Application
CONTACT INFORMATION
| Event/Activity Name |
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| Facility (See link to park locations and descriptions above) |
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| Event Date |
July 7, 14, 21, 28 + Aug 4, 11, 18, 25
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| Applicants Name |
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| Contact Person |
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| Email Address |
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| Cell Phone |
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| Day Phone |
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| Address |
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EVENT INFORMATION
| Name of Supervisor/Vendor on Site |
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| Supervisor/Vendor Phone Number |
+18573649036
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| Name of Second Supervisor on Site |
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| Second Supervisor Phone Number |
+18572850669
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| Total Estimated Number of Participants |
30
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| Estimated Number of ADULT Participants |
10
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| Estimated Number of YOUTH Participants |
20
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| Organization Type |
Non Profit - may be asked to provide State Tax # or Federal EIN#
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| Activity |
Community Use (please specify below)
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| Brief Description of Event |
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First Preference For Event Date
| Is this event happening on one date or multiple dates? |
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First preference: Two or More Dates - Times
| Dates (i.e. Every Sunday starting June 1 until September 1, from 10am-12pm) |
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Second Choice Interest: Two or More Dates
| If your first choice dates are not available, do you have a second choice? |
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Specialized Event
| Does your event fall under one of these categories? |
No
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Licensing Department and Inspectional Services Department
| Are any of the following part of your event? |
Music, entertainment, or amplified sound on site
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Food and Beverage/ Fire Department and Licensing
| Will food and beverages be: |
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| Please specify all food and beverages that will be provided |
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| Food Trucks |
No/No
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Music and Entertainment: One Day Entertainment License Requirement
| Please describe the type of music or entertainment to be provided: |
Small radio for ambient music, casual dancing
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Department of Public Works
| Will you require electricity? (Please call 617-466-4200 during business hours, and 617-470-2747 after hours).) |
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Additional Information
| Please list any additional Special Requirements |
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Indemnification/hold harmless/cleanup
Indemnification/Hold harmless/cleanup
| The signatory shall be responsible for and shall indemnify and hold harmless the City of Chelsea from and against all damages, claims or demands that may, during the term of this license, arise by negligent or intentional acts of signatory or signatory's employees. |
I am responsible for any and all indemnity and hold harmless the City of Chelsea
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| If a permit is issued, I agree that my organization will leave the permitted area clean and orderly, and that all trash will be placed in trash receptacles. |
I agree to pick up and clean any trash caused by this event
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| I understand that I am completing a binding electronic signature when I submit this form constitutes a legal signature. |
Yes
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| Up Load Insurance policy/agreement |
BLANK FOR CLEARGOV.docx
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First Review by Special Events Coordinator
Decide which Departments should review this application:
| Should Fire Department review? |
Yes, FD should review.
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| Should Police Department review? |
Yes, Police Department should review.
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| Should Licensing review? |
No, no Licensing review needed.
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| Should Inspectional Services review? |
Yes, Inspectional Services review.
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| Should Public Works review? |
No, no PW review.
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| Should Traffic and Parking review ? |
Yes
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