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2. 

3. City of Lake Wales

   201 W. Central Ave.

   Lake Wales, FL 33853

   863-678-4182 x1254

4. Official Use Only:

   Tent Permit #

6. Applicant Information:
8. Organization Name:*
10. Is this organization classified a 501c3 status by the IRS?*

    1. Yes
    2. No
12. Please upload a copy of the determination letter.
14. Address*
16. City*
17. State*
18. Zip*
20. Phone Number*
22. Event Contact Information:
24. First Name*
25. Last Name*
27. Address*
29. City*
30. State*
31. Zip*
33. Phone Number*
34. Email Address*
36. Event Information:
38. Name of Event:*
40. Please note: All events requesting a street closure must have approval from the City Commission.
42. Event Type:*

    1. Festival - an organized public gathering in a park or downtown e.g. Art Show
    2. Organized Competitive Event - a planned race, walk, tournament or other contest
    3. Parade/Walk - a public or private march, run, walk or parade of any kind.
    4. Circus or Carnival
    5. Other
44. Please provide a description of the event type:
46. Event Description:*

    Provide a description of the activities available at this event.

48. Setup and takedown date/time*
    Setup and takedown date/time Start Date

    Setup and takedown date/time Start Time

    —

    Setup and takedown date/time End Date

    Setup and takedown date/time End Time
49. Event start and end date/time:*
    Event start and end date/time: Start Date

    Event start and end date/time: Start Time

    —

    Event start and end date/time: End Date

    Event start and end date/time: End Time
51. Is this a reoccurring event? *

    1. Yes
    2. No
52. If yes, please provide more details:
54. This event will be:*

    1. Gated/Ticketed

    1. Open to the Public

    1. Private

    1. Other
56. Please provide a description:
58. Event Location:*

    1. Lake Wailes Park
    2. Downtown Market Place

    1. Kiwanis Park
    2. Stuart Park

    1. Crystal Lake Park
    2. Other
60. Please provide a description:
62. Site Plan Requirements:

    Please attach a clear and legible site plan/map with the following indicated:

    1. Depiction of the area (streets, park, etc) where the event will be held.

    2. The overall event area such as parking and requested street closures.

    3. The location and dimensions of all physical equipment being placed; such as stages, vendors, booths, tents, barricades, restrooms, dumpsters, etc.

    4. Disabled parking and handicapped access clearly defined.

    5. Location of temporary alcohol sales where both sales & consumption will occur.

    (Sale or consumption of alcohol requires additional permitting from the state and hiring of at least two off-duty police officers)

64. Attach site plan:*
66. Event Components:
68. Please check all that apply to the event.*

    1. Alcohol - (Special Permit Required)*
    2. Portolets
    3. Sales/Distribution/Display
    4. Food Distribution/Sales
    5. Use of electric outlets
    6. Use of water spigots
    7. Live animals
    8. Temporary Structures
    9. DJ
    10. Amplified Sound

    1. Stage
    2. Inflatables (bounce houses)
    3. Concerts/Live Music
    4. Installation of additional outlets
    5. Tents (permit required for tents larger than 30x30)
    6. Boat Racing
    7. On-Site Cooking
    8. Amusement rides
    9. Other
70. Please provide a description:
72. *Events involving the sale and consumption of alcohol must have a designated area where the sale and consumption of alcohol will take place. Sponsor must get an additional permit from the State Division of Alcoholic Beverages and Tobacco and requires the presence of a police detail.
74. Other Information:
76. Will City Streets be closed?*

    1. Yes
    2. No
78. Please list all affected City Streets:

    *Street closure requires approval from the City Commission.

80. Will any alleys, parking lots or other public places be closed?*

    1. Yes
    2. No
82. Please provide a description:
84. Will State Roads be closed? (SR 17)?*

    1. Yes
    2. No
86. Please list all affected State Roads:

    *Closure of State Roads requires an FDOT Permit.

