Common use of APPLICANT AND SPONSORING ORGANIZATION INFORMATION Clause in Contracts

APPLICANT AND SPONSORING ORGANIZATION INFORMATION. ■ Commercial (for profit) Noncommercial (nonprofit) Saloon #10 Sponsoring Organization: Xxxx Xxxxxxx Chief Officer of Organization (NAME): Xxxx Xxxxxxx Applicant (NAME): Business Phone: ( 000-0000 ) Address: 000 Xxxx Xx Xxxxxxxx, XX 00000 (city) (state) (zip code) Daytime phone: ( ) Evening Phone: ( ) Fax #: ( ) Please list any professional event organizer or event service provider hired by you that is authorized to work on your behalf to produce this event. Name: Address: (city) (state) (zip code) Contact person “on site” day of event or facility use 000-000-0000 Pager/Cell #: (Note: This person must be in attendance for the duration of the event and immediately available to city officials) ✔ Is your organization a “Tax Exempt, nonprofit” organization? If YES, you must attach a copy of your IRS 501C Tax Exemption Letter to this Special Event Permit application (providing proof and certifying your current tax exempt, nonprofit status). ✔ Are admission, entry, vendor or participant fees required? If YES, please explain the purpose and provide amount(s).: Please provide a detailed description of your proposed event. Include details regarding any components of your event such as use of vehicles, animals, rides or any other pertinent information about the event: Bev's Poker Run is the annual motorcyle event that is a fund raiser for Relay for Life. Motorcyle Parking is being requested on June 25, 5 pm until 10 pm from Xxx St. to Wall St. as the last part of the event takes place at the Saloon #00 - 000 Xxxx Xx. Parking will be on east side of main street only. Does the event involve the sale or use of alcoholic beverages? If YES, please provide your liquor liability insurance information to the last page of this application. Will items or services be sold at the event? If YES, please describe: ■ ■ Does this event involve a moving route of any kind along streets, sidewalks or highways? If YES attach a detailed map of your proposed route, indicating the direction of travel and provide written narrative to explain your route. Does this event involve a fixed venue site? If YES, attach a detailed site map showing all streets impacted by the event. In addition to the route map required above, please attach a diagram showing the overall lay-out and set-up locations for the following items: ⮚ Alcoholic and Non-alcoholic Concession and / or Beer Garden Areas. ⮚ Food Concession and / or Food Preparation Area(s). Please describe how food will be served at the event: If you intend to cook food in the event area, please specify the method to be used: ELECTRIC CHARCOAL OTHER (specify): ⮚ First Aid Facilities and Ambulance locations. ⮚ Tables and Chairs. ⮚ Fencing, Barriers and / or Barricades. ⮚ Generator Locations and / or Source of Electricity. ⮚ Canopies or Tent Locations. ⮚ Booths, Exhibits, Displays or Enclosures. ⮚ Scaffolding, Bleachers, Platforms, Stages, Grandstands or Related Structures. ⮚ Vehicles and / or Trailers. ⮚ Trash Containers and Dumpsters. (NOTE): You must properly dispose of waste and garbage throughout the term of your event and immediately upon conclusion of the event, the area must be returned to a clean condition. Number of trash cans: N/A Trash Containers w / lids: Describe your plan for clean-up and removal of waste and garbage during and after the event or use of facility: ⮚ Other Related Event Components not covered above. Please describe your procedures for both Crowd Control and Internal Security: N/A Please describe your Accessibility Plan for access at your event by individuals with disabilities: N/A ■ Have you hired any Professional Security organization to handle security arrangements for this event? If YES, please list: Security Organization: Security Organization Address: (city) (state) (zip