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2. 
3. Special Event Application Form

5. Events that are open to the general public and take place within the public right-of-way; require closure of streets or parking lots, sound amplification, fireworks, or are located within a park are coordinated through the special event application & permit process. Typically, these events require permits, licenses, and approvals from several City departments, depending on the size and nature of the special event. To apply for a Special Event Permit, please complete this application. Your application, including required attachments, needs to be submitted no later than forty-five (45) days before your event. Facility Use Agreements should also be completed at this time (if applicable).

7. Event Name:*
9. Event Date:*
   Event Date: Start Date

   —

   Event Date: End Date
10. Event Hours:*
    Event Hours: Start Time

    —

    Event Hours: End Time
12. Requests included in this application:*

    1. Road Closure
    2. Parking Lot Closure
    3. Parade Permit - with escort & closures ($250 Fee)
    4. Parade Permit ($50 fee)
    5. Noise Permit
    6. Fireworks Permit ($50 fee)
    7. Special Event Liquor License ($500 fee)
    8. Consumption Permit ($500 fee)
14. Time Requested for Road Closure
    Time Requested for Road Closure Start Date

    Time Requested for Road Closure Start Time

    —

    Time Requested for Road Closure End Date

    Time Requested for Road Closure End Time
16. Time requested for Parking Lot Closure
    Time requested for Parking Lot Closure Start Date

    Time requested for Parking Lot Closure Start Time

    —

    Time requested for Parking Lot Closure End Date

    Time requested for Parking Lot Closure End Time
18. Event Information:
20. Overall Event Description:*
22. Please check all that apply:*

    1. This is a first time event.
    2. This event is open to the public.
    3. Admission will be charged.
    4. Vendor and / or participant fees are required.
    5. The event includes the sale or use of alcoholic beverages.
    6. Items and / or services will be sold at the event.
    7. The event will be held in a City Park or Facility.
23. Total anticipated attendance:*
25. Name of Group Sponsoring the Event:*
27. Is your organization a "Tax Exempt", non profit organization?*

    1. yes (please attach 501C Exemption Letter)
    2. no
29. Event Application Contact Person:*
31. Contact Person's Email:*
32. Phone Number:*
34. Day of Event Contact Person:*
36. Phone Number:*
37. Email Address:*
39. Facility Use, Route Map, and Impacted Areas
41. Please provide a detailed description of what facilities and equipment will be used (including bleachers, picnic tables, water, electricity, etc.), and what closures are needed. Attach a copy of the Event Map with your application. The event map should show overall layout and setup locations of the following items: Alcoholic concessions, beer gardens, food concessions, food prep areas, first aid facilities, trash containers/dumpsters, fencing/barriers/or barricades, sources of electricty/generators, canopies or tent locations; stages, platforms, seating, or related structures.*
43. This event will include the use of:*

    1. Indoor Park Shelter ($117.15 Park & Rec Fee)
    2. Outdoor Park Shelter ($58.58 Park & Rec Fee)
    3. City Facility or Other City Building
    4. Picnic Table Rentals ($25/each/day- Park & Rec Fee)
    5. Bleacher Rentals ($35/each/day- Park & Rec Fee)
    6. Electricity - Main Street Only (Confirm Fee with the Corn Palace)
    7. Water - Main Street Only (Confirm Fee with Corn Palace)
45. Safety, Security, and Accessibility
47. Please provide a detailed description of the safety, security, and parking plans for the event. Please describe your procedures for crowd control, internal security, and accessibility plans for individuals with disabilities as well as what arrangements have been made for First Aid, and parking/shuttle plans to the special event.*
49. Noise Permits
    Special events that cannot comply with Mitchell City Code Title 5, Chapter 5, Noise Control; are required to obtain a noise permit. MCC 5-5 can be found at: www.cityofmitchell.org/specialevents
51. Will Sound Amplification be used?*

    1. Yes
    2. No
52. What time will sound amplification be used?
    What time will sound amplification be used? Start Time

    —

    What time will sound amplification be used? End Time
    Please list the start time and finish time.
54. Will sound checks be conducted prior to the event?

    1. Yes
    2. No
55. When will sound checks be preformed?
    When will sound checks be preformed?
57. Fireworks Permits
    If any fireworks, rockets, or other pyrotechnics will be used, you must complete the information below. Fireworks permits require that the applicant provide a copy of a certificate of liability insurance coverage with a $1,000,000 per occurrence coverage with the City of Mitchell must be listed as an additional insured.
59. Contact information for the person(s) in charge of firing the display:
61. Name
63. Address
65. City
66. State
67. Zip Code
69. Phone Number
70. Email Address
72. Date of Display
    Date of Display
73. Time of Display
    Time of Display Start Time

    —

    Time of Display End Time
75. Type of Fireworks

    1. Class B Explosive (special fireworks)
    2. Class C Common Fireworks
77. Exact Location of Display:
79. What are the width perimeter requirements?
81. Insurance Requirements

    Insurance for your event will be required before final permit approval. Special Events: you will need $1,000,000 commercial general liability insurance. Liquor liability insurance is required if you are planning to sell alcoholic beverages at your event or facilities rental. A minimum of $500,000 liquor liability is required. Fireworks Permits require $1,000,000 of liability insurance per occurrence. All required insurance must name the "City of Mitchell, its officers, employees, and agents" as an additional insured. Insurance coverage must be maintained for the duration of this event. For insurance related questions, please contact the City's Human Resources Office at (605) 995-8417. You can email the certificate to hr@cityofmitchell.org or mail to City of Mitchell, Human Resources, 612 N. Main Street, Mitchell SD 57301.

83. I have the following coverages and will provide a copy of the Certificate showing the City of Mitchell as an additional insured as required above.*

    1. Special Event Permit: $1,000,000 Commercial General Liability
    2. Special Event Liquor License: $500,000 per occurrence
    3. Fireworks Permit: $1,000,000 General Liability
85. Name of Insurance Company*
86. Agent's Name
88. Policy Number
89. Phone Number
91. Affidavit of Applicant
    By typing your name by each of the items below, you are providing your acknowledgement of the requirements listed.
93. I understand that this application is subject to Mitchell City Council approval. Any violations of the approved permits will be grounds for law enforcement to require the immediate termination of the event.*
95. I acknowledge and agree to allow the City of Mitchell to publish the Contact Person and media referral telephone numbers on the internet in conjunction with the public notices and calendar of upcoming events in the City of Mitchell.*
97. I certify that the information in the foregoing application is true and correct to the best of my knowledge and belief and that I have read, understand and agree to abide by the rules and regulations governing the proposed special event and I understand that this application is made subject to the rules and regulations established by the City Council of Mitchell. I agree to abide by these rules and further certify that I, on behalf of the organization, am also authorized to commit that organization, and therefore agree to be financially responsible for any cost and fees that may be incurred by or on behalf of the Event to the City of Mitchell.*
99. I am attaching the following items:

    1. Parade Route Map
    2. Road or Parking Lot Closures Map
    3. Site/Event Map
    4. Certificate of Liability Insurance
    5. Certificate of Liquor Liability Insurance
101. Parade Route Map Attachment
103. Road or Parking Lot Closure Map Attachment
105. Site/Event Map Attachment
107. Certificate of Liability Insurance Attachment
109. Certificate of Liquor Liability Insurance Attachment
111. 
Leave This Blank:


113. 1. Receive an email copy of this form.
114. Email address

     This field is not part of the form submission.

115. Submit Submit and Print

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