City of St. Clair Shores Permit for Special Events, Festivals, Fairs, Carnivals & Other Charitable Events Office of the City Clerk, 27600 Jefferson Avenue, St. Clair Shores MI 48081 Phone: (586) 447-3303 Fax: (586) 445-0469
Name of Event Type of Event: Carnival Festival / Fair Outdoor Music Event Other Event Date of Event Hours of Event Location of Event Details of the Event
Name of Organization/Business Address Phone Contact Person Address Zip Code Phone Email ♦ The applicant agrees to hold harmless, indemnify and defend the City of St. Clair Shores, its officers and employees, from any liability, which may arise out of this event. Applicant shall maintain General Liability Insurance with limits of liability of not less than One Million Dollars ($1,000,000.00) per occurrence, and /or aggregate, combined single limit for personal injury, bodily injury and property damage. St. Clair Shores shall be named as an additional insured on applicant’s General Liability Insurance Policy and also shall be named on applicant’s automobile policies, if any vehicles will be used. AMOUNT MAY NEED TO BE INCREASED DEPENDING UPON SIZE OF EVENT AND SUBJECT TO APPROVAL OF CITY MANAGER. ♦ The applicant agrees to comply with all City and County ordinances and regulations in connection with the event and to pay the City for its direct costs in connection with staging this event, if assessed. ♦ Special Events with Music Disclaimer: Should the Police Dept. receive a complaint regarding the volume of the music, and the responding officers determine the volume to be unreasonable, the responding officers shall summon an on-duty supervisor. If the responding supervisor deems the music volume unreasonable, the Applicant shall reduce the volume to a level deemed acceptable by the on-duty supervisor. Should the Applicant fail or refuse to reduce the volume to a reasonable level as determined by the supervisory officer, then the permit would be void and the applicant would be subject to any and all enforcement action. ♦ A deposit for Police services may be required.
Applicants Signature Date
**USE OF CITY PARK - SECURE A PARK PERMIT FROM PARKS & RECREATION, 20000 STEPHENS, (586) 445-5350 YES NO Is the event outside? If so, a plot plan/mapping of area for Fire access and tent locations to be included. Will you be using a tent? If yes, you must provide fire retardants. Fire Marshal approval is required for all tents. Tent size Will you be using outside electricity? If yes, you must contact CDI for Electrical Inspection ($100 fee) and provide us with receipt #______. Will sidewalks be used? Will streets be used? Are barricades/cones requested? Number of barricades_____ cones _ __ (Must be returned to DPW following work day 7:00am - 3:00pm) Live Animal Expositions (i.e., petting zoo, animal demonstrations etc.) Vendor Name and contact information:
Will you be putting signs up? If yes, apply for a temporary sign permit with Community Development Dept. 447-3340
Cc: Petitioner Code Enforcement Fire Marshal Traffic Lt. Police Dept. Finance DPW P&R w/ attachments w/ attachments if insurance needed if applicable rev. 3/16/2021 1:01 PM
♦ The following documents must be submitted with this application: A detailed map showing the location of the event, streets to be closed and affected intersections General Liability Insurance with limits of liability of not less than One Million Dollars ($1,000,000.00) per occurrence, and /or aggregate, combined single limit for personal injury, bodily injury and property damage. St. Clair Shores shall be named as an additional insured on applicant’s General Liability Insurance Policy and also shall be named on applicant’s automobile policies, if any vehicles will be used Event Diagram Map Tent fire retardant certificate (tent size larger than 10 x 10) Approval letters from the affected businesses Festivals/Fairs/Carnivals: A copy of the State of Michigan Certificate of Inspection of Rides must be approved by the Fire Marshal. ♦ Please Submit any additional information that may be pertinent such as: − Brochures, Letters of Recommendation, Requested miscellaneous support documents on Organization letterhead. ♦ Any business with a current liquor license that will be serving outdoors and/or in a tent MUST apply to the Michigan Liquor Control Commission to add this to their license. ♦ The applicant hereby applied for a non-competitive/Special Event permit for the event described above and on the attachments.
The foregoing information is provided for your information and/or approval. Please acknowledge and return to the City Clerk’s Office.
Cost Department Approved Signature estimates Community Development
City Clerk Fire Route Insurance & waivers required Insurance, Participant Waivers, Hold Harmless Police Is an overtime deposit required for overtime costs to the City? Department of Public Works Route, Road Closures Parks & Recreation
This Permit as requested is hereby approved, subject to the following conditions:
APPROVED DENIED DATE
City Manager City Clerk
♦ Note: This permit does not relieve applicant from meeting any applicable requirements of law or other public bodies or agencies. If you are preparing food/serving food, you need to obtain a food handler permit from the Macomb County Health Department.
Cc: Petitioner Code Enforcement Fire Marshal Traffic Lt. Police Dept. Finance DPW P&R w/ attachments w/ attachments if insurance needed if applicable rev. 3/16/2021 1:01 PM