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Special Event Permit

  1. Application Fee
    A $50 application fee is due with the application. Proof of liability insurance should accompany this application; no permit will be granted until proof of insurance has been submitted.
  2. Include address or name of the city facility or park. If the event requires a broad area, describe the area and include street names that border the area. A site plan for the event may be attached. For road races, please include proposed race route.
  3. The proposed event is:
  4. The purpose of the event is:
  5. Please check all items that would apply to your event as proposed:
  6. Signature of Applicant implies express agreement in compliance with all federal, state, and local laws.
  7. By signing this application, Applicant acknowledges understanding of the following provisions:
    • Applicant shall provide for the collection and removal of all trash, garbage, and litter caused by or arising out of the special event.
    • The City may impose a service fee for any clean-up costs incurred by the City as a result of the event.
    • The City may impose a service fee for any personnel costs related to the provision of security, traffic control, public safety, or general maintenance required for the special event.
    • The City may impose a usage fee for any utility services provided for the special event.
    • Applicant shall provide for portable restroom facilities if deemed necessary by the City.
    • Applicant shall secure any additional permits for operations or activities related to the event, including but not limited to public health permits, temporary occupancy permits, or permits for temporary structures.
    • Applicant agrees to hold the City of Xenia, its employees, agents, servants, boards and commissions harmless from liability arising from the issuance of the special event permit and from the conduct of the participants of the event or any vendors or subcontractors associated with the event. Applicant indemnifies the City of Xenia, its employees, agents, servants, boards and commissions against all claims of injury or damage to persons or property caused by the negligent acts of the applicant.

    Applicant agrees that he/she is the primary contact person in charge of the special event; and, at the time application is made, Applicant has submitted proof of liability insurance coverage for the special event or adequate liability coverage for the organization sponsoring the special event.
  8. This permit has been issued in accordance with #1062.21 of the Xenia Codified Ordinances subject to revocation or suspension for cause and is not transferable. A copy of this permit is provided for the applicant/organizer; the original is on file with Xenia City Manager's Office.
  9. Leave This Blank:

  10. This field is not part of the form submission.