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OTSEGO COUNTY PARKS AND RECREATION DEPARTMENT Special Event Permit Application 315 S. Center Street, Gaylord, MI 49735 Telephone: (989) 732-6521 Email: [EMAIL REDACTED] APPLICANT AND SPONSORING ORGANIZATION INFORMATION Please complete all data as required. Name of Organization: Address: City: State: Zip: Daytime Phone: Eve. Phone: Fax: Mobile: Email: Manager On Site Day of Event: Mobile: * Any change in the above information, please notify the Parks Department immediately. Type of Organization: Government For Profit Non-Profit Tax ID: Private - County Resident Private - Non-Resident Other SPECIAL EVENT INFORMAITON Complete all data as required for event of any size. Type of Event: Run/Walk Parade Wedding Ceremony/Photos Fair Concert Picnic Other (specify): Event Title: Event Date(s): Estimated Attendance (peak): Requested Event Location: Park Name: (Community Center; Irontone Springs; Libke Fields; Louis M. Groen Nature Preserve; Otsego Lake County Park; Wah Wah Soo) Area of Park (Describe Physical Boundaries): Are you planning on charging for the event: yes no Actual Hours of Event: AM/PM - AM/PM Set Up Times: AM/PM - AM/PM Take Down Times:______ AM/PM - AM/PM Description of Event Set Up: Please attach additional sheets as necessary, including plans, drawings, maps, etc. EXPENSE/REVENUE INFORMATION REQUIREMENTS Funds raised at the Louis M. Groen Nature Preserve must be used to offset expenses, with any profits deposited with Otsego County Parks for use at the Groen Nature Preserve. Organizers of events permitted at the Louis M. Groen Nature Preserve are required to submit a tentative budget including expected expenses, revenues, and profit. In addition, a profit and loss report will be required at the ---PAGE BREAK--- completion of the event. All activities at the Louis M. Groen Nature Preserve must be in compliance with the Conservation Easement recorded on Liber 1271 Page 786 at the Otsego County Register of Deeds Office. INSURANCE REQUIREMENTS During the performance of any and all events when there is a charge for participation, the applicant shall proivde a certificate of insurance meeting the following requirements: a. General Liability Insurance, with a minimum combined single limit of $1,000,000 for each occurrence and aggregate. b. Motor Vehicle Liability Coverage, and Michigan No-Fault Coverages including all owned, non-owned, and hired vehicles. c. Workers Compensation and Employers' Liability, Michigan Statutory Limits of Liability. d. Otsego County, and the Otsego County Parks and Recreation Commission will be named as Additional Insured on all insurance coverage, with the exception of Workers Compensation and Employer's Liability insurance. e. A Waiver of Subrogation is required on the certificate of liability insurance. Otsego County, and the Otsego County Parks and Recreation Commission, are not responsible for any accidents or damages to persons or property resulting from the issuance of this permit. AFFIDAVIT OF APPLICANT Everything that I have stated on this application is correct to the best of my knowledge. I have read, understand, and agree to abide by the policies and rules and regulations listed on this form as they pertain to the requested usage. By signing this application, the applicant agrees to follow all rules and regulations. The Permit, if granted, is not transferable and is revocable at any time at the absolute discretions of the Parks Department and/or Parks and Recreation Commission. All programs and facilities of the Otsego County Parks and Recreation Department are open to all citizens regardless of race, sex, age, color, religion, national origin, or handicap. MISCELLANEOUS RULES 1. Trash Removal: You are responsible for securing additional receptacles or having your trash hauled away if park containers won't accommodate the needs for your event. 2. Portable Toilets: You are responsible for securing the appropriate number of portable toilets for your event. They should be delivered at the latest date and time possible prior to your event and removed from Park property no more than 24 hours after your event ends. 3. Tents/Displays: The Otsego County Parks and Recreation Department are not responsible for any tents or items set up for your event. Tent staking is not allowed without previous approval by Parks and Recreation staff as to location. 4. It is the applicant's responsibility to be familiar with Parks and Recreation rules and to ensure their event complies with such. Name of Applicant: (print) Signature: Date: OFFICE USE ONLY Approved Notes: Denied Signed: Date: