04202009 commission agendadocsonline.palmettofl.org/palmetto/agendas/city/2009/042009/com… · 0 t...
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SPECIAL FUNCTION PERMIT
fiOiSEEXCEP T10N PERMIT
pHECKLISTIi
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Cicode IIII YO FestivalAlvarez Mexican Restaurant
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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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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
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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
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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
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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
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RPR 13 2008 02 41P FROM NORTH RIVER FIRE QIS 941 721 6701nt uo g V ct
V vr 4II 1 1laTO 97234576
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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
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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
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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
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3 PRQJECTED OR PROPOSED HOURS OF EVENT FromS Yh To It YYh
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4 STATEMENT OF GENERAL COMMUNITY IMPORTANCE OR BENEFIT
t 4r9qdhw to
5 IDENTIFY PROPOSED EFFECTIVE MITIGATION MECHANISMS
D1vI
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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
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fl 4 62 691 Q 32
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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
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EVENT College GraduatioriPartyWinifredD Nlitcheil
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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
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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
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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
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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
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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
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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
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FOROFnCEUSEONLYApproved or Denied
Date Recd
FeeS CollectedReceipt S
palmetto Historical Commission
Palmetto Parks llnd ReaeaUununeut
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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
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A
rd
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SPECIAL FUNCTION PERMITCHECKLlST
EVENT 3rd Arnualiylopar Ma l1ess gar Tru k ShowManasota Mopar Club Inc
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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
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I HAVE READ AND UNOERSTAlIDTHE ABOVE SPECIAL FUNCTION PERMIT APPLICATION0I
CONIITIONS ANn QoUn
y
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Parks DepartmentPolice DepartmentNorth River Fire
APPROVED BY COMMISSION
Internal use oillyDate Recei ed
ll
Date 74Date
Date
Date
Date
Date
Date
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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
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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
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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
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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
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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
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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
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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