Special Events Permit Application Information

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Special Events Permit Application Information Thank you for contacting the City of Tuscaloosa. We look forward to helping you plan your next event that utilizes City property. The information below outlines the special event process for 2016. Email events@tuscaloosa.com for more information. Special event applications and requests for space rental will be evaluated in the order they are received. Special event applications must be filled out completely. A non-refundable $25 permit processing fee must accompany all permit applications in order to start the review process. Submitting a completed application does not guarantee event approval or that the requested event space is available. Permits must include a detailed map and any City resources requested. City resources may require additional costs. You will be notified of your event approval/denial via email or phone call. Government Plaza 2016 Rental Information: Government Plaza Gazebo and paved area around: $100/hour including setup and breakdown Government Plaza park: $250/hour including setup and break down Government Plaza park 1-day: $2,000 including setup and breakdown Rental fees are due within 30 days of the event. A deposit may be required to secure event site. Race/Walks Information: Any race/walk is required to have participants sign a waiver of liability releasing the City, its agents, servants and employees from any liability arising out of said participation. This release may be contained in a general release on the application for the race and must include the following: The undersigned does, for himself/herself, his/her heirs, assigns, executors and administrators, remise, release and forever discharge the city of Tuscaloosa, a Municipal Corporation, its officers, agents, and/or employees, event sponsors, and event volunteers of and from all manner of action and actions, suits, and sums of money, dues, claims, or demands, whatsoever, which arise out of or in any manner grow out of, property damage, injuries or death sustained by the undersigned or his/her minor child, including injuries known or unknown, by reason of being permitted to participate in the aforesaid activity in the City of Tuscaloosa. Final approval for an event will remain pending until the following documents are received and all associated fees submitted. -Completed application -Indemnity Form -Detailed map of event -List of City resources requested for event -Insurance Certificate (if required) Updated: 11.29.16

City of Tuscaloosa Special Event Permit Application Department of Infrastructure and Public Services Public Services Division 3440 Kauloosa Ave, Tuscaloosa, AL 35401 events@tuscaloosa.com 205-248-4900 www.tuscaloosa.com APPLICANT AND SPONSORING ORGANIZATION INFORMATION Please complete all data as required. NAME OF ORGANIZATION: APPLICANT NAME: ADDRESS: CITY: STATE: ZIP DAYTIME PHONE: ( ) EVENING PHONE: ( ) _ FAX: ( ) E-MAIL: WEB SITE: MANAGER ON SITE DAY OF EVENT: CELLULAR: ( ) Any change in the above information, please notify IPS immediately. SPECIAL EVENT INFORMATION Complete all data as required for event of any size. Type of Event: RACE* RALLY PARADE WEDDING FAIR CONCERT PICNIC OTHER (specify): *A race shall obtain a written waiver of liability, approved by IPS, for each participant releasing the City, its officers, agents and employees, from liability arising out of said participation. EVENT TITLE: EVENT DATE(s): ESTIMATED ATTENDANCE REQUESTED PUBLIC PROPERTY: Please note, Insurance Requirements are based on attendance. ACTUAL HOURS OF EVENT: AM/PM to AM/PM SET UP TIMES: AM/PM to AM/PM TAKE DOWN TIMES: AM/PM to AM/PM DESCRIPTION OF EVENT SET UP: Please attach additional sheets as necessary, including plans, drawings, maps, etc.

