2011-09-28 CC Packet - Laserfiche WebLink

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Attach a copy of your fire department permit(s) to this application if you will use parade floats; an open flame; fireworks or pyrotechnics; vehicle fuel; cooking facilities; enclosures (and tables within those closures); tents, air supported structures, canopies, or fabric shelters. Give the name, address and phone numbers of the agency or agencies which will provide first aid staff and equipment if required. Attach additional sheets if necessary. Name of agency: Centennial Lake Police and Fire Departments. Name of Representative: Previous years, Sergeant Pat Aldrich Address: 200 Civic Heights Circle Circle Pines, MN 55014 Day phone: _763- 784 -2501 Evening phone: Indicate medical services (if required) that will be provided for this event: Ambulances: Doctors: Nurses: Paramedics: 10. VENDORS OR CONCESSIONAIRES: Describe what vendors /concessionaires you will allow in conjunction with the event, and the purpose of these concessions: All Concessions will be run by the Centerville Lions, to help raise funds to help to pay for the Haunted House. Describe how you intend to regulate, monitor and control the type, number and quality of vendors /concessionaires whom you may permit to operate in conjunction with the event: N/A 11. CITY SERVICES/EQUIPMENT: Describe city services and/or equipment requested for this event: City barricades, cones, signs, picnic tables and other equipment which may be borrowed on an as- available basis. You should make advance arrangements to pick up and return this equipment. If you or any volunteers cannot pick up and return this equipment, please attach a letter requesting these services and explaining why your organization cannot perform them. This will be reviewed, then approved or denied by the public works foreman. Street barricades /cones and all LaMotte Park facilities. 12. OTHER PERTINENT INFORMATION: Please list below any other miscellaneous information you feel would be important and have a bearing on the approval of this Special Event Permit request: As in years past, a Food Drive for the local Food Shelf will be done and fee discounts offered to encourage spectators to do so. Page 5 of 10 15