TAB3

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1

SPECIAL FUNCTION PERMIT

fiOiSEEXCEP T10N PERMIT

pHECKLISTIi

I

Cicode IIII YO FestivalAlvarez Mexican Restaurant

1II

IIu L n c

REASONSFQR SPECIALFUNCTION PERMoIT

EVENT

CITY SERVICES If In kind services Supply 40 conesUSE OF CITY PROPERTY Closure 15th Streetbetween 8th Aven 9th Ave

CITY EXPENSES None

WAIVER OF CITY FEES ii None

INSURANGE REQUIRED lnslJ rarice will eprovld d prlor tothe event

NOISE EXCEPTION PERMITil

D J providlng music lTIuslcaccompanying thedan cels

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1

0

9 08 07 36af

t t of Palm eeo 8417234576 p l

EffiNT DATE 5 01r

EVENT TIME 3 1 frTJPHONE q 722 j254PHONE qfi 7i1 l232

DETAILS OF FUNCTION LOCATTON P ARAjE oUr l ETC B41v LulcLl ldhfJeuJ AtM 2 JYltlU 1J 11C f L Eefbo4 CDY t

NlASlf JnJtrAn ltLt1l1 nCt1lers UiL ct tSn t 1CITY SERVICES REQUIREDPOLICE Streets Blocked Traffic Control

PUBLICWORKS Barricades Clean upSecurity VSet up

OtherOther

if J tflmporary restroom is utilized f01 a period gHlarlr thtln fiV S days a Temporary Use Permit s requiredApplication is available at City Hall

TEMllORARYRESTROOMFACILITIES ofunits 1 ofdclYsProposed location s t5AlR Ncp4hLU 5t Qoll l e

INS CEREQUIREME1lT Organized events open to the public require insuran ce naming the City ofPalmenoas an Adqitionallnsured iand the insurance policy must be provided to the City Clerk ten 10 dayspribr to the event If you havee teredinto a rental agreem0nt for a City H1Cility for a private event noinsurance is required Please re iew Flhibit A for lusurancecoveragerequircmcnts

TIle Special Funclion Pemlit Application mustbesubrnitted to City COlnmission for approval at least 30 daysprior to the event Sale or consun1ptiori of alcoholic beverages on City properLy is strictly prohibited If yourevent will include the llsenfloudspeakers youl1iay be required to apply for a Special Pemut Exceplioll lu theCity s Noise Ordinance See Chapter 5Amusements of the titofPalmetto Code ofOrdinances

o P

TIDSPORTIONORTHE PAGEINTENT ONALLY LEFT BLANK

l PLEASE CONTNUE TO lAGE 2

APl0609 07 36ar Gtt of Pa 1metto 9417234576 p 2

Special Function Permit ApplicationPage 2

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EVENT t to dt tQ Event Date 5 q 01

Ali

fJSt7J INDEMNITY

M ro 7 I D xtJ0

I OJ t JQ L U Vtt Pennittee agrees to defend indemnify and hold hanuless the CITY OFPALMETTO its officers agents emplqyees anci volunteers irmn all loss cost and expense arising out of anyliability 01 claim orUability forpersonaIinjury bodily injury H persons contractual liability and damage toproperty sustained or claimed to have been sustained arising out ofactivities ofthe Pemlittee or those of any ofits officers agents employees licensees or invitees whether sllch ct is authorized by this pemtiJ e r not andPermittee shall pay for any and all dah1age to the property of the CITYOF P ALMETI O or loss or thlft of s chproperty done or caused by such persons CITY OF PALMETTO assumes 110 responsibility whatsoever foran propert pltlccd on the r misc s Po enl1i tt cfurlher agrees 0 waive all rights of subrogation ag inst CITYOl PALMETTO 1he prOVISions of thisparagraph clause do not apply to any damage or loss caused solely bythe negligence ofthe CITY OF PALMETTO orany ofits aJ1ents or employees

T HAVE READ AND UNDERSTAND THE ABOVE SPECIAL fUNCTION PERMIT APPUCATIONCONDITIONS AN D INDEMNITY

Ala4

Pelitte

CITY APPROVAL

PUbli Works D reclor

k hN N 7LParks DepartmentPolice DepartmentNOlth River Fire

APPRO VElJBY COMMISSION

Dale 4 709Date

Date 1 Co 0fDate f1 1Date

Date

Date

Internal use onlyDate Received

l

Apr 0709 11 02a An oinett Kil reRpr DG 09 07 43a Cie of PalMe eo

941 723 48301 i Jt fb

p 110

SpccialFuudioil PermitApplicatiolllPage 2

EVENT tJLO de D Event Date 5 q dL

Iol

JftC INDEMNITY

JIOJ t 10Jt2Ad tD rmittee agrees to defe d indemnjfy and hold harmless the CITY OFPALMEITO its officers agents employees and volunteers from 11l105s

