SPECIAL EVENT APPLICATION & PERMIT PACKET Public Exhibitions, Gatherings, or Lectures Pomona City Ordinance No. 3866

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1 SPECIAL EVENT APPLICATION & PERMIT PACKET Public Exhibitions, Gatherings, or Lectures Pomona City Ordinance No Completed application must be submitted to the Community Services Department four weeks (28 days) prior to the scheduled event. Incomplete applications will not be accepted for review. 2. *All special event and street closure applications require a Certificate of Public Liability Insurance in the amounts indicated on the attached example. An endorsement naming The City of Pomona as an additional insured with the EXACT language as stated on the enclosed example must be attached. Any type of entertainment (such as pony rides, carnivals, rock climbing, bouncers, skateboarding, and demonstrations) at your event must be listed on the application. All companies MUST have and provide the City with proof of insurance with the SAME requirements listed on the certificate of insurance and second page endorsement, TWO WEEKS PRIOR to the event. FAILURE TO PROVIDE THE CERTIFICATE OF INSURANCE WITH THE CORRECT AMOUNTS AND THE SECOND PAGE ENDORSEMENT, WITH THE CORRECT LANGUAGE, MAY RESULT IN THE DENIAL OF THE APPLICATION FOR THE SPECIAL EVENT PERMIT. The permit fee, insurance fee, public facilities fee, and other related fees may be waived by the Community Services Manager for bona fide incorporated religious institutions, churches, military and veteran organizations of the United States, or religious, state and local school systems and nonprofit organizations that hold a valid designation under 26 U. S.C. 501@. In the event such applications or fee waiver is denied, the applicant shall be permitted to appeal the denial to the office of the City Manager for final review by the City Manager or his/her designee. The decision on appeal shall be final. 4. The application and the following forms included in the application shall be signed by the applicant: Statement of Understanding Hold Harmless/Indemnification Agreement Noise Ordinance Agreement County of Los Angeles Fire Dept Declaration Letter County of Los Angeles Fire Dept Information Sheet Event Holder Application Supplemental /Vendor List 5. In the event of a street closure, special conditions are required by the Public Works Department: A. Compliance with Section of Standard Specifications for Public Works construction, latest edition. B. A 14-foot wide lane of travel for emergency vehicles must be provided. C. Applicant must provide at each intersection, Barricades which can be rented from a private company. Type C3A Signs, indicating ROAD CLOSED TO THRU TRAFFIC and NO PARKING SIGNS must also be obtained. The No Parking Signs must be posted 72 hours prior to event. D. Street closure (partial or full) is a $40.00, filed and paid at Public Works. E. Signatures of residents affected by this street closure indicating their approval or objections must be submitted (including addresses). 6. A Plot Plan of the event must be provided. (Instructions included on the page). 7. A letter from the property owner granting permission of the use of the property is required. 8. If a Fire and /or Police Department Fees is a condition of approval, fees must be paid at least 72 hours prior to the event. 9. If ANY food/beverages will be served to the public, whether sold or without charge, a Temporary Health Permit must be obtained from the Los Angeles County Health Department. The West Covina office can be reached at (626) If there are any questions, please feel free to call the Community Services Department at (909) NOTE: Failure to adequately comply with the instructions and special conditions may be grounds for revocation of the Special Event Permit.

2 CITY OF POMONA APPLICATION FOR SPECIAL EVENT PERMIT Public Exhibitions, Gatherings, or Lectures (Pomona City Code Chapter 24, Article I) TERMS AND CONDITIONS Pomona City Code Sec provides that a completed Special Event Permit application, including all required documents such as proof of insurance, must be filed with the Community Services Department a minimum of 28 calendar days prior to the date of the event to allow for processing. An application must be reviewed and be approved by various City Departments, including the Fire and Police Departments before a permit can be issued. A Special Event Permit application that does not allow the administrative time required to process is subject to review by staff. An approval or denial recommendation by staff is made based on the complexity of the event and will be the final decision. STATEMENT OF UNDERSTANDING I fully understand the time requirements for processing a Special Event Permit application. I agree to accept the decision of approval or denial by City staff if minimum time required (4 weeks) has not been allowed for Department approvals and appeal of denials to the City Administrator s office. NAME (Please print) SIGNATURE DATE 2

