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11,
<br /> 3) If allcohol is being mind, copy 10f Mlrre,irft on-sMe fiq,Aor ficense rntist be provided.
<br /> ris tj„„iiirari ice
<br /> I Viie Clity ofCeft--u,vvilllle requires clertain lever'lits to GkAahri insuirancid,109' tO allplIpirovaIII. "rhe folllowh"l
<br /> events iirn lu id Iparades and/or other Im ille events utfliziir"l City of Centerville streets, everft open to the pubfic
<br /> with a Wgia- ukl of attendees, CRY staff, or any other events deernedIr” airy by the City of CentrivVille.
<br /> As a ir.:,;ondifiioin ofthis pleirmit t1hr--,,,,, applicaint s1haill:
<br /> I[ijPirocksire and irruaintain uinsurance, w111,,ii111iiD1I,,iii lIhnWudies UI,iiie C'0'11i�y irviliflas
<br /> ie ind or addi
<br /> amied finsuireffiloinali
<br /> of Ceinle
<br /> �Iiinstl111 Nlote::: 11 istiir',ig the City as the Ceftificalie 1l Wider does not Irru r°u the it 1s ,.-in additionW inqureu:J.. It
<br /> imust state, in the descrOfilon box the Cit, (or if listed as Ceird-ficate Holider) ilsi aIrl addffior4 insun'...,id.
<br /> ]If alcohol is beiirl sew ved, the entityvarl the alcohel rrmst prol Cerfificzate a.Yf I. iabifity.
<br /> Insurance and Ill turn the City o-11r CeintenellIlle as ainu;RdrlftionaI finm,.nred,
<br /> IF3Thftii-1 q,:Yf Ilan sil..irance rnust
<br /> I......................................l.t....i....a.&.....s........u........b.. .m... .ft.......t....e......-d.. i. .............t.....h........l..:... ........
<br /> Ilii tiro
<br /> l ..........
<br /> El his insuiraince W1111 t"ieedto providethe levell of coverage that the City of Cein-1 determines to The
<br /> riecessairly air'W adequate UndE.-on,9'm Gircumsta inces.,
<br /> I W1 or iqain events the City irnay irc.imquire slin"ii1plie proof ifinsix"pi-ine r
<br /> Is [risuivance requiirpd (as determined by City staff): =Yes �Il un
<br /> 1111.41 A/ 2 l
<br /> Si,glrlaftfl,e: d'"O%A0d1X1 ll,ieA �ei/2
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<br /> Return this form to. Oty of Centervi I Ve
<br /> 1880 IMaM Street
<br /> Centervik,MN 55038
<br /> Vieusermte that1�,hipreoivrie .5
<br /> il assir;rlated livith th,le aCINA ,the IVirird eposit, Userf"ele, ilUl tc.)
<br /> *1f,you would like your ev ent published on the rity's websire or Reader Board? Please iridic ate: OV ' &S' ,D&O ivo
<br /> Please note,it must meet the City", criteria as beldw-.°
<br /> .1. Information related to City business or other government encies
<br /> 2. Requests from Cen rennialSichool District 12
<br /> 3. Requestsfrom all regifstered non-prqf1t organizations located within-the City of Centerville
<br /> A, May not be registered as a non-pr9frr organization(Il . School events, Fete des Lacs,etc.)
<br /> 2 g
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