Licensing Department, City Of Chelsea, MA
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Special Event Request 2023

Aug 22, 2023
submission #164
Application

CONTACT INFORMATION

Event/Activity Name ---
Facility (See link to park locations and descriptions above) ---
***Other Description A chance to welcome new members to our staff and programs
Event Date 9/7/2023
Applicants Name ---
Contact Person ---
Email Address ---
Cell Phone ---
Day Phone ---
Address ---

EVENT INFORMATION

Name of Supervisor/Vendor on Site ---
Supervisor/Vendor Phone Number +16174663076
Name of Second Supervisor on Site ---
Second Supervisor Phone Number +16174663076
Total Estimated Number of Participants 100
Estimated Number of ADULT Participants 80
Estimated Number of YOUTH Participants 20
Organization Type Non Profit - may be asked to provide State Tax # or Federal EIN#
Activity Community Use (please specify below)
Brief Description of Event ---
Special Requirements ---

First Preference For Event Date

Is this event happening on one date or multiple dates? ---

First preference: Single Date - Time

Date 2023-09-07
Total Time (ex. 2:00pm-6:00pm) ---
Set-up Time (ex. 2:00pm-3:00pm) ---
Total Event Time (ex. 3:00pm-5:30pm) ---
Breakdown Time (ex. 5:30pm-6:00pm) 8pm-9pm

Second Choice - Single Date

If your first choice date is not available, do you have a second choice? ---

Second Preference: One Date

Date ---
Total Time (ex. 2:00pm-6:00pm ---
Set-up Time (ex. 2:00pm-3:00pm) ---
Total Event Time (ex. 3:00pm-5:30pm) ---
Breakdown Time (5:30pm-6:00pm) ---
Facility (please see link above for park locations and descriptions) ---

Specialized Event

Does your event fall under one of these categories? Yes

Type of Event

Select which event type your request is for Community Event

Licensing Department and Inspectional Services Department

Are any of the following part of your event? More than 50 people in attendance, Food and beverages , Music, entertainment, or amplified sound on site

Food and Beverage/ Fire Department and Licensing

Will food and beverages be: ---
Please specify all food and beverages that will be provided ---
Food Trucks No/No

Department of Public Works

Will you require electricity? (Please call 617-466-4211 (during business hours) and 617-697-3913 (after hours).) ---

Requested Usage from City of Chelsea

Tables ---
Chairs ---
Electricity ---
Stage ---
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
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
I understand that I am completing a binding electronic signature when I submit this form constitutes a legal signature. Yes
Up Load Insurance policy/agreement GreenRoots COI City of Chelsea.pdf, GreenRoots revised COI Eastern Minerals.pdf, GreenRoots revised certificate Rock Chapel Management.pdf, COI GreenRoots holder City of Chelsea 2022 to 23 term.pdf
First Review by Special Events Coordinator

Decide which Departments should review this application:

Should Fire Department review? No RD review necessary.
Should Police Department review? Yes, Police Department should review.
Should Licensing review? Yes, Licensing should review.
Should Inspectional Services review? Yes, Inspectional Services review.
Should Public Works review? Yes, Public Works review needed.
Should Traffic and Parking review ? Yes