Form Center

2. No Fee- Application

   The $50 fee for all Special Event applications is waived.

4. Name of Event*
6. Event Start Date & Time*
   Event Start Date & Time

   Event Start Date & Time
7. Event End Date & Time*
   Event End Date & Time

   Event End Date & Time
9. Set-up Date & Time*
   Set-up Date & Time

   Set-up Date & Time
10. Tear-down/Clean up END Date & Time*
    Tear-down/Clean up END Date & Time

    Tear-down/Clean up END Date & Time
12. Sponsoring Organization*
13. 501(c) Non-Profit (Check if NFP)
15. Event Coordinator*
17. Cell Phone*
18. Email Address*
20. Address*
22. City*
23. State*
24. Zip*
26. Website Link*
27. Estimated Attendance*
29. Upload Drivers License*
31. Describe Event*
33. Is this a new event in Moline?*

    1. Yes

    1. No
34. Are you charging admission?*

    1. Yes

    1. No
36. Where did the event previously occur?*
38. Is this event open to the public or by invitation only?*

    1. Open to the public
    2. Invitation Only
39. Public Events*

    1. I understand that public events require a certificate of insurance.
41. Will you be requesting funding from the Special Events Committee*

    1. Yes
    2. No
42. How much funding are you requesting?*
44. 1. Will the event attract regional visitors?*

    1. Yes
    2. No
45. 2. Will the event build a new audience for the City?*

    1. Yes
    2. No
47. 3. If this event was held previously, did it meet or exceed projected attendance?*
49. 4. Is this event likely to support local businesses?*

    1. Yes
    2. No
50. 5. Does this event generate overnight stays?*

    1. Yes
    2. No
52. 6. Is the event innovative or offer something unusual or unique?*

    1. Yes
    2. No
53. 6.a. How is this event unusual or unique? *
55. 7. Does the event include volunteer involvement, inter-jurisdictional, corporate, business and or civic organizations?*

    1. Yes
    2. No
56. 7.a. Please list all volunteer, inter-jurisdictional, corporate, business and/or civic organizations. *
58. 8. Does the event have additional funding sources supporting the event?*

    1. Yes
    2. No
59. 8.a. Please list other funding sources. *
61. 9. Is the event benefitting a non-profit or not-for-profit?*

    1. Yes
    2. No
62. List the non-profit(s) or not-for-profit(s) the event will benefit.*
66. Will a bike path, park property, or park shelter/pavilion be used?*

    1. Yes

    1. No
67. Park Use Events
    Parks Special Use Info

    Contact the Parks & Rec Executive Coordinator with questions: 309-524-2424

69. Park or space requested (Please check all that apply to this event)*

    1. Ben Butterworth Parkway (22nd - 55th St & River Drive)
    2. Browning Park (15th St & 22nd Ave)
    3. Butterworth Park (15th St & 8th Ave)
    4. East End Park (46th-48th St & 4th Ave)
    5. Greenvalley Park (48th-70th St &52nd Ave)
    6. Karstens Park (6th St & 23rd Ave)
    7. Kiwanis Park (18th St 13th Ave)
    8. McCandless Park (1st St & 7th Ave)
    9. Millennium Park (79th St & 34th Ave)
    10. Optimist Park (27th St &18 Ave A)

    1. Petersen Park (37th St & 8th Ave)
    2. Prospect Park (16th St & 30th Ave)
    3. Ralph Birks Recreational Trail (1st - 55th St along the Miss. River)
    4. Riverside Park (31st-34th St & 5th Ave)
    5. Stephens Park (7th St & 15th Ave)
    6. Stephens Square (18th St & 6th Ave)
    7. Sylvan Island (2nd St & 1st Ave)
    8. Sylvan Trailhead Park (2nd St & 1st Ave)
    9. Velie Park (11th St & 11th Ave)
    10. Wiman Park (8th St & 35th Ave)
71. Describe the exact location of the event to take place on park property:*
73. Do you plan to use a park shelter/pavilion?*

    1. Yes

    1. No
74. If yes, please provide name(s):*
76. Do you understand that alcohol cannot be sold/served on park property, as per city ordinance?*

    1. Yes

    1. No
77. Will any stages, bleachers, volleyball nets or other temporary structures be set up?*

    1. Yes

    1. No
79. What other special services are you requesting for the Moline Park and Recreation Department to provide?*
81. Will any part of the event take place at Bass Street Landing?*

    1. Yes

    1. No
82. Bass Street Landing Use Info
    Bass Street Landing Reservation

    Contact the Recreation Coordinator with questions: 309-524-2427

84. Will alcohol be sold/served on/at Bass Street Landing?*

    1. Yes

    1. No
85. Who is providing the alcohol service?*
87. Does your event use a Public Right-of-Way?*

    Examples: Street, sidewalk or parking lots

    1. Yes

    1. No
88. Public Right-Of-Way
    Special Event Policy

    Contact the Executive Coordinator with questions: 309-524-2002

90. What timeframe does this Public Right-of-Way (street, sidewalk or parking lot) need to be closed?*
    What timeframe does this Public Right-of-Way (street, sidewalk or parking lot) need to be closed? Start Date

    What timeframe does this Public Right-of-Way (street, sidewalk or parking lot) need to be closed? Start Time

    —

    What timeframe does this Public Right-of-Way (street, sidewalk or parking lot) need to be closed? End Date

    What timeframe does this Public Right-of-Way (street, sidewalk or parking lot) need to be closed? End Time
94. PLEASE CHECK ALL OPTIONS BELOW THAT APPLY TO YOUR EVENT

    Some fees will be invoiced prior to the event and others after the event. Please save the Special Event Fee Schedule for your event budget. 

