2007, 7-14 Fill the Boot Special Event PermitSPOKANE POLICE DEPARTMENT ROKANE
SPECIAL. EVENTS OFFICE � � � �'
SGT. Jason Hartman
jbartman@spokanepolice.org
IX)�)�)1
MAILIN G ADDRESS: 1100 W. MALLON
SPOKANE, WA 99260 -0001
ACTUAL ADDRESS: 901 N. MONROE #320 — SPOKANE, WA 99260
(509) 835 -4575
FAX (509) 835 -4596
—FAX COVER SHEET—
Message to: Jana Worthington/All City Departments
Fax #: 325 -3902 Telephone #:
Message from: Sgt. Mason Hartman late= July 12, 2007 Timc: 1045
—4 Pages follow this covet page.
C0NF'jT ENTL4LITY NOTICE. THE DOCUMENT (S) ACCOMPANYING THIS TELECOPY
TRANSMISSION DO (ES) CONTAIN CONFIDENTIAL INFORMATION BELONGING TO THE
SENDER, WHICH IS LEGALLY PRIVILEGED_ THE INFORMATION IS INTE-DED ONLY FOIL THE
USE OF THE INDIVIDUAL OR ENTITY NAMED BELOW. IF YOU ARE NOT THE INTE•NDFD
RECIPIENT, YOU ARE HEREBY NOTIFIED THAT ANY DISCLOSURE, COPYING DISTRIBUTION,
OR THETAKING OF ANY ACTION IN RELIANCE UPON THE CONTENTS OF THIS TELECOP[FD
INFORMATION IS STRICTLY PROHIBITED. IF YOU HAVE RECEIVED THIS TELECOPY IN
ERRROR, PLEASE IMMEDIATELY NOTIFY US BY TELEPHONE TO ARRANCYE FOR THE RETURN
OF THE ORIGINAL DOCUM ENT$ TO US_
Additional Continents: Firefighters FW the Boot for MDA
Is a Hard Copy Being Mailed? No
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AUTHORiZATION
AND
ADDITIONAL PROVISIONS
EVENT: Firefighters Fill the Boot for MDA
DATE: July 14, 2007
DEPARTMENT INVOLVEMENT: Monitored by on duty Officers, when possible.
APPROVED INTERSECTIONS: Division /Newport Hwy, Francis/Wall, and
Francis /Nevada
ADDITIONAL PROVISIONS: The Sponsor is responsible for the safety of all
participants. Each participant will wear a traffic safety vest at all times. No participant
shall enter into traffic to go between vehicles that occupy the intersection /roadway. The
participants will concentrate their activities to the curb lane avoiding moving traffic at all
times. There will also be one designated Sponsor representative at each location
during all hours that the fundraiser is going. Signs are approved; they must be made of
paper or cardboard with large letters for ease of reading. No sticks over % " in
thickness can be used to support the signs. Sandwich board type signs are approved.
No minors shall participate in this event. The sponsor shall keep a copy of this permit at
each location.
This permit does not authorize any activity outside the City of Spokane. The sponsor
and all participants will follow all Federal and State taws as well as all Ordinances of
the City of Spokane.
REVIEWING OFFICE
SG ASON HARTMAN
SPECIAL EVENTS
APPROVED:
ANNE KiRKPATRICK
CHIEF OF POLICE
C,OCATION�J� /U1�
ACTUAL HOURS OF EVENT: A JPM - -!5 APM
SET UP TIMES: 4 AM M - AMIPM TAKE DOWN TIMES: AMIPM - AW�M)
DESCRIBE SPECIFICALLY YOUR SET UP WORK: A
LIST ANY STREET(S) REQUIRING CLOSURE. INCLUDE STREET NAME(S). DATE AND TIME OF CLOSING A D TIME OF
REOPENING: f
SPONSORING
APPLICANT
CONTACT DAYTIME PHONE:( EVE, PHONE:L
• • .• 0474-7 ii
OVERALL EVENT DESCRIPTIONIROUTE MAP /SITE DIAGRAM
Please provide a DETAILED DESCRIPTION of your event. Include details regarding w °e of vehlcles, anlmafs, rides or any other
CITY OF SPOKANE SPECIAL EVENTS PERMIT PAGE 1 OF 3
NO , YES
❑ DOF_S THIS EVENT INVOLVE THE SALE OR USE OF ALCOHOLIC BEVERAGES? ]F S0. YOU MUST
CONTACT THE WASHINGTON STATE LIQUOR CONTROL HOARD (509) 625 -5513 AND THE SPECIAL
POLICE PROBLEMS DIVISION (509) 625.4089.
