122 East 3rd Street
City of Papillion Papillion, NE 68046
FACILITY USE & EVENT PERMIT APPLICATION Phone: (402) 597-2021
Fax: (402) 339-0670
INFORMATION PROVIDED ON THIS FORM WILL BE VERIFIED. INACCURATE OR INCOMPLETE
RESPONSES MAY RESULT IN THE DENIAL OF A PERMIT. ONE APPLICATION PER EVENT. IN ADDITION TO
THE APPLICATION FORM, YOU SHOULD REFER TO PAPILLION MUNICIPAL CODE CHAPTER 146 CONCERNING
FACILITY USE AND EVENTS AND THE CITY OF PAPILLION MASTER FEE SCHEDULE PERMIT FEES. IF YOU HAVE
QUESTIONS, CONTACT THE CITY CLERK AT 402-597-2021.
APPLICANT INFORMATION:
FULL NAME OF APPLICANT:
NAME OF EVENT ORGANIZER/PRODUCER: TITLE:
PRODUCTION COMPANY/ORGANIZATION FEDERAL TAX ID or SOCIAL SECURITY # :
STREET ADDRESS: APT/ UNIT/ SUITE:
CITY: STATE: ZIP CODE
E-MAIL ADDRESS:
DAY TIME PHONE: FAX: CELL PHONE:
EVENT SPONSOR: Are you, the applicant, organizing this event on behalf of another organization? (Please check YES or NO below)
YES NO Name of Organization: .
ADDITIONAL DOCUMENTATION REQUIRED: If you checked “yes” above, please submit an endorsement letter from the organization (on
their official letterhead) on whose behalf you are organizing this event.
NAME OF SPONSORING ORGANIZATION CONTACT: SPONSORING ORG. CONTACT PHONE:
ADDRESS OF SPONSORING ORGANIZATION: CITY: ZIP CODE:
EVENT INFORMATION:
EVENT NAME:
1st CHOICE PARK LOCATION: DATE(S):
2nd CHOICE PARK LOCATION: DATE(S):
ADDITIONAL INFORMATION REQUIRED: If your event includes multiple days and/or varying times, please attach a schedule.
# of Minors and their role: _____________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
FACILITY USE & EVENT APPLICATION
122 East 3rd St. Papillion, NE 68046 Phone (402) 597-2021 Fax (402) 339-0670 www.papillion.org
EVENT DESCRIPTION: Please check what type of event this is: (Check ALL that apply)
Walk/Fun Run (untimed) Race/Timed Run Sailing/Water Activity
Art Fair/Festival Public Rally/March Concert/Performance/Service
Bike Ride Cultural Event Other ___________________________________________
*Please provide a detailed description of your event. Document(s) with this information or other materials describing this event may be attached.
FOR ALL WALKS, RUNS, RACES OR OTHER ACTIVITIES IN WHICH PARTICIPANTS WILL BE FOLLOWING A COURSE:
Walk/Run/Race events will only be considered for approval if they are contained within the park trail system. A permit does not give the event organizers exclusive
use of the park. Public patrons will always have full access to the park.
What is the start time for your walk/run/race or other activity? (If you are having multiple walks/runs/races, please provide the type of event with the start time of
each walk, run, and/or race.)
EVENT SET-UP DATE(S): SET-UP TIME(S):
From: To:
EVENT TEAR-DOWN DATE(S): TEAR-DOWN TIME(S):
From: To:
NUMBER OF PARTICIPANTS: ESTIMATED NUMBER OF SPECTATORS: ACTUAL TIME(S) OF EVENT(S):
From: To:
PREVIOUS YEAR DATE/LOCATION: Has this event been previously held? (Please check YES or NO)
YES Event Name: ___________________________________________________________________
NO Location: _______________________________________________Date: __________________
NUMBER OF PARTICIPANTS: Additional Documentation Required - If event is a recurring walk/run/race/event, please also submit the previous
year number of participants.
Current Year: ________ Number of Participants:_________________ Previous Year: _______ Number of Participants:____________
ADMISSION FEES, PARTICIPANT ENTRY FEES & SUGGESTED DONATIONS: Will you be collecting money in connection with this activity?
(Please check YES or NO below)
YES If yes, please describe the purpose of the collection, the place and manner in which you intend to collect the money,
and from whom you will be collecting: ____________________________________________
NO
_____________________________________________________________________________________
If you marked YES, please provide proof of a Nebraska sales tax permit, including the state tax identification number, or exemption from the state
and federal taxing authorities, if applicable.
State Tax ID #: _________________________________________
EVENT FEATURES:
All event features are subject to the approval of the City of Papillion. Additionally, certain event features such as street closures and separate
permits may be required from the City of Papillion. For information regarding City of Papillion permits, please call 402-597-2021.
