City of Molalla

City Of Molalla

PO Box 248

Molalla OR 97038

Phone: 503-829-5600 FAX: 503-829-3676 Email:

Number to call during event if there is a conflict: 503-793-9043

Application Date: ______Must keep App/Permit on site of event.

PARK USE APPLICATION/PERMIT

Please Note: If a key is needed (electricity access, gates, etc.)

a $25.00 refundable deposit is required.

$1000 Deposit required for larger events per the discretion of the City of Molalla

Event Date: ______Day of the Week______

Time (s)______- ______Estimation of Attendance ______

Applicant Name: (name or organization name)

______

Address: ______Phone: ______

City: ______State: ______Zip: ______

Contact Name: ______Phone: ______

Is group: Profit___ Non-Profit___ Corporation ___ Partnership___ Individual___

Type of Event to be Conducted:

______

______

Applications must be submitted 30 days BEFORE the scheduled event.

Please check which facility you wish to use:

____ Long Park (next to Fire Dept.) ______Clark Park (near Buckeroo Grounds)

____ Fox Park (next to library) ______Sheets Field (next to primary School)

_____ Ivor Davies (access off E. 5th St) ______Bohlander Field (unimproved field)

Will you be using the entire facility, or a portion of the facility? Please list:

______

Will you need the use of the Pavilion at Fox Park? Yes____ No____

Will you need the use of the gazebo at Long Park? Yes____ No____

Will you need the use of electricity? Yes____ No____

Will you need the use of the 20’X20’ tent? Yes____ No____

Tent Rental ($250.00)

SECURITY REQUIREMENT FOR LARGER EVENTS

The City of Molalla may require Permittee to provide security personnel during events. Contact the City of Molalla Police Department to determine if security procedures and personnel are needed. Applicant must contact Molalla Police Department at least 10 days prior to the event to discuss security issues.

If it is determined that additional security is needed, the City of Molalla has the right to bring in additional security at the expense of the permittee.

If security is required, what security will you provide? Include Business names, address and telephone number. ______

______

Police Chief, Sergeant or Designee must sign to provide proof that they are aware of the event and applicant has discussed such event with them.

______(Authorized Signature from MOPD)

INSURANCE REQUIREMENTS FOR LARGER EVENTS

Proof of liability insurance must submitted with this application, providing a $1,000,000.00 per occurrence/$2,000,000.00 aggregate liability coverage naming the City of Molalla as an additional insured on applicant’s policy.

If you intend to have alcoholic beverages, you must obtain a special permit by writing your request to the City Manager or designee and the request will then be considered. If approved, you must then obtain a permit from OLCC (Oregon Liquor Control Commission) and present proof of such permit with this application AND a $1,000,000.00 alcohol liability insurance policy is required with the City of Molalla named as an additional insured.

CERTIFICATE(S) OF INSURANCE MUST BE RECEIVED BY THE CITY OF MOLALLA AT LEAST 10 DAYS PRIOR TO THE EVENT AS WELL AS ANY PERMITS IF REQUIRED FROM ODOT

(Oregon Dept. of Transportation)

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Proof of liability insurance(s) attached? Yes ___ No ___

Park Use Deposit______Key Deposit______Tent Rental ______

APPROVED ______DENIED ______

______

Authorized City Personnel Signature & Date