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4. REQUESTED EVENT COMPONENTS: <br /> Date requested: _July 17, 18, 19, 2015_ Alternate date: NA_ <br /> Requested hours of operation: _8am (a.m./p.m.) To: _lam (a.m./p.m.) <br /> Set up beginning date and time: July 16 2015 Evening <br /> Complete dismantle date and time: July 19 2015 Evening <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: _100 Spectators: 2,000+_ <br /> 5. INSURANCE: Received and forwarded from ACE American Insurance Company <br /> Attach to this application either an insurance policy or a certificate of insuranSe including the policy number,amount, <br /> and the provisions that the City of Centerville is included as an additional insured. (Please note that insurance <br /> requirements depend upon the risk level of the event. Also, if your event can be classified as first amendment <br /> 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 containers <br /> during the event. Indicate who and how many will be responsible for cleaning up after animals if they are present <br /> during the event. Indicate who and how many will be responsible for cleaning up after the event. Describe the number, <br /> type and location of portable toilets to be provided for the event(or permanent toilets to be used in the event.) Include <br /> any other plan you have for ensuring post-event cleanliness and material preservation of city facilities, equipment, <br /> premises and streets A deposit of$500 will be required for clean-up and restoration. If premises are left in <br /> satisfactory condition this deposit will be refunded in full following inspection.Waste Management is donating <br /> trash containers to be used by participants. The Lions Club will clean up any left garbage. Please waive deposit, a <br /> good standing letter can be provided from Central Bank if needed. <br /> 7. LOCATION: Laurie LaMotte Park in Centerville, Kelly's Korner Parking Lot <br /> Please attach a map of your event land design. Check off below items that apply to your event and <br /> 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. X Entertainment or stage locations (grandstand operators should provide you with a <br /> "to scale" drawing.) <br /> E. X 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 /> 22 <br />