code) Security Director (Name): Business phone: ■ Is this a night event? If YES, please state how the event and surrounding area will be illuminated to ensure the safety of the participants and spectators: Please indicate what arrangements you have made for providing First Aid Staffing and Equipment? Number N/A Ambulance(s) – How provided? Number N/A Emergency Medical Technicians – How provided? APPLICANT specifically acknowledges and agrees that it shall be solely responsible for any damage to personal property located in or stored in or upon DEADWOOD’s property pursuant to the activity for which approval is being sought and that DEADWOOD shall not be responsible for any damage or loss to or of APPLICANT’s property which results from any cause or reason with regard to personal property owned by APPLICANT stored or located on DEADWOOD’s property pursuant to approval of the activity for which approval is being sought herein. Acknowledge acceptance with initial: cs APPLICANT agrees to hold DEADWOOD harmless and indemnify DEADWOOD from any sums of money which DEADWOOD might have to pay to any person as a result of property damage, personal injury or death resulting from APPLICANT’s use of the City property pursuant to approval of the activity for which approval is being sought herein. Acknowledge acceptance with initial: cs Please describe your plans to notify all residents, businesses and churches impacted by the event: Residence and businesses will be notified through public hearing notice ■ Are there any musical entertainment features related to your event or facilities rental? If YES, please state the number of bands and type of music. Number of Stages: Number of Bands: Type of Music: ■ Will sound amplification be used? If YES, please indicate: Start Time: AM / PM – Finish Time: AM / PM ■ Will sound checks be conducted prior to the event? If YES, please indicate: Start Time: AM / PM – Finish Time: AM / PM Please describe the sound equipment that will be used for your event: ■ Will any fireworks, rockets or other pyrotechnics be used? If YES, please attach a copy of your permit (issued by the State Fire Xxxxxxxx’x office) to this application. ■ Will any signs, banners, decorations or special lighting be used? If YES, please describe: Will this event be promoted, advertised or marketed in any manner? If YES, please describe: Through posters and social media Will there be any live media coverage during your event? If YES, please explain: Applicant acknowledges and agrees to allow the City to publish the Contact Person and media referral telephone numbers on the internet in conjunction with the Calendar of Upcoming Events in the City of Deadwood. If you have a home page and want us to link with our Calendar, please provide the Internet address for your homepage: xxxxxx00.xxx Refer all event public inquiries and / or media inquiries for this event to: Xxxx Xxxxxxx NAME: 000-000-0000 PHONE: Name of Insurance Company: Agent’s Name: Business Phone: Policy Number: Policy Type: Address: (city) (state) (zip code) For final permit approval, you will need commercial general liability insurance that names “the City of Deadwood, its officers, employees and agents” as an additional insured. Insurance coverage must be maintained for the duration of the event. To determine the amount of insurance coverage necessary, please contact the Finance Office at (000) 000-0000 – Fax # (000) 000-0000. The City must be named as an “additional insured.” Please obtain the required insurance and mail an original insurance certificate to: City of Deadwood, Finance Office, 000 Xxxxxxx Xxxxxx, Deadwood, SD 57732. Name of Insurance Company: Agent’s Name: Business Phone: Policy Number: Policy Type: Address: (city) (state) (zip code) Please obtain the required insurance and mail an original insurance certificate to: City of Deadwood, Finance Office, 000 Xxxxxxx Xxxxxx, Deadwood, SD 57732.

