K-3 - Special Events Application - Prairie West Block Party - Joe and Caitlin Thornburg

Event Description: Prairie West Block Party Name of Applicant: Taylor Getting & Joe & Caitlin Thornburg Phone: 515-570-4404 Location of Event: See attached picture. Date of Event: 6/25/2022 Time of Event: 5-7 PM Estimated Number of Participants: 80 people Person Responsible for Monitoring Event: Joe & Caitlin Thornburg Plan for Restroom Facilities: People’s own homes in the neighborhood Plan for Police Protection: N/A Describe Clean Up Plans: Volunteer teams will clean up the park after the event Parking Plan: N/A Description of Mechanical or Electronic Equipment to be used for Sound Amplification: One small speaker for background music Number and Type of Vehicles Including Bicycles to be Used in Event: none Temporary Signage Request: N/A Special Circumstances Requested from City: We’ll semi-close the road so kids can safely play in the bouncy house and yard games in the street there. Proof of Insurance Attached: ☒ or ________________________________ 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 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 _____