ALCOHOL SERVICE: Are you requesting to sell and/or serve alcohol at your event? (Please check YES or NO below)
YES NO
Additional Information Required: If you checked “YES” above, a special designated liquor license is required by the Nebraska Liquor Control
Commission, with local approval by the Papillion City Council.
FOOD AND NON-ALCOHOLIC BEVERAGES: Are you requesting permission to sell and/or serve food and/or non-alcoholic beverages? (Please
check YES or NO below)
YES NO
Additional Information Required: If you checked “YES” above, you must comply with all state health code requirements to sell and/or serve food
and/or non-alcoholic beverages.
FACILITY USE & EVENT APPLICATION
122 East 3rd St. Papillion, NE 68046 Phone (402) 597-2021 Fax (402) 339-0670 www.papillion.org
VENDORS: A complete listing of all vendors participating in the event, including the name, address, and phone number of all the managers and
the type of business that will be conducted as well as the list of items for sale, including food, beverage(s), and other merchandise.
MERCHANDISE:
Are you requesting permission to sell merchandise? YES NO
If you checked “YES”, please provide proof of a Nebraska sales tax permit, including the state tax identification number, or exemption from the
state and federal taxing authorities, if applicable.
State Tax ID #: _________________________________________
AMPLIFIED SOUND: Are you requesting permission to have amplified sound? Amplified sound must be directed away from residences and must
comply with the City of Papillion noise ordinance. No amplified sound before 8:00 a.m. or after 10:30 p.m. without permission from the Papillion
Chief of Police. (Please check YES or NO)
YES Hours of Amplified Sound: ____________________ To: ____________________
NO Describe Sound System: ________________________________________________________
(Please describe purpose & plans for amplified sound) ________________________________________________________
________________________________________________________
Additional Information Required: If you checked “YES” above, please identify the proposed location of sound system, direction of sound and
location of speakers on your site map. A Temporary Noise Ordinance Waiver may be required, and approved by the Papillion Chief of Police.
TENTS AND CANOPIES: Will your event feature any tents and/or canopies? (Please check YES or NO below).
YES Number of Tents/Canopies: ______________________________________________
NO
Tent/Canopy Size(s): __________________________________________________
*If you have multiple
tents/canopies with ___________________________________________________
varying sizes, indicate
the number with the ___________________________________________________
corresponding size.
Additional Documentation Required: If you checked “YES” above, please indicate the number of tents with the corresponding size. A separate
document with this information may be attached. All tents and/or canopies must be indicated on the site map. The event organizer is responsible
for any damage caused to the park property/facility and must consult the City of Papillion prior to installation.
BOUNCE HOUSES/INFLATABLES: Will your event feature any bounce houses/inflatables? (Please check YES or NO below)
YES Number of Bounce Houses/Inflatables: ______________________________________
NO
Bounce House(s)/Inflatable(s) Size(s): ______________________________________
_______________________________________________
_______________________________________________
Additional Documentation Required: If you checked “YES” above, please indicate the number of bounce house(s)/inflatable(s) with the corresponding size
and description. A separate document with this information may be attached. Placement of all bounce house/inflatables must be indicated on the site map.
Location of placement is restricted and must be approved by the City of Papillion prior to setup/installation of the bounce house(s)/inflatable(s). The event
organizer is responsible for any damage caused to the park property/facility including and not limited to landscaping, grass, and irrigation systems, and must
consult the City of Papillion prior to installation. Bounce houses/inflatables must be removed immediately at the end of the event. At no time may the
bounce house(s)/inflatable(s) be left unattended by the event organizer and all manufacturer guidelines must be followed.
FACILITY USE & EVENT APPLICATION
122 East 3rd St. Papillion, NE 68046 Phone (402) 597-2021 Fax (402) 339-0670 www.papillion.org
VEHICLES: Are you requesting permission to operate vehicles on City of Papillion service roads for delivery of equipment and supplies? (Please
check YES or NO below)
YES Number of vehicles: _________________
NO Vehicle Description(s): _____________________________________________________
______________________________________________________________________
Are you requesting permission to retain vehicles on-site for the duration of the event?
YES Number of vehicles: _________________
NO Vehicle Description(s): _____________________________________________________
______________________________________________________________________
PARKING: Will your event require parking? (Please check YES or NO below).
YES Estimated Number of Vehicles: ______________________
NO Description on where the vehicles will be located during the event:____________________________
___________________________________________________________________________________
Will your event require transportation of participants/spectators from the parking lot site(s) to the event site?
YES NO Describe: _____________________________________________________________________
Additional Information Required: If you checked “YES” above, please identify the proposed location(s) of parking on your site map.
STAGES/PLATFORMS, PORTABLE TOILETS, DUMPSTERS, FENCING, BARRICADES AND OTHER STRUCTURES
If you are planning to erect, install, or use any of these structures, please describe below and identify the locations of all structures on your site
map. Include sizes and quantities of individual structures.