CO t and expense arising out ofany

liability or claim or liability forpersollal injUry bodily injury 10 personscontracrualliability and jamagllo

property sustained or claimed to have been sustained arising out ofactivities ofthe Permittee or thOofany of

its officcrs llgents employc es lifosecs or irivitees hethl mlchact is authoLiled by this permit O not and

Permittee shall payfor any alld all damage to theproperty ofthc CITYOF PALMETTO or loss orTheft ofsueb

property done or ca by suehpersons CnYOF PALMETIOassumes noresponsibility whatsoever for

anypropeJtyplac don the p mises Permittee 1Unher agrees10 waivt all righLivf subrogation ag linst crrv

OF PALMEITO The provisions oftilispara8tapbclause do nllt apply to any danlabreor losscauseai solely by

the negligence fthe CITY OFPALMbTIO or anyofits agents or employees

I TiAVE READ AND UNDERSTAND THE ABOVE SPE IAL FUNCfIONPERMIT APPI ICATlON

CONDlTIONS AND INDEMNITY

J liuc

CiTY APPROV AL

Date

Date

Date

Date

Date 1JtfjJ6 9

Pllblic Works Director

Planning Zoning

Ride M3D3gcmellt

Parks Department

P liceDepartment

Nortb River fireDate

DateAPPROVBD BY COMMISSION

Internal use onlyDate Received

RPR 13 2008 02 41P FROM NORTH RIVER FIRE QIS 941 721 6701nt uo g V ct

V vr 4II 1 1laTO 97234576

T

P 2 2

Spedal Ftlnction Permit AppncaPage 2

lVEN tlCU d o Event Date q

vl17

tINDEMNITY

Aru I pl ofJOJlt Joa UACF Permittee apes tdefendl indemnify and hold baunless tbe CITY OFPA ME1 O itsoffite agentsJeinploy s andvol lI1teerstrol1alll COst BJdexpensc arising outofanyIillbiUty or claim or liabilily for nol iqjury bodJlyinjury tD petSODS contractUal liability and damage toproeertysustained orclaimedto ha e sustainedarisingoutofactivities ofthe Permittccor those ofany ofitsofticen agents employees JiceDsees oriovi whether such act is authorized by this permit or not andPermittec aba1 pay fOTny and aUdam8geto the property ofthe CITY OFPALMEITO or Joss or thaft ofmchproperty done or caused oymchpersons CITYOFrALME ITO assumes no responsibility wbatsoever fortny propertplaeed on the premiscs l tUrther agrees b waive all rights otstIbrogalion8gainl CJTYOF PALMElTO The provisions fthisp p lause do notapplto any damage Ot lossC8used solely bythenes1igcnce ofthe CITYOF P ALME1T orany of its agent oremplyees

I HAVE READ ANO UNDERSTANDnm ABOVE SPECIALPUNCTION PERMIT APPLrCATIONCONDliIONS ANDlNDEMNITY

f

1p ttee

CiTY APPROVAt

Public WOTksDiretor

PI8Di1ingZOninLRisk ManagementParks Departmentlonce hepamnentNorth River Fire

Dato

Date

Date

Date

D e

Date floISDate

1 t

I

SpecialFunction PermitTemporary Use Permit Application

Cincode Mayo FestivalAlvarez Mexican Restaurant

Saturday May 9 20095 00p m 11 00 p m

In Kind ServicesCones 40

No other costs associated with this event

MEMORANDUM

TO CIlY OFPAIMElVOCOMMISSION

FROM RON KOPER RISKMiNAGER SAFElY DIRECTOR

SUBJECT CINCODEMAYOFESTIVAL

DATE 4 6 2009

Insurance IS reguired fori this event

NGTE Ariy vendors participatiDg in this eventWill be required t provide a Certificate ofCoverage

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APPLICATION FORSPECIAL PERMIT EXCEPTIONTQ lRECITY S NOISE ORDINANCE

APPLICATIlJNMUST BE FILED NO LESS THANTllIRTYl30 DAYSPRIOR TOTHE DATE FEVENTlJROCCUllRENCE

lVllfltcm I JKQst6Applic8nt s Name eJlf l 6UAvc liS

mLt FL34

5 9 oC7Eventnate

7d 0 5qTelephone

Represlmtative

The ApplicalttheJ by applies for a Special Permit Exception SPE to certainprovisions of the City iiof Palmetto s Code regarding the prohibition of andabatement of noise distllrban es Oil private andpubIicproperties The SPE issought for

