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3) If atcohiol is ib6ililng seir ved:, loopy of cuirirer u't on Sale Hiclulor IHcenso imust be provided, <br /> The City. of Conte irvill 111e, requhres li�:iimeiritls to obtain iiirnsuur uin Ipriorto tiilp1piroval Ihe followling <br /> ii-i-wents irx.:.lude parades aridlor otheir rnolbile events utillizing City of Cerihaneille stm.,ets, events open to the public <br /> with a large niarinber c-.)f attendees, lit,lf staff, or airiy othier event s deem ed necessary l�,-.)y the City of Ceintewille.. <br /> As acondition (.:)f tl°n Ipeirimit the applicarilshaill: <br /> m4rocuire and run amint aiiri linsuraince, whichin.cludes the City of Centemillie. as iriuarned insurod oraddifloinal <br /> insure,4.r l4Ot8::: 11 istling tlhc..) if as the Certificate Holder does inot inn the City is an additional linsured.. It <br /> MUSt state irii t1he description lbox the City (oir if listed as Certificate 1I lolder) is an additional lirisured. <br /> ............ If alcolh(,.:nl is being served, the entity slarvi rwg the alcohol must provide a Gertifivate of I iquor I labifity <br /> .......... <br /> Insurance. and 111stling the (',ity of Centerville as �an addltionall lirisured.. <br /> III........... <br /> ,,,1...h e Certil-ficate of Insurance miust be si.,ibirritted wi-10"i this gwn,ftllii�q44r,n <br /> Jr.]This iinftirarice will inlir..)ed tic:) provide the Ilevel of coveiragig that the City of Ceriterville deterrnlruies to The <br /> neic.essary and adequate urider 9"ih"curnstairices, <br /> ejFoir certaiin events the City imay requlire sirriple proof of iirisii.iin: <br /> IIs iinsurairme it ';u (as determined Iby it Staff).,., ....................... Yes ............................................ <br /> Siginatt,iire: Date: <br /> Return this form to. City of Centerville <br /> 1880 In Street <br /> Centerville, MN 55038 <br /> *Please note that there are fees associated twith the use of the Otys parks(Deposit, User Fee® Ftc.) <br /> *f you would like your event published an the Cit "s website or Reader Board? Please indicate: Z,Ym-E No <br /> Please note,it must meet the city'®s criteria=below. <br /> 1. information related to City business or other government agenries <br /> Z Requests.from rentennial School District 12 <br /> 3- equestsfrom ofd registered non-proft organizations located within the City of 'an-tewill <br /> e <br /> 4. May not be registered os a non-profit organization(i.p. School events, Fete des Lacs,,etc.) <br /> 2 h F" a <br />