STAGES/PLATFORMS: Will your event include the installation of stages/platforms? The location of the stages/platforms must be identified on
the site map and approved by the City of Papillion. (Please check YES or NO below).
YES Number of Stages: _____________
NO Stage(s) Description(s): ___________________________________________________________________
PORTABLE TOILETS: Will your event include the use of portable toilets? (Please check YES or NO below).
YES Number of Portable Toilets: _________ AND Number of Accessible ADA Portable Toilets:__________
NO Descriptions: _____________________________________________________________________
Additional Documentation Required: If you checked “YES” above, please clearly indicate the location and the number of portable toilets on the
site map. All portable toilets must be removed from City of Papillion property within 48 hours of event (i.e., if event is on a Saturday or a Sunday,
portable toilets must be removed that following Monday). The locations must be approved by the City of Papillion.
DUMPSTERS: Will your event include the use of dumpsters? The location of the dumpsters must be identified on the site map and approved by
the City of Papillion. (Please check YES or NO below).
YES Number of Dumpsters: _______________
NO
Description(s): ________________________________________________________________________
FACILITY USE & EVENT APPLICATION
122 East 3rd St. Papillion, NE 68046 Phone (402) 597-2021 Fax (402) 339-0670 www.papillion.org
FENCING: Will your event include the installation of fencing? The location of the fencing must be identified on the site map and approved by the
City of Papillion. (Please check YES or NO below).
YES Description: ______________________________________________________________________
NO ________________________________________________________________________________
BARRICADES: Will your event include the use of barricades? The location of the barricades must be identified on the site map and approved by
the City of Papillion. (Please check YES or NO below).
YES Number of Barricades: _________________
Description(s) of location: ____________________________________________________________
NO
OTHER STRUCTURES: Will your event include other structures not identified above? The location of all other structures must be identified on
your site map and approved by the City of Papillion. (Please check YES or NO below).
YES Number of Structures: _______________
NO Description(s): _________________________________________________________________
______________________________________________________________________________
STREET CLOSURES OR USE OF PUBLIC WAY: Are you requesting to close off a city street for an event?
YES Description: ______________________________________________________________________________
NO _______________________________________________________________________________________
All street closures and proposed routes are to be identified on the site map and are subject to approval by the City of Papillion. For more information regarding
the closure of city streets, please contact Papillion Public Works at 402-597-2043. The City of Papillion is not responsible for any costs associated with the private
rental of barricades or road closure signs.
Is any portion of this event on a state highway?
YES Description: ______________________________________________________________________________
NO ________________________________________________________________________________________
If you checked “YES”, a separate permit will be required by the Nebraska Department of Roads.
POLICE AND/OR FIRE PERSONNEL: Will your event require any police or fire department personnel?
YES Description: ______________________________________________________________________________
NO ________________________________________________________________________________________
__________# of Police __________# of Fire
MAPS
SITE MAP: (Required for all applications)
Please attach a site map clearly indicating the set-up of your event. The site map should indicate the relative location of the following: all sources
of amplified sound and direction of sound, tents and canopies with sizes, bounce houses/inflatables with sizes, stages, promotional vehicles, porta-
ble toilets, dumpsters, trash receptacles, fencing barricades, and other structures, proposed driving paths for all equipment and supply vehicles,
location of vehicles you wish to retain on City of Papillion property during the event, locations of alcohol (in a fenced off area), food and mer-
chandise service/sale, and proposed street closures. All site maps are subject to the approval of the City of Papillion.
ROUTE MAP: (Required for only RUNS, WALKS, or other COURSE ACTIVITIES)
All run, walk, or other activities in which participants will be following a course will be required to attach a route map and a written document of
the proposed route of the event. All proposed route maps are subject to the approval from the City of Papillion. The use of any outside park-
ways or parks such as city streets, must be identified on the site map and approved by the City of Papillion. Additionally, the City of Papillion is
not responsible for any costs associated with the denial of the proposed route.
FACILITY USE & EVENT APPLICATION
122 East 3rd St. Papillion, NE 68046 Phone (402) 597-2021 Fax (402) 339-0670 www.papillion.org
SIGNATURE
I, the applicant, agree to indemnify and defend the City of Papillion, its officials, agents and employees (the “Indemnities”) against
any losses, costs, damages, liabilities, claims, suits, actions, causes of action and expenses resulting from, arising out of, or relating
to any negligence or intentional misconduct by the applicant of the sponsoring organization, its officers, employees, or any person
under its control in connection with this permit.
I do so solemnly swear (or affirm) that all answers given and statements made on this application are complete and true to the best
of my knowledge and beliefs. I have read and understand the terms and conditions outlined in this document and the terms of City
of Papillion Municipal Code Chapter 146 and the Policy Governing the Facility Use and Event Permits and agree to abide by them.
