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<br />JAN 26 2004 13:12 FR ARTESYN ENGINEERING 612 392 6740 TO 96514298629 <br /> <br />P.03/11 <br /> <br />4. REQUESTED EVENT COMPONENTS: <br /> <br />Date requested: _August 7-8, 2004 Alternate date; Nonc_ <br />Requested hours of operation: _llam (a.m.lp.m.) To: _lam (a.m.lp.m.) <br />Set up beginning date and time: August 5th. 2004 <br />Complete dismantle date and time: August 9th. 2004 <br />Describe the number and type of animals (if any) to be used in this event: None <br /> <br />Attach a draft of the entry form for participants and/or spectators. <br />Anticipated number of participants: _10 to 60 Spectators; _100 to 500_ <br /> <br />S. INSURANCE: Applied for, see attached request to T J Adams Group Ins. <br /> <br />Anach to this application either an insurance policy or a certificale of insurancc including me policy number. <br />arnounl. and the provisions that the City of CcntervilIe is included as an additional insured. (Please nOle mat <br />insurance requirements depend upon the risk level of the evenL Also, if your event can be classified as lirsl <br />amendment expressive ilctivity, insurance requirements can be waived under certain circumstances.) <br /> <br />6. SANITATION: Please see note after a deposit of $500. <br /> <br />Anach your "Plan for clean-upJM:alerial Preservation". Include number. rype and localion of aash conlainen ro be <br />provided for the evcnL Indicate who and how man will be responsible for emptying and cleaning up around <br />eonlainers during the event. lndieare who and how many will be responsible for cleaning up after animals if rhey arc <br />present during Ihe event. Indieare who and how many will be responsible for cleaning up afler rhe event. Describe <br />the number, Iype and location of portable toilers ro be provided for Lbe evenr (or pennanent toilets to be used in rhe <br />evenL) Include any other plan you have for ensuring post-evenr clean]ine." and material preservation of city <br />facilities. equipmen~ premises and streelS. A dellosit of $500 will be required for c1ean.ull nnd restoration. If <br />Dremises are len in satisfaelory condition. this deDosit will be refunded in full follDwin~ InsDeelloR. Waste <br />Managemenl usually donates lTash containers to be used by participants. The Lions Club will clean up any left <br />garbage. Please waive deposit, a good standing letter is provided. <br /> <br />7. LOCATION: LaMotte Park in Centerville <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. _X_ Entertainment or stage locations (grandstand operators should provide you with a <br />"to scale" drawing.) <br />E. _X_ Alcoholic beverage concession area. <br />F. _X_ Non-alcoholic concession area. <br />G. _X_ Food concession area. <br />H. _X_ General Merchandise concession areas. <br /> <br />Page 2 of 10 <br />