3 Date application submitted: 1. Name of Organization Address Zip City/State 2. If a non-profit organization, please provide the following: Federal Tax Exemption No. State Tax Exemption No. 3. Name of Authorized Representative Telephone No. Fax # Driver s Lic. # 4. Type of Event Project Name Event Location: 5. Date(s) of event Event Hours: Set-up Starts: Clean up Ends 6. Date and Place event was last held 7. Price of Admission (if applicable) $ 8. Estimated daily attendance 9. Is the event to be: Indoors Outdoors If the event is Outdoors, is the area fenced in or otherwise enclosed? 10. Will tents or canopies be set up? Yes No Size(s) of tent(s) or canopy(ies) x Is surface paved Unpaved 11. Tent Fireproofed by Date 12. What provisions has the organization made for sanitation facilities? Contract: Phone: No. of Sanitary Facilities Handicap Sink Applicant s Initials All temporary sanitation facilities must be removed the first business day following the date of the event. 3

4 13. Will any alcoholic beverages be served or sold? Yes No If yes, ABC License No. Name of individual responsible for policing the area to prevent law violations, such as drinking by minors Name of Liquor Liability Insurance carrier (Must include the City of Pomona as an additional insured). Coverage Limits: 14. Are you seeking permission to post a banner to advertise the event? Yes No If so, a banner permit is required and must be secured from the City s Public Works Department/ Engineering Division. (Must be applied for separately at the Public Works counter). Fee $ Will there be cooking/other equipment that emits a flame, heat or spark on site? Yes No If yes, describe (barbecues, deep fryers, etc.) 16. 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-up Who is the person/group/company responsible for the clean-up and collection of trash from private property and on public streets? Applicant's Initials: Note: List of City Approved Trash & Recycling Companies attached. (page 19) Please be aware that Noise Ordinance (Ord. 3120) is in effect in the City of Pomona and is enforced by the Pomona Police Department. If you answer Yes to this question, we suggest that you inform nearby locations (residents and businesses prior to your event so as to try and avoid possible complaints to the Pomona Police Department. 17. Will any form of music be provided, including but not limited to, amplified sound/music or percussion instruments? Yes No 4

5 18. Street to be closed Limited by cross streets Closing Date 1) Day of Week am am 2) Time From pm To pm All street closures requests must be approved by the City s Public Works Department and require a permit. The permit fee is $40.00 applies 19. Describe fully provisions for detouring traffic: 20. State the ingress and egress capabilities for vehicles and access routes for safety/ emergency services such as Fire, Police and ambulance 21. Name of person designated to remove barricades in event of emergency and to remove barricades when street is reopened: 22. Attach petition from the residents who reside on the street to be closed. List those who object and those who do not object to the street closure. (See pg. 11 and 12) 23. Map - A plot plan reflecting boundaries and landmarks showing the street affected by closure and indicating where barricades are to be placed must be attached. The map must also reflect paved parking and emergency access routes to be used for this event. (See pg. 13) Should the Pomona Police Department determine that police officers be in attendance, the applicant shall pay the fee for policing at a rate which is established by resolution of the Pomona City Council prior to the occurrence of the event. I hereby declare under penalty of perjury that I have read and understand the requirements and acknowledge any applicable fees in the above statements. Date / / 2009 Signature of Applicant Official Title 5

6 CITY OF POMONA HOLD HARMLESS /INDEMNIFICATION AGREEMENT The undersigned applicant agrees to and shall indemnify, defend and hold harmless the City of Pomona including elected or appointed officials, directors, officers, agents, employees, volunteer, or contractors against any legal proceeding in law or equity, and further shall indemnify, defend, and hold harmless the City of Pomona and its agents, officers, elected and appointed officials, employees and volunteers from and against any and all claims, liabilities, demands, suits, judgments, expenses, costs, and other legal expenses of every kind to which the City may be subject by reason of any act or omission, whether intentional or negligent, or from strict liability, arising from the conduct of any participant, invitee, attendee, sponsor or any third person who is or is not an invitee, attendee, participant, or sponsor of the event. Event: Date (s) of Event: Name of organization or company: Name/Title (please print) Signature Date Name/Title (please print) Signature Date Name/Title (please print) Signature Date 6

7 NOISE ORDINANCE AGREEMENT City of Pomona Ordinance There will be no violation of the City's Noise Ordinance. If two (2) complaints of noise are made, and the second meter verifies that the noise is excessive; there will be no more amplification. Each violation after the first warning will result in a separate citation. PARKING/TRAFFIC AGREEMENT 1. Sufficient off-road parking will be provided to prevent a traffic problem to the surrounding area. I have read and understand the above. Signature Date 7

