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Form Download

Please Note that in order to submit this application electronically, Adobe Acrobat must be installed and the application must be either completed in Internet Explorer or within the Adobe Acrobat program itself. Otherwise, please print the application and email the completed application to Jobalena.Yates@azdoa.gov or mail it to 1840 W Jackson, Phoenix AZ, 85007.

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Solicitation and Special Events Permit Application

This application accompanies a Solicitation and Special Event Handbook. Permits may not be issued more
than 60 days prior to the event. The payment of fees does not guarantee event approval.

Date of Application *

Month

Day

Year

Permit Application #: (For office use only)

This is an application for a: *

Special Event in accordance with A.A.C. Title 2, Chapter 11, Article 4

Solicitation in accordance with A.A.C. Title 2, Chapter 11, Article 3

Section 1

Applicant Information

Name of Applicant (must be on site during the event) *

Driver’s License Number

State

E-Mail Address for Correspondence *

Phone number *

Business Address

City

Corporation/Organization Name (D.B.A.)

State of Incorporation

State tax ID #

501(c)3 # (if applicable)

City Sales Tax ID #

Have you ever coordinated/promoted another event(s)? If yes, please provide the following:

Yes

No

Last event

Location

Date

Month

Day

Year

Contact Name

Contact Phone #

Section 2

Event Information

Name of Event *

Anticipated Daily Attendance *

Event Date(s) *

Set-up Date and Hours

Hours of Event Each Day (begin and end times)

Take Down Date and Hours

E-Mail Address for Public Information

WEB Address for Public Information

Location of Event/Physical Address

Sponsor(s) of the Event

Description of Event *

Has this event been held in another location? If yes, please provide the following:

Yes

No

Last Event(s)

Location

Date

Contact Name

Phone #

Section 5 – Use of State Utilities

Will any State electric hookups be used?

Yes

No

Electric Location, including amperage

Will any State water hookups be used?

Yes

No

Water Location(s)

Will waste water/gray water be generated?

Yes

No

If so, how will it be disposed?

Section 6 – Event Security

Number of personnel:

After reviewing the event application, you may be required to use Off-Duty DPS Capitol Police Officers for the event.
To schedule Off –Duty DPS Capitol Police Officers, please contact:
Lisa Reyna, via email LReyna@azdps.gov, or phone (602) 223-2816; or
Brandy Reissner, BReissner@azdps.gov, or (602) 223-2855

Are you using off-duty Police officers?

Yes

No

Are you using private security?

Yes

No

Number of personnel

The State allows only security companies that are licensed and bonded in the State of Arizona.

Security Company and Contact Info.

AZ Dept. of Public Safety ID#

Section 7 – Emergency Medical Services

Are you providing off-duty EMTs?

Yes

No

Number of personnel requested

Applicants may be required to provide off-duty EMT’s or paramedics for the event. ADOA GSD will notify the applicant of such a requirement after reviewing the event application.

Section 8 – Facility/Park Maintenance

What is your trash removal and clean-up plan?

Volunteers Or Outside refuse company

Company Name

Contact Name/Phone

The following are guidelines, in conjunction with rules in Title 2, Chapter 11, Article 4, for safety when utilizing State Property. By submitting this signed application for approval, Applicant of the special event agrees to follow the following guidelines. NOTE: The following guidelines address ADOA GSD management of Solicitations and /or Special Events on state property, and are not all inclusive. Appropriate authorities should be consulted for further information regarding applicable standards for supporting activities/requirements.

1.All costs for containers, dumping and removing, are the responsibility of the applicant/promoter. The Wesley Bolin Plaza must be returned to its original condition and all equipment removed based on permitted time frame or daily rental fees will be assessed. The State Capitol Grounds and/or the Wesley Bolin Plaza Property, including all State buildings and parking lots, shall be litter free and policed during the date(s) of the special event. This shall be done according to the Arizona Department of Administration’s specifications. The Applicant agrees to an inspection by State representatives of the Sections secured for the special event. Applicant further agrees to accept liability for documented problems and will pay for any damages or costs associated with cleanup identified by State representatives, including ADOA or DPS Capitol Police. Documentation will be in writing and/or pictures, and will occur during the post special event inspection.

