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Agenda 03/11/2014 Item #16A10/'*IN 3/11/2014 16.A.10. EXECUTIVE SUMMARY Recommendation to approve a permit to conduct the annual Harvest Fest Carnival, on Friday, Saturday & Sunday March 28, 29 & 30, 2014 located at the Immokalee Airport, and to recommend waiver of the Surety Bond in the amount of $2,500 for the Harvest Fest Carnival. OBJECTIVE: Recommendation that the Board of County Commissioners approves a permit to conduct the annual Harvest Fest Carnival on Friday, Saturday & Sunday March 28, & 30, 2014 and waives the Surety Bond in the amount of $2,500. CONSIDERATIONS: The Immokalee Chamber of Commerce, has made an application to the Board of County Commissioners for a permit to conduct their annual carnival which includes mechanical rides, food & beverage booths to include pizza, popcorn, cotton candy, soda, lemonade, caramel apples and corn, as well as beer and wine, and has presented sufficient evidence that all criteria has been meet for the issuance of a carnival permit. The required insurance amount of $1,000,000 has been purchased. The Immokalee Chamber of Commerce is a not - for -profit entity. All other not - for -profit agencies applying for carnival permits were granted waivers to the Surety Bond. FISCAL IMPACT: There is no Fiscal Impact associated with this executive summary. GROWTH MANAGEMENT PLAN IMPACT: There is no Growth Management Impact associated with this executive summary. LEGAL CONSIDERATIONS: This item is approved as to form and legality, and requires majority vote for Board approval. -SRT RECOMMENDATION: Staff recommends that the Board of County Commissioners approve this permit to conduct the annual Harvest Fest Carnival and waive the Surety Bond in the amount of $2,500. The Immokalee Chamber of Commerce is a not - for -profit entity. All other not - for - profit agencies applying for carnival permits were granted waivers to the Surety Bond. Prepared By: Claudine Auclair, Business Center Manager Growth Management Division, Planning & Regulation Operations & Regulatory Management Attachments: 1)Application; 2)Site Plan; 3) Letter from Collier County Parks and Recreation requesting Waiver of Surety Bond; 4) Letter from Sheriff's office 5) Letter from the East Naples/Golden Gate Fire Control; 6) Insurance Certificates; 7)Exempt Status; and 8)Alcohol Approval Packet Page -587- 3/11/2014 16.A.10. COLLIER COUNTY Board of County Commissioners Item Number: 16.16.A.16.A.10. Item Summary: Recommendation to approve a permit to conduct the annual Harvest Fest Carnival, on Friday, Saturday & Sunday March 28, 29 & 30, 2014 located at the Immokalee Airport, and to recommend waiver of the Surety Bond in the amount of $2,500 for the Harvest Fest Carnival. Meeting Date: 03/11/14 Approved By 03/05/2014 05:33:57 PM ochs 1 FINAL APPROVAL — COUNTY MANAGER Packet Page -588- Play, Connect er Discover February 26, 2014 Planner Zoning & Land Development 2800 North Horseshoe Drive Naples, FL 34103 Dear Zoning & Land Development Planner: 3/11/2014 16.A.10. The Collier County Parks and Recreation Department is applying for a carnival permit for Harvest Festival. The carnival is held at the Immokalee Airport. Located in 700 CR - 846 Immokalee FL 34142 on Friday March 28, 2014 from 5:00 pm- 11:00 pm Saturday March 29, 2014 from 9:00 am — 11:00 pm Sunday March 30, 2014 from 10:00am — 10:00pm. Tolve Presentations Inc. exceeds the one million dollar insurance policy and has named the Board of Collier County Commissioners as additional insured. We are requesting a waiver of the Surety Bond of $2,500. If you have any questions, please contact me at 252 -4677. Thank you for your assistance. Sincerely, Annie