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<br />13. FEE STRUCTURE / EVENT CHARGES: <br /> <br />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 />Free Event <br /> <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: <br /> <br />Centerville <br />Special Event Permit <br /> <br />NAME AND TYPE OF EVENT: <br /> <br />DAY, DATE AND TIME: <br /> <br />1. PARKS AND RECREATION DEPARTMENT <br />FINAL APPROVAL AND SIGN OFF <br /> <br />Signature <br /> <br />Title <br /> <br />Date: <br /> <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 /> <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 /> <br />Permit is hereby revoked: <br /> <br />Signature <br /> <br />Title <br /> <br />Date: <br /> <br />Page 6 of 10 <br /> <br />->17:, <br />