SPECIAL FUNCTION PE APPIdICATIN

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APPLICANT l t

ADDZESSDD 1CONTACT y V t

D AILS O FUNC ION LOLCATION PARADE ROUTE ETCjG tN 41 LfG Q tocrnpl t2n c Se

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CITY SERVICES REQITIREDPOLICE Streets locked rcControl SecurityPUBLIC WORKS Barricades Cleanup Setup

XCe YSJU

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Other

Other

Ifa temporary restroom is utilized for a period greater than five S days a Temporary Zse Permit is requiredApplication is available at eityHall

TEMORARY RESTROONIItII S ofututs

Proposed locationsofdays

INSITRAlICEREQUIREMENT Organized events open to the public require insurance naming the City ofPalmetto asanAdditional Insured and the insurance policy must be providito the City Cierk ten 10 daysprior to the event If yau have entered into a rental agreement for a City facility for a private evem noinsurance isretured Please review Ezhibit A for insurane coverage requirements

The Special Function Fermit Application must be suhmittedo City Commission for approval at least 30 daysprior to the event Sale or consumption ofaltoholic beverages an City progerty is strictly prohibited If yourevent will include the use af loudspeakers you may be required to apply for a Special Permit Exception tothe

CitysNoise Ordinance See Chapter5Amusements ofthe City ofPalmetto Code ofOrdinances

THIS PORTION OF TI3E PAGE INTENTIONALLY LEFIBLANK

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PLEASE CONTINUE TO PAGE 2

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PALMTIOIISTO1tCAiPARK RENTALAPPLICATION AG tT

lessecolete thisaplicatiaa with as much detail as possible Retean cvmpleted applicationwitjAZL ll8tltiritBl CCB diA mAtl to thE adtle88 AbovC or dD eison to 518 10Ave Wametto

Nme ofAppirnt Name ofOrganiaatioa

For Profit NotFor Profit

A c z3P one daytiztae Phone eveaing Phone cell Mail Addresa

Contsctiifother than applicant one da aPh hone evening

applzcantContact 5 ifotheF Phone day Phone evetaingOMacimumAaticipated attendance Mlns

late ofUse 1 Dysvfweek

tStatt time ineleoratingsetuptime ndectude cleanup time

Irhis afuadraising evenka Yes No

NoIs an entry fee ticket orregitrationfrequireda Y sCAre ny ocbetteawitb c1 Vent C r o

Ifyes to any of the abave pleaseelain how funds will beued

Pleaecheck all that applp to this event

BabyBridal Shower C aBithday Party Church FtinctionSocial FamrlyGatheringRemionCField Use Games ox Practicea FielUae Recreational MeetinccnicrClinic

CPolitical Fanction Tournament 1Wedding or Reception G aXoutk Leagve MeetmgEleetrie ifavailable Water ifavilable Otber describe

Ptaletto1to1Cp1TI RCntSI Fee3

Please check ALL facilities being requesteci for use and circle the application fees

CaxCiegie LibraryC ment Floor Oaly kES1300oFirat 3 Howsl4000each additionalhourBementF1r Grounds FEFS R4vooFirst s HourslSOOeach addatoealhour

ChapelooovSecurity depoait FEES500oan hour

N01FA SPECTALF1tCTiUN ANDADDFCCTYD ALSM F

AYS lN ANY 1DAY PERIOD SRALIiIRE12YCOIONkQMIOTIFCAPPROVAI FEFS FOgLONGRENTALU 11CIIsSIALLSE BASEDONiHEADDTIIQNAL

IId

ecura Deo500oper faciltyuxiless adiffretamounc is specified above hiamount is payabte at time of

xeservatxoa andirefimdblealpon the Completion ofafavorable inspectiou Up to loo9b of tbe secuxity deposittaayhc

retained far damage andorceanuif deemed necessary by maiaagement Insddition the appicant shall 6e

responsible fox payment ofcleaniz damage cbarges ineccess ofthe securitydewst

otaCesEncoCdtt V h CbeCC FOYIiOYA TCe8 OTDPOS1tBA Drivers License is requincifor eck for tlepeonwluse name is on the chee

