3THE CITY OF PLEASANT LIVING
CITY OF SOUTH MIAMI
OFFICE OF THE CITY MANAGER
INTER-OFFICE MEMORANDUM
To: The Honorable Mayor & Members of the City Commission
From: Steven J. Alexander, City Manager
Agenda Item No.:3 Date: May5,2015
Subject: A Resolution authorizing the City Manager to permit L'atelier School to
hold their 20th Anniversary celebration on Sunday, May 9, 2015, on SW 71
Street .
. Background: L'Atelier School will be celebrating their 20 th Anniversary on May 9th, 2015 by
partially closing down a small section of SW 71 Street, between SW 61st Ave. and
SW 59th Place from 11:00 a.m. -3:00 p.m.
Expense:
Account:
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 will be
different exhibitions involving performers,and a variety offoods.
The applicant paid $500 for the deposit, $100 for administrative fee and $60 for
an application fee; totaling $660.
In addition, the applicant has also paid for the following fees:
• Police: $120 (One officer for three hours at $40 per hour)
• Public Works: Barricades $100
N/A
Not Applicable
Attachments: Resolution
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RESOLUTION NO. ___ _
A Resolution authorizing the City Manager to permit L'Atelier School to hold their 20·h
Anniversary celebration on Sunday, May 9, 2015, on SW 71 Street.
WHEREAS, L'Atelier School will be celebrating their 20 th Anniversary on May 9,2015, by partially
closing down a portion ofSW 71 Street from 11:00 a.m. -3:00 p.m.; and,
WHEREAS, the school has been in business since 1995 and would like to celebrate their
anniversary with the children, teachers and parents of the school; and,
WHEREAS, there will be different exhibitions involving performers, and a variety of foods; and,
WHEREAS, the applicant has paid $500 for the deposit, $100 for administrative fee and $60 for an
application fee; totaling $660; and,
WHEREAS, the applicant has also paid for the following fees:
• Police: $120 (One Officer for three hours at $40 per hour)
• Public Works: Barricades $100
NOW, THEREFORE, BE IT RESOLVED BY THE MAYOR AND CITY COMMISSION OF THE CITY
OF SOUTH MIAMI, FLORIDA:
Section 1. The Mayor and City Commission authorize the City Manager to permit L' Atelier School,
to hold its 20·h Anniversary celebration, on Sunday, May 9,2015, on SW 71 Street from 11:00 a.m. -3:00
p.m.
Section 2. Payment for this special event will be 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 is for any reason held
invalid or unconstitutional by a 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 this _ day of ___ ~. 2015.
ATTEST:
CITY CLERK
READ AND APPROVED AS TO FORM,
LANGUAGE, LEGALITY AND
EXECUTION THEREOF
CITY ATTORNEY
APPROVED:
MAYOR
COMMISSION VOTE:
Mayor Stoddard:
Vice Mayor Harris:
Commissioner Liebman:
Commissioner Welsh:
Commissioner Edmond:
·t·,.~~,
L'ATELlfR SCHOOL
A lltGG10 EMlllA PH1LrnOPHY INSPIIl[D SCHOOl. SINa 19'15
Miami April 16th, 2015.
To whom it may concern;
L' Atelier school located at the 5960 Sw 71" St it's been on business since 1995. This year is our 20 th
Anniversary. We as a community of parents, children and staff want to celebrate this important time in a
special way. Our idea is to close a partial part of the street, from our space to the right corner. We already
talked with our neighbors: Sparkling pools and Best Miami Hotel about the event and there are ok and
willing to cooperate.
The event will starts at 11:00 am to 3:00 pm. We are going to incorporate different aspects to the event
that shows who we are as a school, telling the story of L'Atelier through different exhibitions involving
parents, teachers, children and outside performers, as: story telling space, a sound and movement space,
culture and food space, and the Ateli.er visibility with a recollection of materials from nature, landscape,
etc.
Attached you will have a sketch or site plan ofthe street and the different spaces we want to incorporate.
Thanks in advance for your help and support as a city and part of our community.