[ ❑ WILL ITEMS OR SERVICES BE SOLD AT THIS EVENT? IF YES, PLEASE DESCRIBE:
A CITY BUSINESS LICENSE MAY BE REQUIRED.
�� ❑ DOES THIS EVENT INVOLVE A MOVING ROUTE OF ANY KIND ALONG STREETS, SIDEWALKS OR HIGH.
WAYS? IF YES, ATTACH A DETAILED MAP OF YOUR PROPOSED ROUTE, INDICATE DIRECTION OF
TRAVEL, AND PROVIDE A WRITTEN NARRATIVE TO EXPLAIN YOUR ROUTE.
❑ DOES THIS EVENT INVOLVE A FIXED VENUE SITE? IF YES, ATTACH A DETAILED SITE MAP SHOW-
ING ALL STREETS IMPACTED BY THE EVENT.
IN ADDITION TO THE ROUTE MAP REQUIRED ABOVE, PLEASE ATTACH A DIAGRAM SHOWING THE OVERALL LAY- OUTAND
SET -UP LOCATIONS FOR THE FOLLOWING ITEMS: (CHECK ITEMS USING)
0 ALCOHOLIC CONCESSION AND /OR BEER GARDEN AREAS
FOOD CONCESSION ANDIOR FOOD PREPARATION AREAS (IF YOU INTEND TO COOK FOOD IN THE EVENT AREA,
PLEASE SPECIFY METHOD: GAS _ELECTRIC _CHARCOAL _OTHER Spoci(Y I
❑ PORTABLE AND /OR PERMANENT TOILET FACILITIES
❑ FIRST AID FACILITIES AND AMBULANCE LOCATIONS
❑ TABLES AND CHAIRS
❑ FENCING, BARRIERS AND /OR BARRICADES
❑ GENERATOR LOCATIONS AND /OR SOURCE OF ELECTRICITY
❑ CANOPIES OR TENT LOCATIONS
❑ BOOTHS, EXHIBITS, DISPLAYS OR ENCLOSURES
❑ SCAFFOLDING, BLEACHERS, PLATFORMS, STAGES, GRANDSTANDS OR RELATED STRUCTURES
❑ VEHICLES AND /OR TRAILERS
❑ TRASH CONTAINERS AND DUMPSTERS
DESCRIBE YOUR PLAN FOR CLEAN -UP AND REMOVAL OF WASTE AND GARBAGE DURING AND AFTER THE EVENT:
PLEASE DESCRIBE YOUR PROCEDURES FOR BOTH CROWD CONTROL AND INTERNAL SECURITY:
PLEASE DESCRIBE YOUR FIRST- AIDIMEDICAL PLAN_ HOW MANY FIRST -AID STATIONS AND WHERE ARE THEY LOCATED
ALONG E ROUTE? HOW WILL THEY BE STAFFED ?:
1
PLEASE DESCRIUY YOUR ACCESSIBILITY PLAN FOR ACCESS AT YOUR EVENT FOR INDIVIDUALS WITH DISABILITIES:_
NO YES
F-6 ❑ HAVE YOU HIRED ANY PROFESSIONAL SECURITY ORGANIZATION TO HANDLE SECURITY ARRANGE-
MENTS FOR THIS EVENT? IF YES, PLEASE STATE:
SECURITY ORGANIZATION: PHONE#:
ADDRESS:
SECURITY DIRECTOR NAME:
CITY OF SPOKANE SPECIAL EVENTS PERMIT PAGE 2 OF 3
❑ IS THIS A NIGHT EVENT? IF YES, PLEASE STATE HOW THE EVENT AND SURROUNDING AREA
WILL BE ILLUMINATED TO ENSURE SAFETY OF THE PARTICIPANTS AND
SPECTATORS:
ENTERTAINMENT I ATTRACTIONS / RELATED EVENT ACTIVITIES
Nf YES
v ❑
WILL ADMISSION BE CHARGED?