State

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Feescoilccted 5b 05 teceipt s

Palmetto Historical Cazuxuvon N1LV

or

Parks andReation

PALMETTOffiTORTCAL PARKAPPLICAN7CtCKNO DGEMENT

The Applicarit herebyacknowledges and a to theolowing

Allctafees and tacesmust be includedwththis applicationSubmittal of the appiictiondoes nat confirm reservation datesReservation requests are subject to City appcoval amd are pcocessed onafirst come firstserved basis

Applicarn has been provided with a copy vf the Palmetto Historical JPazk Facility RentalRules and Regulations andaees to abide by same

ApplicaztJhereby afuumstatthe infonmationcontained in this applicatlon is true and correctacknowledges receipt ofa coyofthe appication and agres to atl ofthe ternas and conditionss outlined in the acility Rerrtal Agreement includin how to proceed in the event ofan

emergecy during the evezkt

In the case oaaeznezgenCy cotactthe Palmetto Police Departxnentact 941723587

By

Pta e N ro l crlf o S

SPECIAL FUNCTION PERMIT APPLICATION

EVENT NAME C tF irvt

APPLICANT b it slL

aDUESS l tt CrqacP5

CQNTACT1d3

DETAILS OF FIINCTION LOCATION PARADE ROUTE ETCr n

EVENT DATE

EVEITTIMLrjuPHONE LPHONE j

Cz1cCc rC 3CITY SEtVICES REQUIREDPOLICE Streets Bloeked Traffic Control r Security OtherPUBLIC WORKS Barricades Cleanup Setup Other

If a tempoay restroom is utilized for a pefiod greateN than five S days a Temporary Use Permit is requiredApplication is available at City Hall

TEMPORARY RESTROOM FACILITIES ofunits of daysProposed locations

INSURANCE REQUIREMENT Organized events open to the public require insurance naming the City ofPalmetto as an Additional Insured and the insurance policy must be provided to the City Clerk ten 10 daysprior to the event If you have entered into a rental agreement for a City facility for a private event no

insurance is required Please review Exhibit A for insurance coverage requirements

The Special Function Permit Application must be submitted to City Commission for approval at least 30 daysprior to the event Sale or consumption of alcoholic beverages on City property is strictly prohibited If yourevent will include the use of lolidspeakers you may be required to apply for a Special Permit Exception to the

Citys Noise Ordinance See Chapter5Amusements ofthe City ofPalmetto Code ofOrdinances

THIS PORTION O TH PAGE INTENTIONALLY LEFT BLANK

PLEASE CONTINUE TO PAGE 2

Speciai Function Pezmit ApplicatioiiPaye 2

EVENT C lL L tr Event Date Cy r JC tcCSJ v i

INDEI2NITY

i 3t J11L Permzttee agrees to defeld indemnify and hald harmless the CITY OF

PALVIETTO its officer agents employees and volunteers fronall loss cost and expense arising out ofailyliability or claizn or lia ility for personal injury bodily injury to persons contractual liability and damage to

propert sustained or claimed ta llave beensistained arising out ofactivrties of the Permittee ar those ofaily ofits officers agents employees licensees or invitees whether sucl act is authorized by this pennit or not anciPenllittee shall pay for any and all damage to the property oftlie CITY OF PALMETTO or loss or theft ofsuclproperty ciolle or caused by such persans CITY OF PALiV1ETT0 assumes no responsibility vhatsoever forany property placed on the prelnises PenZlittee futther agrees to waive a11 rights ofsubrogation against CITYOF PALiVIETTQ The provisions ofthis paragraph clause do not apply to any damage or loss caused solely bythe negligence of the CITY OF PALMETTO or any ofits agents or employees

I HAVE RE4D AND UNDERSTAND THE ABOVE SPECIAL FUNCTION PERMIT APPLICATIONCONDITINSAND INDEi12NITY

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CITY APPF

Public Wor

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Risk ManagParks DepatPolice DepartlzleztNorth River Fire

