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Res No 071-15-14410RESOLUTION NO.071-15-14410 A Resolution authorizing the CityManagerto permit L'Atelier Schoolto hold their 20th Anniversary celebration on Sunday,May 9,2015,on SW 71 Street. WHEREAS,L'Atelier School willbecelebratingtheir 20th AnniversaryonMay9,2015,bypartially closingdownaportionofSW71Streetfrom11:00 a.m.-3:00 p.m.;and, WHEREAS,theschoolhasbeeninbusinesssince1995andwouldliketo celebrate their anniversary withthechildren,teachers and parents oftheschool;and, WHEREAS,there willbe different exhibitionsinvolving performers,and a variety offoods;and, WHEREAS,theapplicanthaspaid$500forthe deposit,$100foradministrativefeeand$60foran application fee;totaling $660;and, WHEREAS,the applicant has also paid for the followingfees: •Police:$120(One Officer for three hours at$40 per hour) •Public Works:Barricades $100 NOW,THEREFORE,BEIT RESOLVED BY THE MAYOR AND CITY COMMISSION OF THE CITY OF SOUTH MIAMI,FLORIDA: Section 1.TheMayorandCityCommission authorize theCityManagerto permit L'Atelier School, toholdits20th Anniversary celebration,onSunday,May9,2015,onSW71 Street from 11:00 a.m.-3:00 p.m. Section 2.Payment for this special event willbe provided by the applicant prior to the event; unless directed differently by the City Commission. Section 3.If any section clause,sentence,or phrase of this resolution isfor any reason held invalid or unconstitutional bya court of competent jurisdiction,the holding shall not affect the validity of the remaining portions of this resolution. Section 4.This resolution shall become effective immediately upon adoption by vote of the City Commission. PASSED AND ADOPTED thisSth dayofMay2015. ATTEST: FORM, APPROVED: it}k*k£ MAYOR COMMISSION VOTE:4-0 Mayor Stoddard:Yea Vice Mayor Harris:Yea Commissioner Liebman:Yea Commissioner Welsh:absent Commissioner Edmond:Yea ^fui'South11 Miami THE CITY OF PLEASANT LIVING CITY OF SOUTH MIAMI OFFICE OF THE CITY MANAGER INTER-OFFICE MEMORANDUM To: From: Date: The Honorable Mayor &Members of the City Commission Steven J.Alexander,City Manager May 5,2015 AgendaItem No.:3 Subject:A Resolution authorizing the City Manager to permit L'atelier School to hold their 20th Anniversary celebration on Sunday,May9,2015,on SW 71 Street. Background:L'Atelier Schoolwillbecelebrating their 20th Anniversary onMay 9th,2015by partially closing down a small section ofSW71 Street,between SW 61st Ave.and SW 59th Placefrom 11:00 a.m.-3:00p.m. The school has been in business since 1995 and would like to celebrate their anniversary with the children,teachers and parents of the school.There willbe different exhibitions involving performers,anda variety offoods. The applicant paid$500forthedeposit,$100for administrative feeand$60for an application fee;totaling $660. In addition,the applicant hasalsopaidfor the followingfees: •Police:$120[Oneofficerfor three hoursat$40 per hour) •Public Works:Barricades $100 Expense:N/A Account:Not Applicable Attachments:Resolution MiamiApril16th,2015. To whom It may concern; T L'AT6LICR SCHOOL A ItfGGlO E^JitA PHILOSOPHY INiPiRtD 5CHOO.SINCE 1995 L'Atelier schoollocatedat the 5960Sw 71st Stit'sbeenonbusinesssince1995.Thisyearisour 20th Anniversary.Weasa community ofparents,children andstaffwanttocelebratethis important time ina special way.Our idea Is toclosea partial part ofthestreet,from ourspacetothe right corner.We already talkedwithourneighbors:SparklingpoolsandBestMiamiHotelabout the event and there areokand willing to cooperate. The