K-2 - Special Events Application - Block Party - 100 block Summerhays

Event Description: Block Party Name of Applicant: Ed Swim Phone: 319 930 0871 Location of Event: Summerhays St From 1st to 2nd Street Date of Event: 8 / 31 / 24 Time of Event: 10 am to 10 pm Estimated Number of Participants: > 24 (less than 24) Person Responsible for Monitoring Event: Ed Swim Plan for Restroom Facilities: Our own homes Plan for Police Protection: N/A Describe Clean Up Plans: We will cleanup after ourselves Parking Plan: N/A Description of Mechanical or Electronic Equipment to be used for Sound Amplification: N/A Number and Type of Vehicles Including Bicycles to be Used in Event: street closed? Temporary Signage Request: road closed signs at 1st and 2nd Street Special Circumstances Requested from City: Proof of Insurance Attached: ☐ or Home owners 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] 7/1/24 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