Alvarez, Region Manager Collier County Parks and Recreation 1 5000 Livingston Road Naples, Fl 34109 Packet Page -589- 3/11/2014 16.A.10. COLLIER COUNTY GOVERNMENT 2800 NORTH HORSESHOE DRIVE DEPT. OF ZONING & LAND DEVELOPMENT REVIEW NAPLES, FLORIDA 410 645 -6968 WWW.COLLIERGOV.NET EVENT INFORMATION HAS THIS EVENT BEEN HELD IN COLLIER COUNTY IN THE PAST? ® Yes ❑ No IF YES, WHEN? 2013 WHERE? Immokalee Snorts Complex WAS THIS EVENT PREVIOUSLY HELD IN THIS SAME LOCATION? ❑ Yes ® No THE FOLLOWING INFORMATION IS INCLUDED IN THIS PETITION. (FOR EXPLANATION, SEE NEXT PAGE.) ❑ 3.a. ❑ 3.c. ❑ 3.e.1) ❑ 3.e.3) ❑ 3.e.5) ❑ 3.e.7) ❑ 3.e.9) ❑ 3.b. ❑ 3.d. ❑ 3.e.2) ❑ 3.e.4) ❑ 3.e.6) ❑ 3.e.8) Comments: Signature of Petitioner 0 Approved: ❑ Not Approved: ❑ Date: Conditions of Approval, if any: SIGNATURE OF COUNTY MANAGER DESIGNEE Packet Page -590- co&er Cmftty COLLIER COUNTY GOVERNMENT DEPT. OF ZONING &LAND DEVELOPMENT REVIEW WW`W- COLUERGOV.NET Excerpt from Ordinance No. 2006 -016 3/11/2014 16.A.10. 2800 NORTH HORSESHOE DRIVE NAPLES, FLORIDA 34104 (239) 252 -2400 FAX (239) 643 -6968 3. Application and Fee for Permit. A minimum of thirty (30) days before occupying carnival or exhibition site an application fora the Manager or his designee in four (4) copies accompanied by: all be submitted to the County a) A surety bond in the penal sum of $2,500, issued by a company authorized to issue such bonds in Florida, conditioned upon the operator complying with each provision of this Ordinance and subject to forfeiture under the terms provided in Paragraph 10 herein below. b) Evidence of current public liability insurance coverage, issued by a company authorized to do business in the State of Florida, in the minimum amount of $100,000 for any one person and $300,000 for any one incident. c) A non - refundable fee in accordance with the current adopted fee schedule for the following: 1) Permit Processing 2) Fire and Safety Inspections; and 3) Electrical and Structural inspections d) A current occupational license issued by the Collier County Tax Collector, and e) Including the following information: 1) The name and headquarters address(es) of the carnival or exhibition company(ies) with a direct or indirect financial interest; name(s) and address(es) of any sponsoring organization(s), and the name and local address of the applicant representing the carnival or exhibition company(ies); 2) A description of every activity to be conducted such as but not limited to, menageries; circus and side -show performances; amusement, merry-go -round and other ride activities; food and drink dispensing of games of skill or chance not prohibited by State awatoibe open to the public for an admission or participation fee and number of persons to operate the activities; 3) Name and identification of each person accountable for the operation of each activity; 4) A description and sketch of the site showing the location of each activity proposed, the location and number of sanitary facilities; parking facilities, and provision for lighting and public water; 5) Application for Food Establishment Operating Permit from the County Health Department as required by Ordinance No. 74-45. 6) The plan for refuse, garbage, debris, and sewage disposal during and after operation of the circus or exhibition; Packet Page -591- er cmnty COLLIER COUNTY GOVERNMENT DEPT. OF ZONING & LAND DEVELOPMENT REVIEW WWW.COLUERGOV.NET 3/11/2014 16.A.10. 2800 NORTH HORSESHOE DRIVE NAPLES, FLORIDA 34104 (239) 252 -2400 FAX (239) 643 -6968 7) Provisions for traffic control, fire safety and security precautions; 8) The date and time each activity is to be conducted and concluded; 9) Written approval from the owner of the property authorizing the use of his premises for such carnival activity; Packet Page -592- C_ o er C my COLLIER COUNTY GOVERNMENT DEPT. OF ZONING & LAND DEVELOPMENT REVIEW WWW.COLLIERGOV.NET 3/11/2014 16.A.10. 