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2. Before filling out an Expanded Use Application, here are a few things you need to know:

   1.) Applications for a Parks & Recreation Expanded Use permit must be completed and submitted at least 30 days prior to your event. 

   2.) You will be required to submit a Certificate of Insurance for 1 million dollars of liability coverage that lists the county as additionally insured. The certificate must be submitted with this form.

   3.) The County of Powhatan is not responsible for obtaining the proper public performance licenses for music or vendors.

   NOTE: Any activity that is held on county-owned property and will be serving alcohol, charging admission, expecting large crowds, VDOT road closures, or requires the use of county services is classified as an Special Event, and requires you to submit a County Temporary Event Permit form.

   If your event is requesting county-owned park property that includes the Pocahontas Landmark Center gymnasium/stage, parks, sports fields, or trails please continue to fill out the Parks & Recreation Expanded Use Permit form below.

4. CONTACT INFORMATION
6. Name of Sponsoring Individual(s), Organizations, or Business(s)*
7. Requester Status*
   -- Select One --Powhatan County GovernmentPowhatan County Parks & Recreation Partner/Affiliated Organization Powhatan County SchoolNon-Profit OrganizationBusinessPrivate Group (Resident)Private Group (Non-Resident)
9. Name of Event Organizer*
10. Phone Number*
11. Email *
13. Are you a Powhatan County Resident?*
    -- Select One --YesNo
14. Billing Address*

    Invoice will be sent to this address

16. EVENT INFORMATION
18. Event Name*
19. Event Occurance*
    -- Select One --First Time EventAnnual Event
20. Event Type*

    Select all that apply.

    1. Tournament
    2. Race
    3. Public Event
    4. Private Event
    5. Fundraiser
    6. Festival
    7. Concert
    8. Parade
22. Event Date(s)*
23. Back-up Event/Rain Date*
24. Requested Day(s) of the Week *

    Select all that apply.

    1. Sunday
    2. Monday
    3. Tuesday
    4. Wednesday
    5. Thursday
    6. Friday
    7. Saturday
25. Event Start Time/End Time*
27. Requested Venue/Site *

    Select all that apply.

    1. Village Park & Gazebo
    2. Parks & Recreation Training Room, 4290 Anderson Hwy
    3. Parks & Recreation Gymnasium, 4290 Anderson Hwy
    4. Parks & Recreation Stage, 4290 Anderson Hwy
    5. Pocahontas Landmark Center, 4290 Anderson Hwy
    6. PLC Pickleball Courts (1-6), 4290 Anderson Hwy
    7. Village Sports Complex (baseball fields), 2340 Skaggs Rd.

    1. Turner Park Softball Fields, 3834 Old Buckingham Road
    2. Turner Park Multi-Use Field, 3834 Old Buckingham Road
    3. Fighting Creek Park Soccer Fields, 2201 Mann Rd.
    4. Fighting Creek Park Baseball Fields, 2201 Mann Rd.
    5. Fighting Creek Park Trails, 2201 Mann Rd
    6. Powhatan Middle School Stadium Field, 2201 Mann Rd.
29. Please provide a description of your event/activity. *
31. How will this event be advertised?*

    Select all that apply.

    1. Newspaper
    2. Television
    3. Radio
    4. Flyers/Posters
    5. Banner
    6. Social Media
    7. No Advertisement
32. What is the overall estimated attendance for this event? If this is a tournament how many teams will be participating?*
33. Will There Be an Admission or Entry Fee?*
    -- Select One --YesNo
35. Select All County Services/Amenities Requested for the Event*

    1. Portable Restrooms
    2. Road Closure
    3. Electricity
    4. Water Access
    5. First Aid Service (EMTs) provided by Powhatan Fire Dept.
    6. Security provided by Powhatan Police Dept.
    7. Crowd Control Barricades
    8. Cones
    9. Trash Cans
    10. None of the Above
36. Select All of the Following Services/Amenities You Will be Supplying at the Event?*

    1. Dumpsters
    2. Trash Cans
    3. Shuttle Services
    4. Catered Food
    5. Food Trucks
    6. Live Entertainment
    7. Sound Equipment
    8. Special Lighting
    9. Inflatables
    10. Booths/Displays
    11. Tents/Canopies
    12. Stage
    13. None of the Above
    14. Other
38. Provide a Description or Requested Quantity for Each County Service Needed Above*
40. LIABILITY INSURANCE INFORMATION

42. All events that occur on County property must have at least $1 Million of liability coverage and the County must be listed as an additionally insured party on the policy.

    The County does not insure private party rentals. GatherGuard is a program through the County’s insurance provider, VACorp, that covers events held by third parties on County property with $1 million of protection.  Renters can purchase this coverage and depending on the type of event, the cost can be as little as $100.  

    https://www.vacorp.org/coverage/tulip/

    The certificate must read as follows:

    The County of Powhatan, 3834 Old Buckingham Road, Powhatan, VA 23139

    Under the description part of the insurance it must read: 

    “The County of Powhatan, its officers, officials and employees are named as additional insured.” 

    Make sure that the box listed as “Additionally Insured” is checked. It will be sent back if not.

    
    

44. Do you have public liability and property damage insurance in an amount not less than $1,000,000 per occurrence?*
    -- Select One --YesNo
45. Liability Insurance

    If you have liability insurance on file, you can upload it here.

47. 
    

    Thank you for choosing Powhatan Parks and Recreation for your place to play! 

    A member of our team will follow up with you within the next 3-5 business days. If you do not hear back from a member of our team, please call us at (804) 598-5765 or email parksandrec@powhatanva.gov.

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49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

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