K-2 - Special Events Application - Pet Adoption - CC Lions Club

Event Description: Pet Adoption Clear Creek Lions Club Name of Applicant: ____________________________ Phone: 319-270-6868 Location of Event: Tiffin Dog Park Date of Event: May 7th Time of Event: 10-6 Estimated Number of Participants: Unknown Person Responsible for Monitoring Event: Tina Grace Plan for Restroom Facilities: Public Facilities Plan for Police Protection: Nothing needed Describe Clean Up Plans: As necessary Clear Creek Lions Club Parking Plan: Parking Lot Description of Mechanical or Electronic Equipment to be used for Sound Amplification: Not needed Number and Type of Vehicles Including Bicycles to be Used in Event: Nine Temporary Signage Request: ? Special Circumstances Requested from City: Water Spicket Working 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. Tina Grace Clear Creek Lions Signature Date 3-22-22 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 _____