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If there is a fee or donation required as a condition of attendance or participation of this event, <br /> please describe the amounts to be collected from various categories of participants or spectators: <br /> Optional Fundraising Raffle for which tickets are sold for is $2 a ticket. Other Events/Rides done <br /> by outside Vendors is done at their own discretion on prices. <br /> 14. If a donation is requested on a purely voluntary basis, describe how you intend to inform <br /> participants/spectators or others that they may participate in the event whether they make a <br /> donation or not: N/A <br /> Centerville <br /> Special Event Permit <br /> NAME AND TYPE OF EVENT: <br /> DAY, DATE AND TIME: <br /> 1. PARKS AND RECREATION DEPARTMENT <br /> FINAL APPROVAL AND SIGN OFF <br /> Signature Title <br /> Date: <br /> Please check or use N/A (not applicable)where appropriate: <br /> 1. Final check has been made of application requirements. <br /> 2. Event is approved by City Council. <br /> 3. All required permits are issued and on file. <br /> 4. Refundable clean up fee has been paid. <br /> 5. Insurance Certificate is on file with City Clerk <br /> 6. Surety Bond is on file to secure payment for applicant's obligation to the <br /> City. <br /> 7. Application is complete. <br /> 8. Special conditions are attached. <br /> REVOCATION: Upon mutual consent, the City Council may revoke a special event permit if <br /> the conditions set fourth in the permit application are not being followed. <br /> Permit is hereby revoked: <br /> Signature Title <br /> Date: <br /> Reason(s)for revocation: <br /> Page 6 of 10 <br /> 16 <br />