Simonetta Cittadini
April 23,d, 2015
"The Catering Division of Perricone's Marketplace"
15 SE 10th Street, Miami, Florida 33131
Tel: (305) 374-9449 Fax: (305) 371-6647
CATERING PROPOSAL
Contact: Shari Kamali
For: MDCCMA
Telephone: 305-663-6319
skamali@southmiamifl;gov Email:
Dear Shari:
We are delighted to present the following arrangements for your catered function as follows.
Please note that this is only a proposal. Any elements may be changed to your liking.
Day: Friday
Date: . June 26th, 2015
Time: 7:00pm -1O: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 section of the permit application is intended to provide the Special Events Permit Committee with an overview of your
event Inform!'tion you provide in this seciion is public information and ,may be used in developing the City of South
Miami's Call1ndar of Special Events. Application must be submitted' no less .than twenty-one (211 days prior to the
effective date of'the event ,'nth all required documents. ' , !". . . . . . , ." " . -.~
TYPE OF EVENT:' 0 Filming DCharity 0 Festivals lKJ Celebration
o Promotion Other:
NAME OF EVENT: . .. 2Iltt! AOO.I'V!!i:!.@.r'f, .. ~,A-\\e' lte(6;;b'ool.
LOCATION OF EVENTf' ;W~::§~~.7t:6"1 .H{fIU('1t'7j,I.L"QL
t ..
'. (Pla.se note: write complete mailing address, as wall as name of any buildings andlor parks if applicable)
Is this an annual event? DNo 0 Yes if yes, this is the~annual event, previous date,., .... ,., ... ~~~,..,."
EVENT DATE{S)j J:/¢cl'ff't!€fIIh... EVENT DAY(S):ItrKfI$#I
ACTUAL EVENT HOURS.: /I : oQa .. ~p,m, UNTIL:',3'.OQ.fUn. .a,m.!@)
(Please note:.event may not begln'earliedheil 8 a,m. oiend later then 11 p.m. in residential araas, or midnight in commercial areBs)
ASSEMBLY DATE(S): .. __ ~_~~_ SETUP/DOWN TIMES; Cf@p,m" ..... ..,.,......,.. .. a.m.!p,m,
ANTICIPATED ATT~NDANCE:.. . TOTAL EVENT DURATION: . ~hrs mlns .---
Namer' 8If)1.Om+/a Odiacllly.
Title,: MIJrj:&r:;,::,,: PW[).fl,j"
CeIi/Phone:C?,OO"") 'iJ'1~ -&39 ~ ....
.',
-. ,
1-16
Name.; (!.cw:42~ .. Ocevec(.o
Title: Vf tC!do r .
• •••••••. _. -"_'r ••.• , '".
APPLICANT/SPONSOR_INFORMATION
The applicant for ,the Special Event Permit must be the authorized representative of the organization/business conducting
the'special event This Person must be available to work with the City's SpeCial Event Permit Committee throughout the
permitting process. A professional event org~riizer, or other representative, may apply for the Special E;vent permit on
behalf of the organization/business. '
. f' ~.
ADDRESS OFORGANIZATIONi . 9<J~O,6C,</.,_JI ,ST
f#t.;yr;u:_ -+ (:.,,33UI3
OFFICE TELEPHoNE: ,(;jOB )60,;:l ~;J.'" FAX:&e~) 6C?Z -20 26
PRESiDENn,~:, __ ~~-----,-__ ~ _____ -=
ADDRESS~
,
PRES. PHONE: ""==~""""",_""""",~~"""'_""':'""" EMAllii"=.,.,,"-,,,,,,,,,,,, ~~~~ __ ~~ __ ~
SEC. PHONE:; ______ ........ ~_...,..,.._~~-e-~EMAIL:,,......,.,.....,.,_~ ___ =....,___,,.,,.,.,.-_~
renter of the event location, pleas~ have the 0" 'oo"rtv
DApplicant/Organi;zation owns the eventlocatlon
o I give permission for the Applicant/Organization to use my property.
"-' .. '-. -' -~
Property Owner's Name: " ___ ~~""" ____ """''"-_..",.,."''-;-~~. Phone;,~~~~~,."....~=--_~"",.
