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4. REQUESTED EVENT COMPONENTS: <br /> Date requested: June 26-28 Alternate date: None <br /> Requested hours of operation: 24 hrs (a.m./p.m.)To: 3PM 6/28 (a.m./p.m.) <br /> Set up beginning date and time: 6/26/15 5:00 PM (d, Laurie Lamotte Park Parking Log <br /> Complete dismantle date and time: 6/28/15 3:00 PM(a, Lauri Lamotte Park Parking Lot <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: 30-40 Spectators. none <br /> 5. INSURANCE.- <br /> Attach <br /> NSURANCE: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. <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 durmg 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. <br /> 7. LOCATION: <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. If a route is involved, the places where buses, autos or other motorized vehicles need to <br /> be considered. <br /> C. If a route is involved, attach separate maps giving two or more alternate routes. <br /> D. Entertainment or stage locations (grandstand operators should provide you with a <br /> "to scale"drawing.) <br /> E Alcoholic beverage concession area <br /> F. Non-alcoholic concession area. <br /> G. Food concession area. <br /> H. General Merchandise concession areas <br /> I. Portable toilet facilities(indicate number). <br /> J. Event participant and/or spectator parking areas. <br /> K. Event organizer's command post. <br /> Page 2 of 10 <br /> �C <br />