event willstartsat11:00amto3:00pm.Wearegoingtoincorporatedifferentaspectstothe event thatshowswhoweareasa school,telling the story of L'Atelier through different exhibitions involving parents,teachers,childrenandoutsideperformers,as:storytellingspace,asoundand movement space, culture and food space,andthe Atelier visibility with a recollection of materials from nature,landscape, etc. Attachedyou will haveasketchorsiteplanofthestreetandthedifferentspaceswewanttoincorporate. Thanksinadvanceforyourhelpandsupportasacityandpart of our community. Simonetta Cittadini Mrp 4mM«»i^<4»i APR 16 2015 April 23rd,2015 Contact: For: Telephone: Email: "The Catering Division of Perricone's Marketplace' 15 SE 10th Street,Miami,Florida 33131 Tel:(305)374-9449 Fax:(305)371-6647 CATERING PROPOSAL Shari Kamali MDCCMA 305-663-6319 skamali@,southmiamifhgov Dear Shari: Wearedelightedto present thefollowingarrangementsforyourcatered function asfollows. Pleasenotethatthisisonlyaproposal.Anyelementsmaybe changed toyour liking. Day:Friday Date:June 26*,2015 Time:7:00pm-10:00pm Event:Meeting Guests:-50 People Location:At Restaurant:Final Location Determined by Final Headcount;Gazebo Private with Minimum Guarantee of 45 Adults,Semi-Private with Less Than 45 Adults SUMMARY OF EVENT This sectionof the permitapplicationis intended to provide the SpecialEventsPermitCommittee with an overview ofyour event Informationyouprovideinthis section ispublicinformationandmaybe used in developing theCity of South Miami's Calendar of Special Events.Application must be submitted no*less.than twentv-one f21)davs prior to the effective dateof the event with all required documents.s TYPE OF EVENT-•Filming •.Charity •Festivals |g]Celebration I 1Promotion Other: name of events-£flffi Annjvfi«yzM^Aj:Ate 1iftf £ohogf LOCATION OF EVENTf:. {Please note:virile complete mailing address,as well as name ofany buildings and/or parks ifapplicable) is this an annual event?Q No.Q Yes if yes,this is the^annual event,previous date EVENT DATE(S)|jQprhi^^^EVENT DAY(S);;;fitpciL £B^ ACTUAL EVENT HOURS;//;OQa/^gyp.m.UNTIL;..,..&jXL(LCn a.m.ffm] (Please note;event maynotbegin earlier then 8 a.m.orend later then 11 p.m.in residential areas,ormidnight incommercial areas) ASSEMBLY DATE(S)i:..SETUP/DOWN TIMESj *?£n53p.n?,.a.m./p.m. ANTICIPATED ATTENDANCES.TOTAL EVENT DURATION:£>hrs mins Names ^jfYvom^/Ck {%h[<2&tLtv Title:.^^a^^^Ot^^:^...... Cell/Phone:feov)Wlt'}^* Name;.Q&TICU&.QjOCMedU>_.... Titles tD/fi?c/or ^ Cell/Phoned ~73 &€>531%(7_ *I L'AJelc&f School :..„,•••••••.. 1-16 -fm(n i.wywigyMffMi APMICANT/SPONSOR INFORMATION The applicantfor the Special EventPermitmustbetheauthorized representative ofthe organization/business conducting thespeclal event.Thispersonmustbe available to work with the City's Special Event Permit Committee throughout the permitting process.A professional event organizer,orother representative,may apply fortheSpecialEvent permit on behalf ofthe organization/business. NAME OF ORGANIZATION*LI/^feY/e^gzhcxzf ADDRESS OF ORGANIZATION;,__^^^Q...&V^ZII &T Hi'ctnni'"^T/....•....--c ••••--•.-..•T-i-;.1-.^:.-.•*•>-g-^----- OFFICETELEPHONE:[<30d}&&2 33P-&>FAX:C%>&)&<f2 '2Q Z& PRESiDENTt ADDRESS . PRES.PHONE: SEC.PHONE;.: SECRETARY: ^EMAIL^, EMAIL: Ifthe organization isa tenant and/or renter ofthe event location,please have the property owner complete the following: (lApplicant/Organization owns the event location [~~l I give permission for the Applicant/Organization to use my property. Comments: Property Owner's Name: Property Owner's Address! Property Owner's Signature^ >Notary Signature: •'•'if ••••!