K-4 - Special Events Application - Country Friday Night - Tony Johnson

Event Description: Country Friday Name of Applicant: Tony Johnson Phone: 319.331.3180 Location of Event: Andersen Square - Tiffin, IA Date of Event: 8-16-24 Time of Event: 5 p.m. 10:00 p.m Estimated Number of Participants: 200 Person Responsible for Monitoring Event: Tony Johnson Plan for Restroom Facilities: Port a Potties be provided Plan for Police Protection: Johnson Co. contact be provided Describe Clean Up Plans: Responsible for all clean-up Parking Plan: Free Parking with Staff hired (1) Food Vendor (1) Alcohol Vendor (1) Fireworks show-Black Thunder (short) Description of Mechanical or Electronic Equipment to be used for Sound Amplification: Sound Equipment provided by Anthony Entertainment Number and Type of Vehicles Including Bicycles to be Used in Event: Park Place Management vehicle/side-by-side Temporary Signage Request: Signage as last year Corner Ferrer Green Park Rd Special Circumstances Requested from City: Tony will again notify business in New York. Request to block part of Boardwalk at Park for Energy Series. Proof of Insurance Attached: ✔ or Provided by Skogman Insurance Series. I certify that I am the person authorized to act on behalf of the event to request this permit and understand and agree to pay on behalf of the City all sums which the City shall be obligated to pay by reason of any liability imposed upon the City for damages of any kind resulting from use of public property and the public right of way, whether sustained by any person or persons, caused by accident or otherwise and shall defend as its own expense and on behalf of the City any claim against the City arising out of the use of public property and the public right of way and agree to follow all other ordinances that shall pertain including Ordinance 2006-277, City of Tiffin, Iowa. I understand that I will not erect any temporary signage for the event prior to City Approval of signage. [Signature] 6/20/24 For City Use: Authorized City Signature Date Copy to Applicant ______ Johnson Co. Sheriff Notified ______ Fees Collected ______ Public Works Notified ______ Tiffin Fire Department Notified ______ Council Approval ______