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i make this application and agree io abide by the Guidelines for use of Community
ahK.
Official Use Only Below this Line-«.«-5---nsancnnwnam Re m eee ee
Event:
Attachments submitted:
wat) Indemnification Agreement
‘ Certificate of insurance
eo Copy of application for sign permit, if applicable. (Upon application approval,
copy of approve sign permit must be filed with the Town Clerk NO LATER
THAN & days prior to scheduled event.)
Application CO Recommended or 0 Not recommended
by Department of Parks and Recreation
Action by Town Beard:
The Town Board, upon review of the application request # submitted by
{organization or individual) took the folowing
action,
with or without conditions (as applicable) and noted below:
Approved: Date:
Supervisor Signature
Denied: Date:
Supervisor Signature
Conditions:
_ Requesting organization shall attach a completed Certificate of Insurance with
Minimum Limits to include public liability coverage with limits of $1,000,000 each
occurrence; property damage insurance with limits of $1,000,000 each occurrence.
Policy shall be endorsed to includé the Town of Aurora as an additional named insured.
Requesting organization shall submit an Indemnification Agreement signed by
authorized applicant or officer of company and duly notarized,
Other
Revised 5/20/21