2024-25-special-events-permit-final-fillable_003.pdf

TOWN OF CENTREVILLE

101 Lawyers Row Centreville, MD 21617 410-758-1180  events@townofcentreville.org Deadline to submit – 6 weeks prior to event; 8 weeks if alcohol permit is required PUBLIC EVENT PERMIT APPLICATION Fee: $50.00 Name of Organization:

Contact Person:

Address:

City State Zip Organization Phone Number:

Contact Person Phone Number:

Contact Person Email Address:

Type of Event:  Parade/walk run  Fair  Concert  Car Show  Street Festival  Movies  Private Block Party  Bike Ride  Other ______________________________________________

Is this a Town event (managed by Town staff)?  Yes  No Expected Attendance:

Is this a one-time event?  Yes  No Is this a seasonal event?  Yes  No If yes, specify season: From ___________________________ to ________________________________

Event Name:

Event Address/Location:

Start Date: End Date: Start Time: End Time From: / 20 To: / 20 From: AM/PM AM/PM

EVENT SPECIFICS

Check all that apply:  Road Closure If checked, which roads and for what duration?

 Food available to public. If checked, are multiple vendors selling/providing food?  Yes No If yes, attach a list of the vendors along with their contact information with your application.

 Alcohol sold/provided to public  Portable toilets Will sidewalks be impacted?  Yes  No If yes, please explain:

Describe how you will dispose of the onsite trash/recycle during and after the event.

The Centreville Town Seal can only be used for Town-managed events. Unauthorized use of the Town seal can revoke the user’s Event Permit and may risk denial of future event permit applications.

By signing this agreement, I understand and am familiar with all policies which regulate the use of this facility and have made participating members of our group or organization familiar with the same and I accept full responsibility.

Name of Responsible Person – Please Print Signature of Responsible Person Group/Organization Phone Number 2024-25-Special-Events-Permit-FINAL

TOWN USE ONLY

 Approved  Approved with the following conditions:

 Denied Authorized Signature Date  Application  Event Map  Payment Received  Check #  Cash  Credit Card  Liability Certi�icate Received  Product Liability Certi�icate (if applicable)  Approval by QAC Health Department (if applicable)  Approval by QAC Liquor Board (if applicable)  Approval by Maryland State Liquor Board (if applicable) 2024-25-Special-Events-Permit-FINAL

ADDITIONAL EVENT PERMIT REQUIREMENTS

EMERGENCY PLAN

In the event of an emergency, is there a public safety operational plan?  Yes  No If yes, please explain or provide a copy of the plan:

EVENT MAP

Please include a drawing/map that shows where event activities will be located as well as portable toilets, and if applicable, vendors.

INSURANCE/USER FEE REQUIREMENT

 All individuals, groups, organizations, etc. shall pay a usage/user fee of $50.00 upon submitting this application. In the event of cancellation, a refund may be requested. Upon completion of the activity, a site inspection will be held.

 There is a required liability insurance coverage of ($1,000,000 CSL) for the planned activity. A certi�icate of liability insurance must accompany this application with the following information: “Town of Centreville” listed as the name insured; the address; and the date of the event. If food is to be sold, a product liability policy will also be required, and applicants must contact the Queen Anne’s County Health Department. A copy of each required

document must accompany this application.

 Insurance can be acquired through a rider on your homeowner’s or business’s insurance policy or at:

https://app.gatherguard.com/  Applications submitted without the user fee and the required liability insurance coverage will not be accepted.

USE OF HISTORIC COURTHOUSE PROPERTY/GREEN

If you are using any County property such as the Historic Queen Anne’s County Courthouse or requesting use of electricity from County property, the event planner must contact Lee Edgar at (410) 758-0920, ext. 4111 or LEdgar@qac.org for permission, complete a separate Use Agreement, and submit a separate certi�icate of insurance to Queen Anne’s County. Lee Edgar will provide speci�ics on certi�icate holder and/or other requirements. If the event

involves the closure of Lawyers Row or Broadway, the event planner must submit a separate certi�icate of insurance to the Town and request permission from the Centreville Town Council to close the road(s).

FOR EVENTS SELLING OR PROVIDING FOOD

If providing or selling food at the event/on-site, describe how you will provide proper hand washing supplies for the public to use.

If providing or selling food, contact Environmental Health (410-758-2281) at Queen Anne’s County Department of Health for a “Class 2 Temporary Food Service” application.

If your event requires a street closure, please explain how the closure will enhance your event.

FOR EVENTS WITH ALCOHOL

 If you are requesting permission to provide/sell alcohol at your event, the non-pro�it or business must submit an alcohol management plan to the Town prior to applying for a County or State permit.

If alcohol is being sold/provided and you are a non-pro�it organization:

 You must complete a Special/Temporary Retail Alcoholic Beverage License form for approval by the Queen Anne’s County Liquor Board for a one-day waiver. (Submit no later than 45 days prior to the event.)  If alcohol is being sold/provided and you are a for-pro�it organization approval by the Maryland State Liquor Board is required for a one-day waiver.

 After the County or State approves an alcohol permit, you must appear before the Centreville Town Council to request a waiver to Chapter 7, Article I, Section 7-2A of the Town Code. Contact Gaye Adams, Town Clerk, to request a date to be put on the Centreville Town Council agenda. Email gadams@townofcentreville.org or call 410-758-1180, ext. 15 2024-25-Special-Events-Permit-FINAL