Special Event Application

Step 1 of 3

Group/Organization Name

Responsible Party

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Is your billing address different than above?

Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone Number

Email Address

Date of Event

Start Time

End Time

Is this a fundraising event?

Name and Purpose of Event

How does your event align with the Mission of the Port of Port Orford?

Clean up is required at the close of the event. The Port of Port Orford staff will inspect the site for cleanliness and damages following the event. Full or partial forfeiture of deposit will result for any damages, repairs, maintenance, or cleaning required as a result of the event. In the event the expenses exceed the deposit amount, the responsible party will be billed for the difference. Any balance is due upon receipt. Any refunds due will be processed within ten days.

Enter your initials to acknowledge

Applicant and applicant’s group agrees to defend, hold harmless and indemnify the Port of Port Orford and its officers, employees, board members, and agents from any and all liability, damages, costs, expenses, and attorney fees arising out of the applicant’s, applicant’s group or their invitees’ while engaged in the activities arising out of this agreement.

Enter your name below if you agree to maintain liability insurance coverage of not less than $1,000,000 per occurrence to cover any liability arising out of or associated with this event, and agrees to name the Port of Port Orford as an additional insured on such policy with a copy of the endorsement attached to the certificate of insurance.

Enter your name below if you further agree to provide the Port of Port Orford with a certificate of liability insurance including additional insured endorsement not less than two weeks prior to the scheduled event and shall amend the notification for cancellation of coverage to 30 days.

If you fail to provide the certificate of insurance and endorsements within the time required herein, this Special Event Application will automatically be revoked.

Application and Appeal Process

Incomplete applications will not be accepted.
An application will be deemed incomplete without a response to each question, and without attaching copies of permits, licenses, and insurances.
Denials will be mailed by US Postal Service within five business days of receipt of the application.
Denials may be appealed. The appeal process is on the confirmation page.

Signature

Your Name

Your Title

Date

300 Dock Rd

PO Box 490

7:00 am – 3:00 pm M-F

Special Event Application

Special Event Application

Application and Appeal Process

Commissioners

Port Staff