APPROVED BY COMVIISSION

CInternal use onlyDate Received

Date

Date

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ISCLAIMER

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ACORD25i204id08 2 of 2 239575

STA7E OF FLORIDA aEPARTMENT OF TRANSPORTRTION 85

Q QCI er MAWTEidRNCE

03106

IrtruCtions 1 Ottain signatures ofi local lawenorcment anai ciiylcounty ofPscialspa orz

2 lhis form must besubmstedby the locaf govemmentat authoriiy fo FDflTtobta6n written appraval Aliow adequate time for Pheeeview

3 Attach any necsssary maps or supporting documents

NAME OF ORGANIZATION PERSNINCHARGE ATE5

F t il 5 lADDRESS OF ORGANIZATION TEIEPHONE NUMBER

TITLEOF EVENT

DATE OF EVENT STARTINt9IMEOF EVENT DURATION OF EYENF APPROX ACTUAL CLOSING TIME INCLUDING SETTING UP BARRIERS EfC

3 v2 e

PROPOSEDROUTE pNCLUDE STATE ROAD NUMBER SPECIFIC LOCATION ETC INCLUDE MAPS J

rt0 1ctV

1 i 1 tZ L itr

t c34a lir at vL l

cc1t t

DETOUR ROUTE INCLUDE ALTERNATE ROUTES INCLUDE MAPS

NAME OF DEPT RESPONSIBLE FOR TRAFFIC CONTROL ETC CIiY POLfCE SHERIFFS DEPTPORIDAHWY PATROL ETCJQNCLUDE PREClNCT NO

g q giC 1 C2l sc 1a LSlLZ9 L

SPECIAL GONDITIONS

THIS SECTION ISTO BE CORAPLETED WHEN PERMITTMG SPECIAL USE OF A S7ATE ROAD FOR FILMING

LiCENSED PYROTECHNICS OPERATOR

APPROVAL OF LOCAL FIRE DEPAR7MENT

UABILITY 1NSURANCE CARRIER

COVERAGE AMOUNT 9OimO MINIMUM

tENGTH OF COVERAGE DAYS

FEDERAL AVIATION ADMINISTRQTION APPROVAL FOR LOW FLYING FIIMINC

ADDITIONAL IIASWTY lNSURANCE AMOUNT

TYPED NAME AND TITLEINCLUDE BADGENO IF RPPROPRIATE

TYPED NAME AND TITLE OFCITYCOUNTYOFFICIAL

POLICY EFFEGTNE DATE

SW000MIM1IIMUM

SIGNATURE OF CHIEF OF LAW ENFORCEPAENT AGENCY I DA7E 51GNED

SIGNATURE OF CITYCOUNTYOFFICIAL DATE SIGNED

UCENSE NO

Al7THORITIES CHAP7ERid65FLORIflA AaM1NiSTRATIVE CODE RULES OF TFdE DcPARTR9ENT OF TRANSPORTA71C3N TEMPORARY CLOSiNG AND SPECIAL USE OFSTATE ROADS SECTIONS3374061406AND 316Q06 FLORIflASTATUTES

8500405

CeatractesoFslagaionto indmnify defna9aatdy for ttae defense or at the epartmen opt3on to partiipatean5scsci witt

tiearmment in th dsffeneand trial of aesy ciarnage claien orsuit and any rE6ated itiement resgafaonsstslibtrigercftsy t9e

egartzntsnotieoff 9aim for ins9emn6fatianto Cortractor ContractorsicbUity to vauate9iablis or i9 eua4tEon of Ibaa@shatl not xcuseortractors cluty to deend and indemnrfywithinsven days after such aatc y tts ae4ent as gven b

egisteredraaiJ On1ranajc9ication or judgeeenfi aferhihest appeal 6s exisausted specificlfy ndngtheprtmevatSOLiY

reglientshall xcuepeaFocmaeeof th6 provision by ontractor Corractorstall pay all cosl ans feesrlaedto t1tioliten

and its enforcemettayth epartreentepartmnts failure to notify Contrctor ofialaim hailrs6easeCoatrctrof the abov

duiy ta ciefnd

tis understood and agreed that the rights and privsleges herein set outare granedonly to theetent of the States right titi and irterest in

the tand to be entered upon and used by the Permittee and the Permittee will a all times assume all risk of and indemnify defend adsave

harmtess the State of Fiorida and the Department frarn nd against any and all ioss damage cost or expsnse arising in any manner on

accoun of the exercise ar afitempted exercases by said Rermittee of the aforesaid rights and privileges

