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2. 
4. Street / Parking Lot Closure Request - General Information
   Please download the (1) Closure Request Steps and Checklist, (2) Sample Notices for Property Owners and (3) Helpful Contacts and Information. Note the process and timeline of the Street/Parking Lot Closure Request. Upload a map of the proposed closure. Contact City Hall 479-621-1117 if you have any questions.
6. Closure Request Steps and Checklist
   Click Here to View/Download
7. Sample Notices For Property Owners
   Click Here to View/Download
8. Helpful Contacts and Information
   Click Here to View/Download
10. All closure event costs, including but not limited to, costs for clean-up, repair, fire services and police services shall be borne by the applicant.
12. Indemnity to Hold Harmless Agreement:
    Please read, understand and agree to the Indemnity to Hold Harmless Clause
14. Event Name*
15. Event Date(s) and Time(s)*
17. Event Location*
19. Indemnity and Hold Harmless Clause
    The Individual or Organization listed within this application (hereafter “User”) hereby agrees to indemnify and hold harmless the City of Rogers (hereafter “City”) as a municipal corporation and any and all of the City’s employees, officers, officials, or agents for any and all injuries or damage to any person entering upon the above referenced premises under express or implied invitation by the User or any property brought on or about the leased premises by said invitees, that is/was caused by the negligence, neglect, or misconduct of the User or any of its employees, contractors, volunteers, agents, officials, or officers. The User further indemnifies and holds harmless the City as a municipal corporation and any and all of its employees, officers, officials, or agents for any damage or injury sustained to any and all persons and/or property due to the building improvements on the premises being out of repair or any and all injuries caused by any leakage of gas, oil, smoke, water, steam, or electricity emanating from the premises. The User agrees to indemnify and hold harmless the City as a municipal corporation and any and all of its employees, officers, officials, or agents from any loss, damage, costs, fees, expenses, and claims, including reasonable attorney’s fees, arising out of the User’s use of the premises. The User agrees to extend the above indemnities to the City and its employees, officers, officials, or agents, to any damages or injury resulting from any street or parking lot closure requested as part of the event or undertaking relative to this application. The City reserves the right to revoke approval of this application at any time.
21. By signing below, the person executing this agreement warrants, asserts, and guarantees that they have the actual authority to legally bind the Organization requesting the Permit in this Application.
23. Signature*
24. Title*
25. Date*
    Date
27. Closure Information:
29. Street/Parking Lot To Be Closed*
30. Upload a Map of the Proposed Closure*
32. Streets Affected*
34. Day 1 Date / Time*
    Day 1 Date / Time Start Date

    Day 1 Date / Time Start Time

    —

    Day 1 Date / Time End Date

    Day 1 Date / Time End Time
35. Day 2 Date / Time
    Day 2 Date / Time Start Date

    Day 2 Date / Time Start Time

    —

    Day 2 Date / Time End Date

    Day 2 Date / Time End Time
36. Day 3 Date / Time
    Day 3 Date / Time Start Date

    Day 3 Date / Time Start Time

    —

    Day 3 Date / Time End Date

    Day 3 Date / Time End Time
38. Event Purpose*
40. Organization Name*
41. Contact Name*
43. Phone Number*
44. Mobile Number*
46. Email*
48. Address1*
50. Address2
52. City*
53. State*
54. Zip*
56. By signing below, the person executing this form warrants, asserts, and guarantees that they have the actual authority to legally bind the Organization requesting the closure.
58. Signature *
59. Title*
60. Date*
    Date
62. This section to be completed by the Rogers Police Department
    This event will / will not create a public safety hazard (please circle one). Signature of the Chief of Police, or designee: __________________________ Date: ____________
64. This section to be completed by the City of Rogers Community Development
    This event meets / does not meet Community Development standards (please circle one). Signature of the Director of Community Development, or designee: __________________________ Date: ____________
66. This section to be complete by Downtown Rogers Inc.
    This event is acknowledged by Downtown Rogers Inc. Signature of the Executive Director of Downtown Rogers Inc, or designee: __________________________ Date: ____________
68. This section to be completed by the Transportation Committee
    Hearing Date and Time:_______________ Request is (circle one) : Approved as submitted / Approved with conditions / Denied · Transportation Committee Chair Signature: ___________________________ Conditions/Notes: _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________
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70. 1. Receive an email copy of this form.
71. Email address

    This field is not part of the form submission.

72. Submit Submit and Print

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