K-3 - Special Events Permit - Lions Clothes Collection

Event Description: Clothes collection for Iowa City Shelter Name of Applicant: Clear Creek Lions Club Kevin Swanson Phone: 217-855-3730 Location of Event: Parking lot at the corner of Highway 6 and North Park Road Date of Event: October 5th 2024 Time of Event: 10:00 AM - 1:00 PM Estimated Number of Participants: 20 +/- People dropping off donated items plus Lions Club member Person Responsible for Monitoring Event: Kevin Swanson Plan for Restroom Facilities: none Plan for Police Protection: none Describe Clean Up Plans: Kevin Swanson will inspect the area for clean up Parking Plan: none. Expecting people to drop off items and leave. 4-5 Lions Club members will park at the come Description of Mechanical or Electronic Equipment to be used for Sound Amplification: none Number and Type of Vehicles Including Bicycles to be Used in Event: 4 - 5. Vehicles for the Lions Club members that are there donating their time to collect items. Temporary Signage Request: none Special Circumstances Requested from City: none. Requesting use of the parking lot Proof of Insurance Attached: □ or ______none 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] Signature [Date] Date 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 _______