It will be the responsibility of the organization to provide personnel at EVERY blocked intersection to ensure that no vehicles enter or cross the designated route during the time of the closure. It will be the responsibility of the event organizer to notify all residents and businesses in the affected area of the closures. Failure to do so may result in future requests being declined. This form must be submitted not less than 45 days in advance of the event. Terms & Conditions Applications must be received not less than forty-five (45) days in advance of the event date to allow time for processing and presentation to the Board of Works for consideration. The organization shall be responsible for providing: A representative to be present at the Board of Works meeting when the application is presented for consideration Someone at every blocked intersection to provide traffic control. Any stages; reviewing stands; chairs; sound projection equipment; podiums; flags; decorations; portable restrooms; etc. – should any of these be required. The city will have barricades placed near the intersections. It will be the organization’s responsibility to set the barricades to block the intersection not more than one (1) hour in advance of the event start time. Barricades are to be pulled by the organization and returned to the curbs as soon as the last runner/unit passes the intersection. The organization will be responsible for notifying all residents/businesses along the route not less than forty-eight (48) hours in advance of the event. When “No Parking” is required, the city will have no parking signs posted not less than three (3) days in advance of the event. The city will be responsible for removing the no parking signs. Failure to comply with these Terms and Conditions may result in future requests being declined. Name of Event* Sponsoring Organization* Organization’s Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of Event:* Month Day Year End Date of Event:* Month Day Year Start and End Times* Location of Event / Route*Primary Contact Person* Telephone* Email Address* Enter Email Confirm Email Secondary Contact Person* Telephone* Email Address* Enter Email Confirm Email Event Description*City Services Requested*Streets to be Closed:Street Name Between (Street Name) Street Name Between (Street Name) Street Name Between (Street Name) From (time of start of closure) To (end time of closure) Additional InformationUpon approval, the organization must submit a Certificate of Insurance naming the City of Martinsville as an additional insured. If concessions or fund-raising activities are a part of this event, contact the City Clerk-Treasurer at 765-342-6012 regarding any necessary licensing; permits and/or additional insurance requirements.* On behalf of the applying organization, I have read the terms and conditions and by submitting this application, I and the organization accept and agree to the terms and conditions as stated.