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1 PARK USE APPLICATION Complete application and return with $50.00 application fee 45 days before the event. Date of application:______________ Park Area of park Telephone (Person or organization name) If organization: name, address, telephone number of authorized representative: Event Event times: Event Event Event (i.e. fundraising, profit making) Description of Open to public: Yes No By Invitation Only: No Will alcohol be consumed: Yes No If yes call the Lewiston Department of Recreation. Anticipated Attendance (estimate): A. Any reservation consisting of 100 people or more may be required to obtain a performance bond, or to pay a security deposit in the form of a cashiers check or money order payable to the City of Lewiston. The performance bond will be returned if the reserved area is left clean and undamaged following the event. The deposit or bond must be submitted 2 weeks prior to event date. B. Liability insurance, naming the City of Lewiston as additionally insured may be required for large groups (500, 100 or 2000 people) or groups with special activities (i.e. inflatables, tents, special equipment). The Certificate of Liability Insurance must be submitted 2 weeks prior to event date. C. A security plan, event layout map maybe required, and approved by the City of Lewiston. ---PAGE BREAK--- 2 D. City Council shall approve 1000 or more people with event lasting more than 2 days long. Admission Fee/Donation? Yes No If yes specify amount: Age restriction on Admission? Yes No If yes specify age required for admission: License/Permit Required: Yes No If yes, specify (State/Municipal) Name of Licensing Authority: (i.e. food, peddlers, outdoor entertainment, liquor). Please contact the licensing authority for permits required. Anticipated need for parking: Yes No If yes, how will you provide parking Anticipated need for sanitary facilities: Yes No If yes, how will you provide sanitary and location of facilities Events with a attendance of 200 persons or more lasting longer than 3 hours must provide portable restrooms at the ration of restroom for each 200 persons in attendance, one-third of which must be ADA specifications. List any materials/equipment /vehicles to be placed on City Lessee must seek City approval before placing on City property. Please contact the Lewiston Recreation Representative at 513-3005 three work days in advance of the event. Clean-up: Yes No Tent or Canopy: Yes No If yes, you must attach a copy of the Flame-Retardant certificate from tent. Will you be using a P.A. system or any other system to amplify sound? Yes No If yes, you must obtain a permit from the Lewiston City Clerks office in advance of your event. In addition, you must check with the Code Enforcement division regarding noise limits in the area. Permittee or designee must be on parks grounds while event/activity is being conducted. All required fees, security deposits, authorizations, and other requirements associated with the use of the Parks shall be paid and/or completed 2 weeks prior to the date and time of the activity. ---PAGE BREAK--- 3 TO BE COMPLETED BY CITY: Acted on by Date Referred to Facility Use Review Date Action taken: Granted with conditions:__________ If Granted with conditions, description of conditions imposed: Security deposit: Waiver Additional fees: (state amount and reason) Additional Security: Licensee must provide: (Type and amount of security) Special requirements: Electrical power connected: Electrical Dig Safe permit required: Yes No If yes please notify Overtime required: Yes No Security Deposit: Licensee must post as a security deposit/performance bond in the event of damage to city property incurred as a result of breach of the agreement. Insurance: Licensee agrees to provide public liability insurance coverage in the amount of for bodily injury and for property damage naming the City of Lewiston as an insured. (Written proof required). Other: A. Labor Costs – The Licensee will be charged the rate of per hour per person ---PAGE BREAK--- 4 for department preparation, clean-up services etc. if required. B. Additional – Licensee agrees to pay to defray additional costs incurred by the City as a result of the event. I agree to comply with the terms set out in my application which is incorporated herein by reference. I have reviewed the above-listed bees/requirements and agree to pay and satisfy them 3 weeks before event date. I have read the City of Lewiston Park Use Policy and agree to be bound by its terms. CONDITIONS OF ISSUANCE OF PARK USE PERMIT An activity will be terminated for non-compliance of the conditions for issuance of the Park use permit or if a responsible City official determines it is in the best interest of the City. Failure to comply with the terms of this application will result in forfeiture of applicable deposits. If an activity is terminated for cause by an authorized agent of the City of Lewiston, no refund of initial fee or security deposit would be warranted or considered. City of Lewiston Return signed copy of agreement to the City of Lewiston Department of Recreation. ---PAGE BREAK--- 5 CITY OF LEWISTON, MAINE PARK USE FEE AGREEMENT Telephone (Person or organization name) Event Event times: Set-up Date & Take down Date & Application Fee: General use Fee: Park Location: Fee: Additional Fees: Overtime Fee: Other: Sub-total: Total Fees and Charges: Sign Licensee or agent. Date