2800 NORTH HORSESHOE DRIVE NAPLES, FLORIDA 34104 (239) 252 -2400 FAX (239) 643 -6968 Name of Event: Harvest Festival Name of Booth: Tolve Presentation Person in Charge of Booth: John Tolve Types of Food or Beverage to be Served: Pizza popcorn cotton candy, soda, lemonade, caramel apples and corn. Florida Administrative Code, Chapter 10D -13 requires all food to come from an approved source. All food storage, preparation and utensil cleaning for this event shall not be done in private homes. Location of advanced food preparation: Self containing trailers How will food be transported to event location? Contained trailers Method of keeping food hot and /or cold at event site: Self contained units Method of cooking food at the location: Cookers in self contained Food must be protected from dust, insects, flies, coughs, sneezes. How will you provide this protection? Describe type of structure: All food is covered in self contained units. Adequate facilities and supplies shall be provided for employee handwashing. How will you provide this? Soap & hot/cold water For information and Assistance contact: Environmental Health & Engineering Department - (239) 252 -2499 Failure to comply with applicable food service requirements in accordance with Chapter 1013-13, Florida Administrative Code, may result in enforcement action. Do you understand this completely? YES ® NO ❑ 1 certify that to the best of my knowledge and belief all of the statements contained herein and on any attachments are true, correct, complete, and made in good faith. 1 understand that these regulations include food intended for service to the public regardless of whether there is a charge for the food. I agree to assume responsibility for this establishment and I certify that said business will be conducted in compliance with the Florida Administrative Code, Chapter 1013-13. Packet Page -593- er +Ant, 3/11/2014 16.A.10. COLLIER COUNTY GOVERNMENT 2800 NORTH HORSESHOE DRIVE DEPT. OF ZONING & LAND DEVELOPMENT REVIEW NAPLES, FLORIDA 34104 WWW.COLLIERGOV.NET (239) 252 -2400 FAX (239) 643 -6968 Packet Page -594- -r minty COLLIER COUNTY GOVERNMENT DEPT. OF ZONING & LAND DEVELOPMENT REVIEW WWW.COLLIERGOV.NET 3/11/2014 16.A.10. 2800 NORTH HORSESHOE DRIVE NAPLES, FLORIDA 34104 (239) 252 -2400 FAX (239) 643 -6968 SPONSOR NOTIFICATION FORM FOR TEMPORARY EVENTS Name of Event: Harvest Festival Address of Event: 700 CR 846E Immokalee FL 34142 Date(s) of Event: March 28 2014 March 29 2014 March 30 2014 Hours of Operation: 03/28/2014 5:00om -11 pm, 03/29/2014 9am -11 pm, 03/16/1410:00am- 11:00pm. Sponsor of Event: Collier County Parks and Recreation Address of Sponsor: 15000 Livingston Rd. Naples Fl 34109 Person in Charge of Food Service: John Tolve Phone: (239) 657 -1951 Number of Food and Beverage Booths: 15 estimate Estimated number of attendees expected at the event at one time? 5.000 Number of toilets to be provided: Portable: Male 10 Female 10 Permanent: Male 2 Female '2 Method of toilet waste disposal: United Site Services will provide 4 toilets, 2 hand washing and 1 handicapped Describe method of liquid kitchen waste disposal: Waste Management Describe containers and method of solid waste disposal (garbage): Waste Management Dumpster Number of solid waste disposal containers provided: 1 dumpster Describe facilities and method of hand- washing: portable and permanent handwashing sinks Describe facilities and method of utensil washing, rinsing and sanitizing: hot & cold running water and