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APPLICATION INFORMATION
1
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NAME OF 'APPLICANT: CU 1 6-ro(,,.Ch"�_ `�r"`-t� � ..,!sue
ADDRESS: 2 1 r 1 _ Y�CIa' (C�,n JC- �" ' 7�i
----; oS- 2_,LC 901
EMAIL ADDRESS:
2. CONTACT PERSON, If different:ri
ADDRESS: .420 41Q1Ne-s
PHON-E.: 27.0 FA): 305'
E-MAIL ADDRESS: C y?
3. SP9 SOR STATUS:
NOT FOR PROFIT ORGANIZATION
] FOR PROFIT ORGA\` ZATION
j INDIVIDUAL
] CHAR' T,AS i,E
] OTHER
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4. EVENT INFORMATION:
N.k_\E OF EVENT
DATE OF EVENT -
I.00A.TIO\ (s)�Gt [Q �� .
SET LP DATE(S) AND TIMES 3 uct n.
EVENT HOURS OF OPERAT/ON., Ir1 ooCrYl
STREET CLOSL'RES DATES AND T DES: •
•
EVENT TEAtO'vi RDT T
DATES ._S AND TEMES s J4p t)J`_
TAX EXEMPT NO:
4.(--
. TITLE:
•
Ve
See_ ce-Dt-a.CAe,a
`75 gg 2
"rg":5+c_ ice&-� - 'e•
.")0/7/7 tafaillern
_7_
] PARADE
( } FAIR/CARNIVAL
3 PRIVATE PARTY
[ ] SPORTS EVENT
CONCERT/PERFORMANCE
ru;,ur��l5ch
]-POLITICAL
[ ] RELIGIOUS
[ ] FILMING
COMMUNITY EVENT
} AWARD SHOW
NAME OF PERFORMER i BANDS; LC r1e... q
a22.
TYPE OF MUSIC: [ ] POPULAR [ ] CLASSICAL [ ] LATIN [ ] ROCK 'OTHER
IF FUNDRAISER, NAME OF CHARITY RECEI TNG FUNDS: . '
roc try o -1- b1
6. BRIEFLYDESCRIBEDESCRIBE THE EVENT: _
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7. ATTACH TENATIVE PRODUCTION SCHEDULE
(Attach as Exhibit A)
8. ATTACH SITE PLAN (Sketch of set up, vendors, staging, parkin.g area, security detail, etc)
(Attach as Exhibit $)
SES-;) El/SO'd PSl?3,bcOE+ lJ^i7 Oed--'It
1s LUUri1:\'U 131—c .-4 i i:\u ruin) N_j 1 J a\L,
1F YES:
[ /]`GAS CHARCOAL [�
ELECTRIC OTHER [ ] (Specify)
14. WHICH OF THE FOLLOWING ITEMS WILL BE UTILIZED?
[ ] BOOTH (S)
[ ] TENT(S)
] CANOPY
[ ] OTHER
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SIZES)
plevaitg
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ABOVE MUST BE CERTIFIED NON-FLAMMABLE AND FURNISH COPY OF
CERTIFICATE TO FIRE DEPARTMENT
15. WILL YOU BE USING ANY OF THE FOLLOWING? [ ] YES i ] NO
FIRE WORKS MECHANICAL RIDES /4.4.1
DATE:
TIME:
PLACE:
DATE:
TIME:
PLACE:
COMPANY NAME:
INSURANCE CARRIER:
AGENT NAME: TELEPHONE: .
NOTE: ALL CARNIVAL, AMUSEMENT, OR CARNIVAL TYPE EVENTS SHALL
PROVIDE THE REQUIRED INSURANCE POLICY OF POLICIES AS STIPULATED BY
THE CITY OF MI.AM.I AND MUST GET PROPER PERMITS FROM BUILDING AND
ZONING DEPARTMENT.
16. \\ILL YOU NEED THE FOLLO«'ING FRC}NI TH.E PARKS DEPARTMENT?
l
] SHO'�OIOBILE ' 16 N "' .y [ ' ELECTRICITY
PODIUM
DI .M ET LS (seats < 5 ter)
1 ?L:B;_IC ADDRESS SYSTEM
] SPEAKERS
„�:f,
S£6-4 El/40 d lei -I
NCI ? SNaid-':,"cf4
tidy; i0 51-20-un?
THE CITY OF MIAMI REQUIRES THAT ORGANIZERS OF SPECIAL EVENTS PROVIDE
A CURRENT CERTIFICATE OF INSURANCE NAMING THE CITY OF 1ZIAMI AS
ADDITIONAL INSLRED AND COMPLYING WITH SPECIFIED INSURANCE
COVERAGES AND LIMITS AS PRESCRIBED BY THE CITY SEVEN (7) WORKING DAYS
PRIOR TO THE CONDUCT OF ANY EVENT, THE INSURANCE COMPANY MUST BE
RATED "A" TO BE ACCEPTED. LIABILITY LIMITS: I MILLION DOLLARS FOR
GENERAL .AND LIQUOR LIABILITY (IF NEEDED).
I. Coverage: 4g,j LhliBJW TY "G, JAI M g94
Ii. Insurance Company: -rtte rgt4,7) fit/.. R.A.
fli. Limits of a Q��; 1}o46,0o0,4eA).
iV. .4?e.ri!.
�'. .agent's Phone Number: 05 70 -4Dg,3
VI. Is the City earned as an additional insured in this policy? •XeS
ODo, ec,
NOTE: PLEASE ATTACH TO THIS APPLICATION A BUDGET SUMMARY TO
INCLUDE ANTICIPATED EXPENSES AND REVENUES .ASSOCIATED WITH THE
EVENT.
IT IS UNDERSTOOD THAT THE APPLTC4 VT IS FI.V4'\'CRLL Y ADMI.''ISTRa TII 'L I'
AND PROGR4:'1lnfATICALLYRESPONSIBLE FOR .ALL ASPECTS OF THE. £1 E.VT
DATE:.._ 6/1/4.
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