Parks Damage Deposit Fee __ Buildings & | Rental Fee: Recreation | Maintenance Hours/Cost: Management Event & Festival Application *ifapplieable, copy) Yes _ COVID-19 Management Plan Received: Yes, Notes; Springfield Department of Parks, Buildings, and Recreation Management Park Permit Personal Infor tion Contact Name? : Sity coumibae Teshha ust {EOE | gyal tists Jushinlngesh ch bsgcruncil 9ysteit cond “CU! NAG Pucker St Tate Spcing held ee OA ee FhoneNonbor Tuya gyusaguy [ ‘Additional Phone Number: a Event Information Date of Event Perraneey RainDae a iu Name of Park eer eT ‘Number of People Attending: “5 oy ‘Sel up Time: AM/PXE: 1090) Sia Time AM/FM: ree End Tine AMP, 226 ‘Additional Event information: All checks are payable to the City of Springfield “All ees, including malntenanee costs, must be paid a miner of 30 dys ‘A mandatory general abit Insurance pelley sting the City Costs Park Rental Rate Mandatory Damage Deposit: Pleese include a payment with this application, if there is no damage, a refind will be fsued, Amount- $200.00 Parks Dept. Use Only ‘ Amount: 20d,90 | Walkathon/Festival Mandatory Damage Deposit: Pleese include e payment with | this application, if there fs no damage, a refund will be issued, Amouttt - $200.00 advance in order to secure your Park Permit, * jpringfeld” as an “additional fusured” is required, seo below. e 220 vu ple: City Resident: $200.00 Non City: 201- 499 people: City Resident: $300.00 Non City: ‘Walkathon/Festival Rates: 1-499 participants: City Resident: $500.90 Non City: $600.00 ‘500-999 participants: City Resident: $750.00 Non City: $850.00 1,000 + participants: City Resident: $1,500.00 Non City: $1,600.00 “*A mandatory general ability insurance policy with minimum eovernge of SL ‘milion dollars isting the “City of Springffeld, In care of Department of Parks, Buildings, and Recreation Matingement™ as an “addltlonal insured” is required for walkathon/festival $300.00 $400.00 Amount: Mandatory Mainenanee Cost: (Must be a minimum of 4 hours) Total Hows, > ‘Park Employee: Electrician: $44.92. 954.0707. Amount: 29 ¢ ¥ L Cancellations MUST be made five business days prior to occasion in order fo qualify for refund Reasetuin over‘Special Cireumstances A Banners A Tenis MA Mega-Sheil (Separate Application) NA Blectricity HA Trask Receptacles LEA Selling ttems (Hawkers/Peddlers License can be obiained from Police Department) HA Police Deal, Liquor License, Cooking Food, orand Amplification @peakers, muse) requires an application fom the City oF Springfield Law Departinent, Applications must be obtained at least twenty-one days (21) prior to your scheduled event so all departments can review and approve or deny your request. Pease contact Anna Martine: at amartinex@springfietdeityhall.com or 413-787-6175 ‘APPLICANT IS RESPONSIBLE FOR OBTAINING ALL NECESSARY LICENSES All Perks Open at Dawa (JH) All Parks Close at Dusk (Fg) NoFires Allowed 4) Alcoholic Beverages Prohibited ( 54°) All Areas Must Be Loft Clean & Orderly 7) Affixing of Notices is Prohibited 'G) No Admission Mey Be Charged (a) Live Animal Rides Prohibited (7) No Amusement Riges/ Bounce Houses Inflatables Or Mechanical Operations (Gy Please complete below Thereby attest that the preceding information is true, Further, agree (o abide by the Rules and Regulations of the Springfield Board of Park Commissioners as stated on the regulations information sheet, I agree to reimburse the City of Springfield, Department of Parks, Buildings, and Recreation Management, for any costs incurred in furnishing this property for ‘uruse, (Such costs include but are not limited to: tash pickups clean up after the event; and/or repair of damages to park property.) ‘The deposit willbe refunded, provided none ofthe aforementioned situations occur. a gostin Weer ‘As the Responsible Party/Authorized Representative of the Applicant for this Permit I (name) agree to the Giebn heise aforementioned and following conditions forthe use of park properties. /WE hereby agree to and shall at all times, defend, iidernify, and hold the City of Springfield and its officers, agents, and employees, wholly hatinless from any and all losses, costs, expenses (including court costs and attorney's fees and. terest), claims, demands, suits by any person or persons, for property damage, personal injuries, including death, and other liabilities of whatever kind of nature, caused by, rosa ing from incident to, connected with, or arising directly or indirectly out of acts or omission of anyone using petk property Pursuant to this Permit, This indemnity shall survive termination of the agreement | have received a copy and agree to abide by the Rules and Regulations of the Board of Park Commissioners. Failure to ‘comply with all policies and procedures may sesult in additional fees. STM Lhave provided a copy of@ COVID-19 Management Plan for review and approval. Signature of Applicant (ie pare_g fe fol If Damage Deposit Was Retained, Explai Park Defartment Authorized Signature: ark Department Authorized Signature: Preliminary Date Approved: inal Date Approved: «Please Note Vehicle Entry into the Park Not Included in Fee*### Springfield Department of Parks, Bulalngs ad Reerentlon Management reserves the right to determine safiag requleements fr events For further gulls please call 13-7876 or wor sorinafisld-na gov