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2. Purcellville Special Event Application
   Thank you for your interest in hosting an event in the Town of Purcellville. This application will allow you to determine if your program meets the definition of an event for the town and if so, it will allow the Town to review your event and gather details such as time, date, location, and crowd size. The need for Town services, such as police service or street closures will also be evaluated. Once these services are evaluated, you will be given an estimate of costs associated with your event for the Town to provide these services. Prior to your event and as a condition of obtaining your event permit the event organizer must pay the estimate and a 10% contingency. After the event is completed, the Town will determine any cost discrepancies and issue a refund or an invoice for remaining costs. In addition to this application please visit the Loudoun County website at the link below and fill out the event information form. This will ensure that your event does not conflict with any other events and gets any required county resources. Please feel free to contact the Town Parks and Recreation Division Manager at 540-751-2350 with any questions.
4. Loudoun County Event Information Form
   Loudoun County Event Information form

   Please take a moment to fill out this form.

6. Organizer/Primary Contact Information
8. 1. First Name
9. 2. Last name
11. 3. Address 1
13. 4. Address 2
15. 5. City
16. 6. State
17. 7. Zip
19. 8. Email Address
20. 9. Phone Number
21. 10. Alternate Phone Number
23. 11. Sponsoring Organization
25. 12. Is the sponsoring organization for-profit, non-profit, or a government agency?*

    1. Charitable Organization
    2. For Profit
    3. Government Agency
26. 13. Business License or Non-profit status paperwork
    Please upload a copy of your business license or proof of your non-profit status. If you do not have this, you may forward it at a later time.
28. General Event Information
30. 14. Event Name
32. 15. Event Street Address
34. 16. Start Date and Time
    16. Start Date and Time

    16. Start Date and Time
35. 17. End Date and Time
    17. End Date and Time

    17. End Date and Time
36. 18. Rain Date and Time (if applicable)
    18. Rain Date and Time (if applicable)

    18. Rain Date and Time (if applicable)
38. 19. Set up time
    19. Set up time

    19. Set up time
39. 20. Tear down/ clean up time
    20. Tear down/ clean up time

    20. Tear down/ clean up time
41. 21. Description of Event
43. 22. Total Anticipated Attendance
44. 23. Anticipated Attendance per Day
45. 24. Anticipated Participants (vendors/staff)
47. Insurance Requirements
49. All sponsoring organizations are required to maintain commercial general liability insurance with a minimum coverage of $1,000,000 combined single limits covering bodily injury, property damage and products/completed operations liability. Coverage is to be on an occurrence form only with an insurer licensed to conduct business in the Commonwealth of Virginia. The coverage shall be provided by insurance companies rated by A.M. Best as not less than A- with a financial rating of at least VII. The insurer must add the Town of Purcellville as an additional insured by endorsement to the general liability policy. A Certificate of Insurance (COI) and the additional insured endorsement shall be provided to the Town by the event manager prior to the event evidencing compliance with these insurance requirements. A notation of the endorsement on the certificate of insurance is not sufficient. The sponsoring organization’s general liability policy shall be primary and noncontributory with any insurance policy maintained by Town. If liquor is to be served and the event is on Town Property, the sponsoring organization must obtain liquor liability coverage in the amount and type specified by the Town. If you need information about how to obtain this insurance, please contact the Town Parks and Recreation Division Manager at 540-751-2350.
51. 24. COI and Additional Insured Endorsement
    Please upload the COI and Endorsement as described above. If you do not have this, you may forward it at a later time.
55. Event Operations, Logistics, and Infrastructure
57. 25. What type of event is this? Parade, race, festival etc.
59. 26. Will any streets, sidewalks, or allyways need to be closed to accomodate your event?

    1. Yes
    2. No
    3. N/A
60. 27. If yes, please list areas that need to be closed
62. 28. Will tents be erected?

    1. Yes
    2. No
63. 29. If yes, please list tent sizes.
65. 30. Would you like to purchase space on the community events sign on the corner of Maple and Main Streets as part of your signage plan?