1 lESCIPTION OF ACTIVITYIEVENTFORWHICII SPEIS REQUESTEDolL tJ 1 cd CUNllAt YU4l

S 11wtL DiLL f JKu CWAJ

2 ESTIMATED ATTENDANCE JtDO

I

3 PRQJECTED OR PROPOSED HOURS OF EVENT FromS Yh To It YYh

6

4 STATEMENT OF GENERAL COMMUNITY IMPORTANCE OR BENEFIT

t 4r9qdhw to

5 IDENTIFY PROPOSED EFFECTIVE MITIGATION MECHANISMS

D1vI

I

6 ANY ALlE ATIVE LOCATIONS FOR EVENT ACTIVITYw A

7 NAME AND N1JM ER OF RESPONSIBLE PARTY TOBECONTACTEDDURING EVENT ACTIYlfVmq L A J Ar Z

c

fl 4 62 691 Q 32

I

lAM AWARE THAT i deterlDining whether rnot an SPEshall be issued theCity ommission shaU ata minimurp consider the nature of the event its possibleadv rseeffects its importance to thegeneralcomlDunityand potential benefit theevent may have uponthe City and the general public the number ofparticipants atthe event the time of th vellt proposedeffectivell1itigationmechanisms a d theavailability of alternativc ocations Review of a denial of an SPE shall be to theCircuit Court in and for Manat eCoul1tyand m J be filed within thirty 30 daysof the date of theCity om missiondecisionrelatlng to the SPE Review shall bebased solely upon therecor generated before th City Commission The burden isI1ponthe applicant to establish by substantial competelltevidence that the activityfor which the SPE is so ght has the means to effectively mitigate potential adverseeffects and impacts upon snrrounfiug prope a ts

Internal Use OnlyDate Received A licant

CITY COMMISSION APPROVAL

7

if

EVENT College GraduatioriPartyWinifredD Nlitcheil

u

1

i It jll Ic

SPECI L FlJNCTION PERMITCHECKLIST

REASONS FOR SPE iALFUNCJINPERMIT

PARK RENTALCITY SERVICESUSE OF CITY PROPERTY

CITY EXPENSES l

WAIVER 0CITYFEESjl

INSURANCE REQUIRED

Carriegielibrary Rental AttachedNoneNone

None

None

50 Security depo itcollectcdRental fee collected by Historical Society andIei bursed tO the CitY ana m n hly basis

Non required because ofexecution ofPaim ttoHistoricaIPalk RentalApplication Agreement

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a SPECIAL FlffiCTIN PERMHAPPLICATlON

ElE1ff N MEA1I tj1

iUILlC Td 0drcl l

ADDRESS l3 E

1j 1tJ

CONTACf P q3 l I

EvENT DATE mCU I 2 0 9

E NTTIME 4PM QptUPHONEg lC3 ta 3 V

PHONE q 1l3 tX12

nET

ITYSERVICES REQUIREDP9LIJE treets Block

Traffic Co trol NI

PpBLIC WORKs Ba111cadesCl anup N Pt

SecuritySet up

Other fJIOther Nl

If atempaary restroamlutilized fJra jJiti04 greater

thanWe 5 dayS a TemporaryUse Permjfis required

Application is availableat CityHall

ofdays

TEltlPORARYRES fROOM FAJtLtrIES ofunits NJ f

Proposed lQcation s

IlIS dEREQUIREMEliT Qrgarii Wenls opentothe eUbtl telIuire inUlance naDlmg

lIe City of

PaJmeito as an iddi iollllllsUtM andheinsurancellQicynWsfbe ptc

ed tQ the City CId ten IO day

P QI tQ thi event IfhaV entered iJl a rei1Wagoierncrttfof a i9

lilii1itY fur apriv eventno

insurance is required Pleiise revieYEx ibit A rorjD Urance coverage

requirements

SPeCitd F OI1 Permit Applieatin1i111SlsuImiltedtQ ity cplIllllission

fur approval al1east 30 days

priortO the event SaIerct lISIlmptiOof alcol1liic evenigeSOD

city IropertY is strictly prohibitedIfymr

eV will inCIuae the 6flQulpeaker you rmIYbe rellllired alillyfura SpecialPermi

ExceprioiltQ the

City s Noise erilinance See Cliapter5 AmuseinelllS ofthe City ofl1a1mtotto

Code oferdinanceI

TIDS PORTION OF THEPAGE INTENTIONALLY LEFT

BLANK

PLEASE CNTINUE1O AGE2

Apr 0309 01 11Hpr u u vI e a

Anto i nette Ii 1 gorevl or alffie o

941 723 4830ItlfC oJt b

p 1p e

Sp bJ lIJ1u aioo Permit ppBkmtiollPagel

EVENT CO e r tl Jn CYVaEvent Date l j J c

OD9

JNDEMNm

kd AI l 10 detend unl tyh1d hormleSS the em OF

PAJMlITTO its olli oytesvoI 11oss

anepense arisi ll outofany

liiebility orclaimorlillbiUty fotpcrsonalinjury bodily injury toperso

liability atld cllunage to

property susiai11Od1 d uncllO wiaf afire tb

ofaJYof

no enipl y Ii or whetheb llCtjS by tbispennlt

or not aod

Permittee sbaUpay for any ind all dalna8etoth pnIllY flhe9lV OH1IIETfO orloss

thefl afsucb

P0IlY dOlloor by suhprsliSQTY 01P IETIO

Iity for

3lIY1fOIMY ptacedlbo JomUtleeliulher asr b alligbts

afaubigalioo CrrY

OF PALMETrO The proiJisionsofthisparsgmpnctai1se donot plytoanydll11ageorlollS cal1sed solely by

