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3 alcohol is being served, copy of current -s i license vi <br /> Insurance 'Ir <br /> The City ill requires In events to obtain insurance prior to approval. The following <br /> events include parades and/or other mobile events utilizing City of Centerville streets, events open to the public <br /> with a large , City staff, or any otherby the City of Centerville. <br /> As a condition i i Ila <br /> and maintaininsurance, is Includes i f Centerville as named insured or addiflonal <br /> Insured. : Listing the City as the Certificate Holder does not mean the City is an additional insured. It <br /> must state in the descriptiono the City(or if listed as Certificateolder) is an additional insured. <br /> If alcohol is being , the entityin he alcohol must providei Liquor Liability <br /> Insurance and listing a City of Centervillen additional insured. <br /> Certificate of Insurance i n li tin. <br /> [:]This insurance ill need to providelevel of coverage that the City 'll i to be <br /> necessary andunder the circumstances. <br /> ❑For certain events the City may require simple proof of insur <br /> Is insurance required (as determined by City staff): I I Yes ___[]_.No <br /> Terrance eeney eneyJR 9/24/17 <br /> Signature: Onto:2D17.09.2419:18:53-05'0d' ate: <br /> Return this form to: City of Centerville <br /> 1880 Main Street <br /> Centerville,MN 55038 <br /> *Please note that there are fees associated with the use of the City's parks(Deposit,User Fee,Etc.) <br /> *!f you would lake your event published on the City's website or Reader rd? Please indicate: 21 Yes No <br /> Please note,it must meet the City's criteria as below: <br /> I. information related to Cfty business or other government agencies <br /> 2. Requests from Centennial School District 12 <br /> 3. Requests from all registe non-profit organizations located within the City of Centerville <br /> 4. May not be registered as a non-profit organization(i.e. School events,Fete des Lacs,etc.) <br /> I'35 <br /> r y, <br />