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2. Please call the Waukee Parks & Recreation Department at 515-978-0007 to check availability of park shelters and similar public facilities before submitting this application.

   The City of Waukee would like to thank you for considering our community as a host site for your Special Event. Please submit this application and other required materials to the Waukee Parks and Recreation Department at least 60 days prior to the date of the event, with proof of insurance and/or other certificates, permits, and/or licenses listed below if needed at least 30 days prior to the date of the event. All events will be approved by Waukee City Staff and/or the Waukee City Council, if a resolution is required. The Special Event Application states which conditions need to be met for the event to be approved.

   City approval of a Special Event Application does not preclude responsibility for any additional permits, approvals, or state and federal regulations. The City may cancel the event with notice, impose special guidelines and/or restrictions; included but not limited to: the nature of the proposed event, its attendant circumstances, weather forecasts, the event being deemed hazardous to public safety and/or public or private property. If the applicant or the City of Waukee cancels the event after approval for any circumstances, the application fee will not be refunded.

   The City of Waukee Special Event Application is necessary for: the use of public property and/or park property that requires right-of-way usage or temporary street closures (excluding block parties), parades, runs/walks, fairs/festivals, outdoor concerts/amplified sounds, athletic events, fundraisers, farmer’s markets, fireworks/pyrotechnics, temporary structures (tents, canopies, stages, inflatables). The City of Waukee will determine whether an event is classified as a Special Event if outside of the description stated above. If your event will be using any part of the Raccoon River Valley Trail please fill out the Special Event application at www.dallascountyiowa.gov/conservation before you submit the Special Event application with the City of Waukee. You must provide proof of approval from the Dallas County Conservation Board before the City of Waukee can accept this application.

4. REQUIRED, AT MINIMUM, 60 DAYS BEFORE THE EVENT:
   1. Completed Special Event Application, $75 non-refundable application fee and shelter/facility payment due. Application will not be reviewed until payment is received.
6. REQUIRED 30 DAYS BEFORE THE EVENT:
   1. Proof of insurance noting City of Waukee as additional insured for event.
   2. Proof of barricade confirmation if applicable.
   3. Proof of temporary structure flame resistant certificate if applicable.
   4. Proof of liquor license if applicable.
   
10. Event Contact Information
12. First Name*
13. Last Name*
15. Address1*
17. Address2
19. City*
20. State*
21. Zip*
23. Email*
24. Phone Number*
25. Cell Number
29. Event Information
31. Event Name*
32. Event Date
    Event Date
34. Event Type*

    1. New Event
    2. Returning Event
    3. Returning Event with Changes
36. Event Location/Park/Facility*
    Pending approval. Call 515-978-0007 to check availability.
38. Event Sponsor/Organization*
40. Event Description*
42. Event Start/End Time
    Event Start/End Time Start Date

    Event Start/End Time Start Time

    —

    Event Start/End Time End Date

    Event Start/End Time End Time
43. Event Setup/Teardown Time
    Event Setup/Teardown Time Start Date

    Event Setup/Teardown Time Start Time

    —

    Event Setup/Teardown Time End Date

    Event Setup/Teardown Time End Time
45. **Please include time frame for delivery of amenities such as sanitation, temporary structures, vendors, etc.
47. Estimated Number in Attendance*
48. Estimated Number of Vehicles*
50. Admission/Registration Fees*
    -- Select One --YesNo
51. If yes, how much?
53. Fees Collected On-site?*
    -- Select One --YesNo
57. Event Street Closures

    Requires City Council approval by resolution. Street closures for parades must follow the provisions of Waukee Municipal Code Section 60.08.