96. Save the Fee Schedule for your event budget:
    Special Event Fee Schedule
98. A. Food Truck/Catering

    1. Yes
99. Food License Requirements
    Food License Information

    Public Events require all food trucks and food vendors to hold a license with the city. Contact the Environmental Health Specialist with questions: 309-524-2373
    
    

101. Estimated number of Food Trucks/Vendors?*
     -- Select One --12345678910 or More
103. Name of Business(s) / Truck(s)*
104. Location food will be served/sold*
106. B. Alcohol being sold/served

     1. Yes
107. Liquor License Information
     Special Event Liquor License Info

     Alcohol can NOT be sold/served on Park Property. 

109. C. Sale of merchandise or goods

     1. Yes
110. License can be obtained with the Finance Department, 309-524-2070
     Transient Merchant License
112. D. Bounce House(s) Present?

     1. Yes
113. Additional Insurance Required *

     I understand that a five million dollar liability policy will be required and I could be required to have a generator to power the Bounce House.  

     1. Yes, I understand these requirements for the Bounce House(s) to be present
115. E. Party Tent Use

     1. Yes
116. Water Barrels*

     Additional cost for Party Tent or other structure to be tethered by Water Barrels. See Special Event Fee Schedule. 

     1. I understand a fee is associated with Water Barrels.
118. F. Amplified Sound/ DJ Service/ Live Band

     1. Yes
119. Sound Restrictions Acknowledgement *

     Click on all to acknowledge the restrictions

     1. Sunday: 10am-11pm, Monday-Thursday: 6am-10am, Friday-Saturday: 6am-11pm
     2. Park Events: Hours for amplified sound will vary depending on park
123. Complete Location (map must be attached)*
125. Plan for event security, including barricades *
127. Expectation/Plan for emergency medical needs*
129. Event fire suppression plan*
131. Sanitation, toilets, trash and clean-up plan*
133. INSURANCE – a certificate of insurance may be required and include the following under the certificate’s Description of Operations section:
     • The event name, date(s) and location; and
     • The following language: City of Moline is an Additional Insured on the Commercial General Liability, Auto Liability and Excess Liability when required by written contract or agreement regarding activities by or on behalf of the Named Insured. This insurance is primary insurance and any other insurance maintained by the Additional Insured shall be excess only and non-contributing with this insurance. A waiver of subrogation applies to the Commercial General Liability, Auto Liability, Excess Liability and Workers’ Compensation/Employers Liability in favor of the Additional Insured. A copy of the (30) days notification of cancellation endorsement needs to be included with the Certificate of Insurance naming the City of Moline.
     • If liquor is being sold or dispensed, $1,000,000 liquor liability coverage must be included.
135. Certificate of Insurance*

     Required:

     1.  Current Certificate of Liability Insurance for Commercial General Liability coverage with limits of $1 Million per occurrence. The following statement should be included in the Description section of the Certificate of Liability Insurance.  

     Project/Event:   List name of event, date and location.
     City of Moline is an Additional Insured on the Commercial General Liability, Auto Liability and Excess Liability when required by written contract or agreement regarding activities by or on behalf of the Named Insured.  This insurance is primary insurance, and any other insurance maintained by the Additional Insured shall be excess only and non-contributing with this insurance.  A waiver of subrogation applies to the Commercial General Liability, Auto Liability, Excess Liability and Workers' Compensation/Employers Liability in favor of the Additional Insured.  

     2.  Additional Insured Endorsement page that lists the City of Moline as an Additional Insured.  

139. Submission of Documents
     • For this application to proceed, all applicable fees must be paid online or at the City of Moline Accounts & Finance Department located at 1630 8th Avenue, Moline, IL 61265.
141. All licenses and permits required herein are separate requirements. Depending upon the nature of the event, it is possible that more than one license or permit will be required and the undersigned acknowledges and understands it is his/her obligation to secure ALL necessary licenses and/or permits. The undersigned is authorized to act on behalf of the organization, and agrees to the necessary costs, insurance requirements, and other guidelines identified in the Special Event Application or any document, license, or permit referenced herein; and further agrees to provide the City Clerk with all required necessary documents, including the executed cost estimated memorandum, which will be forwarded to the Event Coordinator shortly after this initial application is completed.
143. Electronic Signature Agreement*

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

     1. I agree.
145. Electronic Signature*
147. Fee
     Application Fee Waived
149. Quantity
151. Shipping Cost
152. Taxable
Leave This Blank:


154. 1. Receive an email copy of this form.
155. Email address

     This field is not part of the form submission.

156. Submit

* indicates a required field