I agree to allow inspections by the Chief Building Official or his/her designee Inspector to ensure all structures comply with City
Code.
I understand that if a permit is granted, it will not be used or represented in any way as an endorsement by the City of Papillion.
Unless expressly provided for in the permit, Facility Use & Event Permit does not grant the permit holder exclusive rights to City
property, including but not limited to any right to restrict access, use, First Amendment activities of any other person on City
property, which is open to the general public.
Cancellations must be made in writing, no later than fourteen (14) days prior to the event for a full refund. Any amendments or
revisions to the original application shall be promptly provided to the City Clerk and must be made at least one (1) day prior to
the event. All requests for amendments or revisions must be made in writing and are subject to the approval of the City.
I agree to be bound by the above terms as a condition to the issuance of the Facility Use & Event Permit.
__________________________________________
NAME OF APPLICANT
__________________________________________ ____________________
SIGNATURE OF APPLICANT DATE
Thank you for completing your application. Before you submit your application to the City of Papillion,
please make sure that the following steps have been completed:
Have you:
Signed and dated your application?
Attached your event site map and/or route map?
Submitted your application 60 days prior to your event?
Provide a Copy of Certificate Liability Insurance? (Minimum coverage amounts of $1,000,000 per occurrence and $5,000,000 general
aggregate, listing the City of Papillion as additional insured)
Reserved park shelter, if applicable (Reservable Shelters: City Park, Halleck Park, Walnut Creek - Grange Shelter) Shelters may be reserved through
the Recreation Department, 402-597-2061.
Included your application fee ($250.00) or verification of non-profit status
Submit your completed application to:
City of Papillion
Attn: City Clerk
122 East 3rd Street
Papillion, NE 68046
Phone: (402) 597-2021
Fax: (402) 339-0670
FACILITY USE & EVENT APPLICATION
122 East 3rd St. Papillion, NE 68046 Phone (402) 597-2021 Fax (402) 339-0670 www.papillion.org
FOR OFFICE USE ONLY
Event:____________________________________________ Date:_______________
1. Event Permit Fee: $_______________________ or NA Total = _________________
2. City Staff Fees: (Write NA in the total column if this even does not require City staff present)
A. Parks & Rec # of Staff__________ X # of hours__________ X $35.00 per hour Total = _________________
B. Police # of Staff__________ X # of hours__________ X $60.00 per hour Total = _________________
C. EMT # of Staff__________ X # of hours__________ X $40.00 per hour Total = _________________
D. Public Works # of Staff__________ X # of hours__________ X $45.00 per hour Total = _________________
F. Other # of Staff__________ X # of hours__________ X $40.00 per hour Total = _________________
3. Fencing Installed by the City ($25/every 50 ft. ) # of feet needed_________________ or NA Total = _________________
4. Barracades/Cones: (Write NA in the total column if this event does not require any additional barricades or cones)
A. Small Barricades # of barricades: _________ X $5.00 each Total = __________________
B. Large Barricades # of barricades: _________ X $10.00 each Total = __________________
C. Jersey Barricades # of barricades: _________ X $20.00 each Total = __________________
D. Small Cones # of cones: _________ X $2.00 each Total = __________________
E. Large Cones # of cones: _________ X $3.00 each Total = __________________
5. Items to be moved: (write NA in the total column if applicant does not need any items moved)
A. Picnic Table (1 - 6 tables = $100, 7 or more tables = $200) # of tables _____________ Total = __________________
B. Bleachers (1- 3 bleachers = $100, 4 or more bleachers = $200) # of bleachers _____________ Total = __________________
C. Other : __________________________________ # of item _____________ Total = __________________
6. Other Rental Equipment: (write NA in the total column if this event does not require additional equipment rental from the City)
A. ___________________ X # of _____________________ X $_______per_______ Total = __________________
B. ___________________ X # of _____________________ X $_______per_______ Total = __________________
C. ___________________ X # of _____________________ X $_______per_______ Total = __________________
D. ___________________ X # of _____________________ X $_______per_______ Total = __________________
E.____________________ X # of _____________________ X $_______per_______ Total = __________________
Grand Total = __________________
Event Representative: ______________________________ Event Representative:___________________________________
(PRINT NAME) (SIGN NAME)
City Representative: ________________________________ City Representative:___________________________________
(PRINT NAME) (SIGN NAME)
Event organizers may also rent equipment from River City or TODCO. Event organizers are not required to rent from the City;
however, they are required to comply with all City instructions given after the review of the application.
FACILITY USE & EVENT APPLICATION
122 East 3rd St. Papillion, NE 68046 Phone (402) 597-2021 Fax (402) 339-0670 www.papillion.org