8 COUNTY OF LOS ANGELES FIRE DEPARTMENT FIRE PREVENTION BUREAU SPECIAL EVENT DECLARATION LETTER Include a detailed letter describing the event you are proposing. Include a description of the event, dates, times, and information that is required. Name of organization event holder Name of contact: Phone: Cell: Name of On Site contact(s): Phone: Cell: Fax: An On Site Contact must be present at the event and in possession of the approved Special Event Permit. Location of event: Detailed Description of event: Date/time of the event: (Include set-up and tear-down time) Medical Services Available? [ ] Yes [ ] No Providing Security Personnel? [ ] Yes [ ] No Using Flammable Liquids or LP Gas? [ ] Yes [ ] No Using Tents or Canopies? [ ] Yes [ ] No Using Cooking/Heating Equipment? [ ] Yes [ ] No Blocking Access Roads/Exits? [ ] Yes [ ] No Using Fireworks? [ ] Yes [ ] No Vendors/Exhibitors/Concessionaires? [ ] Yes [ ] No How Many? Caterer? [ ] Yes [ ] No Food/Non-Alcoholic Beverages Served? [ ] Yes [ ] No Food/Non-Alcoholic Beverages Sold? [ ] Yes [ ] No Entertainment Activities? (Provide a List) [ ] Yes [ ] No If you answer yes to any of the above questions, please include detailed information about each item in your application letter. Signature Date 8

9 FOR ALL CONCESSION STANDS AND/OR RIDES 1. The sponsor of the event shall have EACH concessionaire complete the attached form. You many copy this form for additional signatures. 2. The sponsor shall turn in the original forms to the City of Pomona and maintain a copy of all forms, in an envelope or book, making them available to the Fire Department upon request the day of the event. 9

10 COUNTY OF LOS ANGELES FIRE DEPARTMENT FIRE PREVENTION BUREAU SPECIAL EVENT INFORMATION SHEET NAME: PHONE: ADDRESS: CITY: CONCESSION COMPANY: PHONE: DATES OF EVENT: TIME: FIRE DEPARTMENT APPROVAL TO OPERAQTE A CARNIVAL OR SIMILAR EVENT AS REGULATED IN THE UNIFORM FIRE CODE (LACC TITLE 32) IS GRANTED UNDER THE FOLLOWING CONDITIONS: 1. A letter must be filed with local Fire Prevention office outlining in detail the proposed event with accompanying plot plan showing all concession stands, rides (denote gas or electric), generators, tents, fencing/barricades and exits. This is to be submitted at least 10 days prior to the event. 2. All cooking areas shall have at least one U.L. approved 2A_10BC fire extinguisher serviced and tagged by a licensed agent. All gas cooking appliances shall have U.L. or A.G.A. approved 100% fuel safety shutoff devices which operate in the event the cooking flame is extinguished. 3. All commercial kitchens (food kitchens) shall have fixed extinguishing systems for hoods, ducts and cooking appliances. The system shall be serviced and tagged by a licensed agent every six months. 4. Where combustible or flammable liquids are used, at least one U.L. approved 40_Bcfire extinguisher within 20 feet of equipment. 5. All motor vehicles shall be removed from public areas prior to event opening. 6. A field inspection will be made by the Los Angeles County Fire Department after the event is set up, but prior to being open to the public, to insure all Fire Department requirements have been met. 7. Additional permits are required for the following: tents and air supported structures, places of assembly. 8. Any other required approval must be obtained from the agencies having jurisdiction for this permit to be valid. Check with the Police or Sheriffs; Building Department; Health Department; and City Hall for additional permits, licenses, for approvals to perform the event. IF ANY NECESSARY APPROVALS FROM ANY REGULATING AGENCIES ARE NOT OBTAINED, THIS PERMIT IS NULL AND VOID. ADDITIONAL REQUIREMENTS: This permission may be granted for a specific period and is subject to revocation for proper cause, for violation of Fire Code, Title 19 California Administrative Code, or when necessary for public safety. Noncompliance with any provision stipulated here in constitutes a violation. FIRE PREVENTION BUREAU (909) FOR ALL CONCESSION STANDS AND/OR RIDES 1. The sponsor of the event shall have EACH concessionaire complete this form. You may copy this form for additional signatures. 2. The sponsor shall return original forms to the City of Pomona, maintaining a copy in a folder or book, making them available to the Fire Department upon request on the day of the event. 10

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13 PLOT PLAN (REQUIRED) Please draw a detailed plot plan or diagram of the event; where the stage, booths, chairs, band, tables, etc. will be placed N W E S 13

