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<br />4. REQUESTED EVENT COMPONENTS: <br /> <br />Date requested: 1~~b Lj Alternate date: .f!! A <br />Requested hours of opera on: ZPrtI.- ~ (a.m./p.m.) To: I Dp^1 (a.m./p.m.) <br />Set up beginning date and time: SI ~ <br />Complete dismantle date and time: 'it!?:'! rO" <br />Describe the number and type of animals (if any) to be used in this event: A'Y' <br /> <br />Attach a draft of the entry form for participants and/or spectators. <br />Anticipated number of participants: I ()() Spectators: <br />. <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 clean-upIMaterial 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 deoo.it of $500 will be required for clean-up and restoration. If <br />premises are left in satisfactory condition. this deposit will be refunded in full foIlowinl! insnection. <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. i Entertainment or stage locations (grandstand operators should provide you with a <br />"to scale" drawing.) 3~4 piec.e.. ~~ <br />E. '{ Alcoholic beverage concession area. . <br />F. i 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 />L_~______ ___ _ . <br />