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4. REQUESTED EVENT COMPONENTS: <br /> Date requested: _Oct. 25th, 26th 2013_ Alternate date: None <br /> Requested hours of operation: _7pm (a.m. /p.m.) To: _10pm (a.m. /p.m.) <br /> Set up beginning date and time: Oct. 19th 2013 <br /> Complete dismantle date and time: Oct. 27th 2013 <br /> Describe the number and type of animals (if any) to be used in this event: None <br /> Attach a draft of the entry form for participants and/or spectators. <br /> Anticipated number of participants: 20 Spectators: 100-500 <br /> 5. INSURANCE: Received and forwarded from Hilb, Rogel & Hobbs. <br /> Attach to this application either an insurance policy or a certificate of insurance including the policy number, <br /> amount, and the provisions that the City of Centerville is included as an additional insured. (Please note that <br /> insurance requirements depend upon the risk level of the event. Also, if your event can be classified as first <br /> amendment expressive activity, insurance requirements can be waived under certain circumstances.) <br /> 6. SANITATION: Please see note after a deposit of $500. <br /> Attach your "Plan for clean -up /Material Preservation ". Include number, type and location of trash containers to be <br /> provided for the event. Indicate who and how man will be responsible for emptying and cleaning up around <br /> containers during the event. Indicate who and how many will be responsible for cleaning up after animals if they are <br /> present during the event. Indicate who and how many will be responsible for cleaning up after the event. Describe <br /> the number, type and location of portable toilets to be provided for the event (or permanent toilets to be used in the <br /> event.) Include any other plan you have for ensuring post -event cleanliness and material preservation of city <br /> facilities, equipment, premises and streets A deposit of $500 will be required for clean -up and restoration. If <br /> Premises are left in satisfactory condition, this deposit will be refunded in full following inspection Trash <br /> Containers will be provided by the Lions Club. The Lions Club will clean up any left garbage. Please waive deposit, <br /> a good standing letter can be provided from Central Bank in needed. <br /> 7. LOCATION: Laurie LaMotte Memorial Park in Centerville <br /> Please attach a map of your event land design. Check off below items that apply to your event <br /> and indicate them on the attached map. Use, where necessary, a "to scale" drawing. <br /> A. If a route is involved, the beginning and finish area with arrows. <br /> B. _X_ If a route is involved, the places where buses, autos or other motorized vehicles need <br /> to be considered. <br /> C. If a route is involved, attach separate maps giving two or more alternate routes. <br /> D. _X_ Entertainment or stage locations (grandstand operators should provide you with a <br /> "to scale" drawing.) <br /> E. Alcoholic beverage concession area. <br /> F. X Non- alcoholic concession area. <br /> G. X Food concession area. <br /> H. X General Merchandise concession areas. <br /> Page 2 of 10 <br />