*",.v ,j'.v*••;• 2-16 r.:\...i.'^r-••-•"••,•.•j-ij-..-..-.—f--- Phoned •.tf.;•-:•••i"'-.• Date: EVEKT HBE ai^ POLICE DEPARTMENT YES NO 1r.Si •Will your event obstruct the normal flow of traffic? 2*e3 •Do you expectthe total attendance for your event tobe over 150 people atany one giventime? 3,.}|5 •Will you be requesting the use of Extra-Duty Police Officers?if yes, howmany t (Please note:if you answered NO,tothis question off-duty officers can still be assigned to your event atacostto you if deemed necessary) If NO,please describe why the event will nothaveasignificant impact on the surroundingpublic streets and/orpropertyarea. Off-Duty Officer'Applicant pg.1l'/See SpecialEventFeeSchedule for costdetail PUBLIC WORKS..,„....,•,''•lUJL'.JJ'."mmtmtimmmmmmm^mtmimfm^^null...im**m^mm**mmmmmmimm0mmmm~mm YES NO 4*12J •Will your event interfere with any public right-of-way,such as roads, sidewalks,alley,etc.? 5a |3 •Will your event require any full and/o(jga^3)>oad closures?If yes, please complete the Right-of-Way Application. *(Please note:any right-of-way clostires will require atleastone off-duty officer and public works employee.) &lEp EZ3 Will your event require the use of barricades?If yes:how many .,...._...ffiwhattype r .. (Please note:all pubic right-of-way closures must have approved barricades) *7*K3 •Would you like the City to provide you with barricades for you event,at a cost?If yes:how many;,,„...„.,.„•». 8.•|§J Will you be applying for a Pole Banner? Please,describeyourplans for thecleanupand removal of recyclable goods,waste andgarbage duripg.and afteryour event. COe coil I QjUccn Public Right-Of-Waiy Applicant pg.12 /Pole Banner Applicant pg.15 See Special EventFee Schedule for cost detail 3-16 PLANNING AND ZONING ...,,,„., YES Nb I I Areyou confident that your eventis in the City ofSouth Miami limits? (Please note:thatit Is thesole responsibility ofthe applicant to ascertain the .location is within thecity's limit.Youmaycall the Planning &Zoning department at (305)6634326 ifyou have any questions}.) 10,•'gfl Will you be hanging any banners over public streets?If yes,please complete theHanging Banner Application. (Please note:that all requests for banner over public streetsmustbe reviewed and approved bythe City Commission,which meetsonlytwice a month,) 11 f,]§?3 -O Have you notified the event location neighbors about your event? Hanging BanneroverStreet Applicant pg.14/SeeSpecialEventFee Schedule for cost detail PARKING DIVISION 12,. 133 14.. YES • NO m • WillyouberentinganyCityparking meters?If yes,how many, (Please note:thatifyou are closingor Interfering with any right-of-way that includes parking meters you are required topaythe meter feeas well.) Doyou have enough on-site parkingto accommodate your event? Will your event involve the use ofa shuttle and/oralternateparking sites? Parking Meter-Rental Applicant pg.13/See Special Event Fee'Schedule for cost detail CODE ENFORCEMENT YES 15;D 1%.• 17,• Willyoubehavingany music and/orloud sounds duringyour event? Willyour event bestarting before 8 a.m.? Will your event endafter 11.p.m.ona weekday and/or12a.m. weekend? iijljh?i i.mi; ^A,RKS_AN.P RgC^EATION. YES 18. 19.• NO j3 Will this event takeplaceinartyofthe South Miami Cityparks? (Please note:A rental fed will be applicable ifa City Park isbeing utilized. Reservations are made through the Parks &Recreation Department {305)668* 7232). Willthis event require the use ofanyParks equipment orstaff? 