2023-09-06 P & R Packet - Laserfiche WebLink

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DocuSign Envelope ID: 1OB96BA6-4D41-4AE9-9666-DC337A7365AA ANOKA COUNTY PARKS 550 Bunker Lake Boulevard NW • Andover, MN 55304 • 763.324.3300 • anokacountyparks@co.anoka.mn.0 SPECIAL USE REQUEST Main Contact/Organization: Teresa Bender - City of Centerville Address: 1,990 Main Street City: Centerville State: Minnesn&p: 55038 Email Address:. thenderncentervillemn.cnm Phone Number: +1 (651) 792-7933 Begin Date: 07/90/2024 End Date: 07/20/2024 Arrival Time: 9700 AM Departure Time: 9-00 AM Location: Rine Creek Chain of Lakes Park Reserve Number of People Attending: 150 Requested Special Use Item(s): Other* . Describe Belowr Description of Request: 5/8K Run through the Park as in years past. Event will start @ 7:30 am. Signage will need to be installed evening prior with City logo'd truck. Either we be given a key or gates will need to be open for run and signage installation Equipment or Assistance Needed? Please describe the equipment/assistance you are requesting below if applicable. See above Insurance may be required due to the nature of the request. Only items described and approved within this use request will be permitted. If required, all appropriate insurance documentation must be on file prior to the date of the activity. Special Use Requests must be received at least two weeks prior to the event date. A fee of $25 (+tax) is required for each special use request that is processed and approved. Requests will not be valid until all fees are paid in full. ocuSigned by: D Signature of Applicant: Date: 8/16/2023 gBOF9C =OEE38473... Office Use Only ® Approved ❑ Not Approved Insurance Required ❑ General Liability Insurance Endorsement of Additionally Insured DocuSigned by: Approved by:-- 4BB45C14E65F41 B... Title: Assistant Director Date: 8/16/2023 Notes: no charge for city sponsored event