88. Will you need additional trash receptacles from the City?*

    1. Yes
    2. No
90. Will you need clean-up assistance from the City throughout the event?*

    1. Yes
    2. No
92. Do you require additional assistance from the City, that was not listed above?*

    1. Yes
    2. No
94. *NOTE*

    For unbudgeted events, the organization must reimburse the City 100% of costs for use of Public Services and Police Department.

96. Please provide your ADA Accessibility Plan*
98. Upload additional documentation (optional)
100. Please provide a description:
102. Please provide any additional information related to the event:

     (Optional)

104. Upload additional documentation:

     (Optional)

106. Insurance Requirements:
108. Liability Insurance is required for all special events involving City property and must name the City of Lake Wales as an additional insured. For events requesting the sale or consumption of alcohol, liability insurance in the amount of $1,000,000.00 is required. All proof of insurance must be submitted to the City of Lake Wales a week before the event. Failure to provide acceptable insurance will result in the cancellation of the event.
110. *Upload proof of insurance:

     *If you have not obtained proof of insurance at this time, skip this field.

112. Agreement to Assume Financial Responsibility for Injury or Damage

     The Sponsor (hereinafter referred to as “the permittee”), shall indemnify, defend, and hold harmless the City of Lake Wales (hereinafter referred to as “the City”), and all of its elected or appointed officials, officers, agents, and employees from any claim, loss, damage, cost, change, or expense arising out of any acts, actions, neglect, or omission by the Permittee, its agent, employees, or subcontractors during the performance of the permitted event, whether direct or indirect, and whether to any person or property to which the City or said parties may be subject, except that neither the Permittee nor any of its agents, employees, or subcontractors will be liable under the agreement for damages arising out of the injury or damage to persons directly caused or resulting SOLELY from the negligence of the City or any of its elected or appointed officials, officers, agents, or employees.

     Permittee’s obligation to indemnify, defend and pay for the defense or at the City’s option, to participate and associate with the City in the defense and trial of any damage claim or suit and any related settlement negotiations, shall be initiated by the City’s notice of claim for indemnification to Permittee. Permittee’s inability to evaluate liability or its evaluation of liability shall not excuse Permittee’s duty to defend and indemnify within seven days after such notice by the City is provided by Certified Mail. Only an adjudication or judgment after highest appeal is exhausted specifically finding the City SOLELY negligent shall excuse performance of this provision by Permittee.  Permittee shall pay all costs and fees related to this obligation and its enforcement by the City.  City’s failure to notify Permittee of a claim shall not release the Permittee of the above duty to defend.

     It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City’s right, title and interest in land to be entered upon and used by the Permittee, and the Permittee will, at all times, assume all risk of and indemnify, defend, and save harmless the City from and against any and all loss, damage, cost, and expense arising in any manner on account of the exercise or attempted exercise by said Permittee of the aforesaid rights and privileges.

     During the event, the Permittee shall observe all safety regulations of the City, and the Permitee shall take measures to ensure the safety of the public.

     By signing this application, it represents the information provided to be true and correct and signifies a binding agreement to comply with the rules and regulations of the City of Lake Wales. Should the City grant approval and a permit be issued, it is further agreed the Permittee will comply with any other requirements provided by Federal, State, and Local Law.

     By execution hereof, the undersigned affirms that he or she is vested with full right and authority to bind the Permittee to the terms of this Agreement.

     In case of non-compliance with the City’s requirements in effect as of the approved date of the permit resulting from this Agreement, said permit is void.

114. Do you agree to the terms listed?*

     1. Yes
     2. No
116. Signature of Sponsor or Authorized Representative of Sponsor:

     Typing your name in the line above will serve as a digital signature and is legally binding.

117. Date:
     Date:
Leave This Blank:


119. 1. Receive an email copy of this form.
120. Email address

     This field is not part of the form submission.

121. Submit

* indicates a required field