K-2 - Special Events Application - Back Berner Bar and Grill

Event Description: Ouside Band located @ Back Berner inside fenced area Name of Applicant: Tina Berner/Back Berner Bar & Grill Phone: 3195303118 Location of Event: 607 E Marego Road Date of Event: 6/19/2021 Time of Event: 7am-11pm Estimated Number of Participants: unknown Person Responsible for Monitoring Event: Tina Berner Plan for Restroom Facilities: Inside restrooms Plan for Police Protection: No Describe Clean Up Plans: N/A Parking Plan: N/A Description of Mechanical or Electronic Equipment to be used for Sound Amplification: Band Equipment Number and Type of Vehicles Including Bicycles to be Used in Event: N/A Temporary Signage Request: Special Circumstances Requested from City: Proof of Insurance Attached: □ or Society Insurance 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 Berner Signature 5/4/21 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 _____