ARE THERE ANY MUSICAL ENTERTAINMENT ERTAINMENT FEATURES RELATED TO YOUR EVENT? IF YES, PLEASE
STATE THE NUMBER OF STAGES, NUMBER OF RANDS AND TYPE OF MUSIC.
NUMBER OF STAGES: NUMBER OF BANDS:
TYPE OF MUSIC:
WILL SOUND AMPLIFICATION BE USED? IF YES, PLEASE INDICATE START TIME: AM/PM -
FINISH TIME: AM/PM.
PLEASE DESCRIBE THE SOUND EQUIPMENT THAT WILL BE USED FOR YOUR EVENT:
ANY INFLATABLE DEVICES OR HOT AIR BALLOONS? IF YES, PLEASE DESCRIBE:
❑ ANY FIREWORKS, ROCKETS OR OTHER PYROTECHNICS? IF YES, PLEASE DESCRIBE:
❑ ANY SIGNS, BANNERS, DECORATIONS, SPECIAL LIGHTING? IF YES, PLEASE
DESCRIBE:
INSURANCE
IN MOST CASES, EVIDENCE OF INSURANCE WILL BE REQUIRED BEFORE FINAL PERMIT APPROVAL PLEASE PROVIDE
CERTIFICATE OF INSURANCE WHICH SHOWS $1 MILLION IN COMMERCIAL GENERAL LIABILITY INSURANCE AND A POLICY
ENDORSEMENT WHICH NAMES THE CITY OF SPOKANE AS ADDITIONAL INSURED. SOME EVENTS MAY REQUIRE A
HIGHER LIMIT OF INSURANCE. EACH EVENT IS EVALUATED ON ITS RISK EXPOSURE. THE CITY ALSO OFFERS A
PROGRAM FOR SPECIAL EVENTS INSURANCE WHICH ALLOWS SPONSOR$ TO PURCHASE SPECIAL EVENT INSURANCE.
CALL RISK MANAGEMENT AT 625 -6222,
I CERTIFY THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND CORRECT TO THE BEST OF MY
KNOWLEDGE AND BELIEF, THAT I HAVE READ, UNDERSTAND AND AGREE TO ABIDE BY THE RULES AND REGULATIONS
GOVERNING THE PROPOSED SPECIAL EVENT UNDER THE SPOKANE MUNICIPAL CODE AND CITY COUNCIL POLICY, I
AGREE TO ABIDE BY THESE RULES, AND FURTHER CERTIFY THAT I, ON BEHALF OF THE SPONSOR. AM ALSO
AUTHORIZED TO COMMIT THE SPONSOR, 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 SPOKANE.
I AGREE, ON BEHALF OF THE SPONSOR, TO DEFEND, INDEMNIFY AND HOLD HARMLESS THE CITY OF SPOKANE, ITS
DEPARTMENTS, EMPLOYEES, AGENTS, OFF ER$ AND VOLUNTEERS FROM ANY AND ALL LIABILITY IN ANY AND ALL
MATTERS CONCERNING THIS SPECIAL, EVI;NTT.
NAME OF APPLICA{NI�Q (- - -•
SIGNATURE: r r ' j / DATE: t Il -Cc) ~ 0-7
ONLY RETURN EVENT INFORMATION PAGES 1 2 B 3 AND PERMIT WHEN APPLYING FOR PERMIT
CITY OF SPOICANE SP_EGIA1. EVENTS PERMIT PAGE 3 OF 3