Permit# ______________________
Folio #____________________
CITY OF MIAMI GARDENS
DEVELOPMENT SERVICES DEPARTMENT
REQUEST FOR SPECIAL EVENT
Date of Applicaon_______________
Secon I.
Applicant Informaon
Organizaon Type: □ Individual □ Corporaon □ Non-Prot/501(c)(3) Charitable Organizaon
(Please aach supporng documents)
Applicant/Organizaon Name ___________________________________________________
Applicant Address______________________________________________________________
Phone Number____________________________ Fax Number_______________________________
Event Details
Designated person in charge__________________________ Phone Number _____________________
Email_____________________________________________________________________
Event Address______________________________________________________________
Event Date(s) _______________Event Start Time _____________ Event End Time ________________
Will this event take place outdoor or indoor________________________________
Secon II.
Event Categories: (Please check all that apply)
□ Anque/Art/Aucon/Cra Show □ Bike/Race/Run/Triathlon/Walk □ Block Party □House Party
□ Retail Sales □ Food Truck Event □ Retail Sales □ Boat/Car Show/Fesval/Market/Tournament
□ Church/Concert/Live Entertainment □ Fireworks □ Fundraiser □ TV Commercial/Movie Filming
□ Parade/Public Assembly □Other (specify) _______________________________________
Non-refundable Application Fee:
$25.00
Permit# ______________________
Descripon of Event in Detail (Please aach a separate page, if needed) ________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Number of parcipants expected ________________ Number of event sta____________________
Will sta have ideners? (i.e. Idencaon Cards, Badges, Shirts, Etc.) □Yes □No
If so, give a descripon_________________________________________________________________
Has this event been held in the past? □Yes □No
If so, indicate the date(s) of the last event: ________________________________________________
Will alcoholic beverages be served at your event? □ Yes □No
If so, what mes will the alcoholic beverages be served? __________________________________
Will there be any use of pyrotechnics and/or reworks displays at this event? □Yes □No
Secon III.
Please check all that apply:
□Music □Live Entertainment □Food □Street Closure, hours____________________
□Alcohol sale/Consumpon
□Tent(s) #_____ Size of tent(s) ________________ (If greater than 10x12, building permit required)
□Bounce House(s) #____________
□Refuse Removal/Sanitary Facilies
□Other (please describe) ____________________________________________________________
City Personnel: Based on responses to quesons within this applicaon certain City personnel may be required
to be present. (i.e. Police Ocers, Community Service Aides, etc.) Once stang needs are determined, applicant
will be required to complete and sign a contract detailing the necessary City personnel needed and the costs
associated with having the personnel present at the event. The applicant will receive an invoice for payment for
any City personnel, and payment is due a minimum of 15 days prior to event. (Please inial)_______
For Commercial Locaons, do you have a current:
□Business Tax Receipt □Cercate of Use □Alarm Registraon
Departmental Applicaons
(Complete all secons that apply)
Public Works Department
Parade or Public Assembly/ Block Party/ Temporary Street Closure Applicaon
Streets to be blocked o (Example: NW 12th Avenue between NW 199th Street and NW 201st Street.)
(“Permied Area”): ___________________________________________________________________
___________________________________________________________________________________
Hours of street closing: _______________________________
Approved by:
________________________________ Date: __________________________
City of Miami Gardens Public Works Department
1050 NW 163rd Street, Miami Gardens
_______________________________________ Date: ________________________________
City of Miami Gardens Police Department
18611 NW 27 Ave, Miami Gardens
_______________________________________ Date: _________________________________
Chief, Miami-Dade Fire Department
Main Locaon:9300 NW 41 Street Miami, FL 33178 (786) 331-5000
North Locaon: 1655 NE 205 Street Highland Oak, FL 33179 (305) 513-7650
South Locaon: 10850 SW 211 Street Miami, FL 33189 (305) 513-7670
Police Department
Applicaon for Public Music-Broadcast Permit
NOTICE TO APPLICANT: All applicants directed to this department for consideraon and acon shall be submied een
(15) working days prior to the date of any projected broadcasng or transming of music or sound by loudspeakers,
ampliers, public address systems, and similar devices in such a manner that would be reasonably loud and raucous or that
would reasonably be calculated to aract a crowd or cause numbers of person to congregate in or on any open space.
Hours to conduct or operate a Public Music or Broadcast Event: _______________________________
(no longer than six (6) hours total and not between the hours of 10:00 PM and 7:00 AM on weekdays
and 10:00 PM and 10:00 AM on weekends).