59. Are temporary street closures needed?*
    -- Select One --YesNo
60. List requested street closures.
    If your event requires street closures, you will be required to contract barricades and signage.
62. List Contractor name and phone number.
64. **Any volunteers/event staff along a race route or road will be required to wear a reflective yellow vest on the outermost part of their clothing.
68. Event Parking
    If approved by City Staff.
70. Are you requesting vehicles be permitted to drive or park on city park grounds?*
    -- Select One --YesNo
71. List requested vehicles (i.e., catering, sanitation, waste removal, participant)
    Vehicles are NOT allowed to drive or park randomly on the turf of City park grounds due to extensive, underground irrigation systems that sustain damage when vehicles drive across control boxes and heads.
75. Noise

    May require City Council approval by resolution.

77. Will you be using amplified sound/speakers, live music, and/or a public address system?*
    -- Select One --YesNo
78. Start Time
    Start Time
79. End Time
    End Time
81. Description of sound equipment. (radio remote, live band, amplified music, etc.)
82. See Waukee Municipal Code 52 "Noise Control."
    Noise Control Ordinance
86. Sanitation
    Trash and portable toilets.
88. Will you be contracting additional dumpsters?*
    -- Select One --YesNo
89. If yes, list Contractor name and phone number.
    Clean up of the event area, including trash removal, is the responsibility of the event sponsors immediately following the event.
91. Will you be contracting additional portable toilets?*
    -- Select One --YesNo
92. If yes, list Contractor name and phone number.
    Requirements for additional portable toilets: *For events with alcohol, one portable toilet for every 150 attendees. *For events without alcohol, one portable toilet for every 250 attendees.
96. City Utilities
98. Will you be requesting additional utilities?*
    -- Select One --YesNo
99. Water (Describe use.)
    Limited water and electrical power are available at some City parks. Additional generator power or water supply is the responsibility of the applicant and may be subject to the approval of city staff.
100. Electricity (Describe use.)
     Limited water and electrical power are available at some City parks. Additional generator power or water supply is the responsibility of the applicant and may be subject to the approval of city staff.
104. Overnight Stay
     If approved by City staff.
106. Will your event be held overnight?*
     -- Select One --YesNo
107. If yes, explain where and how participants will sleep (RVs, tents, etc.)
     Emergency shelter plan must be submitted by applicant with written approval from emergency shelter host site.
111. Temporary Structures
     If approved by City staff.
113. Will your event have a tent or canopy?*
     -- Select One --YesNo
114. If yes, list square footage.
115. Structure type

     1. Open
     2. Enclosed
117. List Contractor name, phone number and email.
     All tents or canopies need to provide a flame resistant certificate from contractor. The use of ground stakes for temporary structures must be pre-approved by City staff and utility locate companies. Staking requests must be received five business days before the event. Supporting guides, wires, or ropes will not be allowed to be tied to or anchored to trees, buildings, bridge railings, City signage, or light poles. Temporary structures must be removed immediately following the event. Please call 8-1-1 before you dig or stake.
119. Will your event have an inflatable(s)?*
     -- Select One --YesNo
120. If yes, describe size and number of inflatables.
122. List Contractor name, phone number and email.
     The use of ground stakes for temporary structures must be pre-approved by City staff and utility locate companies. Staking requests must be received five business days before the event. Supporting guides, wires, or ropes will not be allowed to be tied to or anchored to trees, buildings, bridge railings, City signage, or light poles. Temporary structures must be removed immediately following the event. Please call 8-1-1 before you dig or stake.
124. Will your event have a stage?*
     -- Select One --YesNo
125. If yes, describe size and stage capacity.
127. List Contractor name, phone number and email.
     The use of ground stakes for temporary structures must be pre-approved by City staff and utility locate companies. Staking requests must be received five business days before the event. Supporting guides, wires, or ropes will not be allowed to be tied to or anchored to trees, buildings, bridge railings, City signage, or light poles. Temporary structures must be removed immediately following the event. Please call 8-1-1 before you dig or stake.
129. **It is the responsibility of the event organizer to have a completed inspection of the temporary structure with the Waukee Fire Department while the listed contractor is still on-site. Failure to do so may result in fines or closing of the structure.
133. Fireworks/Pyrotechnics
     Requires City Council approval by resolution.
135. Will your event have fireworks or pyrotechnics?*
     -- Select One --YesNo
136. If yes, explain location and type of fireworks/pyrotechnics.
138. List licensed and competent operator's name, phone number and email.

