Special Events Permit Application Form – Fill Out and Use This PDF

OAKLAND POLICE DEPARTMENT

Special Events Permit Application

TF-807-3 (Jul 10)

APPLICANT INFORMATION

Applicant Name			Date of Birth	Contact No.	Alternate Contact No.
Applicant’s Address	City		Oakland		Zip Code

EVENT INFORMATION

Date of Application	Type of Event			Other Event (Describe)
	SELECT ONE
Location/ Address of Event	Date of Event			Time/ Start-End
No. Persons Expected	Persons Allowed			Ticket Sales
	SELECT ONE			SELECT ONE
No. of Monitors/ Security	Security Company			Telephone No.
Type of Music	Other Music (Describe)			Will food/drink be sold
SELECT ONE				Yes	No
PERMIT INFORMATION
HAVE YOU EVER BEEN DENIED A PERMIT?		Yes	No

Applicant agrees to abide by Oakland Municipal Code Dance Hall Regulations, Section 5-4.03

HOLD HARMLESS AGREEMENT

The Special Event applicant or president of designee of the sponsoring organization(s) (hereafter called “permittee”) agrees to reimburse the City of Oakland (hereafter called “City”) for all losses incurred by it in repairing or replacing damage to City Property proximately caused by the permittee, its officers, employees, agents, monitors, or any other persons or forming the special event, who were, or should have been, under the permittee’s control. Persons who merely attend or join in a special event are not considered by that reason alone to be “under the control” of the permittee.

The permittee further agrees to defend without costs, indemnify, and hold harmless the City, its officers, agents, and employees from any liability to any persons, damages, losses, or injuries arising out of or alleged to arise out of the permitted special events, which was proximately caused by the actions of the permittee, its officers, employees, agents, including monitors, or any other persons attending or joining in the special event who were, or reasonably should have been under the control of the permittee. Persons who merely attend or join in a special event are not considered by that reason alone to be “under the control” of the permittee.

I have read and I understand the Hold Harmless Agreement and I declare under penalty of perjury that the information provided in this application is true and correct.

Permittee’s Signature ________________________________________ Date ________________

Police Overtime cost Attached:	Yes	No		Application Fees Paid:	Yes	No
			Verified By:
ABC Endorsement: Approved	Denied		________________________________________				_____________
				Special Events Personnel			Serial No.

Pursuant to OMC §9.52.080, a Special Events Permit is conditionally approved in order for the applicant to obtain additional required documentation.

_______________________________________________	______________	___________________
Signature of Special Events Coordinator	Serial No.	Date Signed

A Permit is Hereby	Approved
	Denied – Pursuant to OMC Section 9.52.090 Subsection (Select Appropriate Subsection)
_______________________________________________		______________	___________________
Signature of Chief of Police Designee		Serial No.	Date Signed