thenegligence oftile CiTY QFPALME1iOor snyofits agents Ofei11ployees

I w lliDAIjD UNlSt ooTIll ABOVE SPEtw

pfllMIt APPucATIml

CONDITIONSJNDiNDEMNITY

W d U itktlPermittee

ClTY APPllOVAI

PublicWorks Director

Pia Zoaing

A

Police Dep entClJNorth verFire

APPROVED BY COMMISSi

Date zT

Date

Date 3 olI

ate i1JfDate l 3 03Date

Date

Jv jC IIP

11 use aaly

Date Reuived

APR 3 2008 11 10A FROM NORTH RIVER

t1pr U U UIU ail1

FIRE 015 941 721 6701Ot alm eG o

TO 97234576I CJ O

P 2 2p t

s Fnctio8Permit AppJlcatioDPage Z

EvM1 Cy nniYlent DaIe

9a9

INPDINIT

k W lr petJiIiItoo 1O demI illd iYhold harmleSs the CITY OF

PALMErro its CI1iCldiageDlS CIIlJlIlld ft aI kloS amI

outofllllY

liabililrQt dllilRorlilllliJibr bcldiIYiIiurytolialIilityllll to

propcty QtclaitnedrOlIlVfIbeeDsu8IlIiaIClIoUl llIiWiesl ftlie

or dIoOoof of

iI o lleDlPCllfllSI or MIelIier

by thisnor IIIll lIIUI

l iblIIIp lblllllYallIa noIlCtotile ofthc1TY9l PAtMITfO

or loss OI1IIoft ofsIdt

OI causecl llYllUtJ errv OPp IlO

Ibr

IIYpl POllY tbeto aIrigIIIslfIll lJluPiOD

crrY

OPI lije oftlliapolljlllPhdOllOlPPIY1O 8I1Y

1ota co 1OoIy by

t enegliJ Qf heCrFlOF pAldBlrQoranyof its agents orcmployees

1 lAvE A1 m i1lIE AQQVE 5JELI

PJlRMIT AfIucA1PI

cOND11IONS ANDDIDEMNlTY

ACtJilJl 1permith

crrYAPPtDV AL

PubticWOIks Dircctor M1PlaDoiog ZoDing

1li

Parks t

PoJiceDcpartmem

NortbRiver Yue

APPJOVEDBY

1s c

Date i4T

Date

Dale sJDatc

Date

DalOYpldDale

i

MEMORANDUM

TO

FROM

CITYOFPALMETfOCOMMISS IONI

RON KOPER RISKMANAGER SAFE1Y DIRECTOR

SUBJECT COLLEGE GRADUATIONPAR1Y 5 2 2009

DATE 3 25 2009

Insurance IS required for this event

NOTE Any vendors participatingin this event will be required to provide a Certificate of

Coverage

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Special Function PermitTemporary Use Permit Application

College Graduation PartyWinifred d MitchellMCly2 20094 QOp h1 lq OO p m

Location Historic Park Carnegie Library estimated attendance 70

Rental Xpplication att ched deposit 50 00 paid rental fee 250 00 due prior toevent Fees collectedbyllistClfic Commission and paid to City after event