Property Owner!s Addres~r .,-",'. """" ....... '"'""'~~ ................. ~~~'-="~~~_---.. ___ ~_~ __ -=-_
-.... ""._---,. --" ;:~--7-;:':::'~';-;';"':" -,-.. ~ ",",",,,-;-,::;" "r" ..... '.,,', ••• '
Property Owner's SignatlJr9::!~: -...:o;,'=""'--""~"-"'~c=...---''''-' ....... ,,--,~
}> Notary
Signature:
2-16
"
.",
. EVENT FEEQUEmONNAIRE
..
POLICE; DEPARiMENT
"
YES NO
1,. ~
2., I&J
.I o Will your event obstruct the normal flow of traffic?
o Do you expect the total attendance for your event to be over 150 people
at anyone given time? .
3 .• , ,rg:J: 0 Will you be requesting the use of Extra-Duty Police Officers? If yes,
how many _, _ (Please note: if you answered NO, 10 this question off·duly
officers can stili be assigned to your event at a cost to you if deemed necessary)
If NO, please describe why the event will not have a significant impact on the
surrounding public streets andlor property area,
Off-Duty OfficerApplicant pg, 11/See Special Event Fee Schedule for cosi detail
,eUSLIC WORKS ... , .. ___ .... . . . "' ,.d.. •• 'r
YES
4. ,~
5, Kl
NO
o Will your,event interfere with any public right-ol-way, such as roads,
sidewalks, alley, etc.?
o Will your event require any full and/o~oad closures? If yes,
please complete the Right-of-Way Application,
. (Please note: any right.ol·way clos~res will require at least one off·duty officer
and public works emPloyee.)
6, ~ DWiU your event require the use of barricades? If yes: how many
.. .. '~jwhattype • -r m .---, , ~," , """, _ ., _ ,', " ... (PI!lase note: all pubic rlght·of·way closures 'niust have'approved barricades)
7" ~ 0 WOl,lld you like the City to provide you with barricades for you event, at a
cost? If yes: hoW many,. ,. ..••
8. 0 IZf Will you be applying for a Pole Banner?
Pleas(,). describe your plans for the cleanup and removal of recyclable goods, waste
and garbage during and after your event.
We cUII/
,--~~'~~~~~~.~.,~ .. ~~~
Public Right·Of-Way Applicant pg.12/Pole Banner Applicant pg. 15
See Special EventPee Schlldula for Cps! detail .
3-16
, .0'
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P!-ANNING AND ZONING
YESNb
9..~' 0
10 .. O· 181
Are you confident that your event is in the City of South Miami limits?
(Please note: that It Is the sole responsibility of the applicant to ascertain the
location is within the city's limit. You may call the Planning & Zoning department
at (395) 663·6326 if you have any question(s).)
Will you be hanging any banners over public streets? If yes, please
complete the Hanging 8antler Application. .
(Please note: that all requests for banner over public streets must be reviewed
and approved by the City Commission, which meets only twice a month.)
11.~, J8J 'OH~veyou notified the event location neighbors about your event?
.. . Hanglrig Banner 6ver Street APpJlcanfpg.14 /Se8 Speclat Event Felt Schedule (or cost detail
.PARKING ONiSION
YES
12 .. .,I:J
13" ~
14. 0
NO
~
0
[2g
...... -.....
Will you be renting any City parking meters? If yes, how many
(Please note: that if you are cloSing or Interfering with any rlght.of-way""th,...a":'"t".. .. ".."..
includes parking meters you are required to pay the meter fee as well.)
Do you have enough on-site parking to accommodate your event?
Will your event involve the use of a shuttle and/or alternate parking
sites? .,
Parking Meter l~enial Applicant pg, 13 /See Spec/slEvent Fee' Sch.edule for cost detail
CODe ENFORCEMENT
----.
YES NO
o
o o
Will you be having any music and/or loud sounds during your event?
Will your event be starting before 8 a.m.?
Wilj your event end after 11. p.m. on a weekday and/or 12 a.m.
weekend? ... . it. ... -;; ......
. -'YES N.O· .
