecPHONE jl 1da
PHONE Lll Sa gr
DTAILS QF FUNCTION LOCATION PARAD ROUTE ETC PL2GGULlNQ s 411D 5 Ruv i S l S
CITERViCES REQUIREDPOLICE Streets Iocked Traffic Control Securzty Other SYZWPUBLIC WORKS Baixicades Cleanup Setup Othert jzrIfa temporczry restroom is utitized for cr periad greater thxn fve S dcrys a Temporary tlse Permit is requiredApplicatian es avairable at Cfty HalZ
TEMP4RARY RESTROOMFACIiITIES ofunits ofdaysPrapased locatians
INSURANCE 2EQUIREMENT Organized events open to the public requize insurance naming the City ofPalznetta asanAdditional Irsured and tte insurance policy xnust be provided to the City Clerk ter 10 daysprior to the event If you lxave entered into a rental agreement for a City facility for a private event noinsurance is required Please reviewEibit Afor insurance coverage requirements
The Speczal Function Perrnit Applicatior rnust be submztted to CityCcmmissian for approval at least 3Q daysprior to the event Sale or constmption of alcaholic beverages on City prQperty is strictly prohibited If yourevent will include the use af loudspeakers you zzzay be required ta apply for a Specia PerzitExceptzon to theCztysNoise Ordinance See Chapter5Amusements afthe City of Palnnetto Cade ofOrdinances
THIS PORTION OF THE PAGE INTENTIONALL LEFT BLANK
PLASE CONTIlViJE T pAGE 2
SpecialIunetion Permit ApplicationPage 2
EVENT ZSOL10UJZQ Event Date
INDEMNITY
GiJGN2G 1 Permittee agrees to defend indemnify and hold harmless the CITY OFPALMETTO its officers agents employees and volunteers from all loss cost and expense arising out afany
liability or claim or liability for personal injury bodily injury to persons contractual liability and damage to
property sustained or claimed to have been sustained arising out of activities of the Permittee or those of any ofits officers agents employees licensees or invitees whether such act is authorized by this permit or not andPermittee shall pay far any and all damage to the property ofthe CITY OF PALMETTO or loss or theft of suchproperty done or caused by such persons CITY OF PALMETTO assumes no responsibility whatsoever farany property placed an the premises Permittee further agrees to waive all rights of subrogation against CITYOF PALMETTO The provisions ofthis paragraph clause do not apply to any damage or loss caused solely bythe negligence ofthe CITY OF PALikIETTO or any ofits agents or employees
HAVE READ AND UNDERSTAND THE ABOVE SPECIAL FUNCTION PERMIT APPLICATION
CITY APPROVAL
Public Works Director
Planning ZoningRisk Management
Parks DepartmentPolice Department
North River Fire
APPROVED BY COMMISSION l
Internal use onlyDate Received
Date
Date
NQRTH RIER FiRE DIS 91721 5701
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Special Function PermitTemporary Use Permit Application
Rockin to the Oldies
Car Show Fundraiser benefiting Big Brothers Big Sisters
Palmetto Automotive405 8t Avenue West
Saturday August 30 2008
500 pm 900pm
COSTS associated for services requested by the sponsor
Portolets2 1 regular1 handicapped 19500
Display Banner one week before event 2500
30 traffic cones NC
Street sweeper discussed with the Streets Department City can not provide
NOTE This is the first of four car shows they plan on sponsoring for various charities
They will submit a Special Function Permit prior to each event once plans are finalized
112908 ChildrensHospital13109 Boys Girls Club
52009 Manatee Vets iFamilies
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egistatoil ree405 Sth Ave V Palmetto
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APPLICATION FOR SPECIAL PERMITEXCEPIIOlT
TO THE CITYSNOISE ORDINAIVCE
APPLICATIONMUSTBE FILED NO LESS THANTIIRTY 30 DAYSIRIOR TO
THE DATE O EVENT OR OCCTRRENCEa
ve ate
r7 ISTelephone
The Applicant hereby applies for a Special Permit Exception PE to certain
provisions of the Cify of Palmettos Code regarding the prohibition of and
abatement of noise disturbances on private and public properties The SPE is
sought for
lDESCIPTION OF ACTIVITYlEVENT RWIICISPE ISREQESED0 aS s i4
B g6 J d
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z EsT1aTEATNac
3 PROJECIED02PIOPOSElH7125 OF EVEITI
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6
4 STATEIYIENT OF GENERAI C IVIMUNIYIMPORTANCE OR BENEFIT
1ivI tcrl d d C vC i
5 IDENTIFY PROPOSEDEIECTIVE1VIITIGATIOI1MECHANISMS
C l
6 ANY ALTERltATIVELOCATI011SFOREVENTACTIVITY
7 NAME AND
DURING EVEN
U f fs j SNUMBER OF RES NS BI ART4 TO CONTACTEI3ACTIVITY 1 722
in C S
I AM AWARE TIAT in determining whether ar not an SPE slaall be issued the
City Commission shall at a minimum consider the nature of the event its possibleadverse effects its importance to the general community and potential benefit the
event may have upon the City and the general public the number of participants at
the event the time of the event proposed effective mitigation mechanisms and the
availability of alternative locations Review of a denial of an SPE shall be to the
Circuit Court in and for Manatee County and must be filed within thirty 30 daysof the date of the City Commission decision relating to the SPE Review shall be
based solely upon the record generated before the City Commissian The burden is
upon the applicant to establish by substantial competent evidence that the activityfor which the SPE is sought has the means to eff tiv y mitig otential adverse
effects and impacts upon surrounding property o rs and r ide ts
Internal Use OniyDate Received
CITCt714I10ISIOIAPPIOVAIo