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Otsego Lake County Park Wah Wah Soo Beach Otsego County Community Center Community Dog Park Libke Fields Pontresina Park Irontone Springs Roadside Park Iron Belle Trail Trailhead Bonny Miller- President, Jack Korte - Vice President, Randy Stults - Secretary, Trevor Burroughs - Otsego County Board of Commissioners, Troy Huff - Otsego County Road Commission, Judith Jarecki - Otsego County Planning Commission, Justin Wing – Commission Member, Jacob Brown – Director, Keri Swantek – Park Coordinator, Josh Brannon – Lead Ranger 1 Organization Information: Legal Name of the Organization: Organization’s Address: City: State: Zip: Organization’s Phone: Organization’s Email Address: Type of Organization: Government For Profit Non-Profit (Tax ID Number: Service Group Other Contact Person Information: Contact Person’s Name: Contact Person’s Phone: Contact Person’s Email: Otsego County Resident Non-Otsego County Resident Otsego County Parks & Recreation Department Special Event Permit Application ---PAGE BREAK--- Otsego Lake County Park Wah Wah Soo Beach Otsego County Community Center Community Dog Park Libke Fields Pontresina Park Irontone Springs Roadside Park Iron Belle Trail Trailhead Bonny Miller- President, Jack Korte - Vice President, Randy Stults - Secretary, Trevor Burroughs - Otsego County Board of Commissioners, Troy Huff - Otsego County Road Commission, Judith Jarecki - Otsego County Planning Commission, Justin Wing – Commission Member, Jacob Brown – Director, Keri Swantek – Park Coordinator, Josh Brannon – Lead Ranger 2 Event Information: Event Title: Event Type of Event: Run/Walk Parade ______Wedding Ceremony/Photos Fair Concert Picnic League ______Other Description of Organization: Estimated Attendance: Requested Event Location: (Otsego County Community Center; Irontone Springs Roadside Park; Libke Fields; Otsego Lake County Park; Wah Wah Soo Beach; Pontresina Park; Community Dog Park; Iron Belle Trail Trail- head) ---PAGE BREAK--- Otsego Lake County Park Wah Wah Soo Beach Otsego County Community Center Community Dog Park Libke Fields Pontresina Park Irontone Springs Roadside Park Iron Belle Trail Trailhead Bonny Miller- President, Jack Korte - Vice President, Randy Stults - Secretary, Trevor Burroughs - Otsego County Board of Commissioners, Troy Huff - Otsego County Road Commission, Judith Jarecki - Otsego County Planning Commission, Justin Wing – Commission Member, Jacob Brown – Director, Keri Swantek – Park Coordinator, Josh Brannon – Lead Ranger 3 Area of Park (Describe Physical Boundaries): Are you planning on charging for the event: Actual Hours of Event: - Set up Times: AM/PM - Take Down Times: _____AM/PM - Description of Event Setup: Description of the Event: Please attach additional sheets as necessary, including plans, drawings, maps, etc. Insurance Requirements: Any and all events when there is a charge for participation, the applicant shall provide a certifi- cate 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 Liabil- ity. ---PAGE BREAK--- Otsego Lake County Park Wah Wah Soo Beach Otsego County Community Center Community Dog Park Libke Fields Pontresina Park Irontone Springs Roadside Park Iron Belle Trail Trailhead Bonny Miller- President, Jack Korte - Vice President, Randy Stults - Secretary, Trevor Burroughs - Otsego County Board of Commissioners, Troy Huff - Otsego County Road Commission, Judith Jarecki - Otsego County Planning Commission, Justin Wing – Commission Member, Jacob Brown – Director, Keri Swantek – Park Coordinator, Josh Brannon – Lead Ranger 4 d. Otsego County, and Otsego County Parks and Recreation Department will be named as Additional Insured on all insurance coverage, with the exception of Workers Com- pensation and Employers’ Liability Insurance. e. A Waiver of Subrogation is required on the certificate of liability insurance. Otsego County, and the Otsego County Parks & Recreation Department, is not responsible for any accidents or damages to persons or property resulting from the issuance of this permit. IDENNITY AGREEMENT To the fullest extent of the law, described as “LESSEE”) agrees to defend, pay on behalf of, indemnify and hold harmless the Otsego County Parks and Recreation Department (hereinafter referred to as “the OCPR”) its elected and ap- pointed officials, employees and volunteers and any others working on behalf of the OCPR, against any and all claims, demands, suits, or loss, including all costs and any fees connected therewith, bought by anyone and for any damages which may be asserted, claimed or recov- ered against or from the OCPR, its elected and appointed officials, employees, volunteers or others working on behalf of the OCPR, by reason of personal injury, including bodily injury and death and/or property damage, including loss of use thereof, brought by anyone which arises out of the sole, comparative or partial negligence, error, omission or commission or any party including the OCPR, its agents or employees and is in any way connected or associated with this contract between LESSEE and the OCPR for the lease of the described premises. LESSEE agrees to guarantee that the following rules will be observed by all individuals in attend- ance at the event. LESSEE accepts responsibility for assuring the following; orderly behavior; financial responsibility for any damage due to use of the facilities; responsiveness to all directives of staff/personnel; that the program is of a nature suitable for presentation on public property; that the activity is lawful and in conformity with regulations of State and Federal laws and the OCPR; that LESSEE with not remove, change, rearrange or revise any- thing in or on the property without the specific approval from the OCPR. Intoxicated persons will not be allowed to enter; those found intoxicated will be removed. Failure by LESSEE to honor these requirements could result in forfeiture of use of the property. LESSEE shall not deny participation in any event of LESSEE or membership LESSEE because of race, creed, color, national origin or handicap. LESSEE understands and agrees that if at any time the OCPR deter- mines that a person’s activities pose a danger to persons or property, the OCPR shall have the right to close down all or part of the property to remove offending persons or groups from the property. ---PAGE BREAK--- Otsego Lake County Park Wah Wah Soo Beach Otsego County Community Center Community Dog Park Libke Fields Pontresina Park Irontone Springs Roadside Park Iron Belle Trail Trailhead Bonny Miller- President, Jack Korte - Vice President, Randy Stults - Secretary, Trevor Burroughs - Otsego County Board of Commissioners, Troy Huff - Otsego County Road Commission, Judith Jarecki - Otsego County Planning Commission, Justin Wing – Commission Member, Jacob Brown – Director, Keri Swantek – Park Coordinator, Josh Brannon – Lead Ranger 5 AFFIDAVIT OF APPLICANT Everything 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 the rules and regulations. The permit, if granted, is not transferable and is revocable at any time at the absolute discretions of the Otsego County Parks and Recreation Department. MISCELLANEOUS RULES 1. Trash Removal: You are responsible for securing additional receptacles or having your trash hauled away if facility containers won’t accommodate the needs for your event. 2. Portable Toilets: You are responsible for securing the appropriate number of porta- ble toilets for your event. They should be delivered at the latest delivery date at time possible prior to your event and removed from the facility no more than 24 hours after your event ends. 3. Tent/Displays: The Otsego County Parks and Recreation Department are not respon- sible for any tents or displays set up for your event. Tent staking is not allowed with- out previous approval by Otsego County Parks and Recreation staff as to location. 4. It is the applicant’s responsibility to be familiar with the Otsego County Parks and Recreation Department rules to ensure their event complies with such. Print Name of Applicant: Date: Applicant Signature: Date: OFFICE USE ONLY: Approved Denied (Notes: Name: Date: Signed: Date: