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Event Date: August 12, 2017 Event Time: 9:00 a.m. 7:00 p.m. Rain Date: N/A

Type Event: Public Demonstration Event Location: McGuffey and Justice Park

Sponsor: Walt Heinecke Contact Name: Walt Heinecke

Address: [redacted] Charlottesville, VA [redacted]

Name of On-Site Event Contact: Walt Heinecke Cell Telephone No.: [redacted]

Street Closing: Will be determined by Charlottesville Police Department

No City Street may be closed for any demonstration or special event, unless done so pursuant to a permit issued by the City
pursuant to Sec. 28.5 of the City Code. To inquire about Street Closing barricades contact the City Traffic Shop at 970-
3362 for assistance.

Amount Due: Payment Due Date:
Amount Security Deposit: $ Payment Due Date:
All checks should be made payable to Charlottesville Recreation & Leisure Services (P.O. Box 911, Charlottesville, VA 22902).
Security checks should be separate from the event fee payment. Security payments will be returned following the close of the
event providing the sponsor has met all criteria.

Insurance/Permits Required:
Special Event Liability Insurance
The Sponsor of a special event shall furnish a general liability and property damage insurance contract insuring the Sponsors
liability for personal injury and death and damages to property resulting from its use of public property. If alcohol is to be
served or sold in connection with the event, then the required insurance shall cover liability specifically in connection with that
activity. The required general liability and property damage insurance shall be provided in an amount not less than
$1,000,000, and the insurance policy shall name the City (including its officers, officials, employees and agents) as an
additional insured party to the insurance contract. Failure to provide required insurance, and documentation of the insurance,
will be grounds for denial and/or revocation a permit.

ABC Permit
Must be obtained from the State Alcohol & Beverage Commission. Copy must be provided to Recreation & Leisure Services at
time of event payment. Original ABC Permit must be posted for public view.

Permit To Allow Vehicular Access To Mall

To be approved by Charlottesville Department of Neighborhood Development Services with copy to Recreation & Leisure


No food or food items may be distributed or provided to participants without obtaining a Temporary Food Permit from the
Thomas Jefferson Health District-Environmental Services Division. This is a State requirement. Food Permits must be posted
for public view unless otherwise requested by State Health Department.


Event Equipment:

#___ TABLES # ____ Tents #__11_ Canopy #____Booths Other:

Public Utilities (Electricity):

Sponsors of events that take place at the Downtown Amphitheater are permitted to use public utilities (Electricity) if
requested. A fee is charged for utility services provided at the Amphitheater venue. Special Events not held at the
Downtown Amphitheater are not permitted use of public utilities.

Time of Day Restrictions:

No demonstration or special event shall be permitted in any park during hours that park is otherwise closed to the public,
except that activities may be permitted in McIntire Park through 12:00 midnight (C.Ref. 18-1 City Code: hours for
Remaining in City Parks oar recreation facilities.
Between March 1 and November 30 each year, no special event shall be scheduled to take place in Central Place, on the
Downtown Pedestrian Mall, during the hours of 11:30 a.m. to 2:00 p.m. and 5:00 p.m. t 8:00 p.m., if such event will
involve noise or amplified sound.
Under no circumstances will any special event involving noise or amplified sound be permitted to take place in Central
Place, on the Downtown Pedestrian Mall between 12:01 a.m. through 9:00 a.m. on any day of the year, except on
January 1.
No community event or special event shall be scheduled to take place in Emancipation Park between 11:00 a.m. and
1:00 p.m. on any Sunday.

Event Rules:

Participants must adhere to all Zoning laws prohibiting blocking of fire lanes, vehicular or pedestrian traffic
All special events shall be conducted in compliance with all applicable City, State and Federal laws.
Your organization shall hold harmless and indemnify the City, its officers, employees and agents against
injury, loss or damage occurring as a result of the demonstration or special event.
Your organization will be required to reimburse the City for any other necessary City personnel labor or
services in preparation for, during and immediately following the event.

Special Circumstances:

Setup has been approved to begin at 8am and breakdown must be completed by 8pm.
Demonstration will begin in McGuffey and Justice Park at 9 a.m. and end at 7 p.m. on Saturday, August
12, 2017.
No vehicles are permitted in the park under any circumstances. All Equipment must be walked to and from
Emancipation Park.
Any damage to park shrubbery, flower beds and or trees resulting from your organizations special event
will require reimbursement for any repairs and or replacement.
3-4 10x10 pop up canopy has been approved for this event at each location. All tents will need to be
properly secured. Reminder no stakes are allowed to be used at McGuffey Park due to irrigation system.
No rain date has been requested or approved for this event.
No city services or equipment has been approved for this event.
Use of electricity and water has been approved for this event. Keys to access these utilities must be
returned on Monday, August 14 to Ron Nolan.

Approved By: Michelle S. Christian Date: July 31, 2017
Title: Business Operations Supervisor

For Information Please Contact our Parks & Recreation Customer Service Representatives at 970-3260


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