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<br />Signature <br /> <br />Title <br /> <br />Date: <br /> <br />Reason(s) for revocation: <br /> <br />TO BE REVIEWED/APPROVED AND SIGNED BY AFFECTED <br />CITY DEPARTMENT HEADS <br /> <br />2. PARKS AND RECREATION DEPARTMENT <br /> <br />Special Events Coordinator: <br /> <br />Date: <br /> <br />Initial! sign-off: <br /> <br />3. POLICE DEPARTMENT <br /> <br />Approved by: <br /> <br />Signature <br /> <br />Title <br /> <br />Date: <br /> <br />1. _ Emergency vehicle access. <br />2. _ Traffic/safety street closures. <br />3. _ Appropriate barricades. (# Required) <br />4. _ Police personnel required/available. <br />5. _ Portable toilet facilities. (# Required) <br />6. First aid facilities. <br />7. _ Internal security and crowd control. <br />8. _ nighttime lighting. <br />9. _ Other provisions as may be required by this department. <br /> <br />4. LICENSING AND INSURANCE <br /> <br />Approved by: <br /> <br />Signature <br /> <br />Title <br /> <br />Page 7 of! 0 <br />