APPLICANT AND SPONSORING ORGANIZATION INFORMATION. ■ Commercial (for profit) Noncommercial (nonprofit) Saloon #10 Naja Shriners Sponsoring Organization: Xxxx Xxxxxxx Xxxxx Xxxxx Chief Officer of Organization (NAME): Xxxx Xxxxxxx Xxxxx Xxxxxx Applicant (NAME): Business Phone: ( 000-0000 ) Address: 000 Xxxx 0000 Xxxxxxx Xx Xxxxxxxx, XX 00000 Xxxxx City SD 57702 (city) (state) (zip code) Daytime phone: ( ) Evening Phone: ( 000-0000 ) Fax #: ( ) Please list any professional event organizer or event service provider hired by you that is authorized to work on your behalf to produce this event. Name: Address: (city) (state) (zip code) Contact person “on site” day of event or facility use 000-000-0000 Pager/Cell #: (Note: This person must be in attendance for the duration of the event and immediately available to city officials) ✔ Is your organization a “Tax Exempt, nonprofit” organization? If YES, you must attach a copy of your IRS 501C Tax Exemption Letter to this Special Event Permit application (providing proof and certifying your current tax exempt, nonprofit status). ✔ Are admission, entry, vendor or participant fees required? If YES, please explain the purpose and provide amount(s).: To enter the tasting in Outlaw Square you pay a fee. This is an annual fundraiser for t he Naja Shriners. Please provide a detailed description of your proposed event. Include details regarding any components of your event such as use of vehicles, animals, rides or any other pertinent information about the event: Bev's Poker Run is the annual motorcyle event that is a fund raiser for Relay for LifeAreas of focus: Outlaw Square. Motorcyle Parking is being requested on June 25, 5 pm until 10 pm from Xxx St. Open container zones: 1 & 2 - Wall Street to Wall St. as the last part of the event takes place at the Saloon #00 Pine Street & Outlaw Square. Requesting open container Friday: July 14th 5PM - 000 Xxxx Xx. Parking 10PM Saturday: July 15th 12PM - 10PM Participants & attendees will be on east side of main street onlyusing Deadwood Chamber event cups. We will ID all tasting participants. ■ Does the event involve the sale or use of alcoholic beverages? If YES, please provide your liquor liability insurance information to the last page of this application. ■ Will items or services be sold at the event? If YES, please describe: We will have open container event cups for sale, day of event tickets, and possible limited merchandise. ■ ■ Does this event involve a moving route of any kind along streets, sidewalks or highways? If YES attach a detailed map of your proposed route, indicating the direction of travel and provide written narrative to explain your route. Does this event involve a fixed venue site? If YES, attach a detailed site map showing all streets impacted by the event. In addition to the route map required above, please attach a diagram showing the overall lay-out and set-up locations for the following items: ⮚ Alcoholic and Non-alcoholic Concession and / or Beer Garden Areas. ⮚ Food Concession and / or Food Preparation Area(s). Please describe how food will be served at the event: If you intend to cook food in the event area, please specify the method to be used: ELECTRIC CHARCOAL OTHER (specify): ⮚ First Aid Facilities and Ambulance locations. ⮚ Tables and Chairs. ⮚ Fencing, Barriers and / or Barricades. ⮚ Generator Locations and / or Source of Electricity. ⮚ Canopies or Tent Locations. ⮚ Booths, Exhibits, Displays or Enclosures. ⮚ Scaffolding, Bleachers, Platforms, Stages, Grandstands or Related Structures. ⮚ Vehicles and / or Trailers. ⮚ Trash Containers and Dumpsters. (NOTE): You must properly dispose of waste and garbage throughout the term of your event and immediately upon conclusion of the event, the area must be returned to a clean condition. Number of trash cans: N/A 10 Trash Containers w / lids: 0 Describe your plan for clean-up and removal of waste and garbage during and after the event or use of facility: Similar to last years event we will have significant organizational manpower to assist in clean up of the Street & Square. ⮚ Other Related Event Components not covered above. Please describe your procedures for both Crowd Control and Internal Security: N/A We will have hired security for the overnight. We plan to handle event security like we did last year with significant Xxxxxxx manpower, in identifiable red fezzes, located throughout the square & Deadwood Street for assistance & safety. Please describe your Accessibility Plan for access at your event by individuals with disabilities: N/A ■ Have you hired We do not have