2.All activities shall be performed in compliance with the ADOA Solicitation and Special Events Handbook, federal, state, and local laws, ordinances, statutes, rules, and regulations, including OSHA.

3.Prior to the special event, DPS Capitol Police and/or local emergency personnel (police, fire) shall be notified of the special event.

4.Applicant is responsible to ensure that emergency vehicles will have access at all times, including ten (10) foot wide lanes of ingress and egress.

5.Applicant shall provide first aid facilities at the special event.

6.Periodic safety checks may be made throughout the special event by DPS Capitol Police or Special Events personnel.

7.Applicant shall coordinate traffic control and parking prior to the special event with DPS Capitol Police and the State’s Office of Special Events.

8.All incidents involving injury or disturbance of the peace shall be reported to DPS Capitol Police and the Office of Special Events, investigated for cause, and unsafe condition(s) shall be eliminated immediately.

9.Applicant may be required to provide additional security as determined by DPS Capitol Police and/or Office of Special Events for the safety of the attending public.

10.Office of Special Events may perform safety inspections on all concessions and exhibits prior to the special event.

11.Applicant shall ensure electrical service/lines are in accordance with the applicable State and City Codes.

12.No flammable liquids, fireworks, or compressed gases shall be used at the special event without prior approval from the Office of Special Events.a.Applicant shall ensure fire extinguishers are on site at all special events where flammable liquids or fireworks are in use.b.If approved for use, and otherwise allowed by law, flammable liquids, fireworks, and compressed gasses shall be controlled and stored in accordance with all applicable State and City Codes.

13.Applicant shall ensure tripping hazards are eliminated.

14.Applicant shall ensure trash/waste disposal is provided throughout the special event.

15.Erection of tents and canopies shall conform to manufacturer's recommendations for anchoring and safety requirements. Additional permitting may be required from the Fire Authority Having Jurisdiction. Please refer to the International Fire Code (2003 Section 105 Permits).

Section 9 – ADA Accessibility Requirements

Parking
Existing Lots: When lots are used for activities other than parking, accessible spaces must be kept open and usable. If not possible, the same number of spots must be provided as close as possible to original spaces and/or main event site.

Temporary lots: Accessible spaces must be created and held in reserve for people with disabilities, laid out in accordance with standards, marked with the accessibility symbol, and connected to the closest accessible route.

Accessible Routes
Accessible routes must connect event site features, including parking, exhibits and activities, and public amenities.

Portable Toilets
A minimum of 5%, but never less than 1%, of portable toilets shall be accessible.

The Arizona Department of Administration complies with the Americans’ With Disabilities Act of 1990. In contacting ADOA to request a State Property Permit Application for special events in Wesley Bolin Plaza, persons with a disability may request a reasonable accommodation, such as a sign language interpreter, by contacting the Arizona Office of Americans with Disabilities, Voice Telephone at (602)542-6276, or TDD Telephone Number (602)542-6686. Requests should be made as early as possible to allow time to arrange the accommodation.

Section 10 – Terms and Conditions

The Applicant (aka Sponsor) by agreeing to stage a special event on State Property (hereinafter known as “STATE PROPERTY” or “SP,” hereby expressly agrees to the following Terms and Conditions:

1.Applicant agrees to provide accurate information concerning Sections 1-9 above, and abide by all conditions therein.

2.Timely payment of associated fees.

3.Scheduling special events on SP is handled in such manner that the minimum amount of degradation to State Facilitiesand the minimum infringement of use to the general public and government operation is caused. TheArizona Department of Administration, Office of Special Events shall confirm special events only after approval.

4.Any such authorization shall include provisions to protect the State from costs due to special event operations, cleanup, or damage repair. The STATE PROPERTY will be inspected at the conclusion of each special event. Anydamage incurred as a result of the special event will be documented by the Office of Special Events or theirdesignee. The Office of Special Events will then invoice the sponsoring group/organization for payment.

5.Alcoholic beverages are strictly prohibited on ADOA managed STATE PROPERTY, pursuant to A.A.C. R2-11-102.

6.Additional lighting for special events during the evening may be required. All costs will be the responsibility of thespecial event Sponsor(s).

7.Additional security personnel may be required. All costs will be the responsibility of the special event Sponsor(s).Special events Sponsor(s) must coordinate all security issues through DPS Capitol Police (602)542-0362.

