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2. Block Party Permit Request Form

   Please complete the information below. A Town representative will contact you regarding availability. Requests must be received at least 4 weeks in advance of the date requested in order to be accommodated. Prior to submitting a request, you must make contact with residents affected by the blocking and all parties must be in agreement and have no objection to the blocking. We suggest you contact your HOA for their permission as well. 

   This permit application is to be used for the gathering of neighbors on a block, not individual private parties. A sketch of the segment of street that is planned to be used for this event, showing the streets that will be blocked and addresses affected by the street closure, is required.

4. Fees
   • Block Party Permit Fee: $25
   • Barricade Damage Deposit Fee: $100 (per pair of barricades)
     • The Town’s Engineering Department requires at least one pair of barricades per block party.
     • The $100 Damage Deposit Fee is REFUNDABLE if no damage to the barricades occurs.
   • Cone Rental Fee: $25
     • Includes a set of 10 cones. One set of 10 cones will be delivered to the Block Party.

   TOTAL BLOCK PARTY FEES: $150 (with the possibility of $100 being refunded providing there is no damage to the barricades that are delivered)

   
   

   It is the responsibility of the party pulling this permit to assure that all affected streets are properly barricaded. Public Works will provide barricades for the event; they will be placed on/near the street corners before your event so you can put them in place when you’re ready for the street to be closed. You will be responsible for placing the barricades in the same place when event is over. Emergency access must be maintained at all times. 

   Payments and deposits can be made by calling 720-382-5500 with credit card information or coming into Admin Services at 311 Fifth St, Frederick, CO 80530 and paying with check, credit card or cash. You may also mail a check to PO Box 435, Frederick CO 80530. 

6. First Name*
7. Last Name
9. Address1*
11. City*
12. State*
13. Zip*
15. Phone Number*
16. Email Address*
18. Date Requested*
    Date Requested
19. Start Time*
    Start Time
20. End Time*
    End Time

21. (All events must end at dusk, due to safety concerns) 

23. Upload Sketch of Street Segment*

    A sketch of the segment of street that is planned to be used for this event, showing the streets that will be blocked and addresses affected by the street closure, is required.

25. Please check each section showing that you acknowledge and agree to the requirements. *

    1. A Block Party Permit is required for blocking or barricading any Town-owned right-of-way, for the purpose of neighbors gathering. Private, individual parties do not qualify for this permit. There is a cost of $150.00 for the permit and rentals.
    2. Prior to submitting a request, you must make contact with residents affected by the blocking and all parties must be in agreement and have no objection to the blocking. We suggest you contact your HOA for their permission as well.
    3. Requests submitted to the Town will be sent to the appropriate departments within the Town as well as the Frederick-Firestone Fire Department for their approval. Requests must be approved by all affected departments before a permit is issued.
    4. Refunds will be given only if the Town receives a cancellation notification 14 days in advance of the reservation. In the event of inclement weather, no refunds will be given, but you may choose another date, that will have to be approved by all departments.
    5. It is the applicant’s responsibility to obtain and set up barricades at the streets intended to be used for this event. These barricades must conform to the Manual of Uniform Traffic Control Devices standards. Public Works can provide barricades for the event that meet Manual of Uniform Traffic Control Devices standards. The applicant may also rent barricades from a local rental company, if they so choose. The applicant is responsible for setting up and taking down all barricades. All barricades
    6. All public rights-of-way and facilities must be cleaned of any and all debris and garbage after the event; if the area is not returned to the original condition, the Town may charge you for clean up fees. If the barricades are damaged upon return, you will be responsible for the cost of replacing the barricade for the Town.
    7. If you have any issues with barricades or the public-owned area, please call the Public Works Department at 720-382-5800 (M-F, 7am-4pm)
    8. Public consumption of alcohol within the public right-of-way is not permitted under the Frederick municipal code. Violators will be ticketed and required to appear in the municipal court.
    9. Event must conclude by dusk, unless written consent is given.

27. By signing below, I/we hereby acknowledge that I/we have received a copy of the Frederick Block Party Rules and Regulations, and that I/we have read and fully understand the content. I/we release the Town of Frederick from and agree to save and hold harmless, defend and indemnify the Town of Frederick from all claims and damages or liability of any kind that may result from my/our performance of services or use or occupation all Public Rights-of-Way, including claims alleging negligence or other wrongful acts or omissions of the Town. I/we agree that neither the Town of Frederick, nor any of its officers, agents, volunteers, assistants, or employees shall be held responsible or made subject to any claims, including any claim for negligence, seeking to assess damages or liability for or arising from personal injury or property damage to self or others in attendance during the use of the Public Rights-of-Way. I/we release and agree to save and hold the Town of Frederick harmless for any claims for damages to myself resulting from suspension, revocation or modification of the permit. 

29. First Name*
30. Last Name*
31. Date*
    Date
33. Town Staff Approval Signature

    For Internal Use Only

34. Approval Date - For Town Staff
    Approval Date - For Town Staff

    For Internal Use Only

Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field