'lrC~"M"i~Vi."FW"i«*^ 4-16 SITE PLAN/SKETCH Amapof the event site is required and should indicate event layout with proposed attractions,recommended street closures^parade or run/walk routes,etc.Please draw you map onthe space provided below;or attach your maptotheapplicationuponsubmittal;The following mustbe identified and labeled: 1.EventSite (label streets,building,etc.)3.Canopies,tents,stages 5.Fencing/Barricades x-x-x 7.First aid facilities + 2.Routes (races,parades,etc.)^"^^4.Restroom facilities R 6.Offduty police officers P 8,Parking Area PA 546 •oat: p X it <0 N if cntz^m \^ni c=7 NOITEICAHON /PETITION Event Namej.^g^..Cin?yiv&r^r'9 of Event Date;.M<sut ^M>. UjHc^U-^3ohoof J We,the<undersigned businesses and/or residents,have been notifiedof street closures associated with theevent noted about on said date,and hereby agree or disagree tothe closiire(s).We are also awarethatthis response maynot effect this application beingapprovedordisapproved. sin soj 7-1 3©$r 46?-6fe4'^proved H Disapproved LJl £^kUt»$&o(\-Krfo ^°7f face {do&Obi12 tO.Approved L3 Disapproved LJ i Approved I—I Disapproved LJ <tr-,L.,."|.ii i»mi Approved LJ Disapproved LJ Approved LJ Disapproved LJ Approved LJ Disapproved LJ Approved LJ Disapproved LJ *-ri-••»*,<ii-iVi'i Approved LJ Disapproved LJ Approved!I Disapproved!I Approved LJ Disapproved LJ 6-16 :^"7i•Jilii ju' (GENERAL REQUIREMENTS Section I *When markinganypublic street,curb and/or right-of-way no permanent marking substance may be used., Allmarking agents must be removed immediately after the completion of the event s Barricadesshallrequireanadditionalrentalfee established bythePublicWorks Department ifa City SponsoredEvent.If not sponsored bythe City,then you must rent barricades through a barricade company. s Nopegs,stakes,oranchoring devices shallbedrivenintotheconcrete,asphalt,orCityhardened right-of- way; *Mapofrouteorsiteplanofthe scheduled event Including all stationsanddescriptionsofactivities. •Any temporary cover forstations such asacanopyshallbeflameretardantandapplicantshallprovide proof ofsuch certificate. '%ev1ew<^^^^immmau^Mt^ s 72hour notice givento all merchants whosestreetwouldbeclosed. > Please initial ^ Section II In theeventofa parade,apermit from theSouth Miami Police Departmentmustbeobtained. If Policeservice for traffic and/orcrowd control is required,arrangements will bemade through theCityof South Miami Police Departmentfor off-duty Police officers.ThePolice Department will determinethe numberof officers,required.(Ptease.be aware thatcosts might changeona yearly basis). being adhereci to. feofoepaflri-rent'.ffarkfnci D^barfaftent4nd/6r:G6a^ rile liabintv4tisiffaffcfr covefaaecertiffcafe nam addjffloijffi loMridifbiv^ to the event!"*-...,™-.-y,......... Barricades:The average hourlyrate for 125 Barricades for one C\)day usageisapproximately$80.00. Please Initial S^ Sectionin. f*&p6i*)ftc;^auly¥mehM Mi r&aattMtKiff SfffelsarTria aBfiitaii.6Vfejftt»(jafeo:publffe_pro&ertV:oiypubilfi $ ** > •;a1i^ltV4%ff^ i^EEniH^^ orqanlz^toft to! bv the Citv. A majority vote pf approval (one-month in advanced bythe City Commission will be required for large events. Depositof Six HundredDollars ($600.001 to defray costof litter cleanup,must accompany application, plusa permit feeof $60.00.If clean-up Is not required,deposit maybe refunded.The litter depositmay differ depending upon the event.