. --' ~"'[ .-
18·0 ~ Will this event take place in at'ly of trye South Miami City parks?
(Please np!e: A rental fee will be applicable if a City Park Is being utlH~ed.
Reservations are made through the Parks & Recreation Department (305) 668-
7232).
19. D(8:l, Will this event require the use of any Parks equipment or staff?
4-16
,0.
SITE PLAN/SKETCH ..
A map of the event site is required and should indicate eventfayout with proposedilttractions, recorimlerided
street closures,· parade or run/walk routes, etc. Please draw you map on the space provided below, or attach.
your map to the application upon submittal. The following must be identified and labeled:
1. EVent Site (label streets, building, etc.) 3. Canopies, tents, stages
. 2. Routes (race" parades, elc.)-+ -+ -+ 4. Restroom facilities R
S. Fencing/Barricades x'x-x
6. Off duty police officers P
,
7. First aid facilities +
8. Parking Area PA
"
i ;.i :,·1 , '
5-16
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,J
1:
j
C]ODDDw,,----_
"'Q
~
ca
\)
L 1)_70 ODD
'1
NOTIFICATION l'PETI110N
Event Name~ "i?Qfh. aom'ver~-M .'. .'. Event Date~ HPJ.q+h . . ." ......... ...... ~ ¥ 8dwo/
We, 'the· undersigned businesses and/or residents, have been notified of street closures associated
with the event noted about on s'aid date, and hereby agree or disagree to the clos'ure(s). We are also
aware that this response may not effect this application being approved or disapproved.
.=1iJ.I1"l Hicu'Yl q:-L
031 '13
'Irac;>SlGi'0iI210 • Disapproved
IAp~)rovled 0 Disapproved
JA~lprovedD Disapproved
'.i'AnNr""Aril I Disapproved
IAopro'ved 0 Disapproved 0
6-16
[Apllrovled 0 Disapproved
;iAo'oro'vedD Disapproved I
IAnnrn"ArlD Disapproved
IAppro'ved 0 Disapproved
i: !
. I
·~: .•..
,/' When marking any public street, curb andlor right-at-way no permanent marking substance may be used ..
All marking agents must be rem'oved immediately after the completion at the event.
,/' Barricades shall require an additional rental fee established by the Public Works Department it a City
Sponsored Event. If not sponsored by the City, then you must rent barricades through a barricade'
company,
,/' No pegs, stakes, or anChoring devices shall be driven into the concrete, asphalt, or City hardened right-of-
way:
,/' Map ot route or site plan at the scheduled event including all stations and descriptions of activities.
,/' Any temporary cover for stations such as a canopy shall be flame retardant and applicant shall provide
proof of such certificate. " ", '"
,/' f(eyjew,iifjilpplIiial1t\&'p@P'epWork fo'ftOfQ'lgoatio-n: aOY·fbod':salllt·YOllJitle;Of:OCijjfeJinilslband·dyra{10n,
,/' 72 hour notice given to all merchants whose street would be closed. "',',' 00' '0" 0 '0
(=:d\\/" Please initial ~
.. ,-,", .
Section /I
,/' In the event of a parade, a permit from the South Miami Police Department must be obtained.
,/' If Police service for traffic and/or crowd control is required, arrangements will be made through the City of
South Miami POlice for off-duty Police officers. The Police Department will determine the
number that change .
L
: .. ' ',.
average hourly rate for 125 Barricades for one (1) day usage is approximately $80,00.
Please Initial Sw---
... i.~
. ,
i'i;;;:f,;';j~vote qf approv~1 (cine-month in advance) by the City Commission will l)e required for large
~~~~~~~~~~~~~~~I to defray cost of litter cle/ln,up, must /lccompany application,
p not required, deposit may be refunded. The litter deposit may
~~~~~~~~~~il~"UIJ'UU will be retained by the City as an Administrative processing fee
average hourly rates are approximate $40.00 per non-supervising employee, per hour,
supervising eil1ployee, per hciur.
Please Initial _~,.r..:.Nl--=~_~_
, ......
