This is NOT the application for business with a permanent physical location. This is for special events taking place in Orem City limits.

Catetory Indoor Outdoor Both Type First-time Application Repeat Application Application Amendment

SECTION I: Event Organizer Information
Applicant		Contact Phone
A. Event Name 'DBA'
B. Mailing Address	Street (include unit #) /PO Box Address / City,State,Zip
C. Web Site

SECTION II: Event Description - General
D. Event is	For ProfitFor A Non-Profit
E. Street Address(s)
F. Date(s)/ Hours(s)	Start Date Start Time End Date End Time
G. What description best     fits the proposed events?	Running    Walking    Biking    (Mark the ones apply) Other
H. Anticipated Attendance
I. number of Vendors (if applicable)
J. Location of Parking
K. This Event will Most    Likely Recur	At the same time each year Never-One-time only Multiple times during the year Other
L. This Event Takes Place     In or On	Licensed business property City Park UVU Land Other private property Other City property/Street (Mark the ones that apply)
M. The following U.D.O.T.     Land would be Used     or Crossed	State Street 800 North Center Street University Parkway (Public Safety Officers/or barricades are required if the event uses any roadway or crosses any intersection.)
N. Other Utah County     Communities Physically     Affected	Not Applicable
O. This Event Includes	Barricades YesNo Portable toilet facilities YesNo Outdoor amplified sounds YesNo Live entertainment YesNo Temporary Power YesNo Temporary structures YesNo Use of City Park or building YesNo Use of roadway YesNo Crossing at least one intersection YesNo
P. Toilet Facilities Location(s)	PortableFixed

SECTION III: Event Description - Specific

SECTION IV: Event Organizer/Event Officers
Event Organizer/Business		Contact Phone
State Entity Type	Sole ProprietorshipPartnershipLLCCorporationNon-Profit Corporation (w/501(c)(3)
Event/Business Officer		Owner Local Manager Employee Volunteer
Officer Information	Contact Phone Address Street (include unit #) /PO Box Address / City,State,Zip SSN   Date of Birth   Driver Lic. # Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming This person can be contacted during the event or after-hours by police, fire, or any other City department.
Other Officers	Other Officer?

SECTION V: Event Insurance Information
Carrier		Contact Phone
Address	Street (#include unit #) /PO Box Address / City,State,Zip
Policy Information	Number # Limit Coverage Date

SECTION VI: Beneficiary Information (If the event benefits a registered non-profit corporation by a for-profit organization)
Beneficiary organization		Contact Name
Mailing Address	Street (#include unit #) /PO Box Address / City,State,Zip	Contact Phone
Web Site

SECTION VII: Additional Notes (Optional)

SECTION VIII: Notifications and Verification of Authority

1) Mandatory review process - This application does not constitute a license. All applications are subject to a review process. Decisions on special event applications take approximately 30 calendar days from the submission of a complete application.

2) Denial of License - Application denial is most often the result of: (i) an inaccurate or incomplete application, and/or (ii) non-compliance with the Municipal Code, the Land Development Code, and/or applicable building, fire, and environmental codes.

3) Other regulatory bodies It is the applicant’s responsibility to determine and comply with any requirements from other regulatory agencies. Issuance of a City of Orem license indicates compliance with requirements specific to the division of Public Safety, and not those of any other agency.

4) Signage - Consult with the division of Planning and Zoning prior to making event signage arrangements.

5) Incomplete applications - - Incomplete applications will not be processed.

SECTION VIIII: Fees/Charges
Application Fee	$50.00 Non-refundable	Clean up Deposit	$200.00   Waive Deposit Fee
Credit Card Information Charge Amount Card Number   Expiration Date e.g. 1203

SECTION X: Upload Supporting Document(s)

An event activity map is normally required. However, you can also upload other support documents as well. (Upload first before you hit Submit button)

SECTION XI: Your Contact Email Address

This will be the email address we use to inform you the progress of your application.

I affirm that: (i) I am an authorized agent of the entity over the event or business for which application is being made, and (ii) the information on this form and on all application materials is both complete and accurate to the best of my knowledge. I also certify that I have read and understand Orem ordinance 12-8.

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