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Application for Public Assembly Permit

  1. Names of individual, corporations, partnerships or other organized groups, addresses, names of directors and officers.

  2. List of all names and addresses of person, corporations, partnerships or other entities to provide financing for the event.

  3. Name and address of the recorded property owner where the event will occur. Upload a notarized letter of permission from the owner to use such property if applicant is not the property owner.

  4. Proposed dates and hours of the event.

  5. Expected maximum number of persons intended to use the property at any one time during the event.

  6. Expected Maximum Number of Persons

  7. - A promoter must comply with all regulations as required by County or State Health Departments. In addition, the promoter must contact the Wyoming County Sheriff and Office of Emergency Services to ensure safety issues are adequately addressed.

  8. - A non-refundable application fee of $200.
    - A promoter will be required to meet the necessary requirements of the permit application and provide Proof of Insurance.

  9. - A non-refundable application fee of $400.
    - A promoter will be required to meet the necessary requirements of the Permit Application and provide Proof of Insurance.

  10. - A non-refundable application fee of $600.
    - A promoter will be required to meet the necessary requirements of the Permit Application and provide Proof of Insurance and Cash Bond Surety.

  11. In the event the Application is not filed within 90 days of the date of the event, a late fee, in addition to the Application Fee and in an amount equal to 4 times thereof, shall be assessed. Upon a showing of good cause, at the discretion of the Chairman, said Late Charge may be reduced or waived.

  12. The number of automobiles expected to use the property at one time as well as a plan for the provisions for parking such vehicle.

  13. Include the nature of the activities and admission fees to be charged, if any.

  14. Fee charged?

  15. Fee charged?

  16. Fee charged?

  17. Was a copy sent to to Wyomning County Health Department?

  18. List names and addresses of all persons providing contract, lease or other arrangements for the event together with such contracts, leases or other arrangements. Information called for in this paragraph shall be supplied no later than 7 days prior to the event and submitted to theWyoming County Health Department (WCHD).

  19. Was a copy sent to to Wyomning County Health Department?

  20. Was a copy sent to to Wyomning County Health Department?

  21. A. The applicant will specify in all advertising and promotional endeavors the limitation on the number of tickets to be sold or otherwise issued as specified in the permit.

  22. B. The applicant also agrees that all tickets will be numbered, and that no other means will be used to grant admission to the site.

  23. The information required of an applicant for a permit under this Application is for the sole purpose of providing notification to the County of Wyoming and to any other municipal subdivision impacted by the permitted event of the arrangements made by the sponsor or promoter for financing, sanitation, security, parking and the other information required in this Application so as to inform the County of Wyoming regarding the character and nature of the permitted event. Issuance of a permit under this Application does not constitute the County of Wyoming’s assumption of responsibility for maintaining the services for which information is required as part of the Application.

  24. For events involving more than 5,000 persons but less than 7,500 persons, no permit shall be issued unless the applicant can furnish to the Chairman of the Board of the Wyoming County Board of Supervisors a Certificate of Insurance showing evidence of insurance coverage as follows and a copy of the policy endorsement showing the County of Wyoming and the Town or Village in which the event is held, named as an additional insured.

  25. - Each Occurrence $1,000,000
    - Aggregate $2,000,000
    - The Certificate of Insurance shall provide no less than 30 days notice of cancellation or non-renewal of the insurance coverage.
    - All Insurance and Bonds shall be written with an Insurance Carrier licensed by the State of New York Insurance Department to conduct business in the State of New York and have an A.M. Best Company rating of A or better.
    - The County of Wyoming and Town and/or Village in which the event is to be held shall be named as an Additional Insured on a primary and noncontributory basis on all policies.
    - Waiver of Subrogation is required on all policies.
    - All Certificates of Insurance must be signed by a licensed agent or authorized representative of the insurance carrier. A broker signature is not acceptable.

  26. For events involving 7,500 or more persons, the limits of insurance shall be established by the Chairman of the Board of the Wyoming County Board of Supervisors and shall not exceed the following limits. No permit shall be issued unless the applicant can furnish to the Chairman of the Board of the Wyoming County Board of Supervisors a Certificate of Insurance showing evidence of insurance coverage as follows and a copy of the policy endorsement showing the County of Wyoming and the Town or Village in which the event is held, named as an additional insured.

  27. - Each Occurrence $5,000,000
    - Aggregate $10,000,000
    - The Certificate of Insurance shall provide no less than 30 days’ notice of cancellation or non-renewal of the insurance coverage.
    - All Insurance and Bonds shall be written with an Insurance Carrier licensed by the State of New York Insurance Department to conduct business in the State of New York and have an A.M. Best Company rating of A or better.
    - The County of Wyoming and Town and/or Village in which the event is to be held shall be named as an Additional Insured on a primary and noncontributory basis on all policies.
    - Waiver of Subrogation is required on all policies.
    - All Certificates of Insurance must be signed by a licensed agent or authorized representative of the insurance carrier. A broker signature is not acceptable.
    - For events involving 7,500 or more persons, no permit shall be issued unless the applicant shall deposit with the Chairman of the Board of the Wyoming County Board of Supervisors cash or good surety company bond in a sum not less than $10,000. The Chairman of the Board of the Wyoming County Board of Supervisors may reasonably require and condition that all requirements of an issued permit be fully performed by the applicant, that no damage will be done to any public or private property and that the applicant will not permit any litter, debris or other refuse.
    - Provided further that should the licensed event necessitate the employment of additional county or town personnel and equipment, such added expense shall be recoverable from the principal and/or its surety. The deposit or its balance is to be returned when the Chairman of the Board of the Wyoming County Board of Supervisors has determined that no such damage has been done and that the County did not incur such additional expense due to a said event or that the cost of the above has been paid by the applicant.

  28. To the extent permitted by law, the applicant agrees to defend, indemnify and hold harmless the County of Wyoming, its officers, directors, agents and employees from and against any and all claims, suits, liens, judgments, damages, losses and expenses including reasonable legal fees and costs arising in whole or in part and in any manner from acts, omissions, breach or default, in connection with the performance of the stated event, by the applicant, its officers, directors, agents, employees and subcontractors.

  29. All information provided in the above application is hereby true and correct and all statements contained herein are true to the best of my knowledge and belief. I further certify that the event will be performed in the manner set forth in this application and in the plans and specifications filed herewith.

  30. By checking the "I agree" box, 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.*

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