7-16
INDEMNIFICATION AGREEMENT
THIS AGREEMENT ("Agreement") is entered into by and between Si'mo 11£,11.&'1. M~
("Applicant"), and the City of South Miami ("City") on the date on which the lastof the Parties executes this Agreement.
RECITALS
WHEREp,.S, the Applicant has submitted a Special Event Permit Application to the City for (event title)
L'4kl,-e/ .2o'ff, CUln.r~.::x:utat. .ff'JGo. ~. 7/.6 T(loealion)on . '-. ,... ''','. , .. ,., ,.
(date(s» ~~ q'fJJ '. ("Special Event"); and WHEREAS, pursuant to of the City's Code and the
City's Special Everegulatic·ns, lli.Applicant must execute an indelllllification and hold harmless agreement protecting
the City from any and all claims which may arise out oflhe Special Event.
NOW, THEREFORE, in consideration of the matters recited above, the mutual covenants set forth llerein, and other good
consideration the receipt and sufficiency of which is hereby acknowledged, the Parties hereby agree as follows:
I. The above recitals are true and correct.
2. Applicant agrees to indemnify, defend and hold the City, its officers, affiliates, employees, successors and assigns,
hannless from and against any and all such claims, suits, actions, damages, or causes of action arising as a result of
the Special Even~ or ofthe condition ofthe site on which the Special Event is heldillcluding any personal injury or
loss of life, or damage to or loss of pro perry, and from and against any costs, attorney's fees, expenses or liabilities
incurred in and about the-defense or settlement or any claims, and the investigation thereof.
3. PermIts for Special Events must be 011 event site at all times.
4. No Street shall be closed without authorization from the City of South Miami Public Works Department and Police
Departm.ent. .
5. Traffic shall be maintained in accordance with Florida. Department of'.Transportation (FDO]'), Miami·Dade County
standards and any additional requirements by the City of Soulh Miami Public Works Department and Police
Department.
6. Event areas shall be restored to equal or belter condition than they were before the event started.
7. !fan restoration work is not perfonned within 30 days of work completion, the City of South
Miami Public Works Department may reslore .the event area and charge the applicant for the cost of restoration
plus a minimum of 15% for administrative fee and any additional incidenlal fees.
8. Applic."nt must payal! fees prior to. the .tort of their event(s).
9. A pplicaht. thaOeceive approva!:for their everit more than thirty (30) days in advance shall notify the City of South
Miami SpecialEventiMarketiiI~ Coordinator at least forty·eight (48) hours prior to start of their event.
10. Any damage to private property Shall be restored to its original condition or belter and as accepted by the Owner.
IN WI1NESS WHEREOF, each of the parties hereto has caltsed this Agreement to be executed and sealed by its duly authorized
signatory(ies) on the date set forth below and notarized.
8·16
I)JOYLEEN MARTIN
NOTARY PUBLIC
STATE OF FLORIDA
• • cam"", EEI31108
. ellPfre891312016
CITY Of SOUTH MIAMI POLICE DEPARTMENT
6130 Sunset DJive, SOllth Miami, FI 33143 (305) 663-6301
Extra-Duty Police Officers
, Application
South l\oJhunl
Florldl1 .' .• * ..... filiP
",300:1.
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 Police Department shall be the final authority in determining the minimum number of officers requJied to police a
particular even!. 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 Applicantwill.be required to compensate the asstgned officer for a minimum of three (3) hours even if the event Is of a 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 each offlcei.
,. The Applicant must compensate the officer(s) for their services at least one (1) day prior to the start of Ihe scheduled event thai Ihe
officer(s) will be aSSigned 10. No monelary paymenl will be accepted. No paymenl by exchange of goods or services is acceptable.
,. If, during a scheduled even~ the Applicant delermines thai he/she needs to extend the time an officer(s) works at the assignment, the
Applicant shall compensale offlcer(s) for a full hour worked if the Offlcer(s) works for more than 20 minutes andlor less 59 minutes
beyond the regularly scheduled time of the event.
» Applicanl must notify of a cancellation request of an Off·Duly Police Officer forty-eight (48) hours prior to the scheduled date of service.