soap Source of potable water: on site For Information and Assistance, contact: Environmental Health & Engineering Department — (239) 252 -2499 As the sponsor of this event you are responsible to notify all food vendors of the temporary food service requirements. Failure to comply may subject the booths to be closed for public health reasons. Do you understand this completely? YES ® NO ❑ I certify that to the best of my knowledge and belief all of the statements contained herein and on any attachments are true, correct, complete, and made in good faith. I Packet Page -595- per County COLLIER COUNTY GOVERNMENT DEPT. OF ZONING & LAND DEVELOPMENT REVIEW WWW.COLLIERGOV.NET 3/11/2014 16.A.10. 2800 NORTH HORSESHOE DRIVE NAPLES, FLORIDA 34104 (239) 262 -2400 FAX (239) 643 -6968 understand that these regulations include food intended for service to the public regardless of whether there is a charge for the food. I agree to assume responsibility for this establishment and I certify that said business will be conducted in compliance th the Florida Administrative Code, Chapter 1013-13. Signature of Applicant (� Date Packet Page -596- 3/11/2014 16.A.10. %AER COU'a,_ Plaj, Connect Z,, Dz ccover To Whom It May Concern: Will you please charge the $ 30.00 for Fire Department Inspection fee for Special Event harvest Festival March 28th, 2014 to 111-156385-649010. Thank you, f, Annie Alvarez Regional Manager Collier County Parks & Recreation 505 Escambia Street Immokalee, FL 34142 (239) 252-4677 (239) 657-3399 fax Packet Page -597- 3/11/2014 16.A.10. _V t.1ER COW.- Play Connect &Discover To Whom It May Concern Will you please charge the $275.00 Collier County Temporary Use Permit Special Event fee for Harvest Festival on March 28, 2014 thru March 30, 2014 to 111-156385-649010. Thank yoga, -7, ,. Annie Alvarez Regional Manager Collier County Parks & Recreation 505 Escambia Street Immokalee, FL 34142 (239) 252-4677 (239) 657-3399 fax Annie al-,,arez@,collierzov.net Packet Page -598- NOE 3/11/2014 16.A.10. New Market Rd. m m X i \� Wj T O O CL CD 0 i Play ground Existing s R O Craft Vendors EXIT EXIT Packet Page -599- y. Packet Page -599- -% uE COIJA.- Play, Connect & Discover February 26, 2014 Planner Zoning & Land Development 2800 North Horseshoe Drive Naples, FL 34103 Dear Zoning & Land Development Planner: 3/11/2014 16.A.10. The Collier County Parks and Recreation Department is applying for a carnival permit for Harvest Festival. The carnival is held at the Imrnokalee Airport. Located in 700 CR - 846 Immokalee FL 34142 on Friday March 28, 2014 from 5:00 pm- 11:00 pm Saturday March 29, 2014 from 9:00 am — 11:00 pm Sunday March 30, 2014 from 10:00am — 10:00pm. Tolve Presentations Inc. exceeds the one million dollar insurance policy and has named the Board of Collier County Commissioners as additional insured. We are requesting a waiver of the Surety Bond of $2,500. If you have any questions, please contact me at 252 -4677. Thank you for your assistance. Sincerely, Annie Alvarez, Region Manager Collier County Parks and Recreation 15000 Livingston Road Naples, F134109 Packet Page -600- SHERIFF KEVIN J. RAAiBOSK 3/11/2014 16.A.10. Collier COurtt-7,/ SlM —iff S Office March 03, 2014 Annie Alvarez Collier County Parks and Recreation Re: Harvest Festival Dear Ms. Alvarez, This letter is to confirm that I have had the opportunity to review and approve the proposed plan for the upcoming festival that will be held at the immokalee Airport, event scheduled for Friday, March 28 thru Saturday, March 29, 2014. Sheriff's Office presence will be available in the immediate area if needed for traffic and safety. However you can arrange for special contract deputies or outside security for full time dedication for this event. For further information on contract deputies, you may contact our Special Services Bureau and speak with Lt. Mike Jones at 239- 252 -0017. Please call us if we can be of any further assistance. AIL Sgt.Marcus Carter Collier County Sheriff's Office h=okalee Substation 239- 252 -9800% Fax 239 -658 -8292 MC/vr . iY .