     See Waukee Municipal Code 41.15(3)B for insurance coverage requirement for fireworks displays.

142. Vendors
     Food and non-food. Liquor license requires City Council approval by resolution.
144. Will your event have product sales on-site?*
     -- Select One --YesNo
145. If yes, please explain.
147. Individual food vendors, as well as the event organizer, are required to obtain a Temporary Food License from the Iowa Department of Inspections & Appeals. Contact 515-281-6538 to obtain such licenses.
149. Will your event have on-site alcohol sales?*
     -- Select One --YesNo
150. If yes, please explain.

     Additional permits and fees for food and/or alcohol may be required by the City and/or the State. These permits will need to be submitted 30 days prior to the date of the event. If selling alcohol, see the Iowa Alcoholic Beverages Division website at https://revenue.iowa.gov/permits-licensing/alcohol. If alcohol is sold the applicant must comply with the recommendations of the Waukee Police Department and additional security may be required.

152. Additional questions/requests
156. Fees
     Special Event Application required (non-refundable): $75
158. Shelter/Facility if applicable: Varies
160. Liquor license required if applicable: Payable to the State of Iowa (Iowa Alcoholic Beverages Division)
162. Total Amount Due*
     Payable to Waukee Parks and Recreation Department.
166. Hold Harmless Agreement
     Applicant hereby agrees to indemnify, defend, protect, and hold harmless, the City, its agents, employees, representatives, and elected officials, from and against any and all claims, losses, demands, liability, lawsuits, damages, or expenses (including, without limitation, reasonable attorney's fees), relating to, resulting from, or arising out of, directly or indirectly, the promotion and/or conduct in any way related to the activities in connection with that event, including but not limited to the activities of applicants, employees, volunteers, contractors, vendors, attendees or participants in the event which is the subject of the application.
170. Event Contact Name*
171. Date*
     Date
173. Electronic Signature*

     By checking this box, I agree that all of the information in this application is accurate to the best of my knowledge.

     1. Yes
177. Event Site Map/Route
     Provide a detailed map of the event site including the locations of: street closures, event parking, additional dumpsters, portable toilets, water, or electricity, overnight stay areas, temporary structures (including interior layouts), fireworks demonstration area, and vendor booths. Attach additional maps if needed.
     
     Please use the following legend when labeling the map:
     Label street names, etc.
     Routes for races, parades, etc.---->
     Fencing (_ _ _ _)
     Restrooms/Portable toilets (R)
     Temporary Structures (TS)
     First aid facilities (1stA)
     Alcohol serving/consuming area (A)
     Street Barricades (B)
     Dumpsters (D)
     Admission/registration fee collection (F)
     Parking (P)
     Vendors (V)
     Fireworks/Pyrotechnics (FP)
179. Upload site/map route*
180. Upload additional map
184. Liability Insurance for Event
     PERMIT HOLDER, at its own expense, shall procure and maintain insurance as to cover all risk which shall arise directly or indirectly from the Special Event for which the City provides a permit. At a minimum the following insurance is required and the requirement level will be determined based on the number of participants and attendees, nature of the event’s activities and type of City property or other resources involved:
     
     General Liability Insurance
     1. Low Risk Event– minimum liability limit $500,000
     A. Events with little or no impact on the public.
     B. Events in City parks or on public property without alcohol.
     C. Large picnics in parks exceeding shelter occupancy and using other park areas.
     
     2. Medium Risk Event– minimum liability limit $1,000,000 (Additional insured and governmental immunities endorsement is required. *)
     A. Fundraising walks and/or runs without street closures.
     B. Sport contests in City parks.
     