($100.00 will be retained by the City as an Administrative processing fee deducted from the $600,00 deposit). fefclfe^^^living increases^ For Grant Recipients:jPaffhffi^f^fl&^i^ifffi^^ approved bv the Citv.—-..-..~~~;.... Public Works-Theaverage hourly ratesare approximate $40.00per non-supervising employee,per hour, and$45.00forsupervising employee,per hour. Please initial Wti/pi 7-16 J9'-.tejtiadfir %V'ihe INDEMNIFICATION AGREEMENT THIS AGREEMENT ("Agreement")is entered into by and between •&/rnoMtJt!&tkjff*uXi*%£ ("Applicant"),andtheCity of South Miami"("City*)onthe date on which the last ofthe Parties executes this Agreement. RECITALS WHEREAS,the Applicant hassubmitteda Special Event Permit Application totheCity for (eventtitle) L'AJe>l*er ^^..^^/y^-ia^P^yaari vflflfrg &+>?/ST .(location)on (date(s))_ 2. 3, 4. 6. 7. 8. 9. 10. relSSel j,("Special Event");and WHEREAS,pursuant to ofthe City's Codeandthe City's Special EveiVtfegulatiohs,the Applicant must execute an indemnification and hold harmless agreement protecting theCityfromanyandallclaimswhichmay arise outofthe Special Event. NOW,THEREFORE,in consideration of the matters recited above,the mutual covenants setforth lierein,andother good consideration the receipt and sufficiency ofwhichishereby acknowledged,the Parties hereby agree as follows: 1.The above recitals are true and correct Applicantagreestoindemnify,defendandholdtheCity,its officers,affiliates,employees,successors and assigns, harmless from and against anyandail such claims,suits,actions,damages,or causes of action arising asa result of the Special Events or ofthe condition of thesiteonwhichthe Special Eventis held including any personal injuryor loss of life,or damage toorloss of property,and from and against any costs,attorney's fees,expenses or liabilities incurred inandaboutthedefenseorsettlementofartyclaims,and the investigation thereof. Permits for SpecialEventsmustbeoneventsiteatalltimes. No Street shallbeclosedwithout authorization from theCityofSouthMiami Public Works Department and Police Department Traffic shall be maintained in accordance with Florida.Department ofTransportation (FDOT),Miami-Dade County standards andany additional requirements bytheCityof South Miami Public Works Department and Police Department. Event areas shallbe restored toequalor better condition than they were before the event started. If all restoration workisnot performed within 30days of workcompletion,theCityofSouth Miami Public Works Department may restore theevent area and charge the applicant forthe cost of restoration plusa minimum of 15%for administrative fee and any additional incidental fees. Applicant mustpay all fees prior to.the start of their events). Applicants that receive approval:fortheireventmore than thirty (30)daysin advance shallnotifytheCity of South Miami Special Event/Marketing Coordinator at least forty-eight (48)hours prior to start of their event Anydamage to private property shall berestored to its original condition or better and as accepted by the Owner. IN WITNESS WHEREOF,each ofthe parties hereto has caused this Agreement tobe executed and sealed byitsduly authorized signatory(ies)onthedatesetforthbelowand notarized. PRIRT NAME AFrrTJWOT "" Subscribed and svwrn before me,this -Ul__day of,.^ft|.^^lfc .a NotatyPublic inand forr^ Gdunfy,SJfatepf _n 846 M APPLICANTS TITLE PATEUOICI.