DAVID R. TROAST
CITY MANAGER / CITY OF HACKENSACK
65 Central Avenue
P.O. Box 608
HACKENSACK, N.J. 07602-0608
(201) 646-3900
Fax: (201) 646-8059 / CITY COUNCIL
John P. Labrosse, Jr., MAYOR
Kathleen Canestrino, DEPUTY MAYOR
David Sims
Leo Battaglia
Deborah Keeling-Geddis

REQUEST FOR BLOCK PARTY / STREET CLOSING

Name of Individual / Organization:______

Address______Telephone______

If an Organization:

1) Representative______Telephone______

2) Representative______Telephone______

Street(s) to be closed (i.e., indicate specific portions)

______

Date(s) needed______Day(s) of week______

Rain date, if any______Time needed: From______to______

# of Participants______Will any non-Hackensack residents be attending? #______

Briefly explain the purpose of request:______

______

Method to be used to detour traffic and/or prevent accidents:

1. Barricades: Yes______No______(If you wish to borrow city barricades, see the section below:)

2. Other:______Explain:______

______

Detours to be used for traffic: Explain

______

The applicant must contact the Chief of Police 201-646-7761 for approval of all detours.

Indicate if any of the following are applicable and explain:

1.  Food to be served______

(Please note – No alcoholic beverages are allowed to be served.)

2.  Entertainment (i.e., live band, recorded music, games)______

______

3.  Any food, beverages or other items to be sold?______

4.  If the use of city barricades is requested: Number needed:______Each barricade is 6’ long, person responsible to set up, take down and store barricades:

5. ______Telephone:______

The applicant must contact the Department of Public Works at 201-646-3951, to make arrangements for these barricades.

If permission is granted, I am aware that I and our Organization must comply with all City Ordinances, particularly in regard to noise, and the clean-up and disposal of any refuse generated. I further understand that I (the Organization) assume full responsibility for all injuries/damages that result from any accidents that may occur and I (the Organization) hold the City of Hackensack harmless from any liability resulting from my (the Organization’s) negligence in the conduct of this event.

______

Representative Signature Date

Request is approved______or denied ______

______

City Manager Date

cc: Police Department, Department of Public Works, Fire Department