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Type of Event:
_ Public Concert
Parade
Motion Picture
Fair
_ Demonstration
_ Grand Opening
Event Title: Tre L
Event Location: M
Festival
Circus
Other
Community vent
Block Party
`t''^ INntr A .\
UO,9.003
Event Date(s): From 1ZrLI 13 to 12 12. 113
Actual Event Hours: 5 a am
Total Anticipated Attendance: 2.00 ( Participants Spectators)
Setup/assembly/construction Date: 11112113 Start time: 3K
Please describe the scope of your setup/assembly work (specific details):
S r -'�a�d s ! :hours ? Ppc- rx.. per ias
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Dismantle Date: 121 is 1 13 Completion Time: ci a
List any street(s) requiring closure as a result of this event. Include street name(s), day
and time of closing and day and time of reopening.
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• iA' Avenue Q-rcm 97'" S-k-. -t-U "?ica,G.
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Sponsoring Organization: Cc nmun► Ca-I1I0a\ i 2010
Chief Officer of Organization (Name) Le 1ce Deese
Applicant (Nam Te \C;✓l C,tSS-a LAWS() flat'?
Address: 12i-t3 NO Icnekk C1 13\vc
Daytime Phone: (Ct$) 336? - L1ZS9 Evening Phone: (
Pax: ('--j' ' E-Mail: \ ' i \ 401 P. 'C1o,i10,003 6`1-11 CCU . 9oV
Contact Person "on site"' day of the event: Lire i Cellular: Personal cep I - 361- 43
NOTE: THIS PERSON MUST BE IN ATTENDANCE FOR THE DURATION OF THE EVENT
AND IMMEDIATELY AVAILABLE TO CITY OFFICIALS
Is your organization a "Tax Exempt, nonprofit" organization? X_ YES NO
Are admission, entry, vendor or participant fees required? _ YES NO
If YES, please explain the purpose and provide amount(s):
$ I v ft Estimated Gross Receipts including ticket, product and sponsorship
sales from this event.
NIA
Estimated Expenses for this event.
What is the projected amount of revenue that the Nonprofit
Organization will receive as a result of this event?
Please provide a DETAILED DESCRIPTION of your event. Include details
regarding any components of your event such as the use of vehicles, animals,
rides or any other pertinent information about the event.
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• V,4m I1 muV233rn opon -\-oufS
• 1Ac an Lem s open Q-or -t& rs
•
Stci-i'�'
_ Y _ NO If the event involves the sale of cars, will the cars come exclusively from National
City car dealers?
0, list an dditional dealers involved in the sale:
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_ YES _XNO Does the event involve the sale or use of alcoholic beverages?
YES _ NO Will items or services be sold at the event? If yes, please describe:
Vood ) do CW-.s clacks -or' sa12
YES NO Does the event involve a moving route of any kind along streets, sidewalks or
highways? If YES, attach a detailed map of your proposed route indicate the
direction of travel, and provide a written narrative to explain your route.
YES NO Does the event involve a fixed venue site? If YES, attach a detailed site map
showing all streets impacted by the event.
_ YES X NO Does the event involve the use of tents or canopies? If YES: Number of
tent/canopies Sizes NOTE: A
separate Fire Department permit is required for tents or canopies.
yYES NO Will the event involve the use of the City or your stage or PA system?
SPECIFY: c.6.1PA 54SionTh W) OP Onicrr]pinoneS
In addition to the route map required above, please attach a diagram showing the overall layout
and set-up locations for the following items: Z con Q. 1aq0.3k decendtrri 0n
Alcoholic and Nonalcoholic Concession and/or Beer Garden areas. r122C,�5 ,
Food Concession and/or Food Preparation areas Please describe how food will be served
at the event:
If you intend to cook food in the event area please specify the method:
GAS ELECTRIC CHARCOAL OTHER (Specify): -TN-)
Portable and/or Permanent Toilet Facilities
Number of portable toilets: (1 for every 250 people is required. unless the applicant can
show that there are facilities in the immediate area available to the public during the event)
Tables # i(Q and Chairs # 15- 100 (MD) Cif j SUS m Fencing, barriers and/or barricadest'e'��{�
Generator locations and/or source of electricity A.ft. J— SCcc-1
Canopies or tent locations (include tent/canopy dimensions)
Booths. exhibits, displays or enclosures
Scaffolding, bleachers, platforms, stages, grandstands or related structures
Vehicles and/or trailers
Other related event components not covered above
Trash containers and dumpsters
(Note: You must properly dispose of waste and garbage throughout the term of your
event and immediately upon conclusion of the event the area must be returned to a clean
condition.) Number of trash cans: Trash containers with lids:
Describe your plan for clean-up and removal of waste and garbage during and after the event:
1 t VLSQ. tL9r) Cans on sr e ab Well as Dodds tib*1 ba25
s•iae L611 be clecaneck 10,A 5-to-CA- Nmluerreees
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atfxer,{ nn�'4 iP 'S,f+- •..:W Yv2tAlry-TauhA'L.+`+!Y, r!%ft*,{cJ'ti7! Sty'n.