�. .c.r 'Y :'�.. 11 •� f Y�1 Packet Page -601- , f. Clk L ' March 4, 2014 Immokalee Fire Control District 502 E. New Market Rd., Immokalee, FL. 34142 Annie Alvarez Collier County Parks and Recreation Dear Mrs. Alvarez, 3/11/2014 16.A.10. The Immokalee Fire Control Dist. will provide fire protection and inspections for the Harvest Festival and Carnival at the Immokalee Airport Park, March 28a' — 30' 2014. When planning the layout, provide at least 24' fire lane around the midway for fire department access. Fire extinguishers will be needed per NFPA 10. Fire extinguishers shall be inspected and tagged as required by law. If you should have any questions, feel free to call me at 657 -2700 or (239) 707 -4829. Sincerely, Leo F. Ro Fire Marshal General Office 239 - 657 -2111 Fire Prevention 239 -657 -2700 Packet Page -602- Fax 239- 657 -9489 3/11/2014 16.A.10. ACORO. CERTIFICATE OF LIABILITY INSURANCE 2/28/14 PRODUCER 203 -931 -7095 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Specialty Insurance, LTD -Tom Plouffe HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 16901 West Haven, CT 06516 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY US FIRE INSURANCE COMPANY A INSURED COMPANY United Midways, LLC, Tolve Presentations & J & S Enterprises, Inc. B -- — 314 SE 22nd Street Cape Coral, FL 33990 COMPANY C COMPANY D COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO ! TYPE OF INSURANCE LTR I POLICY NUMBER POLICY EFFECTIVE I DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS GENERAL LIABILITY USS212380 4/11/13 4111/14 !GENERAL AGGREGATE $ 2,000,000 A ': A COMMERCIAL GENERAL LIABILITY I PRODUCTS - COMP /OP AGG $ 2,000,000 I` 1 I CLAIMS MADE 1=�_I OCCUR PERSONAL & ADV INJURY S 1,000.000 OWNER'S &CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000 __— 1 FIRE DAMAGE (Any one fire) ......._._.._ I $ 300,000 MED EXP (Any one person) b 5,000 4 AUTOMOBILE -._... LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ I BODILY INJURY I $ (Per person) ALL OWNED AUTOS t SCHEDULED AUTOS HIRED AUTOS WON-OWNED AUTOS I i BODILY INJURY y $ (Per acddent) -- - -- ---- PROPERTY DAMAGE $ i (... _ _ I ..............__ . ......__..__. - _._..___._ I I I . GARAGE LIABILITY I AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: I I I ANY AUTO i EACH ACCIDENT S AGGREGATE $ EXCESS LIABILITY UMBRELLA FORM ` EACH OCCURRENCE. $ E '$ _ �__.____..._- OTHER THAN UMBRELLA FORM I $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ' I TORY L WC LIMIMITIT I OTH- S . ER EL EACH ACCIDENT $ Aq. THE PROPRIETOR/ PARTNERS/EXECUTIVE INCL i OFFICERS ARE: ! EXCL °-- ---C- -IDENT EL DISEASE - POLICY LIMIT $ „W — EL DISEASE - EA EMPLOYEE $ OTHER E Date of Event: March 28 -30, 2014 DESCRIPTION OF OPERATIONSILOCATIONS fVEHICLESISPECIAL ITEMS Collier County Board of Commissioners 3301 East Tamiami Trail Naples, FL 34112 is added as an additional insured but only with respects to the operations of the named insured during the policy period. Location: Immokalee Airport Park 700 CR -846 Immokalee FL 34142 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Collier County Board of Commissioners EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR To AWIL 3301 East Tamiami Trail 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO TW J.EFT, Naples, FL 34112 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION 00 4►1{IUTY Attn: Leonor Montelongo OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPOU"7- ATMIS, AUTHORIZED REPRESENTATIVE LeonorMontelongo @colliergov.net i Thomas A. PIWffq ACORD 25-S (1/95) © ACORD CORPq RA "1988 Packet Page -603- Mar 05 14 01:03p JIohn Toive ' WE Ap r7$ rte.. ch ,i►; :off; O, N m �tti -4-0 i ;Z� �- _ �O m'. row ' zy�.os: z. 0 C.M ..,g o m _. to, C . m m'� r� � —fir :r �• . -to • to WX. Packet Page -604- 2394248109 p.1 3/11/2014 16.A.10. 