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RESEARCH TOOLS › SAMPLE DOCS › MUNICIPAL FORMS › Special Events/Filming Permit Application
 
Coupeville Special Events/Filming Permit Application

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TOWN OF COUPEVILLE
SPECIAL EVENTS/FILMING PERMIT APPLICATION

1. Applicant's legal name:
  Street address:
  City/State/Zip:
  Telephone:
2. Local representative or agent:
  Telephone:
  Contact person:
3. Summary of proposed filming/event:
  a. General description: (Include locations and property ownership, and specify whether event will take place in Town Park and in the Historical Commercial District. See Item 5 below.)
  b. Date of event:
  c. Number of persons involved in event on behalf of Applicant:
  d. Number of vehicles, boats or other special equipment:
  e. Date(s) parking spaces or areas required:
  f. Number of persons expected to attend the event: (See Item 5 below.)
  g. Traffic or crowd control requirements:
  h. Street closures required:
  i. Safety and security measures required:
  j. Special effects, e.g. explosives, pyrotechnics, aircraft:
  k. Animals being used:
  l. Other features:
  m.

Public Liability Insurance Company:

        Policy No. ______________________________ Agent:__________________________

        Expiration Date___________________________ Amount_________________________
  n. Safety and security measures provided by the Applicant:
  o. Electric power, water and sewage requirements:
  p. Emergency services required:
4. Insurance: The Town of Coupeville does not maintain insurance that will cover claims against the Applicant arising out of the use of Town property or facilities by the Applicant, its members, or those attending the event. Depending on the size and/or activity and the risk level of your group, the Applicant may be required to obtain bodily injury and property damage liability insurance of $1,000,000.00 and be responsible for obtaining and paying for said insurance. If required, attach a copy of the policy and the receipt for its payment. The policy must stipulate that the Applicant may not cancel the policy prior to its expiration date without prior written approval from the Town of Coupeville.
5. Any event which attracts 1,000 or more persons to Town Park, or any event that involves activities in both the Town Park and the Historic Commercial District and which attracts 100 or more persons, will require the closure of the pathway between the Town Park and the Historic Commercial District. In any such case, the Applicant will be required to pay the Town a supplemental permit fee to cover the Town's costs of installing and maintaining physical barriers to close the pathway during the course of the event.
6. The Applicant agrees to defend, indemnify and hold the Town of Coupeville, its agents, employees and officials, while acting within the scope of their duties, harmless from any and all claims, suits, demands and judgments, including the attorney's fees and other costs of their defense, for public or private nuisance, inverse condemnation, personal injuries, property damage or death arising out of, occurring during or the result of activities or appliances of the Applicant, his employees or otherwise, except for the sole negligence of the Town. The Applicant further agrees to comply with all provisions of pertinent laws, rules and regulations. This permit may be revoked at any time.
Signed this __________day of __________________________, 199___.
   
  _______________________________
  Signature of Applicant or Agent

Witness

 _____________________________________
Address _____________________________________
  _____________________________________
Telephone # _____________________________________

TOWN ACTION:

    [ ] Town Marshal Review ______________________________________________________

    [ ] Administrator Review _______________________________________________________

    [ ] Referred to Town Council _______________________________________________________

    [ ] Copied to Central Whidbey Fire & Rescue _______________________________________________________