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4. <br />21 <br />7. <br />REQUESTED EVENT COMPONENTS: <br />Date requested: June 23-25 Alternate date: none <br />Requested hours of operation: 24 hrs (a.m./p.m.) To: (a.m./p.m.) <br />Set up beginning date and time: 6/23/17 (a) 5:OOPM <br />Complete dismantle date and time: 6/25/17 (a7 9:OOPM <br />Describe the number and type of animals (if any) to be used in this event: <br />Attach a draft of the entry form for participants and/or spectators. <br />Anticipated number of participants: 40 Spectators: 15 <br />INSURANCE: <br />none <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 />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 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 />»remises are left in satisfactory condition, this deposit will be refunded in full following inspection. <br />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 />