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Please describe your procedures for both Crowd Control and Internal Security:
lU CPO Lo 1) be on aiee 'ar eve
YES NO Have you hired any Professional Security organization to handle security
arrangements for this event? If YES, please list:
Security Organization:
Security Organization Address:
Security Director (Name): Phone:
YYES _ NO Is this a night event? If YES, please state how the event and surrounding area will
be illuminated to ensure safety of the participants and spectators:
Exis-tinc Streek 1'1n+t and pOSS'OOlu ft'ntir
nc}ditanal peckriners
Please indicate what arrangement you have made for providing First Aid Staffing and Equipment.
ki 0 w \ be, r m merle event
Please describe your Accessibility Plan for access at your event by individuals with disabilities:
O 1\ ()seas o se acckss i bl e
�r"•*tihr f�i �.T..rt "•Ifi r`It It'r„�-
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i m R•�•. o- the ti #. ;+,.... w,c�tt n.,.r- �'•• `+': e4.:♦:.
Please provide a detailed description of your PARKING plan:
txtis�; no spar w 1143
Please describe your plan for DISABLED PARKING:
Z--)d i oc deolcc@ed `"t"' '
Please describe your plans to notify all residents, businesses and churches impacted by the
event: e 1L t �
NOTE: Neighborhood residents must be notified 72 hours in advance when events are
scheduled in the City parks.
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> Z, .f r. �.,3erwrvroi
YES _ NO Are there any musical entertainment features related to your event? If YES,
please state the number of stages, number of bands and type of music. Number
of Stages:
Type of Music:
Number of Bands: T ?
YES _ NO Will sound amplification be used? If YES, please indicate: Start time:
5 an Finish Time 8 am/CD
4_ YES _ NO Will sound checks be conducted prior to the event? If YES, please indicate: Start
time: "1 aml'1 inish Time
5-
Please describe the sound equipment that will be used for your event:
lPnc i ie ' Y stem cram Cit and )or
Rodko btockion �T
NO Fireworks, rockets, or other pyrotechnics? If YES, please describe:
YES _ NO Any signs, banners, decorations, special lighting? If YES, please describe:
a•l d" ���" i+1 t} nw.l t -e c.
S�a-e on6 poss,* orAditional 1 ti 09
Revised 02/29/12
City of National City
PUBLIC PROPERTY USE HOLD HARMLESS AND
INDEMNIFICATION AGREEMENT
Persons requesting use of City property, facilities or personnel are required to
provide a minimum of $1,000,000 combined single limit insurance for bodily
injury and property damage which includes the City, its officials, agents and
employees named as additional insured and to sign the Hold Harmless
Agreement. Certificate of insurance must be attached to this permit.
Organization
C tas1Q r Cfino
Person in Charge of Activity LnAk Pr) [ (},}fit\m
Address
12�1� NGOtiora1 Qlva
Telephone L12E,C1 Date(s) of Use 12) 12- / I
HOLD HARMLESS AGREEMENT
As a condition of the issuance of a temporary use permit to conduct its activities
on public or private property, the undersigned hereby agree(s) to defend,
indemnify and hold harmless the City of National City and the Parking Authority
and its officers, employees and agents from and against any and all claims,
demands, costs, losses, liability or, for any personal injury, death or property
damage, or both, or any litigation and other liability, including attorneys fees and
the costs of litigation, arising out of or related to the use of public property or the
activity taken under the permit by the permittee or its agents, employees or
contractors.
dSig ature of Applicant Official Title Date
� l 6U , 64t0Ank.
Wagmen+ alu 5±
For Office Use Only
Certificate of Insurance Approved Date
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