No costs associated With this everttr

l

3

uu

Phone

Maximum

OaY 8 ofweek 1Lk OCL

e

p almetto Historical Parkkental Fees

Please check ALLfacilities being requestedfor use and circle the application

fees

Ca1Jegie Libraryr mcnt FloOr Only

FEE 150 00 Firsts HOUrsI000 each dditional hour

r iaseU1out Floorlit Groundll

FEfS HO OIl FirstHoura oo h dditioool

hour

rJCbapel lOQ OQSecuriY dpoSitFEElk 60oo lDlbour 1

Ifro GO

N rt r ii 9 gJlSESeCurity Deposit OO QO per

faciity d dilft amountspecilied ahove This

amountpayable ttime o

rv tioo and refundable uponthe CoIDP1etion of favorable iospetion

Up to 00 of secoritydeposit may be

retailied for damage andorc1 uprd necesSary by

t In ddition the applicant shall be

reSporuible for payntentlf olUfii1IamlJ8lelllrllCs itielcceSS

ofthe security deposit

t tolFeeS Iilclos C1k SO rR F f

nepoaita

DeivLiceDaelO ithe

w nthecheck

State

I

t

APiicODt foIIYun tands that ubJnittal ofthiSappicatlmI

dQes not eonfinnmylour request ODd that ALL

R tal Fees OJUiT MBe blcludedWJtIi Appliadio

IlWe Urtherundentandthat ALL requests

subject st8lf approvlli ODd are proceaaedcma firSt come firSt served basis Upon

revieW designated stali

member will notifyor one o mycutacts reganting the status 01

thiS request ODd whetherornot theis

1addiii na1infonnatKnrequiredor iI y tal andordeposits

still remain to be paid IWealso

seiJDwled tbatlWebave eivdciPy aIuuderotandODd fuIl1

ogreeto aU ofthe itemS ODdtermS

outlinedin die facilityRentalA tincudinll baW to prOced

in the event ofODY emergencynding

mmediateatttntion duringtlieeventIlWelurlhOralinU that the infonnation

contained in this application is

tru andcorreCt to the bestofmyour lmowledge

Sipature ofApplicaBrt0 I phiDtc Lc II Date

PleaseJIlIke AIJclleeM payableto thePalJnettO HiStorical eoJDDJisSiOD

JI

t

FOROFnCEUSEONLYApproved or Denied

Date Recd

FeeS CollectedReceipt S

palmetto Historical Commission

Palmetto Parks llnd ReaeaUununeut

l

F

fifil

l 1l

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PALMETTO BlSTORlCALPARKAPPLICANT tCKNOWLEDGEMENT

The APPlicant IJ Mclcye

I

ack1loWledges an agreesto the foUowif1

Jhereby

All rental eesa11d IlXesll1Ustbeinolude4witb thisapplicatioD

Submittalof thellPplioatio donotconfirDi lion

elates

leservlIt1on reiquests are aUbjetto Pity apprOvllla11dare processed

00 a first comefirst

served basis

APPlimIas beeDprvid04witbaOPY oftbe Palmetto

Hislorioallark FacilityRental

Rules and Regulations andagteest abide by same

APpliCUlbe@ YaffliUt tlilltmeiOfonnation contained intbisapplication

is lJUe a11dco

knowledge receiiltoflloPl Y ofthe awliOlltionancI W a1 ofthe telJDS

a11d oonditi

as outlined in tbe Facility lIentaligreetnenl includitig bOwlproel

in the event Ofan

emergency duringthe event

In the case ofan emergencyOOJll8lltbelaImetlO PoliceDepartment

at 941 7234587

The aPl lialBtheril yatoind nifyalld hQld

harntless the

Palmetto Histori l CQIIlJiliSsiQBand the City ofPaDl

o their agents and

employees againSt anyalld aJldaiIJls lellllllldS

tQStse and nabilityof

every kind uatuajldd riptiOIl diredly QtiJllllredlY

Ilrising from or

relited to the use ofilleIaliiletto Jistoncal PllrllFacllity

pertnitted nnder

this rentalagreemen

Theundersiglledll ppllCllnt t1ifitulthe or she accepts

respoJlllibility

011 behatfofhislher orpnizatioJigrollpalldWsgu

ts for any damageor

theftslllltailled b thePalDlO lJistOnCllI Par llredli5eSo

landsellping

equipDlent fI1rDitllreeca of oUllllailey Qf

the pllII1etto HiStorical Plllk

Facility b the organizatiQD

llulve read anclagreeto comply with the

rul llnd regulations statedin

or incorpOlllted intQillislllBtal agreelllent The

cost of any special cleaningor

dalllage to theP ILFaeilityeqQiPlllellt of

unds dne to the scbecluled

activity or event will bedecluetedfrolllthe seerity deplSit

provided Jor

herem 111 theeventtult SuchcOllts es thll 1Il01l1lt

Qfthe rity deposit

the undelllignedllgreestohe persoJl8lty tellpOJlSihle

for the payment to the

Palmetto HistoricalCommissionof any overages

By c1J Y

l1int e 6 Vd NyxcV e I

t

Jate tArxv C lo lexY

A

rd

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SPECIAL FUNCTION PERMITCHECKLlST

EVENT 3rd Arnualiylopar Ma l1ess gar Tru k ShowManasota Mopar Club Inc

I

REASONS FORSPECIAL FbNCTIONPE MITi

PARK RENTALt j

II

CITY SERVICES iiUSE OF CITY PRPP RTY

i

Lamb Sutton PilrksRental AttachedInklnd servlces Supply20 cones

CI s re of10th Ave betweenLamb Sutton Parks

CITY EXPENSE None

WAIVER OF CITFEES None3 ei1t i and s8cut1tydeposit collected

INSURANCE REqUIREDI

L 1

Insuranc willbeprovidettp iorto the event

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SPECIAL FuNcTION PERMIT APPLICATIONa iHfrltat Ofo fClI feS Clt IEE J NAME U LShbW EVENT DATE D 4 O a51 ooq

