Special Event Permit

Organization Requesting Permit:
Name of event:
Date of event:
Type of event:
If other, describe:
Assembly time for event participants:Select:
Actual start time of event:Select:
Actual end time of event:Select:
Starting location of event:
Ending location of event:
Person making application:
Name:
Phone:
Address:
Email:
Business name:
Business address:
Chairman or person in charge of event:
Name:
Phone:
Email address:
Names and contact information of directors/trustees of the organization are:
State the purpose or objective of the proposed event:
Is this event political in nature?:
Proposed location/route of event (describe location(s) and attach map):
Estimated number of pedestrians/attendees:
Is traffic control needed?:
Will road closures be required?:
If yes, describe:
Are barricades required?:
Are you requesting Village staff be present for this event?:
Insurance Required
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

Signature of Person Making Application:Date:
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.

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