C7urirgthe event ail safety regulations fi the Department shali be obsenrdand thehider must take measursinduding ptacing and disp6ayof afetydvices that may bencessary in order to safely conduct the public through the project area iea accordartce with theeeral Manuat

on tlriform TraffcCartrol Devices fVltlTCt aamended ardtheCepactmentsiaest fdoadvvay and TracEesign 4andards

in case ofnoncompliance with ttae Departmensrequirements in effect as of the approvddate of thi permit this peamit is void and th faciiityvvill havfo be brought into comp0iance orremved frorn the R1kVa no cost o the Department

Submitedby t Piace CorpartePertrritlee

1 cc1Signature nd T e Attesied

y

epartmettaf TcanspaRafiion Approval This equest is Hereby Apprved

t2ecomrnenderi for approva Title Date

Approved by C3ateDistrieY Secretary or Designse

DtSTRIl1T1flt Origtnal Permittcee

1st copy District Maintenance Offrce

2nd capy Loca6AaintenaneEnginer

Speczal FunctionPermilTemporary Use Perxnit Application

Stepping Out Against Domestic Violence

Hope Family Services Inc

Saturday October 25 2008

800am1IQ4am

Sutton Park Walking from Sutton Park over Green Bridge to Bradenton and back to

Sutton Park map attached Walkers will register at Suttfln Park pzior ta walk

COSTS associated with Hope aznity Services Stepping Out Against Domestic Violence

beginning at Sutton Park

Overtime hours 2 employee 4 houxs @2900 23200

Salaried staff employees NC23200

InKind Services requestedSutton Paxk Renal 6500

150 Cones

extra trash cans

cxo

oPECIAL FUNCTION PERifeku3t c

EVENT NAMEvh1Se CL S tAPPLICANT ChfltttADsGCONTACT ytJ itpti1

MIT APPLTCATIOlY 9EVEN DATE

EVENTTNIEtecPHONE jl 1da

PHONE Lll Sa gr

DTAILS QF FUNCTION LOCATION PARAD ROUTE ETC PL2GGULlNQ s 411D 5 Ruv i S l S

CITERViCES REQUIREDPOLICE Streets Iocked Traffic Control Securzty Other SYZWPUBLIC WORKS Baixicades Cleanup Setup Othert jzrIfa temporczry restroom is utitized for cr periad greater thxn fve S dcrys a Temporary tlse Permit is requiredApplicatian es avairable at Cfty HalZ

TEMP4RARY RESTROOMFACIiITIES ofunits ofdaysPrapased locatians

INSURANCE 2EQUIREMENT Organized events open to the public requize insurance naming the City ofPalznetta asanAdditional Irsured and tte insurance policy xnust be provided to the City Clerk ter 10 daysprior to the event If you lxave entered into a rental agreement for a City facility for a private event noinsurance is required Please reviewEibit Afor insurance coverage requirements

The Speczal Function Perrnit Applicatior rnust be submztted to CityCcmmissian for approval at least 3Q daysprior to the event Sale or constmption of alcaholic beverages on City prQperty is strictly prohibited If yourevent will include the use af loudspeakers you zzzay be required ta apply for a Specia PerzitExceptzon to theCztysNoise Ordinance See Chapter5Amusements afthe City of Palnnetto Cade ofOrdinances

