Type of event:
Person making application:
Chairman or person in charge of event:
List name, phone and email of each
Is this event political in nature?:
If yes, please provide documentation of political status.
Is traffic control needed?:
Will road closures be required?:
Are barricades required?:
Are you requesting Village staff be present for this event?:
Note: The Village my require reimbursement for staff participation
Applicants must provide a current certificate of liability insurance with a general liability minimum coverage of $1,000,000 per occurrence, with a Minimum General Aggregate amount no less than $2,000,000.
In addition, the following language naming the Village listed as an additionally insured party must be included with the insurance certificate:
"To the fullest extent permitted by law, the Applicant agrees to indemnify, save harmless and defend the Village of Westchester, and their respective elected and appointed officials, employees, agents, consultants, attorneys and representatives and each of them against and hold it and them harmless from any and all lawsuits, claims, injuries, demands, liabilities, losses, and expenses; including court costs and time resulting from such injury, or any damage to property, which may arise or which may be alleged to have arisen out of, or in connection with this event. The foregoing indemnity shall apply except if such injury is caused directly by the willful and wanton conduct of Municipalities, its agents, servants, or employees or any other person indemnified hereafter."
Failure to provide adequate insurance will result in automatic denial of this application
I have carefully read the foregoing application and swear that every statement made therein is true and correct to the best of knowledge and belief.