Please return completed application form and any additional paperwork to: Mayor's Office 41 City Hall Place Plattsburgh, NY 12901 Phone (518) 563-7701 or fax (518) 561-7367 carlinb@cityofplattsburgh-ny.gov Applications and additional paperwork can be submitted electronically or applicant can mail completed application and additional paperwork to the address above. If submitting additional paperwork electronically please click on the link below. PLEASE BE ADVISED that all required paperwork, such as certificate of insurance, alcohol permit from NYSLA, Clinton County health department permits, worker's compensation, etc., must be submitted WITH application. Any application that does not include such supporting documentation will be returned. Due to COVID 19 please be sure all PAUSE NY requirements are being followed. Also, effective 05-28-2020 the Common Council adopted the following: Any individual who is over age two and able to medically tolerate a face-covering shall be required to cover their nose and mouth with a mask or cloth face-covering when in any City of Plattsburgh Building. This will be in effect until PAUSE NY or other health directives no longer recommend or require face-coverings. Upload Additional Paperwork One file only.5 MB limit.Allowed types: pdf.5 MB limit per form. EVENT INFORMATION If this request is to hold a "small event" please read the information below. If your event qualifies as a "small event" complete Section A of this application, scroll to bottom of page, Section C, complete applicants signature area and hit submit. If you do not qualify as a "small event" complete application in its entirety. SMALL EVENTS Small events is defined herein as an event which does not involve a request to close a street or parking space; a parade; or to use, consume or serve alcohol on City property. Similarly a "Small Event" shall not require substantial use of electricity, or other City resources, including Police and DPW personnel. *****Street Solicitations require Common Council Approval and are not considered a "Small Event" ***** Section A: Name First Middle Last Email Address Address Address City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code Phone Number Fax Number Location of Event Site: Plattsburgh City Beach Macdonough Monument Bandshell Trinity Park Plattsburgh City Marina-portopottys must be provided Crete Civic Marina Plattsburgh Recreation Facility (Room Fees May Apply) City Park (Please select from list below) City Hall Building Other: Please list in box below Other Site: City Hall Auditorium/Rotunda If the request is for the use of Auditorium/Rotunda, and you are an individual or a for-profit organization, please describe how the event is for a public benefit, and which non-profit civic group the event profits will be forwarded to, including contact information for that non-profit civic group. List of City Parks Belmont Park Broadway Park Centennial Park Champlain Park Fort Brown Park Hamilton Park Jay Park & Terry Gordon Bike Path Lakeview Park & Soldier Point MacDonough Park Melissa Penfield Park Peter Blumette Park Riverview Park South Acres Park South Platt Street Park Tremblay Park Trinity Park U.S. Oval Wilcox Dock Brief Description of Event and Date Requested If requesting use of electricity or water a fee may apply. Will there be food or beverage served at this event? Yes No If yes please be aware proper permits will be required. If alcohol is served this no longer qualifies as a small event and Common Council approval will be required. Section B: Type of Event Festival Tournament Parade Run/Walk-a-thon Bicycle Race/Ride Music Event Sidewalk Sale Marina Booking - porto-pottys must be provided Demonstation Street Solicitation: No rain dates, map of permitted intersections and guidelines are available from the City Clerk's Office Other: Please specify In box below Other Event Type: Event Date/Time Event Date/Time: Date Event Date/Time: Time Set-Up Date/Start Time: Set-Up Date/Start Time:: Date Set-Up Date/Start Time:: Time Tear Down Date/End Time: Tear Down Date/End Time:: Date Tear Down Date/End Time:: Time Estimated Attendance Admission Fee Event Details Is your group a non-profit/charitable organization? Yes No If yes, charitable donation #: Other Event Details Power Required? Yes No Water Required? Yes No Trailer Stage Required? Yes No Firework Yes No Sanitation Facilities Yes No Vendors Yes No Recycling Event Coordinator In accordance with the City's recycling policy, any events organized in public spaces need to appoint a recycling coordinator. The recycling coordinator for the event shall be designated to work with DPW about the location of waste and recycling bins. The coordinator shall organize volunteers to direct the public in the use of these bins. Please indicate the contact for the recycling coordinator for this event. Additional Details/Requirements Not Previously Mentioned: Alcohol? Yes No Applicant is responsible for obtaining applicable Liquor License. NYS Liquor Authority Rules and Regulations http://www.sla.ny.gov ROAD CLOSURES/PUBLIC WORKS Does your event require road closures? Yes No If so what roads/intersections? PARADE/WALK INFORMATION Describe the Proposed Event Route of Parade: EMERGENCY MANAGEMENT Designated Emergency Liaison (Event Day): Cell # of Liaison: Alternate Contact Person: Cell # of Alternate Contact: SECURITY The City Police Department will not provide security for events. Will your event require security, if so please describe how you will secure the event venue. If no security required simply note such. First Aid/Training/Evacuation: Who is responsible for first aid at your event, please identify their location? What training will you provide to your volunteers/staff/participants regarding emegencies? How will you evacuate the area in the case of an emergency/disaster? Location of exits? TENTS If you plan on having tents at your event, please list all sizes. CHECKLIST Detailed Route Map (parade or walk) Map of Road Closures NYS Liquor License/Special Occasions Permit (Food vendors need permit for Clinton County Health Department, Certificate of Liability listing City of Plattsburgh as additional insured and permit from the City Clerk's Office if approved) Insurance Certificate (City of Plattsburgh listed as additional insured) Application Signed Please submit the documents mentioned above (if applicable)with your event application. Once all required forms are received your event will be presented to Common Council for approval/disapproval. By signing, you do hereby hold and save harmless and agree to indemnify the City of Plattsburgh and its elected officials, directors, officers, employees, servants, agents, contractors and their respective heirs, executors, successors with respect to any and all actions, debts, suits, demands, costs, damages and expenses whatsoever arising either directly or indirectly as a result of the rental/use of the facility/park. Municipal Events Rules Please click on the link for full text of Municipal Events Rules. Are you in need of insurance?https://venueliability.com/TULIP/LesseePortal/Home.aspx?cid=WXGZS%2fhTxqezXl4qdSVSdg%3d%3d Please click on the link for access to purchase insurance. I have read and understand the Municipal Events Procedures and I will abide by all guidelines therein. ***NOTE: Applications for small events should be submitted 10 days in advance of event. All other events require submission 45 days in advance of event.*** Application Signature Sign above Receive an email copy of this form