THIS PORTION OF THE PAGE INTENTIONALL LEFT BLANK

PLASE CONTIlViJE T pAGE 2

SpecialIunetion Permit ApplicationPage 2

EVENT ZSOL10UJZQ Event Date

INDEMNITY

GiJGN2G 1 Permittee agrees to defend indemnify and hold harmless the CITY OFPALMETTO its officers agents employees and volunteers from all loss cost and expense arising out afany

liability or claim or liability for personal injury bodily injury to persons contractual liability and damage to

property sustained or claimed to have been sustained arising out of activities of the Permittee or those of any ofits officers agents employees licensees or invitees whether such act is authorized by this permit or not andPermittee shall pay far any and all damage to the property ofthe CITY OF PALMETTO or loss or theft of suchproperty done or caused by such persons CITY OF PALMETTO assumes no responsibility whatsoever farany property placed an the premises Permittee further agrees to waive all rights of subrogation against CITYOF PALMETTO The provisions ofthis paragraph clause do not apply to any damage or loss caused solely bythe negligence ofthe CITY OF PALikIETTO or any ofits agents or employees

HAVE READ AND UNDERSTAND THE ABOVE SPECIAL FUNCTION PERMIT APPLICATION

CITY APPROVAL

Public Works Director

Planning ZoningRisk Management

Parks DepartmentPolice Department

North River Fire

APPROVED BY COMMISSION l

Internal use onlyDate Received

Date

Date

NQRTH RIER FiRE DIS 91721 5701

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Special Function PermitTemporary Use Permit Application

Rockin to the Oldies

Car Show Fundraiser benefiting Big Brothers Big Sisters

Palmetto Automotive405 8t Avenue West

Saturday August 30 2008

500 pm 900pm

COSTS associated for services requested by the sponsor

Portolets2 1 regular1 handicapped 19500

Display Banner one week before event 2500

30 traffic cones NC

Street sweeper discussed with the Streets Department City can not provide

NOTE This is the first of four car shows they plan on sponsoring for various charities

They will submit a Special Function Permit prior to each event once plans are finalized

112908 ChildrensHospital13109 Boys Girls Club

52009 Manatee Vets iFamilies

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APPLICATION FOR SPECIAL PERMITEXCEPIIOlT

TO THE CITYSNOISE ORDINAIVCE

APPLICATIONMUSTBE FILED NO LESS THANTIIRTY 30 DAYSIRIOR TO

THE DATE O EVENT OR OCCTRRENCEa

ve ate

r7 ISTelephone

The Applicant hereby applies for a Special Permit Exception PE to certain

provisions of the Cify of Palmettos Code regarding the prohibition of and

abatement of noise disturbances on private and public properties The SPE is

sought for

lDESCIPTION OF ACTIVITYlEVENT RWIICISPE ISREQESED0 aS s i4

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3 PROJECIED02PIOPOSElH7125 OF EVEITI

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4 STATEIYIENT OF GENERAI C IVIMUNIYIMPORTANCE OR BENEFIT

1ivI tcrl d d C vC i

5 IDENTIFY PROPOSEDEIECTIVE1VIITIGATIOI1MECHANISMS

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6 ANY ALTERltATIVELOCATI011SFOREVENTACTIVITY

7 NAME AND

DURING EVEN

U f fs j SNUMBER OF RES NS BI ART4 TO CONTACTEI3ACTIVITY 1 722

in C S

I AM AWARE TIAT in determining whether ar not an SPE slaall be issued the

City Commission shall at a minimum consider the nature of the event its possibleadverse effects its importance to the general community and potential benefit the

event may have upon the City and the general public the number of participants at

the event the time of the event proposed effective mitigation mechanisms and the

availability of alternative locations Review of a denial of an SPE shall be to the

Circuit Court in and for Manatee County and must be filed within thirty 30 daysof the date of the City Commission decision relating to the SPE Review shall be

based solely upon the record generated before the City Commissian The burden is

upon the applicant to establish by substantial competent evidence that the activityfor which the SPE is sought has the means to eff tiv y mitig otential adverse

effects and impacts upon surrounding property o rs and r ide ts

Internal Use OniyDate Received

CITCt714I10ISIOIAPPIOVAIo