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<br />Signature <br /> <br />Trtle <br /> <br />Date: <br /> <br />1. Dance and/or live entertainment. <br />List types or permits or licenses required: <br /> <br />2. Alcoholic beverages. <br />3. Peddlers. <br />4. Noise abatement. <br />S. Other provisions as may be required: <br /> <br />INSURANCE: Your iDsurBllce eoverqe Blast be reviewed and appnved by the <br />City's insurance carrier. <br /> <br />1. Public liability insurance naming City ofCentervine and other public agencies <br />additionally insured is required. . <br />2. Hold harmless forms executed and failed. <br />3. List and approve/disapprove other insurance coverage as may be required. <br /> <br />S. PIRE DEPARTMENT <br /> <br />Approved by: <br /> <br />Signature <br /> <br />Title <br /> <br />Date: <br /> <br />1. Emergency vehicle access. <br />2. Use of fireworks, pyrotechnics, vehicle fuel, open flame. <br />3. Cooking facilities. <br />4. Occupancy and spacing of tables, enclosures. <br />S. Parade, floats. <br />6. Tents, air supported structures, canopies. <br />7. Other provisions as my be required by this department: <br /> <br />6. Btm..DING DEPARTMENT <br /> <br />Approved by: <br /> <br />Signature <br /> <br />Title <br /> <br />Date: <br /> <br />Page 8 of 10 <br /> <br />~ <br />