Application
EVENT INFORMATION
| Event/Activity Name |
Chelsea Annual Overdose Vigil
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CONTACT INFORMATION
| Facility (See link to park locations and descriptions above) |
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| ***Other Description |
Chelsea Square (Winnisimmet Park)
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| Event Date |
Thursday, Sept 18th
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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 |
+16178846130
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| Name of Second Supervisor on Site |
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| Second Supervisor Phone Number |
+16178846130
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| Total Estimated Number of Participants |
100
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| Estimated Number of ADULT Participants |
50
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| Estimated Number of YOUTH Participants |
10
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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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| 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: 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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Second Preference: Multiple Dates
| Dates (i.e. Every Sunday starting June 1 until September 1, from 10am-12pm) |
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| Facility (See link to park locations and descriptions above) |
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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 |
Community Event
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Licensing Department and Inspectional Services Department
| Are any of the following part of your event? |
None of these will be part of my event.
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Food and Beverage/ Fire Department and Licensing
| Please specify all food and beverages that will be provided |
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| Food Trucks |
No/No
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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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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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Equipment
| How many tables are needed? |
4
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| How many chairs are needed? |
25
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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 |
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First Review by Special Events Coordinator
Decide which Departments should review this application:
| Should Fire Department review? |
No RD review necessary.
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| Should Police Department review? |
No, no PD review needed.
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| Should Licensing review? |
Yes, Licensing should review.
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| Should Inspectional Services review? |
No, no IS review needed.
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| Should Public Works review? |
Yes, Public Works review needed.
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| Should Traffic and Parking review ? |
No
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