Temporary Closure Road Occupancy

Temporary Closure/Road Occupancy for Special Events on Township Roads
Permit Application

Name of Organization:

Address:

Postal Code:

Phone:

Email:

Fax:

Contact Person:

Municipal Road(s) to be used:

Please enter the date (mm/dd/yyyy)

Time:

Purpose of Event:

Application will not be considered if following requirements are not provided:

1. Include sketch or diagram indicating location of Road Occupancy (ie. identify 911#/Civic Address of the start and stop locations of occupancy)

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2. Notify all of the following organizations and provide name of person contacted from each organization.

Police Department Phone #

Name:

Ambulance Service Phone Number:

Name:

Local Hydro Authority Phone #:

Name:

1. Attach a copy of Certificate of General Liability Insurance ($5 million), covering the event, and naming the Township of North Kawartha as additional insured. (Contact an insurance agent for this information).

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2. Complete Release Form below, date, sign and have signature witnessed.

3. Documentation must be received at least 30 days prior to the scheduled event.

Whereas the Corporation of the Township of North Kawartha has granted permission to:

(This does not include any policing cost in respoect to the said event.)

Witnesseth that in consideration thereof, the:

hereby covenants and agrees to indemnify and save harmless the Township of North Kawartha from any and all claims and demands which may be made or brought against the said Township by any persons by reason of the use made of the aforesaid lands by:

Name of Organization:

for the purpose aforesaid.

Signed, Sealed and Delivered in the Presence of:

Witness:

Signature(s) of two Authorized Officers of Organization

Signature of Officer 1

Clear

Signature of Officer 2

Clear

Dated this date

This application will be provided to the North Kawartha Fire Department & Roads Department for comment/recommendations prior to approval by the Clerk. Arrangements for appropriate traffic control and signage must be approved.

Forms

Temporary Closure/Road Occupancy for Special Events on Township RoadsPermit Application

Temporary Closure/Road Occupancy for Special Events on Township Roads
Permit Application