     3. High Risk Event– minimum liability limit $2,000,000 (Additional insured and governmental immunities endorsement is required. *)
     A. Firework/Pyrotechnic displays.
     B. Parades.
     C. Events requiring street closures.
     D. Events that expect large crowds on public property.
     E. Large events taking place for more than one day.
     F. Large events that include alcohol on public property.
     
     *Endorsements when required must read:
     
     1. Additional Insured Endorsement:
     Except for Workers’ Compensation and Professional Liability, the policies shall include the City Additional Insured Endorsement of: The City of Waukee, Iowa, including all its elected and appointed officials, all its employees and volunteers, all its boards, commissions and /or authorities and their board members, employees, and volunteers, are included as additional insureds with respect to liability arising out of the Insured’s work and/or Services performed for the City of Waukee, Iowa. This coverage shall be primary to the additional insureds, and not contributing with any other insurance or similar protection available to the additional insureds, whether available coverage be primary, contributing, or excess.
     
     2. Governmental Immunities Endorsement:
     A. Non-waiver of Government Immunity The insurance carrier expressly agrees and states that the purchase of this policy and the including of the City of Waukee, Iowa, as an Additional Insured does not waive any of the defenses of governmental immunity available to the City of Waukee, Iowa, under Code of Iowa Section 670.4 as it now exists and as it may be amended from time to time.
     B. Claims Coverage The insurance carrier further agrees that this policy of insurance shall cover only those claims not subject to the defense of governmental immunity under the Code of Iowa Section 670.4 as it now exists and as may be amended from time to time.
     C. Assertion of Government Immunity The City of Waukee, Iowa, shall be responsible for asserting any defense of governmental immunity, and may do so at any time and shall do so upon the timely written request of the insurance carrier. Nothing contained in this endorsement shall prevent the carrier from asserting the defense of governmental immunity asserted by the City of Waukee, Iowa.
     D. Non-Denial of Coverage The insurance carrier shall not deny coverage under this policy and the insurance carrier shall not deny any of the rights and benefits accruing to the City of Waukee, Iowa , under this policy for reasons of governmental immunity unless and until a court of competent jurisdiction has ruled in favor of the defense(s) of governmental immunity asserted by the City of Waukee, Iowa.
     E. No Other Change in Policy The insurance carrier and the City of Waukee, Iowa, agree that the above preservation of governmental immunities shall not otherwise change or alter the coverage available under the policy.
     
     Certificate of Insurance Requirements
     
     A Certificate of Insurance is required evidencing all required insurance coverage as provided above with any required endorsements attached so as to evidence their inclusion in the coverage. The Certificate of Insurance is due 30+ days before the Special Event. The following format is required:
     
     1. List the name of the Event and Date in the Description of Operations section.
     2. The following address must appear in the Certificate Holder section: City of Waukee, Iowa Special Event Application 805 University Avenue Waukee, Iowa 50263
     3. The Producer’s contact person’s name, phone number and e-mail address is required.
     4. Endorsements, as required, shall be included with the Certificate of Insurance to evidence that the policy has been endorsed.
188. Additional Special Event Information

     Waukee Parks & Recreation Department: 515-978-0007 or www.waukee.org/parksandrec

     To hire an off-duty police officer for security at your event, submit your request and find details at https://www.waukee.org/offdutyofficer.

     Iowa Alcoholic Beverages Division: 515-281-7400 or Alcohol | Department of Revenue

     Iowa One-Call: dial 8-1-1 or submit your request to have utilities marked at www.iowaonecall.com

     Dallas County Public Health Department: 515-993-3750 or dallascountyiowa.gov

     Dallas County Conservation for permits on the Raccoon River Valley Trail: conservation@dallascountyiowa.gov or 515-465-3577

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190. 1. Receive an email copy of this form.
191. Email address

     This field is not part of the form submission.

192. Submit

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