Date Received: _________________________________ Processed By: __________________________________________
MIAMI GARDENS POLICE DEPARTMENT NOTIFICATION:
______________________________________ _______________ _____________________________________________
Person Noed Date By Whom
Special Informaon: _____________________________________________________________________________________
Permit Number: Police Chief, Miami Gardens Police Department
______________________ By; _________________________________________
Secon IV.
Fees & Charges:
Special Event Permit Fees Broadcast, Block party, and Tent Sales
More than 30 days prior to event Residenal $10.50
Small acvity/event $157.50 (150 or less) Residenal (less than 30 days prior to event) $21.00
Large acvity/event $315.00 (151 or more) Commercial $26.25
Less than 30 days prior to event Commercial (less than 30 days prior to event) $52.50
Small acvity/event $315.00 (150 or less) Block Party Permit—$52.50
Large acvity/event $630.00 (151 or more) Retail Tent Sale—$262.50
Special Event Fees Non-prot Expedited Fees
More than 30 days prior to event 7-13 days—$500
Small acvity/event $105.00 (150 or less) 0-6 Days—$1,000
Large acvity/event $210.00 (151 or more)
Less than 30 days prior to event
Small acvity/event $210.00 (150 or less)
Large acvity/event $420.00 (151 or more)
Special Noce: During review by various City Departments, addional condions may be imposed. This permit is
only valid for the me indicated on this permit. In event that the applicant fails to fulll the requirements (as set
forth in this permit) or fails to obtain proper authorizaon to proceed, if condions have changed, or the
expected outcomes, impacts, or condions are substanally altered, the permit will be voided immediately by
authorized City personnel and denial of future events may occur.
Applicant Agreement and Waiver of Liability:
I, the undersigned, will indemnify, defend and hold harmless, the City of Miami Gardens, its agents,
employees, ocers and any and all other associates, from and against any and all acons, in law or in
equity, from liability or claims of damages, demands or judgments to any person or property which
may result now or in the future from conduct of this event. The undersigned has read and voluntarily
signed the release and waiver of liability and Indemnity Agreement, and further agrees that no oral
representaons, statements, or inducements apart from the foregoing wrien agreement have been
made. The undersigned agrees to pay all required fees and charges and will abide by all the rules and
procedures presented therein and non-compliance may result in denial of current or future events.
_____________________________________________ ________________________________
Signature of Applicant/ Person designated Date
as being in charge
_________________________________________
Print name
Permit# ______________________
Secon V.
Request for Special Event
Required Items for Permit Applicaon Submial
Checklist
Items Needed Received
Yes No
□ □ □ Special Event Applicaon
□ □ □ Block Party Permit
□ □ □ Parade/Public Assembly Permit
□ □ □ Broadcast Permit
□ □ □ Building Permit Applicaon
□ □ □ Temporary Signage Permit Applicaon
□ □ □ Park Rental Permit (Applicable if 150 or more patrons)
□ □ □ Miami-Dade Filming Permit
□ □ □ Site Plan (Lay out of event site)
□ □ □ Route Map
□ □ □ Maintenance of Trac Plan (M.O.T.)
□ □ □ O-duty Ocer/Security Contract
□ □ □ Copy of Sta Idener
□ □ □ Property Owner Leer of Approval (Commercial Property Only)
□ □ □ Residenal Impact Nocaon
□ □ □ State Alcohol License
□ □ □ Food Preparaon License
□ □ □ 501(c)(3) Exempon Cercate
□ □ □ Insurance Cercate
□ □ □ Security Deposit
□ □ □ Applicaon Fees
City of Miami Gardens
Public Works
Department
Parade or Public Assembly/ Block party/ Temporar y Street
Closure Application Checklist
Please submit the following information:
__ Section IV of the Request for Special Event (after approved/signed by Miami Gardens Police and Public Works departments, Applicant
must submit to Miami-Dade Fire department for approval/signature, and then resubmit back to the City)
__Maintenance of traffic (MOT) plans
__ Copy of Barricade Company contract/receipt (road closure) to provide the barricades as per the approved MOT plan
__ Written consent of all property owners whose property abuts the permitted area (block party only).
__ Liability Insurance (Not less than $1,000,000 combined single limit per occurrence bodily injury including death and
property dam-
age). The City of Miami Gardens must be named as an additional insured.
__ Minimum $500 refundable deposit (if restored to its prior condition and cleaned up by 11:00 p.m. on the date of the event)
__Florida Department of Transportation (FDOT) special events permit (if necessary). FDOT permit required for utilization of the following
roads:
NW 183rd St (Miami Gardens Drive)
441 ( NW 2nd Ave)
NW 215 East of 27 Ave ( County Line Road)
NW 47 Ave ( north of 183 ST)
FDOT application form may be downloaded at:
http://www2.dot.state.fl.us/proceduraldocuments/forms/informs/85004065.pdf
