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Special Event Permit

2. Name (First and Last)*

3. Organization/Company Name*

5. Email Address*

6. Cell Phone Number*

8. Address*

10. City*

11. State*

12. Zip Code*

14. Organization Type*

    Please select one

    1. Roosevelt Island Youth 501(c)
    2. Roosevelt Island Youth
    3. Adult Group with less than 25 people
    4. Non Profit 501(c)
    5. For Profit (fees collected)
    6. Individual-Private Event
15. Event Type*

    Please describe the type of event you would like to hold. ie. wedding, corporate softball game, company picnic

17. Event Location and Address*

    Please provide the name of the location with address of the space you would like to rent. ie, Southpoint Park, Good Shepherd Chapel

18. Event Layout Diagram

    Please upload a diagram of your event layout.

20. First Choice- Event Date and Start Time *
    First Choice- Event Date and Start Time

    First Choice- Event Date and Start Time

    Start times must include set up time.

21. First Choice- Event Date and End Time*
    First Choice- Event Date and End Time

    First Choice- Event Date and End Time

    End time must include breakdown time.

23. Second Choice- Event Date and Start Time*
    Second Choice- Event Date and Start Time

    Second Choice- Event Date and Start Time

    Start times must include set up time.

24. Second Choice- Event Date and End Time
    Second Choice- Event Date and End Time

    Second Choice- Event Date and End Time

    End time must include breakdown time

26. Total number of participants/spectators/attendees*

    Please estimate your expected attendance for the event.

27. Will you be charging your attendees or spectators?*

29. Will your group need access to and/or provide any of the following?*

    Select all that apply. RIOC may not be able to supply all of the items below. RIOC will let the permittee know what items they will need to provide.

    1. Catered Food
    2. Amplified Sound
    3. Electricity
    4. Tables and Chairs
    5. A/V Set Up (projector and screen)
    6. ADA-Cart Services
    7. N/A
30. Do you have valid event liability insurance?*

    1. Yes
    2. No

32. Will you need parking for your event's production or setup/breakdown?*

    1. Yes
    2. No

33. If yes, please list the all vehicle types and what they will be used for?

37. Insurance

39. Certificate of Insurance

41. RIOC Insurance Requirements
    All permit applicants must provide a certificate of liability in the amount of $1 million in general liability per occurrence. Roosevelt Island Operating Corporation must be listed as the certificate holder. New York State, New York City, Empire State Development Corporation, and Division of Housing and Community Renewal must be listed as additional insured on the certificate.

    All permit applicants must provide a certificate of liability in the amount of $1 million in general liability per occurrence. Roosevelt Island Operating Corporation must be listed as the certificate holder. New York State, New York City, Empire State Development Corporation, and Division of Housing and Community Renewal must be listed as additional insured on the certificate.

45. 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.
47. Electronic Signature

Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

* indicates a required field