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

Exactly as extracted, unformatted — for checking against the original. The readable version is easier to read.

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

Town of Centreville Venue ID codes for Insurance:
Name ID Code
Millstream Park 2618
North Pocket Park Front St. 2619
South Pocket Park Front St. 2620
Centreville Town Square/Lawyers Row 2621
Centreville Wharf 2622