K-2 - Special Events Application - National Night Out

Event Description: National Night Out Name of Applicant: Eric Holzhueter Phone: 319-361-1131 Location of Event: Deer View Park Date of Event: August 1, 2023 Time of Event: 6:00 pm - 7:30 pm Estimated Number of Participants: 100 Person Responsible for Monitoring Event: Johnson County Sheriff and Eric Holzhueter Plan for Restroom Facilities: Existing porta-potty at park Plan for Police Protection: Hosted by Johnson County Sheriff Describe Clean Up Plans: Groups involved will clean up Parking Plan: Use existing parking at park. Many will walk to event. 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: Police vehicles, fire vehicles, possible other EMS equipment Temporary Signage Request: None Special Circumstances Requested from City: Exemption to Deer View Park Registration Fee and event fee Proof of Insurance Attached: ☐ or Community event hosted by Johnson County Sheriff 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. Eric Holzhueter 5/31/2023 Signature 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 _____