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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 />, . <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: _larn (a.m.lp.m.) <br />Set up beginning date and time: AUl!Ust S'h, 2004 <br />Complete dismantle date and time: August 9'h. 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 />Attach to this application either an insurance policy or a certificate of insurance including the policy number, <br />amount. and the provisions that the CilY of CenterviIle is included as an addilional insured. (Please note that <br />insurance requirements depend upon the risk level of the event. Also, if your event can be classified as lirsr <br />amendment expressive activity. insurance requiremenrs can be waived urtder certain circumslances..) <br /> <br />6. SANITATION: Please see note after a deposit of $500. <br /> <br />Anach your "Plan for clean-uplMateriall'rcscrvation". Include number, type and location of crash containe.. to be <br />provided for the event. Indicate who and how man will be responsible for emptying and cleaning up around <br />conlainers during the event. Indicate who and how many will be responsible for cleaning up after animals if [hey are <br />present duTing [he event. Indicate who and how many will be responsible for cleaning up afrer the event. Describe <br />the number, type and location of portable toilers to be provided for lhe event (or pennanentloilels 10 be used in [he <br />evenL) Include any other plan you have for ensuring posHVent cleanliness and material preservation of city <br />facilities, equipmen~ premises and streets, A dellasit of $500 will be required far c1ean-uIl and restoration. If <br />Dremises are lelt in satisfactorv COndition. this deDos!! will be refunded In full followin!! insIlection. Waste <br />Management usually donates trash containers 10 be used by participants. The Lions Club will clean up any 1efl <br />garbage. Please waive deposil. a good standing lelter 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 [mish 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 /> <br />I <br />