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If dlioohoi lisp Ibeliing served,, c.qj::)y of cuii--reiii,iit on-sale Illliiruaii--141iiceiriisip irnu st Ibe Ilprr.wiided, <br /> 111 insiulvinalrice 11R., ulred: <br /> .......................... ............2.9.......................... <br /> The City of Centerville requires certain 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 number of attendees, City staff, or any other events deemed necessary by the City of Centerville. <br /> As a condition of the permit the applicant shall: <br /> Procure and maintain insurance, which includes the City of Centerville as named insured or additional <br /> insured. Note: Listing the City as the Certificate Holder does not mean the City is an additional insured, It <br /> must state int description box the City(or if listed as Certificate Holder) is an additional insured. <br /> []If alcohol is being served, the entity serving the alcohol must provide a Certificate of Liquor Liability <br /> Insurance and listing the City of Centerville as an additional insured. <br /> El The Certificate of Insurance must be submitted with this application. <br /> [:]This insurance will need to provide the level of coverage that the City of Centerville determines to be <br /> necessary and adequate under the circumstances. <br /> .....------------- -------- <br /> E]For certain events the City may require simple proof of insur <br /> Is insurance required (as determined by City staff):=Yes No <br /> W,- ff <br /> signature: U&%&Aj—- Date: <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 parft(DOOposit,User Fee,Etc.) <br /> *if you would like your event published an the CWs webske or Reader Board? Please indicate.- _ZYes-Z No <br /> Please note,it must meet the OWs criteria as below: <br /> ® Information related to City business or other government agencies <br /> ® Requestsfiwa Centenakd School DishW12 <br /> ® Requestsfrorn all registered ® r organizationsl c m the City of Centerville <br /> ® #Wdy not be registered as a ® r organization(i.e. School events,Fete des Lacs, tc® <br /> 2 1 �7` <br />