Failure to do so will require the Applicanl to compensale Ihe assigned officer for a minimum of Ihree (3) hours,
,APPLICANT INFORMATION , .... , ......... .
Business/Organization Name
6"'14>0 oc..tJ. qLf.]~ ..
Business/Organization Address
.. .. . .... ., . AppHcant's
. ApplicantName .' , .. ,
City
Cellular Number' .
Event Lo.cation
11-16
Stale Zip Code
&hh~ . ... '·-rypecji Event'· .
'Anticipated Attendance· .
, :D;~pPROI/ED WI~H CONDITION
NO. Hours ,.3 ,.1,'-'5 ..
CITY OF SOUTH MIAMI PUBLIC WORKS DEPARTMENT-
Soull, ML~"'I
1'" 1 D ,. I d • 15X..., 4795 SW 75 1h Avenue, Miami, FI33155 (305) 668-7205 Fax (305) 66a-7208 HI'll' Application to Conduct A Special Event Function on,
Public Right.of-W,ay ~. , t .• ,
ltl~',:
NOTE: ALL FIELDS SHALL BE FILLEp .. No action can be taken on this application until all questions have been answered. As set 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:
. 'l[!J j.g,&«C'x?hpo L .-
Bu'sfnesslOrgsilization Name' ..
'~-.c-' 6OJ~& ~.·7/,67.
BusiriesslOrgimizailon Address
1300) t;62?oZ(,
Phone Number .~. ,"'-"
.Event Information:.
Authorized Representative Name
Hraryu" . -:f=L ~/(,b3
. . City"" ... State .... Zip Code"
(gQ~)."h2"20?(;I.c.-/~/L~@ /aAclJte-r. 'OIq.
--Fax Number E-Mail-.J
Event Name
Project LocaHon
Even! Date(s)
Event Start Time
Event Setup TirT)e
H.,~ 'l ,Event Day(s) .'_'. $ .. ::.,o ..... : .. ~. :::;'. Type of Event 04 hr~'
/1;0.0, @pm) Event End Time '.' .3; Q 0 . (am I e!li) Anticipated Attendance _____ ""'-~
. ""/.'00. ~ !pm) Breakdown Time, .. (j ,pO (am I~ Total Duration (Include setup) =~'7.;....,.~...,...,.
I HEREBY REQUEST A PERMIT FORTHE FOLLOWING:
Anticipated effects on vehicular and pedestrian traffic d.urlng pr~l~Cl Maintenance of trafflc provisions are specific (include sketch If nec:essary)f
~ ..
The following docume.nts have beel'l submitted with this permit application: o Site plan I sketch of event. Clearly define boundaries and liriear fool of road closures.
o Maintenance of Trliffie (MOT) for vehicular and pedestrian traffic during event.
'in sigNing this apptication, I understand that separata City and/or County permits may be required for this project. Furthermore, I am aware that I am
responsible for ensuring that the project Is completed in accordance with the plans and specilieslions as stipulated in the permit approval condflions. As
weH 8S a~nowledge thal.an
y
rlghl-of-way closures ~iII reqUi~ :;:~::;:c~w:rks employee and bam~i~\\~TE .••...•......
Approvedl
Disapproved By Date
12·16
JOY\.EEN MARTIN
NOl'ARY PUIIUC
Permit Fee Comments
. .....
9,"
CITY OF SOUTH MIAMI
SPECIAL EVENTS/MARKETING DIVISION
5800 SW 66 Street. SQuib Miami; FI33143 (305)663-6319 Fax (305) 668-7388
Special Events Clean-Up Deposit
Refund Request Application
In order to receive your clean-up deposit. (or a poilion thereo~. you must complete and return this form to the Sp'eciat Events /
Marketing Division. no sooner than twenty-four (24) hours after your event. The Deposit of Six Hundred Dollars ($600.00) is to defray
cost of litter clean-up. If clean-up is not required and your event occurs without any city damages and/or costly issues, $500 of your
deposit may be refunded bact< to you. A $100.00 non·refundable administrative fee will b. deducted from the S600.00 deposit. . L'{)-Ie!te-r' ,. . ..