PLJCANT ffi aS C1 c lTNc EVENT TIME CCApD SS act tClu 3ct b tPP rAS fOirOl PHONE lq44 Loll CL

CONTACT n L D r Ufd PH N lCll Q qr

ofl r o

c 7l

e Q

I o a b llAY 41 7 ICITY SE ICESREQUlRED IIROLICE streets Blocked rraftlcControl

UBLICWdR1s rBafric des X J c CleartpeC es

If atemporary restroom is utilized lor aperiqd geat tthan jive 5 days a Temporary Use Permit is requiredApplication is tivi1iab atCityJial

tiI

SecuritySei up

OtherOther

I

TEMPORARYRESTROMFACJLITIES W ofunitSProposedlo ation s t

ofdays

URANCE ImQUlREMENT Organized eyentsopen to the public require insurancenatlling the City ofPalmet1oas an Additional Insured dthe insurance policy must be provided to the City Clerk ten lO dayspriQrto th

O

yent If you have entered into a rental agreement for a City facility fora priv te event noihsuraJ1cei required Iease reviewExhi A cor insurance coverage requirements

h dt or 5 7

te Spec al F tion Permit Applic iOlf must be submi e9 to City Gommission for approval at least Jaysprirto the even Sale orcolsumption of alcoqoli beveragesnCity property isstric ly prohibited Ifyour

event iUjnclude the use ofloudspe ers you nlay be r quirecl to apply for aSpecial Permit Exception to theCity s Noise Ordinance SeeChap erj5 A inlemellts oftheCity ofPalmetto Code ofOrdinances

THISPORTIONORI EPA KINTENfIONALl Y LEFT BLANKV PLExSE CONTfNUE TO pAGE i u

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Sp ci IFunctionPernit ApplicationPagel

EVENT Rpdfi ffal ffOvnC mQ DeSS Event Date Oe4 OO iQCU k V OvJ

INDEMNITY

1 11 Pennittee agre s ttdefend indemnify and hold hannlessttJ CIfYOFALMEFTO its offi ers ag ts employeesand

volunteers fromaH loss cost and expense arising out ofanyliability ordairllor liability forper onal injury bodily injlty top rs ns contractu lliability arid d mage toproBertysu il d rcl ime i9h Yrbeen slstai 1ecl risingo tofactivities oftheP rrnitteeor thosi ofanY ofo its officers agents employees licerisees orinvitees whether such act is authorized by this pemiitor not andPermittee shaHpay for y and all damage to the property ofthe CITY OF PALMETTO or loss or theftofsuehproperty doneorcalJsedby sllchp tsons CITY QfPALMETTO assumes no responsibility whatsoever forany property placed onthepremises Perniitt e furthetagrees to waive alLrights ofsubrogation agail1sLCITYOFJALMEfTO The proyisions o this paragraph clause do not applY to anyjiamage or loss caused solelyhythenegligence ofthe CITY OF PALMETTO or any ofits agents or employees

L

I HAVE READ AND UNOERSTAlIDTHE ABOVE SPECIAL FUNCTION PERMIT APPLICATION0I

CONIITIONS ANn QoUn

y

7

i

Parks DepartmentPolice DepartmentNorth River Fire

APPROVED BY COMMISSION

Internal use oillyDate Recei ed

ll

Date 74Date

Date

Date

Date

Date

Date

kr

Apr 14 q9 11 39a

Apr 1309 12 S9p

Antoinette KilgoreCi of Palmet o

941 723 4830941723457

p lp 2

Special FuoctioD Permit AppliclltionPlIge 2

YtNT III Wlf Event DJot OQhS

I dOOCjCOoX UC Z SV9

w

INDEMNITY

uV tkb In tl2 p lmin agrees to dfen itldenmifyand N Idhannless the CITY Of

l ALMBTrO i sufficers a8 ts plnyeeo arnJvolunteersfrom aIUo cost llnd xpensc arising uut ofany

liability or claim or liability forpt rson t nJuro bodilyi1iUl10 persons conltactualfiahility and camage

tt

prol erty sustained or claimedto have bem stainedBrising oul ofacliVities of

the permittee or those ofany of

it l nicerS agel1ts empJoy lilt1I srir invitc cJ whethcr 1Cb actisauthori7bthythis permit or not

and

Permittee shan pay for any anda1t damagc to theiptoprtY ofthe CITY OFPJLMFrTO or

loss or tbdl of suth

property done or cauSed by such persons CITYOfPAUvtErrOassumesnoresponsibilily whatl tever tOr

any propertypl8ced eR the Premises Permittee furtheragrees10 waive aU ri hbOrsubs ogation against CITY

