Request For Special Street Use Form printable pdf download

REQUEST FOR SPECIAL STREET USE

CITY OF STERLING

Please attach detailed map of desired route

This application must be submitted to the City of Sterling Police Department thirty (30) days prior to the

event that necessitates street closures or traffic rerouting, such as a parade or race. A current copy of

the applicant’s CERTIFICATE OF INSURANCE MUST accompany this application listing the CITY AS

ADDITIONAL INSURED. Liability limits (single $150,000; more than one $600,000.

Application Date: __________________ Event Date: _______________ ___, 20__.

Organization/Individual requesting permit: __________________________________________

Address: ______________________________________ Lane Line: _____________________

(Street)

(City)

(State)

Cell: __________________________

E Mail: ________________________

Organization Representative _____________________________________________________

(Name)

(Title)

Event Description: _____________________________________________________________

Number of anticipated participants/parade units: ________ Length of Event ________________

(Yards)

Time Duration of Event: from __________ to __________

Assembly area for event: ________________________________________________________

Disbursement area for event: ____________________________________________________

Detour for event proposed: (include parking) ________________________________________

____________________________________________________________________________

Traffic Control requested: _______________________________________________________

In order to provide needed assistance for your event, it is necessary to attach a current map

or diagram of route, showing all traffic control points and any detours proposed.

If a state highway is needed for this event, please explain: _____________________________

____________________________________________________________________________

Will animals, unlicensed vehicles, or dangerous vehicles, items or substances be used in the

event: ___ Yes ___ No. If yes, explain ___________________________________________

___________________________________________________________________________

(For safety of all, if candy or other items are to be distributed at the event, you are

encouraged to use walkers for distribution purposes)

Sponsor: __________________________ Co-Sponsor:_________________________

(Signature)

Approved: _________________________ __________________________________

(Chief of Police)

(Public Works Director)

_________________________ __________________________________

(Risk Management)

(City Manager)

Request For Special Street Use Form