|_.i . DATE:I * JOYLEEN MARTIN NOTARY PUBUC STATE OF FLORIDA Coram*EE831S06 Expires V3O016 CITY OF SOUTH MIAMI POLICE DEPARTMENT 6130 Sunset Drive,SouthMiami,Fl 33143 (305)663-6301 1 Extra-Duty Police Officers :,Application South Miami Florida 4Ul>ftroarifc»CU» 'Mil' A police officer for employment that is indigenous to their law enforcement authority commonly referred to as "Extra-Duty" employment.The following policies and procedures must conform in order to schedule a police officer for employment on a temporary or infrequent basis; >The South Miami Polioe Department shall be the final authority In determining the minimum number of officers required to police a particular event If more than three officers are hired,a supervisor must also be hired.The City Manager Office and South Miami Police Department will determine the supervisor to officer ratio for larger events. >The Applicant will .be required to compensate the assigned officer for a minimum of three (3)hours evenif the event isofa shorter duration.Currently the rate for Extra-Duty Police Officer is $40 per hour &$50 per hour for Supervising Officer,plus a $3.00 charge for radio usage for eachofficer. >The Applicant must compensate the officers)for their services at least one (1)day prior tothe start ofthe scheduled event that the officer(s)will be assigned to.No monetary payment will be accepted.No payment by exchange of goods orservices is acceptable. >If,during a scheduled event,the Applicant determines that he/she needs to extend the time an officers)works atthe assignment,the Applicant shall compensate officers)for a full hour worked ifthe Officer(s)works for more than 20 minutes and/or less59 minutes beyondthe regularly scheduled time ofthe event. >Applicant must notify ofa cancellation request of an Off-Duty Police Officer forty-eight (48)hours prior tothe scheduled dateof service. Failure todoso will require the Applicant to compensate the assigned officer for a minimum ofthree (3)hours. ^.APPLICANT INFORMATION. m/tmrnrnmrnm le*'3&f>3&/z Business/Organization Name Business/Organiza'tion Address mtmmmm Applicant Name Miatru ^L 33ty3 City State ZipCode fc/QS)£^Z?3Z6>Csoeft&G&2Q&6 -Lather €>,}&fcl/&r.ore* me Number Fax Number £-Mail ^Phone Number Fax Number mm •EVENTJNFORMATLQN.^.,._. Lh^<&oe tfccA/eeCo Ori-Site Contact Person *mm mmm ~it&ers&fZ n Cellular Number IMt'il.l.XU'JMin "*"""TypebfE\feht" ^ffij^~Ssl&0 3<aJ 1[3T Niameof Event Event Location Anticipated Attendance I acknowledge and accept financlat responsibilities to pay alt costsand fees associated with this request form prior tothe service date(s)* ;_t)ateAppllcant's^Ss re FOR QFFICEOSES ONLY: NO.Office:*I«'•>.'I,i Til M"" COMMENT: POLICE DEPARTMENT SIGNATURE CZJ^^^^^'^^^^^^P'SMisS ^Qapproved with condition a X NO.Radio:X NO.Hours ,3»J>™,... DATE 11-16 Estimated Total Cost kilo.6t> 'CITY OF SOUTH MIAMI PUBLIC WORKS DEPARTMENT 4795SW 75,h Avenue,Miami,Fl 33155 (305)668-7205 Fax (305)668-7208 Application to Conduct A Special Event Function on Public Right-of-Way Soutti Mlvml Mil 17 NOTE:ALL FjELDS SHALL BE FILLED.No action can be taken on this application until all questions have been answered,Asset forth in Ordinance No.21-09-2013;temporary full roadway and sidewalk closure (NO SINGLE LANE ROADWAY CLOSURE PERMITTED)for special events,eight (8)hours max.Schedule of fees is attached.Use blank paper if you need additional writing space.PLEASE PRINT clearly,except for signature. Contact Information: Business/Organization Name Business/Organization Address City State Zip Code" 'Phone Number —•.*——•»"pax Number •=«-:• .Event Information:, Event Name Il./9fe4f&r]J)Gi*.„OLnoi.