2017-10-04 P & R Packet - Laserfiche WebLink

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3) If alcohol is being served, copy of current on-sale liquor license must be provided. Insilairanice, Ilegg,�red: .................. The City of Centerville requires certain events to obtain insurance prior to approval. The following events include parades and/or other mobile events utilizing City of Centerville streets, events open to the public with a large number of attendees, City staff, or any other events deemed necessary by the City of Centerville. As a condition of the permit the applicant shall: OProcure and maintain insurance, is includes the City of Centerville as named insured or additional insured. Note: Listing the City as the Certificate Holder does not mean the City is an additional insured. It must state in the description box the City (or if listed as Certificate Holder)is an additional insured. If alcohol is being served, the entity serving the alcohol must provide aCertificate of Liquor Liability Insurance and listing the City of Centerville as an additional insured. The Certificate of Insurance must be submifted with this Agpaqafim. [:]This insurance will need to provide the level of coverage that the City of Centerville determines to be necessary and adequate under the circumstances. ---------~-------—----------- -----—------------~--------------- For certain events the City may require simple of of 1 Is insurance required (as determined by City staff):=Yes _—ID—No Signature: ,—/ .—Date-.,. 2f J-el 7 Return this form to: City of Centerville 1880 Main Street Centerville, MN 55038 *Please note that there are fees associated with the use of the City's parks(Deposit, User Fee,Etc.) *if you would like your event published on the Cit)es website or Reader Board? Please indicate.- ]ZYes M NO Please note,it must meet the CiWs cdterla as below. 1. information related to City business or other government agencies 2. Requests from Centennial School District 12 3. Requests from all registered non-propt organizations located within the City of Centerville 4. May not be registered as a non-profit organization(i.e. School events,Fete des Lacs,etc.) 2 g