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<br />~ <br /> <br />I <br /> <br />4. <br /> <br />REQUESTED EVENT COMPONENTS: <br /> <br />Date requested: ~ t if 1 D I Alternate date: <br />Requested hours of operation: q -- AAid.CM ~.Ip.m.) To: <br />Set up beginning dare and time: ~ . <br />Complete dismantle date and time: ~A IIu1.t ./ <br />Describe the number and type of anhnals (if any)'\., be used in ~ent: <br /> <br />(a.m.lp.m.) <br /> <br />Attach a draft of the entry form for participants and/or spectators. <br />Anticipated number of participants: {f?O-- {'fj; Spectators: <br /> <br />5. INSURANCE: <br /> <br />Attach to this application either an insurance policy or a certificate of insurance including the policy number, <br />amount, and the provisions that the City of Centerville is included as an additional insured (please note that <br />insurance requirements depend upon the risk level of the event. Also, if your event can be classified as first <br />amendment expressive activity, insurance requirements can be waived under certain circumstances.) <br /> <br />6. SANITATION: <br /> <br />Attach your "Plan for c1ean-up/Material Preservation". Include number, type and location of trash containers to be <br />provided for the event. Indicate who and how man will be responsible for emptying and cleaning up around <br />containers during the event. Indicate who and how many will be responsible for cleaning up after animals if they are <br />present during the event. Indicate who and how many will be responsible for cleaning up after the event. Describe <br />the number, type and location of portable toilets to be provided for the event (or permanent toilets to be used in the <br />event.) Include any other plan you have for ensuring post-event cleanliness and material preservation of city <br />facilities, equipment, premises and streets. A deposit of $SOO will be reauired for dean-uD and restoration. If <br />premises are left in satisfaetorv condition. this deposit will be refllnded in run foDowin2 insoeetion. <br /> <br />7. LOCATION: <br /> <br />Please attach a map of your event land design. Check off below items that apply to your event <br />and indicate them on the attached map. Use, where necessary, a ''to scale" drawing. <br /> <br />A. _ If a route is involved, the beginning and finish area with arrows. <br />B. _ If a route is involved, the places where buses, autos or other motorized vehicles need to <br />be considered. <br />C. _ If a route is involved, attach separate maps giving two or more alternate routes. <br />D. _ Entertainment or stage locations (grandstand operators should provide you with a <br />''to scale" drawing.) <br />E. _ Alcoholic beverage concession area. <br />F. Non-alcoholic concession area. <br />G. Food concession area. <br />H. General Merchandise concession areas. <br />I. _ Portable toilet facilities (indicate number). <br />J. _ Event participant and/or spectator parking areas. <br />K. _ Event organizer's command post. <br /> <br />Page 2 of 10 <br /> <br />I <br />3J" I <br /> <br />---- -- --~-------~---------------- --- --------- ------ <br />