Of PALMETTO The provisions ofthispal8Gl8Pbclausedo l lllapply to any dasnagcor loss caused solely by

theuegligence of tbeCIT9F PAI METT09r I1Y ofilSagenlor employees

I HAye READ AND UNDERSTA DllIEABOVE SPeCIALFUNCTI N PFRMIT APPlICATIQN

CONDITIONS N IND

11 4ifemuttee

Risk Mallagement

Pnrks Department

PolietOCpartmenrGNtrth Rivtr Fire

APPROVEDBV COMMISSION

T

bAJfi

Date 7

D l

Date ifIiI D CfDate

Date

1

Internal use onlyDate Rc ved

APR 1 200808 37A FROM NORTH RIVER FIRE DI5941 721 6701npr g c v I UTralQ U

TO 97234576ru

P 212

peeial F ctioD Permit AppHcatioa1

EVENT Bcd n al rn 6oe s EveutOafe Oe ooqaar r u S tw

INDEMNITY

W hIDQc 1 lfy llldhold harm lheC1TY 01l MO it1 orrecen enaptoyccs VC lUritcemtromalIIOSrost and expense arising rlllt

oflUly

liability or claim orlUti iIIlCor injwy bodiIyilijury co contraclllalliabiljty and c1amagecoPIO SUIi1abcdOfc imecHbhavebeen sustained erisingoutofactivitiesoftltePennitteeorthose

of Illof

its ot11cers agentst etJJpJuca li ilWiteetWhdbel HUchaetis authori1edhy lhis permit 01 not and

Permittee Sban pay forlnymclaUd tottcFopaty OfthcCITY OFPALMBTJO or Iossorthdlofsueh

property doneorQdred by such CITYOFPALM1lToasswnesno bi61ycrfor

anY prOpeltyplated9D th8pnmi P i tlnberagm s 10 waive allri5hofsuillat CITY

OFPALMElTO lbe provisionsofids paragmph do ut apply toany cIama or loacausedlOtcty bythllne8lis ofthe C1TVOPPALMEllor8lly of 8IP1 orertIP oYClCS

IliAVEREADAND UNDERS1IND11iEABOVE SPECIAL FUNcnONPFRMIT APPUCAnON

CQND1TIONSAND1ND

Il

crtAPPROVAL

Illb Wb tPlanniogIe Zonq V

Risk Managtment

Parks DcpartmentPolice DepartmentNorth RivcrFiM

APPROVBDBY

ZAJr

Date fr74Date

DaIo

Date

Date

14

rtemaJ use only

f ifi

CITY OF PALMETTOFACILITY RENTAL APPLICATION

APPLIC lAC OWLFDGEMENT

TheApplicant iWo q lJ Qacknowledges amla ees to the followmg

hereby

I i

All rental feesandtaxes pustoeincluded with this applica i riSubmittaloftheapplication dqesnot confirm reservation datesReservation requests are subj cttoCity approval andareproces ed on a first come firstserved basis

Appncanthasbeenprovid d ith atopy ofthe City facility Rerttal Rules and Regulationsand agrees to abide bys rrte

n

Applicantherebyaffinns thattheihfollIlatiort contained in this application istrue and correctacIrnowfedges reCeiptofa Cbp r ftheapplication and agrees to alI ofthe terms and conditions asoutlinedirt th FaciJity Rental Agreement including howtproceed in the event of an emergencyduring theev I1t

I

Injhe case ofan emergency ontactthe Palrnetto PoHce Departm ntat 941 7234587

Tjleap UcallfherebY a rees to indem ify n holdba mless theCity ofPalmettoCity itsag ntsandelDploiees aagainstanY andaUclaims demands costs expenses a d

Iibility ofeverykindnatureanddes ription directly orindirectly arising from or relat dtothe useofthe CityFaciU per itted under thisrentalagree8ent The undersigned applicantcedifiesthathe or She acceptsrespODsibilityonbehalfof hislher organization Igroup alldit sguests fora ydam geortheft sustainedbythe City premises land cllpillg equipmentfUrniture becaus of occupancy ofthe City FaciUtyby theoranization Thavereadalldagree to comply wi htherules alld regulations stated in or incorporated into this rentalagreement The cost orany p ialcl anillg or dam@getothe City Facility equipment ofgrounds due to the scheduled activity or evelltwiUbededucted from the security depositprovided for hrerein In t1eevent tbatsuch costs exceed the amount ofthe security deposit JheU d

J zsr the ymeut Wthe i or any

Print uame NLth LhlAblopnate Jujl J Ooq

3

1

Special Function PermitTemporary Use Pe tApplication

3rd Annual MoparMadness Car Truck ShowManasota MoparClub Wanda Dunlhp

J

Sunday October 25 20097 00 a m 5 00 p m

Sutton and Lamb Parks

SuttonlLafnbParkRented City Facility Rental Application attachedSutton PavilionBallfield 200 00Lamb PicfjicGrounds 65 00Deposit refundable 100 00