265ij. r2 n 1 m ! '� �. . Map 2. t t * �A Packet Page -604- 2394248109 p.1 3/11/2014 16.A.10. Detail by Entity Name etail by Entity Name rida Non Profit Corporation EATER NAPLES CHAMBER OF COMMERCE, INC. ,ocument Number EI /EIN Number ate Filed tate tatus ast Event vent Date Filed vent Effective Date 390 TAMIAMI TRAIL NORTH UITE 210 APLES, FL 34103 04/26/2005 )0 TAMIAMI TRAIL NORTH ITE 210 PLES, FL 34103 :hanged: 04/26/2005 registered Agent Name & Ac arson, Joan 390 TAMIAMI TRAIL NORTH UITE 210 IAPLES, FL 34103 me Changed: 04/19/2013 dress Changed: 04/10/2006 'ices /Director Detail me & Address itle C N, MICHAEL A 703230 590688292 11/21/1961 FL ACTIVE AMENDED AND RESTATED ARTICLES 05/02/2006 NONE 3/11/2014 16.A.10. httpJ/ search . sunbiz.org /Inquiry/Corporation Packet Page - 605 - t]tDetail/EntityName /domnp -... 3/5/2014 3/11/201416.A.10. DBPR Ak -6003 - Division Of Alcoholic Beverages and Tobacco Application for OnelTwo/Three Day Permits or Special Sales License STATE OF FLORIDA DBPR Form DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Revised 9/2010 NOTE - This farm must be submitted as part of an application packet you ti—e Yny rmadtinns nr need assistance in completing this application, please contact Me Department of Business and Professional Regulation or your local district office, Please su it your completed application to your local district office at least {7) days prior to the fast date of the vent to insure the permit is issued by the event date. This application may be submitted by mail, or can be dropped off.. A Disttt Office Address and Contact Information Sheet can be found on AB& s page of the DBPR web site at the fink provided below. htt :t /www state fl usldborlabticontact/index.shtmi nsaction Type: ! One/TworThree dray Permit ❑_ Special Sales License Packet Page -606- Al ., y a , ��, • a A" A , 9 i� �ijy r �; miff ,� tl�� ^ � ' �i� Full Name of Applicant p Organization (This is the name a license /permit will be issued in) 9 � � -�- '�'`�,.• / �' Sri bt �vyr 1Q Depart ent of StatelDivision �(? of Garporations Document # FE(o$e S ! H-000 G .-) Business Name or Na Me of EventA���%v-O� -- Location of Event (S4reet and Number)hl y, t City G unty State Zip p Mailing Address (Sheet or P.OLBox) p City a. Code :3 Go ct Pers n Telephone Number _ � `i _ 6 5 c L) G eexxt. Email Address v t r S r 0 o Date {s) Perm /i�Q�eJs"ea Packet Page -606- 3/11/2014 16.A. 10. SA .. ... � � -1 81E COMPL.ETEti !' Ip f+ iFtTM Full Name of Appii : nt Organization �� 1-41 i (:!1 t Gc/y -rt - Z-P.tf The named applicant for a license /permit has complied with the Florida Statutes concerning egistration for Sales and Use Tax and has agreed to pay any applicable taxes due. Signed do Qmfe 313 I -OIL/ Tiller" Department of Rever`ue Stamp:►9 i Location ttion f E ent (5 reet and-Number) City only Cz�tre Gc .> I A The location complies temporary oning requirements for the tempory sale of alcoholic beve ages pursuant to this applicatiom ford wo/Three day Permit. i Sign _ Date 3 / Title'(rr� /t ► G,�'' Note: College fr4ternities and sororities must meet certain additional conditions which cant be found In the application instructions and requirement. 2 Eff.11�16/2010 Packet Page -607- -- I ___