Application
EVENT INFORMATION
| Event/Activity Name |
Chelsea Chase 5K
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| Is this a 400th Event? |
No
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| Is this event approved by the 400th committee? |
No
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CONTACT INFORMATION
| Facility (See link to park locations and descriptions above) |
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| ***Other Description |
Road Race- Chelsea Station Restaurant, 3.1 miles through City.
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| Event Date |
05-11-2024
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| Applicants Name |
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| Contact Person |
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| Cell Phone |
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| Email Address |
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| Day Phone |
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| Address |
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| Name of Supervisor/Vendor on Site |
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| Supervisor/Vendor Phone Number |
+16174611053
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| Name of Second Supervisor on Site |
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| Second Supervisor Phone Number |
+17813164588
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| Total Estimated Number of Participants |
250
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| Estimated Number of ADULT Participants |
200
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| Estimated Number of YOUTH Participants |
50
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| Organization Type |
Chelsea Youth Organization - must have 51% Chelsea Residents, Non Profit - may be asked to provide State Tax # or Federal EIN#
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| Activity |
Other (please specify below)
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| Brief Description of Event |
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| Special Requirements |
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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: Single Date - Time
| Date |
2024-05-11
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| Total Time (ex. 2:00pm-6:00pm) |
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| Set-up Time (ex. 2:00pm-3:00pm) |
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| Total Event Time (ex. 3:00pm-5:30pm) |
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| Breakdown Time (ex. 5:30pm-6:00pm) |
11:30am-12:00pm
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Second Choice - Single Date
| If your first choice date is not available, do you have a second choice? |
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Specialized Event
| Does your event fall under one of these categories? |
Yes
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Type of Event
| Select which event type your request is for |
Parade/Procession/Street Race
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Licensing Department and Inspectional Services Department
| Are any of the following part of your event? |
More than 50 people in attendance, Admission fee for participants, Event will generate revenue/ make money (e.g. sponsorships, vendor fees), Items will be for sale at 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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Items for Sale - Detail
| Please describe the items that will be available for sale at the event |
Food will not be sold for the event. Chelsea Station will still be serving their usual Brunch to the public, who are not affiliated with this event.
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Music and Entertainment: One Day Entertainment License Requirement
| Please describe the type of music or entertainment to be provided: |
One speaker and microphone will be placed in parking lot of Chelsea Station. Music will be played using Iphone.
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Department of Public Works
| Will you require electricity? (Please call 617-466-4211 (during business hours) and 617-697-3913 (after hours).) |
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Attachments
| Please upload any attachments (proposed site plan) |
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Additional Information
| Please list any additional Special Requirements |
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Requested Usage from City of Chelsea
| Tables |
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| Chairs |
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| Electricity |
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| Stage |
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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 |
City fof Chelsea Insurance Binder for CC5K 23-24 CPKG,CUMB,CAUT CWCO (as of 112024) - City of Chelsea (1).pdf
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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? |
No, no IS review needed.
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| Should Public Works review? |
No, no PW review.
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| Should Traffic and Parking review ? |
No
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