8.All Certificates of Insurance shall be received by OSE 15 days prior to the special event. OSE reserves the right torequire additional insurance be secured in accordance with this provision based on the type of special event being held.

9.The Applicant shall designate a representative to work with the Office of Special Events prior to and throughoutthe special event date(s).

10.The State of Arizona, Department of Administration, reserves the right at all times to immediately remove or cause tobe removed any and all items of display it determines: would damage STATE PROPERTY; cause the State discreditor harm; or inhibit egress or raise safety issues of the STATE PROPERTY, attendees, or the public.

11.The Applicant shall be responsible for furnishing all necessary labor, material and equipment.

12.A special event is not considered scheduled or approved until the Applicant has received a Permit from the Office ofSpecial Events as confirmation of reservation.

13.Any applicant denied use of STATE PROPERTY for reasons other than conflicting dates of special events or incomplete application may appeal directly to the Director of the Department of Administration within 30 days.

Section 11– Indemnification Requirements

SOLICITATION and SPECIAL EVENT INDEMNIFICATION
INDEMNIFICATION HOLD HARMLESS CLAUSE:

PROFIT / NON-PROFIT
To the fullest extent permitted by law, applicant shall defend, indemnify, and hold harmless the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees (hereinafter referred to as “Indemnitee”) from and against any and all claims, actions, liabilities, damages, losses, or expenses (including court costs, attorneys’ fees, and costs of claim processing, investigation and litigation) (hereinafter referred to as “Claims”) for bodily injury or personal injury (including death), or loss or damage to tangible or intangible property caused, or alleged to be caused, in whole or in part, by the negligent or willful acts or omissions of Applicant or any of its owners, officers, directors, agents, employees or vendors. This indemnity includes any Claim or amount arising out of or recovered under the Workers’ Compensation Law, or arising out of the failure of such Applicant to conform to any federal, state or local law, statute, ordinance, rule, regulation or court decree. It is the specific intention of the parties that the Indemnitee shall, in all instances, except for Claims arising solely from the negligent or willful acts or omissions of the Indemnitee, be indemnified by Applicant from and against any and all Claims. It is agreed that Applicant will be responsible for primary loss investigation, defense and judgment costs where this indemnification is applicable. In consideration of the award of this permit, the Applicant agrees to waive all rights of subrogation against the State of Arizona, its officers, officials, agents and employees for losses arising from the work performed by the Applicant for the State of Arizona.

Applicant / Vendor is a Profit/Non-Profit

By typing your name here, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.

Applicant Signature *

Date

Month

Day

Year

OR

PUBLIC ENTITY
Each party (as “Indemnitor”) agrees to defend, indemnify, and hold harmless the other party (as “Indemnitee”) from and against any and all claims, losses, liability, costs, or expenses (including reasonable attorney’s fees) (hereinafter collectively referred to as “Claims”) arising out of bodily injury of any person (including death) or property damage but only to the extent that such Claims which result in vicarious/derivative liability to the Indemnitee, are caused by the act, omission, negligence, misconduct, or other fault of the indemnitor, its officer, officials, agents, employees, or volunteers.

Applicant / Vendor is a Public Entity

By typing your name here, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.

Applicant Signature *

Date *

Month

Day

Year

Section 12 – Certification

I hereby certify that the statements made in this application are true and complete to the best of my knowledge, and that I am authorized to execute the application. Intentional omissions or falsification of information is sufficient grounds for denial of the application and subsequent revocation of the permit. I agree to defend, indemnify and hold harmless the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees from any and all losses, claims, liabilities, damages, costs and expenses, including reasonable attorney’s fees and court costs, resulting from any facility closure due to inclement weather. I also understand that the State reserves the right to determine if park facilities are unusable as a result of inclement weather. I realize my submittal of this application request constitutes a contract between the State of Arizona and myself and is a release of Liability. I agree to abide by all terms and conditions of this application.I have read the ADOA Solicitation and Special Events Handbook and agree to conform with the handbook.I agree to abide by all state, county and federal laws and regulations.I am the said applicant and submit this application request on my own free will.

By typing your name here, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.

Applicant Signature *

Date *

Month