Total 365 00 pd ck 17824 6 09

In Kind Services

Cones 20

No other costs associated with this event

City ofPalmettoParks Recreation Department600 17th StreetWestPalmetto Florida 34221

Building Facilities Rental FeesPlease check ALL facilities being requested for use and circle the application fees

Sutton Park

JPavilionJPavilion Per DayJBalI FieldJBall Field Per Day

Pavilion Ball Field per Day

FEES 65 00 First 3 HoUrs 2000 each additional hourFEES 175 00 First D y 100 00 each additional dayFEES 30 00 First 3 Hours 5 00 each additional hourFEES 55 00AUDay 45 00 ea h additional day 6

4 EEES 2oo 00 First DaY l00 OO each additional day 00

Lamb ParkTennis Courts

icnic Grounds

C Cel bration CenterJCelebration Center

FEES 20 00 First 3 Hours 5 00 each additional hourFEES 3000 First 3 Hours 5 00 each additional hourFEES 90 00 First 3 Hours 20 00 each additional hour

FEES 225 00 All D y 150 00 each additional day

17th Street Park

JPaviIi llJPaviIion

FEES 55 00 First 3 H sl 15 00 each additional hourFEFS 150 00 All DaY lOO OO each additional day

t

Palmetto HistoricalPark

Carnegie LibraryBasement Floor OnlyBasement Floor Grounds

Chapel 100 00 Security deposit

FEES 130 00 First 3 Hours 40 00 each additional hourFEES 140 00 First 3 Hours 45 00 each additional hour

FEES 50 00 an hour

JSoccer Field FEES 45 00 First3 Hours 15 00 each additional hour

Riverside Park WestPavilion FEES 60 00 FirstSHours 20 00 each additional hour

FEES 150 00 Per dayFEES 200 00 Security deposit

NOTE ASPECIAL FUNCTION PERMIT AND ADDITIONAL SECURITY DEPOSIT ALSO MAY BE REQUIIlEDPURSUANT TO CHAPTER 19 ARTICLE VI OF THE CITY CODE OF ORDINANCES RENTAL OF CITYFACIUTIESFOR MORETIfANFIVE 6 DAYS IN ANY TFlIRTY so DAY PERIOD SHALLREQUIRE CITY COMMISSION

i APPROVAL FEES FOR LONGTERMRENTALOF CITY FACILITIES SHALL BE BASED ON THE ADDITIONALOPERATION AND MAlNTENANCECOSTSINCURRED BY tHE CITY IN CONNECTION wrtHsuclI loNG TERMUSE

Green Bridge Fishing Pier Tournalllents

Security Deposit 5000 per facility unless a different amount is specified above This amount is payable at time ofreservation and is refundable upon the Completion ofafavorable inspection Up to 100 ofthe security deposit may beretained for damage and or clean upifdeemed necessary by management In addition the applicant shall beresponsible forpayment ofcleaningdamage charges in excess of the security deposit

1 11 00 J So

I r1 00TotaIFeesEnclosed cas or for RentalFeep for Deposit s LlLQA Drivers License is reqlire for ALL clieck ort e personw hose name is onthe check aCoc tt SStatetL D54l Q L d lof fi21 D

Applicant fully understands that submittal ofthis application does not confirm my our request and that ALLRental Fees and T es Must BeIncluded With This Application I1We further understand that ALL requestsare subject to staff approval and are processed on a firstcome first served basis Upon review a designated staffmember will notify meor one ofmy contacts regarding the status ofthis requestand whether or not there isany additionalinformation required or ifanyrentaLfees and ordeposits still remain to be paid I1We alsoacknowledge that I1We have received a copy read understand and fully agree to all ofthe items and termsoutlined in the Facility Rental Agreement incltiding l1ow to proceed in the event ofany emergency needingimmediate attention dllringthe event lWe further affirm that the information contained in this application istrue and cortec tto the be t Wkn OWI

Signature ofApplicantJJarutlty Jy u J11Jj u Dateplease make ALL checks payable to the City ofPalmetto

FOR OFFICE USE ONLY

Date Recd Approved or Denied

Fees Collected Receipt s

Palmetto Historical Commission

aJmettoParks nd RecreationDe artment

2

MEMORANDUM

TO CIlY OF PALMETfoCOMMISSION

FROM RON KOPER RISK MANAGER SAFElYDIRECTOR

SUBJECT 3RD ANNUAL MOPAR MADNESS CAR TR iK SHOW

DATE 4 6 2009

InsuranseIS requiredfor this evcnt

NOTE Any vendors participating in this eventwill be required to proVide a Certificate ofCov eraget

RK