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Applicant Information

All Special Event Permit Applications for events are to be filed at least fourteen (14) days prior to initial advertisement of the event. Events requesting use of the Leist Memorial Band Shell or pyrotechnics must be submitted at least thirty (30) days prior to the initial advertisement of the event.
Submission of the application does not constitute approval of the permit. A permit will be issued to the applicant upon City approval.
Applicant Name*
Email Address
Address
City
State
Zip Code
Phone Number
Business or Organization Name
Event Contact Name*
Event contact person should be someone who will be available at the event.
Event Contact Person Phone Number
Event Contact Person Email Address
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Event Information

Event Activities and Organization

Required Documentation/Fees

1) Site Plan
For events other than those contained within a park pavilion - attach a detailed site plan for the proposed location showing all applicable event facilities and activities. Site plan should include the entire location to be utilized by the event and include:
• Requested street closure blockade locations.
• Emergency vehicle access (blocked streets require maintenance of an 18’ wide fire lane containing no parked vehicles, trailers, stages, vendor booths, tents, etc. (Some temporary, lightweight tables and chairs may be allowed to encroach into fire lane, upon approval of the Fire Marshal.)
• Merchandise/service vendor locations (specific names of vendors not required on site plan)
• Food vendor locations (specific names of vendors not required on site plan)
• Location of rides and other attractions/activities, and all tent locations (vendor locations are assumed to possibly include pop-up canopies and are not required to be shown separately as tents).
• Stage locations/lighting plans/sound system locations.
• A complete list of all vendors selling merchandise, services, or food/beverage at the event, including their contact information.
• For parades and run/walks, a map of the entire route, staging area, starting and finish lines.
• Any other pertinent features of the event.
Site plan upload
2) For events including the sale of alcohol:
Attach a copy of State of Missouri Division of Alcohol and Tobacco Control Picnic or Temporary Caterer’s License for the event.
3) Only for events including the sale of alcohol:
A City of Jackson Temporary Caterer’s or Picnic License for the sale of intoxicating beverages is required. Please submit the required $10 license fee to the City Clerk's office along with the application for this license, if applicable. This license will be issued to the applicant/organization for the event.
4) Only for event applicants/organizations selling food, beverages, merchandise, or services at the event:
A current City of Jackson vendor’s license is required for the organization, unless the organization is a non-profit corporation or the business already has a City of Jackson Business License. Please submit a completed City of Jackson Business License Application, Missouri Certificate of No Tax Due (http://dor.mo.gov/tax/business/sales/notaxdue/), and required license fee for application for this license.
5) For all events involving businesses, organizations, or not for profits, and for all events selling alcoholic beverages or providing alcohol free of charge:
Attach a certificate of insurance as evidence of coverage as detailed below.
INSURANCE REQUIREMENTS:
1. The applicant shall purchase and maintain Commercial General Liability Insurance with a minimum limit of $1,000,000 each occurrence/$2,000,000 general aggregate written on an occurrence basis.
2. Prior to activities commencing, the applicant shall furnish the City with certificates of insurance evidencing the coverage, conditions, and limits required by this agreement, including a separate endorsement for liquor liability if alcohol will be sold or served at the event, and have the City named as an additional insured in a separate additional insured endorsement.
3. All policies of insurance must be on a primary basis, non-contributory with any other insurance and/or self-insurance carried by the City.
4. No provision of this agreement shall constitute a waiver of the City’s right to assert a defense based on the doctrines of sovereign immunity, official immunity or any other immunity available under law.
5. If the applicant maintains higher limits than the minimums required, the member requires and shall be entitled to coverage for the higher limits maintained by the applicant.
6. Insurance required by this agreement and supported by the additional insured endorsement shall be as broad as necessary to support the hold harmless requirement in said agreement or as broad as the indemnitor’s insurance coverage, whichever is broader.
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Applicant Responsibilities

1. The applicant is responsible for maintaining lawful use of any location and/or facilities, and must report immediately to the Jackson Police Department any illegal activity or disturbance occurring at the event.
2. The applicant is responsible for the care of any city-provided barricades, utility equipment, and other city-provided items before, during, and after the event. Street barricades will be provided on site, and are to be set in place by the applicant no sooner than the beginning of the approved street closure time, and must be removed to the side of streets no later than the ending of the approved street closure time.
3. The applicant is expected to contact adjacent property owners and obtain their consent to any street closure requests which temporarily restrict access to any private property.
4. The applicant is responsible for restoring the area to a presentable appearance immediately upon the close of the event.
Site inspections may occur prior to or during the event by City staff. Failure to obtain the required permit and/or failure to abide by the conditions of an issued permit, or to abide by City ordinances or state or federal law may result in revocation of the permit and/or closure of the event.
HOLD HARMLESS AGREEMENT:
To the fullest extent permitted by law, applicant agrees to indemnify, defend and hold harmless the City of Jackson, its officers, agents, volunteers, lessees, invitees, and employees from and against all suits, claims, damages, losses, and expenses, including but not limited to attorneys’ fees, court costs, or alternative dispute resolution costs arising out of, or related to the use of City’s facilities, buildings, equipment or infrastructure under this agreement involving an injury to a person or persons, whether bodily injury or other personal injury (including death), or damage to property (including loss of use or diminution in value), but only to the extent that such suits, claims, damages, losses or expenses are caused by the negligence or other wrongdoing of applicant its officers, agents and volunteers, or anyone directly or indirectly employed or hired by the applicant or anyone for whose acts the applicant may be liable, regardless of whether caused in part by the negligence or wrongdoing of City and any of its agents or employees.
Signature:*
I certify that the above information is correct to the best of my knowledge and belief. The applicant and/or sponsor agrees to follow the requirements of all applicable City of Jackson ordinances. The applicant and/or sponsor also agrees to the Hold Harmless Agreement stated above. The applicant and/or sponsor further agrees to be responsible for any expenses incurred by the City as a result of the special event for stolen or damaged City property, costs of materials and utilities, and for City employee overtime wages.
Date of Application*
Date of Application

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