Name of Event: _______________________________________________________
Date(s) of Operation: _________________________________________________
(Note: Events that are 3 days or longer have special requirements. Please contact the Health Department for details.)
Location of Event: ___________________________________________________
(Street) (City)
Event Sponsor/Organizer: ___________________________________________
CO Dept. of Revenue Acct. Number: __________________________
Contact Person (for event review): ___________________________________
Phone: _________________________
______________________________
(Day)
(Night)
Contact Person (at event site): ______________________________________
Phone: _________________________
______________________________
(Day)
(Night)
Pursuant to CRS 25-4-1607, Larimer County will assess a fee of $30.00 per hour for the actual costs of services provided. An invoice will be prepared by this Department and submitted to the event coordinator. Fees will be due at the completion of the event.
Estimated fees for this event are __________________________________.
_______________________________________
(Signature)
_______________________________________
(Title)
________________________________________
(Date)
Please complete the following information.
Provide a proposed layout of the event site on a separate sheet of paper.
Projected Attendance: ______________________________
Number of Food Booths: ______________________________
Company to be used for trash pick up: ______________________________
Phone: _________________________________________________________
Supplier for Portable Toilets: ________________________________________
Phone: _________________________________________________________
Number of Toilets Supplied: ___________________________________
Emergency Services: ________________________________________________
Phone: _________________________________________________________
Potable Water Supply: _______________________________________________
Will a receptacle for waste water be provided? _____ Yes _____ No
Will a refrigerated truck or other holding facility be provided at the event site?
_____Yes _____ No
If yes, indicate supplier or source of refrigeration and holding capacity. _____________________________________________________________
Will ice be supplied for vendors’ use? _____ Yes _____ No
If yes, indicate supplier. _______________________________________
What steps have been taken to ensure that adequate power will be supplied for vendors’ equipment?