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Official t'se Only
Event:
Attachments Subntitteled
_ indemnification Agreement
wan - UFtificate of Insurance
!%,.. Map with area(s) requested to be used indicated
meen. PKI and Troflie plan
. _ Copy ofapplication for sign permit, iPapplicable, (Upon application approval copy of approved sign
permit must be filed with the Town Clerk NO LATER THAN 5 days prior to scheduled event.)
Copy of this application to NYS Parks and Recreation c/o Evangola State Park
Application LL
Pettderererarasnver
Recommended or Not reconimended
by the Recreation Department.
Action by Aurora Town Board
The Aurora Town Board, apon review of the application request #__—ss submitted by
(organization or individual)
took the followi ing action with or
Without conditions {as applicable) noted below:
Approved: Date:
Supervisor's Signature
Denied: Date:.
Supervisor's Signature
Conditions:
Police Department Approval
Highway Department Approval
_ Building Department Approval
Requesting organization shail attach a completed Certificate of Insurance with minimum limits to
include public liability coverage with limits of $1,000,000 cach occurrence: property damage insurance with
Hintits OF $1.000,000 each occurrence. Policy shall be endorsed to include the Town of Aurora as an additional
name insured
Requesting organization of individual shail submit an Indemnification Agreement signed by
authorized applicant or officer of company and duly notarized,
______ Approval of parking and traffic plan
. __ Arsenal Soccer Contacted ~ No Conflicts. Date: algq| ae
Other