Special Event Permit - City of Pomona

Estimated Attendance: Total: ____________ Per Day: _____________Admission: $_____________ (if applicable)Event Date & TimeSet-up: Date: ______________ Time: _____________ Day of Week: __________Event Starts: Date: ______________ Time: _____________ Day of Week: __________Event Ends: Date: ______________ Time: _____________ Day of Week: __________Final Clean-up done by: Date: ______________ Time: _____________ Day of Week: __________TRAFFIC & PARKINGA Traffic Control Plan is required and is subject to approval by Engineering Staff. If revisions are required they willbe completed by Traffic Engineering and all costs will be applied to the fee for the event. If your event involves alane or full street closure, you must notify local businesses that will be impacted by your plans, no less than one weekin advance of the event and proof of notification provided to the City. Signature sheets can be requested from theCity.BarricadesBarricades MUST be provided at each intersection of the street closure and must be staffed at all times in the event ofan emergency. Please ensure that barricades are removed immediately upon conclusion of the event or completion ofclean up. Barricades can be rented from a private company or from the City for a fee. (Fee list attached)No Parking SignsType C3A signs indicating “ROAD CLOSED TO THRU TRAFFIC” AND “NO PARKING SIGNS” must also beobtained. The signs must be posted 72 HOURS PRIOR TO EVENT.Traffic & Parking (cont.)1) Do you wish to close any streets or sidewalks for this event? If yes, please list all streets and sidewalks that willbe closed.2) What period of time would these streets be closed?3) Do you anticipate towing any cars or equipment before, during, or after this event? YES NO4) Will any traffic routing/control device be used for this event/activity? YES NO5) What kind of traffic routing/control device be used? ___________________________________________6) Does this event involve a moving route of any kind along streets or sidewalks? YES NO7) Please provide a description of your parking plans (i.e. where event attendees will park).8) Please describe your plan for emergency vehicle access.9) Please describe your plans to notify residents, businesses, and churches impacted by this event.POLICEThe police department may assess fees based upon the nature of your event and the requirement of police presence.2

ALCOHOL1) Will alcohol be served/sold? YES NO• If yes, what kind of alcohol will be served/sold? _____________________________________• Hours during which alcohol will be served/sold? _____________________________________If serving alcohol, Alcoholic Beverage Control (ABC) permit is required. Additional security may also be required.MUST provide a copy of the ABC permit to the Police Department.Name of Liquor Liability Insurance carrier ________________________________________________(Must include the City of Pomona as an additional insured).FOOD1) Will food be prepared, served or sold at this event: YES NO• If yes, please describe how food will be served and/or prepared.______________________________________________________________________________________________________________________________________________________________________________________(If selling food a Health Permit is required from the Health Department. Insurance from food vendors is alsorequired).2) Do you intend to cook food in the event area?• If yes, please check the specify method.Gas Electric Charcoal OtherVENDORSIf any vendors and/or concessionaires will be present, a list of all vendors must be provided, along with a signed holdharmless agreement from each vendor.*PLOT PLAN*A detailed plot plan or aerial map indicating all event layout and features must be submitted along with theapplication.Banners, Tents, Structures, & Entertainment Devices1) Are you installing or constructing any structures (e.g. temporary buildings, etc.)? YES NOIf yes, please describe type, size, and number of structures (and show on site plan)2) Are you installing any tents or canopies? YES NO If yes, how many? _________Canopy Size _____________________ Tent Size _________________________3) Are you installing any portable stages: YES NOIf yes, please show locations and dimensions on the site plan.4) Do you plan to have any sound amplification? YES NO3

Music: ___________________Other, please describe: _______________________________________If yes, Start Time: _________________ Finish Time: __________________5) Please describe the sound equipment that will be used for your event: ________________________________6) Is electrical power required (for sound amplification, lighting, etc.) YES NO7) Are you seeking permission to post a banner to advertise the event? YES NOIf so, a banner permit is required and must be secured from the City’s Public Works Department (909) 620-2281.Should a banner be displayed in the City advertising your event prior to authorization, it will be taken down andorganization will be charged a fee.InsuranceIf activities involve public streets, parks, City-owned facilities, etc., applicant must submit a Certificate of Insurancenaming the City of Pomona as additional insured and the Additional Insured Endorsement as an attachment.RestroomsYou are required to provide portable rest room facilities at your event, unless otherwise determined not necessary bythe Department of Community Services (909) 620-2321.• If required, the number of portable toilets will be determined by Community Services.• Location placement of facilities will be determined by Community Services.Restroom Company: _________________________________________________________Address: _______________________________________________________________________________________Business Phone: _________________________________Fax: _______________________________Equipment Setup: _________________ Date: _____________________ Time:__________________Equipment Pick: __________________ Date: _____________________ Time: _________________Trash ReceptaclesYou are required to provide trash receptacles at your event, unless otherwise determined not necessary by theDepartment of Community Services (909) 620-2321.Clean Up DepositA Clean Up Deposit is required upon approval of event request. It is fully refundable five business days after theevent, if the public area/facility is left in its original condition. Depending on the scale of the event, the deposit willvary. See fees attached.The applicant will be responsible for the following:• Supplying additional trash cans and/or dumpsters (if required)• Making arrangements for clean-up and/or special trash pick up• Applicable fees charged for trash clean-up and/or special trash pick up4

NOISE ORDINANCE AGREEMENTThere will be no violation of the City's Noise Ordinance. If two (2) complaints of noise are made, and the secondmeter verifies that the noise is excessive; there will be no more amplification. Each violation after the first warningwill result in a separate citation.PARKING/TRAFFIC AGREEMENTSufficient off-road parking will be provided to prevent a traffic problem to the surrounding area.STATEMENT OF UNDERSTANDINGI fully understand the time requirements for processing a Special Event Permit application. I agree to accept the decision ofapproval or denial by City staff if minimum time required (4 weeks) has not been allowed for Department approvals andappeal of denials to the City Administrator’s office.HOLD HARMLESS AGREEMENTThe applicant and its successors in interest shall indemnify, protect, defend (with legal counsel reasonably acceptable to theCity), and hold harmless the City of Pomona and any agency or instrumentally thereof, and its elected or appointedofficials, directors, officers, employees, agents, volunteer, or contractors from and against any and all liabilities, claims,actions, causes of action, proceedings, suits, damages, judgments, liens, levies, costs, and expenses of whatever nature,including reasonable attorney’s fees and disbursements (collectively “Claims”) arising out of or in any way relating to thisevent, any discretionary approvals granted by the City related to the development of the project. If the City Attorney isrequired to enforce any conditions of approval, all costs, including attorney’s fees, shall be paid for by the applicant.___________________________Event Applicant’s Signature_______________________Date__________________________________Event Applicant’s Name/Host Organization (Print)5