PLEASE INDICATE WHETHER THE FOLLOWING ITEMS PERTAIN TO YOUR EVENT YES NO FOOD CONCESSION AND/OR FOOD PREPARATION AREA(S) DO YOU INTEND TO COOK FOOD IN THE EVENT AREA Please Specify Method: GAS ELECTRIC CHARCOAL OTHER: TRAFFIC CONTROL DEVICES ALCOHOL SALES/SERVICE SECURITY FIRST AID FACILITY(IES) AND AMBULANCE(S) WILL YOU SET UP TABLE(S) AND/OR CHAIR(S) HOW MANY?: FENCING, BARRIER(S) AND/OR BARRICADE(S) DOES YOUR EVENT REQUIRE ELECTRICITY? SOURCE: BOOTH(S), EXHIBIT(S), DISPLAY(S) AND/OR ENCLOSURE(S) CANOPY(IES) AND/OR TENT(S). Please include dimensions: SCAFFOLDING, BLEACHER(S), PLATFORM(S), GRANDSTAND(S) OR RELATED STRUCTURE(S) VEHICLE(S) AND/OR TRAILER(S). HOW MANY? TRASH CONTAINER(S) AND/OR DUMPSTER(S) PORTABLE TOILET(S) If yes, please indicate company providing units: STAGE(S) Please include dimensions: ENTERTAINMENT Please describe: INFLATIBLE DEVICE(S), AMUSEMENT(S) BANNER(S) SPONSORSHIP/VENDING OR PROMOTIONAL ACTIVITY? Please describe: SPECIAL EVENT PERMIT FEES A damage deposit or a deposit for the cost of cleanup may be required for certain properties. A reservation/rental fee may be required for certain properties. OTHER PERMITS/REQUIREMENTS Please note all components of the event are subject to the Department of Infrastructure and Public Services (IPS) approval and may require approval by and/or permits from other entities. Approval by IPS does not constitute permission from other agencies, departments or entities. It is the responsibility of the applicant to secure all necessary permits from all entities, including the adjacent property owner if activity is occurring on private property adjacent to the City controlled right of way. For the term of the permit, the permitted area is not considered to be a public way or public space for any franchise agreement granted by the City, and all franchisees of the City must comply with all applicable ordinances related to the operation of their franchise. INSURANCE REQUIREMENTS 1. All for profit events or events in excess of 500 persons participating shall require insurance as follows: A minimum of One Million Dollars ($1,000,000) of General Liability insurance providing coverage for all activity authorized by the permit, listing the City of Tuscaloosa, its officers, agents, and employees as additional insureds thereon and furnishing to the City of Tuscaloosa proof of Insurance to such effect, and to immediately notify the City of Tuscaloosa of any changes in, modifications to or cancellation of said policies. 2. All permits that require an alcoholic beverage license shall include the following insurance at all times applicable to the permit to be carried by either the permittee or alcohol vendor: A minimum of One Million Dollars ($1,000,000) of both Dram Shop(Liquor Liability) insurance and General Liability insurance providing coverage for all activity authorized by the permit, listing the City of Tuscaloosa, its officers, agents, and employees as additional insureds thereon and furnishing to the City of Tuscaloosa Proof of Insurance to such effect, and to immediately notify the City of Tuscaloosa of any changes in, modifications to or cancellation of said policies. NAME OF APPLICANT: (print) SIGNATURE: DATE: APPROVED DENIED NOTES: SIGNED: OFFICE USE ONLY

Release and Indemnity Agreement In consideration of being granted this permit, the undersigned voluntarily assumes all risks attendant with the activity as enumerated above, and does hereby agree to release, indemnify and hold harmless, the City of Tuscaloosa, a Municipal Corporation and its officers, agents or employees from any and all civil liability, whatsoever, which directly or indirectly arise out of or in any manner grow out of the permitted activity. The undersigned expressly warrants that this Release and Indemnity Agreement is to be binding upon his/her executors, successors, administrators, and assigns. It is further warranted by the undersigned that no promise or inducement has been offered, except as herein set forth, and that the undersigned is of legal age, legally competent to execute this Release and agrees to all the terms of this Release and Indemnity Agreement, making all warranties herein set forth and accepting full responsibility therefor, and this Release is a full and final release of all claims known and unknown, anticipated and unanticipated. THE UNDERSIGNED has read this Release and Indemnity Agreement, fully understands the same and is legally authorized to execute. 20. WITNESS my hand and seal, this the day of, WITNESS: Undersigned / Permittee

DETALED MAP OF EVENT, including all roads requested you are requesting access to and onsite event layout (use additional pages if necessary) INCLUDE A LIST OF ALL CITY RESOURCES REQUESTED (police support, barricades, etc ), including the quantity, length of time. Note: the cost City resources may be charged back to your event Requested Resource Quantity Requested Duration Requested