Park Use Permit Application

THE TOWN OF CENTREVILLE 101 LAWYERS ROW CENTREVILLE, MD 21617

410-758-1180 FAX 410-758-4741 WWW.TOWNOFCENTREVILLE.ORG

PARK USE AGREEMENT

 Millstream Park Pavilion  South Pocket Park Pavilion  Centreville Wharf Park (422 S. Liberty Street) (103 Front Street) (235 Watson Road)  North Pocket Park Pavilion  Pavilion 1 - Sloop (115 Front Street)  Pavilion 2 - Blue Heron  Pavilion 3 - Rockfish Name of Organization Contact Person Address Phone Number Cell Phone Number Email address Type of Activity Date of Activity Number of people attending _________Time:

Will Admission Be Charged:  Yes  No Will Food Be Served to the Public:  Yes  No

INSURANCE/ USER FEE REQUIREMENT:

A. All individuals, groups, organizations, etc. shall provide a usage/user fee of $50.00 per pavilion, upon executing this agreement. In case of cancellation, a refund may be requested. Upon completion of the activity, a site inspection will be held.

B. There is a required liability insurance coverage of ($300,000 CSL) for the planned activity. A certificate of liability insurance must accompany this application with the following information: “Town of Centreville” listed as the name insured; the pavilion name and address; and the date of the event. If food is to be sold, a product liability policy will also be required and applicant must contact the Queen Anne’s

County Health Department. A copy of each required document must accompany this application.

C. Applications submitted without the user fee and the required liability insurance coverage will not be accepted.

REGULATIONS:

A. All Town of Centreville Parks are open for use from dawn to dusk. Hours may be extended through approval by the Centreville Town Council.

B. Pursuant to Chapter 7 of the Centreville Town Code, no alcoholic beverages are permitted.

C. Applicant is to be in charge of the event and shall be responsible for the following:

i. Submitting proper agreement and insurance for use of the ground’s facilities;

ii. All trash and decorations must be placed in trash containers provided. If container is full, then it is the responsibility of the applicant to remove trash, etc. away from the park;

iii. The buildings and grounds must be clean and in order for the next event.

D. Campfires are not permitted.

E. Overnight camping is not permitted.

F. If grills are used, they must be maintained and safety procedures observed at all times. All fires and embers must be fully extinguished prior to leaving the park.

G. Grills may only be used by adults or under adult supervision.

H. Any individual or group using the facilities is responsible for any damage above normal wear and will be assessed the actual cost of any damages incurred. The Town of Centreville will assess damages following the activity and notify the user of any damage within one (1) week. The individual or group referred to in this agreement further agrees to pay any damages in the amount assessed by the Town of Centreville. Payment for damages incurred will be due and payable thirty

(30) days after receipt of the damage assessment notification.

I. All applications for park use will be subject to the approval of the Town Staff, who will review each application on an individual basis and determine approval or disapproval.

VIOLATION OF THESE REGULATIONS MAY CAUSE THE DENIAL OF FURTHER USE

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

TOWN USE ONLY

 Approved  Approved with the following conditions:

 Denied Authorized Signature Date  Payment Received  Check #  Cash  Credit Card  Liability Certificate Received  Product Liability Certificate (if applicable)  Approval by QAC Health Department (if applicable)