14 NOTE: PER RISK MANAGEMENT- please read carefully and pay close attention to the insurance requirements detail in the next few pages. **Under no circumstances shall any vendor begin set up until all insurance documents for the event has been approved. If your organization has its own insurance, please forward the attached "example" of the Certificate of Liability and the Second Page Endorsement to the company and request them to insure your event, naming the City of Pomona as additionally insured. They may fax it directly to the City at If you, or your organization, do not have a 2,000,000 insurance policy, the City of Pomona provides the contact information for two companies that cover "Special Event". Complete the Event Holder Application carefully and sign. Complete the Supplemental/Vendor List, which will give you the answers to questions to secure your quote. The attached completed forms will declare which vendors require "Hold Harmless Forms" and/or ones that require insurance naming the City of Pomona as additionally insure and a second page endorsement. (See example) 1. List all non-profit organizations giving out information only. Submit a "Hold Harmless" form signed by each organization participating. 3. List all retail vendors, 4. List all food vendors shall be completed and submitted at the same time the entire packet is turned in, 30 days prior to the event. ************************************************************ Please pay specific attention to detail in the next four pages of information. Complete the Event Holder Application carefully and sign. Complete the Supplemental/Vendor List, declaring ALL vendors name, address, phone, contact person and activity. You may make additional pages as needed to list all vendors. 14

15 Please print or type EVENT HOLDER APPLICATION (To be attached to Permit Application) (Retain in your file s only) Name and Address of Renter or Permit Holder: (Same as on Permit Form or Rental Form). Event Contact Person: (Authorized to sign all documents) Daytime Phone Number: EVENT INFORMATION Date(s) Held: (Include set-up and take down days) Time: Location of Event: Detailed Description of Event: Total Attendance (Per Day) including Participants and Spectators Day One Day Six Day Two Day Seven Day Three Day Eight Day Four Day Nine Day Five Day Ten Additional Event Exposures Yes No Vendors/Exhibitors/Concessionaires? How Many? Caterer? Food/Non-Alcoholic Beverages Served? Food/Non-Alcoholic Beverages Sold? Entertainment Activities? (Provide a List) Please review contracts and attach a separate sheet, listing names and addresses of all parties requiring to be named as Additional Insured. Date Applicant Signature 15

16 EVENT HOLDER APPLICATION SUPPLEMENTAL/VENDOR LIST Insured Event Holder Date Location Type of Event POLICY Primary - General Star Indemnity Co. IYG325268B Excess - Genesis Indemnity Insurance Co. ZZXB300176E CERTIFICATE NUMBER ENTITY - City of Pomona List ALL vendors, exhibitors, concessionaires, sponsors, promoters, and entertainers, etc. (Please print) Name Street City, State, Zip Phone Number Contact Person Activity The undersigned applicant agrees to and shall indemnify, defend and hold harmless the City of Pomona, its agents, officers, elected and appointed officials, employees, and volunteers, for the acts of any activity or contractor not listed herein and shall indemnify, defend, and hold harmless the City of Pomona, its agents, officers, elected and appointed officials, employees, and volunteers from and against any and all claims, liabilities, demands, suits, judgments, expenses, costs and other legal expenses of every kind to which the City may be subject by reason of any act or omission, whether intentional, unintentional or negligent, or from strict liability, arising from the conduct of such activity or contractor, or any injury or claim filed by any participant, invitee, attendee of the event. Applicant Signature 16

17 NAME OF INSURED: 17

18 NAME OF INSURED: POLICY NUMBER: COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: Name of Person or Organization: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE The City of Pomona including elected or appointed officials, directors, officers, agents, employees, volunteers, or contractors. (If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your use of premises owned or leased by the additional insured. This insurance provided by this policy shall be primary as respects any claims related to the (name of and date(s) of event). Any insurance, pooled coverage or self-insurance maintained by the City of Pomona, its elected or appointed officials, directors, officers, agents, employees, volunteers, or contractors shall not contribute to it. Authorized Signature from Insurance Company 18

19 TRASH & RECYLING SERVICE FOR BUSINESS AND INDUSTRY Competitive, Non-Exclusive Franchise Haulers Approved to Operate in Pomona (Resolution ) Any of the following companies can provide price quotes for commercial weekly bin service and/or rolloff service, for any location in Pomona. Typical bins are 3 cubic yard metal dumpsters and rolloffs are 20-foot long metal containers, ranging in size from 20 to 50 cubic yards of capacity. 1. Art s Disposal Service (800) Van Norman Road (323) fax Montebello, CA Athens Services (626) Valley Boulevard (626) fax City of Industry, CA Burrtec Waste Industries, Inc. (909) Cherry Avenue (909) fax Fontana, CA Universal Waste Systems, Inc. (909) E. Holt Avenue (909) fax Pomona, CA Valley Vista Services (800) E. Railroad Street (626) fax City of Industry, CA Waste Management (626) E. Live Oak Avenue (626) fax Baldwin Park, CA