\^ Project Location a Event Date(s) S/m^ne//^(Uih^irvQ Authorized Representative Name <33>/<4>3 E-Mail Shr&zj Jnfrqoj nj jfa J^J^fy^ Jt&&jEvent Day(s)Type of Event „&UkJb&^^ Anticipated AttendanceEventStartTime*-J/-/OQ.1@m)pm)Event £nd Time %3.\QjQ.(am / Event Setup Time .?-'<?.Q.jga /pm)Breakdown Time...&'P&.(am /<ggj}Total Duration (Include setup)*? I HEREBY REQUEST A PERMIT FOR THE FOLLOWING; Anticipatedeffectsonvehicularandpedestriantrafficduring ProjectMaintenance of traffic provisions arespecific (include sketchifnecessary): The following documents havebeepsubmittedwiththispermit application: [~J Site plan /sketch of event.Clearly define boundaries and linear foot of road closures. |I Maintenance of Traffic (MOT)for vehicular and pedestrian traffic during event. 7n sifeftfog this application,I understand that separate City and/or County permits may be required for this project.Furthermore,Iam aware thai Iam responsible tor ensuring thai the project is completed in accordance with the plans and specifications as stipulated in the permit approval conditions.As w&B as acknowledge that any rlght<vf*way closures will require at least ohe off-dutypfficert public works employee and barricades." 'APPLICANT JOYLE6N MARTIN NOTARY PUBUC STA18 OF FlOtt&A BommlBEWBrt Explret 9/3/2010 Permit No: Approved/ Disapproved By i Date i 4 1 §: P •,n,i^,—•-frr. Permit Fee ,Comments i i i •.: :.....»......... 12-16 CITY OF SOUTH MIAMI SPECIAL EVENTS/MARKETING DIVISION 5800 SW66 Street.Soutn Miami;Fl 33143 (305)663-8319 Fax <305)668*7388 Special Events Clean-Up Deposit Refund Request Application Sou Ml Miami Florida Tim* In ordertoreceiveyour clean-up deposit,(ora portion thereof),youmustcomplete and return thisformtotheSpecialEvents/ Marketing Division,no soonerthan twenty-four (24)hoursafteryourevent.TheDepositofSixHundred Dollars ($600.00)istodefray costof Jitter clean-up.If clean-upisnot required andyoureventoccurs without any city damagesand/orcostly issues,$500of your depositmayberefunded back toyou.A $100.00 non-refundable administrativefee will be deducted fromthe S6Q0.00 deposit Event Name *^&&,^£#Q 7'6T Hfctrnt "ZFL 2&ryaEventLocation Event Date(s). Event Start Time hiau.°(4^Event Day(s) OO <5>Event End Type of Event Q^Uh^^^- .......P-m*Time &4<OQ a.m. <3jj5)Total Duration were unscheduled Police Officercalledouttoyourevent? were there anydamagestoanycityand/orprivate properly? haveyoupaidalttherequiredfeesassociatedtoyourevent? Comments,problems and/or suggestions (if any);. IfRefund Request Applicationisapproved,wouldyoulikethepaymenttobe: Refund to: (Full Name V —'•-"-•••--'--i-v-—Lz _—^ Mail Address): • Mail Check • D • • D "In signing this application,1 understand that Refunds will notbe processed until this form hasbeen completed and signed off.bydesignated City Departments.If anycost incurred is outstanding,it will bededucted from deposit and that I will be heldresponsibleforany overages." Applicant's Signature Date m FOR ORFlCE USE$OhlLY: Police Department^ PublicVVerks Dep. Parks &Recreation . Code Enforcement Date Date. ....Date Date ..,,.,Dale,. Date •|1 Denied||Amount Due:$ ±Approved ||Denied j|Amount Due:$_ ^Approved |jDenied ||Amount Due:$_ Approved]|Denied ||Amount Due:$_ .Approved]IDenied |JAmount Due:$_ Approved I 1Denied 1|Amount Due:$ Planning &Zoning^ Parking Division FINANCE DEPARTMENT USE ONLY; Total Amount Deposited:$ TotalAmount Returned:,^., Date: Date: .Amount of Service Rendered:j_ Total Amount Owned:$ ™.Datefr ^-^_-^FinanceDepartmentAuthorizedSignature: CITY MANAGER OFFICE USES ONLY:Review&Final Approval City Maniager Authorized Signature^Date; 17-16