    1. Yes
    2. No
66. 31. If yes, please click the link below and fill this form out to apply for space on the community events board.
    Community Events Sign Application
67. 32. Please upload your completed Community Events Sign Application here, or bring it into Town Hall at 221 S Nursery Ave
69. 
    
71. 33. Do you plan on placing temporary signs around town as part of your communications plan?

    1. Yes
    2. No
    3. N/A
72. 34. If yes, please click the link below and fillout the Temporary Sign Application to apply for a sign permit.
    Temporary Sign Permit
73. 35. Please upload your completed Temporary Sign Permit Application with your signage plan here.
75. 36. Do you plan on having bounce houses or carnival rides at your event?

    1. Yes
    2. No
77. 37. Do you plan on using staging?

    1. Yes
    2. No
79. 38. Do you plan on using any type of fireworks or pyrotechnics?

    1. Yes
    2. No
81. 39. Will alcohol be served or sold at your event?

    1. Yes
    2. No

    ***Please note if your event is on town property and alcohol will be served, you will be required to have security on site for the duration of your event and submit a liquor liability rider with your certificate of insurance and endorsement.

83. 40. Will there be security on site?

    1. Yes
    2. No
84. 41. If yes, who will provide this service?
86. 42. Will there be parking control staff or volunteers?

    1. Yes
    2. No
87. 43. If yes, how many parking control persons will be on site?
89. 44. Will any items be left overnight?

    1. Yes
    2. No
90. 
    
92. 45. If yes, what are the items:
94. 46. Will you provide portable restrooms?

    1. Yes
    2. No
95. 47. If yes, how many?
    ***Please note, 1 portable toilet per 100 attendees at the peak of your event is the guideline.You will need to include some accessible toilets as well. The Town DOES NOT supply portable toilets.
97. 48. Will you have EMTs stationed onsite at your event?

    1. Yes
    2. No
98. 49. What is the plan for trash and recycling? Please include the number of trash and recycling containers you plan to use.
100. 
     
102. 50. If your event is being held on town property, please describe the emergency preparedness plan. If you wish, you can upload it as part of your site plan at the end of this form.
104. 51.How many staff provided by the host organization will be onsite during the event?
     ***Please note some events will require Police or public works staff to be onsite during the event. the Event organizer will be notified of this and the estimate for man hours will be provided to the event organizer prior to the event.
106. 52. Site Plan Instructions
     An event site plan is required for any portion of an event that is held on public property including roadways, sidewalks, parks, and public buildings. If your event is being held any of these areas, please upload your event site plan below. Use as many pages as needed to create this plan. Make sure to include the following information: ~Map and route of a proposed road race/walk ~Map and route of a proposed parade ~ Map of an event site including ;location of event entrances, location of tents, location of portable toilets - indicate wash stations and accessible units, locations of ABC perimeters if applicable, trash and recycle bin locations, stage locations, First Aid station or EMT location, and emergency preparedness plan.
108. 53. Site plan
110. 54. Hold Harmless*

     The individual signing below verifies that he or she is legally authorized to bind and act on behalf of the sponsoring organization. The sponsoring organizations, including all of its employees, agents, and other representatives, hereby agrees to hold harmless and to indemnify, defend and protect the Town of Purcellville and its Council Members, employees, agents, volunteers and other representatives against any and all claims, losses, damages and liabilities whatsoever to persons or property incurred as a result of the actions of the sponsoring organization, including, but not limited to, the sponsoring organization's installation, removal, maintenance, occupancy, and/or use of the town premises , at the Sponsored Event. Sponsoring organization agrees that any damage to the property of the Town of Purcellville, and any related equipment or property, due to the actions of the Sponsoring organization will result in a financial obligation of the Sponsoring Organization to the Town of Purcellville to replace, repair or otherwise correct such damage. I agree that all representatives acting on the Sponsoring Organization's behalf for any matter pertaining to the Event will be subject to all rules in the Special events ordinance as well as any rules provided to the Sponsoring Organization's representatives prior to and/or during the Event.

     1. I Agree
Leave This Blank:


112. 1. Receive an email copy of this form.
113. Email address

     This field is not part of the form submission.

114. Submit

* indicates a required field