Eve.n! Name .;20 -H, l+nr)!YeI-~Y
Event Location "l:f1r;.C?QfU '"!f ~T i-fl'~;nl -;:P(?;:qrlj;~
Event Date(s)_ Ncyd. q-.J-t,. Event bay(s) ~ Type of Event ~
Event SI,ut
Time
,7':00 ('j)j) Event End <3~oi'9' a.m.
Time ~~~ .. _ •.• "c ___ <iDD Total Duration
"~~1'.&_r.mglli~~~~'
d-o·y·c).!' IIIJ"~" ." .•• ·· .. ··f·jti .. "~I·"·· 'f' S' d'"'' ··I· ... I·tilt "l"~"'" . 7' O' .'. '0' j '.' ,U ~9.69"'~S Y. e.", .• ,,,~ " •. , .... "".' , ... c .... Ilp. .
wer~ unscheduled Police Offic.;called out to your event? . ~ '0
were there any damages to any city and/or private property? 0 0
have you paid all the required fees associated to your event,? fi(1 0
Comments, problEm)" and/or suggestions (if any)":",.; __ ~ ___________ ~ __ _
, If Refund Request Application is approved, would you like the payment to be: Mall Check 0
Refund to: , (Full Name & .. "'. """,,,""'-'-~"""<'~_~~~.....c=--'-"-___ ~ ___ ~-'-___ ~ ____ .....
I Mail Address):,
'.:' .. : ... ,,"
"In signi~9 this application, I understand t~at Refunds will not be processed until this torm has been completed and Signed
off by designated City Departments, If any cost incurred is outstanding, it will be deducted from deposit and that I will be
held responsible for any overages,"
. "Applicant's Signature Oate
FOR OF:FICE U~ES'ONL Y:
Pollee Depart l11 ent.: ~~,. Date Approved 0 Denied D Amount Due: ,,$:..... __ _
-
Public Works Dep.. .. .. Date , :·.APprovedD Dented D Amount Due: ,,$'-__ _
PBr.ks a Recreation . --.. , .' Date .. "APprovedD Denied DAmount Due: ,,$,-" __ _
Code Eriforcement, Date" Approved 0 Denied 0 Amount Due: -,,$,-__ ~
Planning & Zoning, . Date '". . . ' APprovedO Denied 0 Amount Due: ,,$'---__ _
Parking DiviSion ,..... . .. ". '. ,.. ..... . ..' Dale. . Approved lliniedD Amount Due: $. FiNANCEOEP~~TMeNru~·~IONLYt·~~·~~m~tW~$;;'~~,~;~~~~~TEf"~rrffi~~ArJ6:~-~~;\J_~:'-~ar~i~i~~~~.&f~~~~W4<·:~"I.~2.;f:!o:"'''''''~.~C:.'! .. '"'t .... "':~i';:"'>r."";~ .. F
Total Amount Deposited:~$_~ __ ~~_ Dale: ,....~~--,...,_..,.J. Amount of Service Rendered:,.:!i"::,;"'""'e",,,,,-,-±~.,., .. ~' ...
Total Amount Returried:.l" Date: Total Amount Owned:,.,;$ ______ -...
Finance Department Authorized Signature.: ... Date,
l!I~II: .. ·.'~II";r;..~I>I~r'.<.:\"~1\..'\,~"~,c< .... ""'~ ... ·~,j.<~,''''·'''ix.-.jf;>~·;;;;,\.;;.;;,' ... ''l~r,-~';'}n~i''''!"'!'}Vr.;"",;r_;..;··~;,,,.:!oIi·.,..,.'.rJi':;'"Y''''"'o\:i::''&' .... ,~,..,.~'*~,~~:¢,;;,.~'iI'~;..I;.¢~.~'; ...... 0<1'.{'"""-~'1.t~"... .... ·"""~·;,·)(,'.,."",·"..,,.,_,~
CITY MANAGER-OFFICE USES ONt y, Revlow & Flna' Approval .'
City Manager Authorized Signature;, ____ -"-~~ __ -~'_.~~_.,....~ Dale;
17-16