one. We will not impair or block any Professional Security organization existing required by law access points to handle security arrangements for this event? If YES, please list: Security Organization: Security Organization Address: (city) (state) (zip code) Security Director (Name): Business phone: ■ Is this a night event? If YES, please state how the event and surrounding area will be illuminated to ensure the safety of the participants and spectators: Please indicate what arrangements you have made for providing First Aid Staffing and Equipment? Number N/A Ambulance(s) – How provided? Number N/A Emergency Medical Technicians – How provided? APPLICANT specifically acknowledges and agrees that it shall be solely responsible for any damage to personal property located in or stored in or upon DEADWOOD’s property pursuant to the activity for which approval is being sought and that DEADWOOD shall not be responsible for any damage or loss to or of APPLICANT’s property which results from any cause or reason with regard to personal property owned by APPLICANT stored or located on DEADWOOD’s property pursuant to approval of the activity for which approval is being sought herein. Acknowledge acceptance with initial: cs APPLICANT agrees to hold DEADWOOD harmless and indemnify DEADWOOD from any sums of money which DEADWOOD might have to pay to any person as a result of property damage, personal injury or death resulting from APPLICANT’s use of the City property pursuant to approval of the activity for which approval is being sought herein. Acknowledge acceptance with initial: cs Please describe your plans to notify all residents, businesses and churches impacted by disabled persons during the event: Residence and businesses will be notified through public hearing notice ■ Are there any musical entertainment features related to your event or facilities rental? If YES, please state the number of bands and type of music. Number of Stages: Number of Bands: Type of Music: ■ Will sound amplification be used? If YES, please indicate: Start Time: AM / PM – Finish Time: AM / PM ■ Will sound checks be conducted prior to the event? If YES, please indicate: Start Time: AM / PM – Finish Time: AM / PM Please describe the sound equipment that will be used for your event: ■ Will any fireworks, rockets or other pyrotechnics be used? If YES, please attach a copy of your permit (issued by the State Fire Xxxxxxxx’x office) to this application. ■ Will any signs, banners, decorations or special lighting be used? If YES, please describe: Will this event be promoted, advertised or marketed in any manner? If YES, please describe: Through posters and social media Will there be any live media coverage during your event? If YES, please explain: Applicant acknowledges and agrees to allow the City to publish the Contact Person and media referral telephone numbers on the internet in conjunction with the Calendar of Upcoming Events in the City of Deadwood. If you have a home page and want us to link with our Calendar, please provide the Internet address for your homepage: xxxxxx00.xxx Refer all event public inquiries and / or media inquiries for this event to: Xxxx Xxxxxxx NAME: 000-000-0000 PHONE: Name of Insurance Company: Agent’s Name: Business Phone: Policy Number: Policy Type: Address: (city) (state) (zip code) For final permit approval, you will need commercial general liability insurance that names “the City of Deadwood, its officers, employees and agents” as an additional insured. Insurance coverage must be maintained for the duration of the event. To determine the amount of insurance coverage necessary, please contact the Finance Office at (000) 000-0000 – Fax # (000) 000-0000. The City must be named as an “additional insured.” Please obtain the required insurance and mail an original insurance certificate to: City of Deadwood, Finance Office, 000 Xxxxxxx Xxxxxx, Deadwood, SD 57732. Name of Insurance Company: Agent’s Name: Business Phone: Policy Number: Policy Type: Address: (city) (state) (zip code) Please obtain the required insurance and mail an original insurance certificate to: City of Deadwood, Finance Office, 000 Xxxxxxx Xxxxxx, Deadwood, SD 57732.

APPLICANT AND SPONSORING ORGANIZATION INFORMATION. ■ Commercial (for profit) Noncommercial (nonprofit) Saloon #10 AAU Wrestling Sponsoring Organization: Xxxx Xxxxxxx Chief Officer of Organization (NAME): Xxxx Xxxxxxx Xxxxxx aka Xxxxx Xxxx Applicant (NAME): Business Phone: ( 000-0000 ) Address: 000 Xxxx Xx Xxxxxxxx, Xxxxxxxx XX 00000 (city) (state) (zip code) Daytime phone: ( ) Evening Phone: ( ) Fax #: ( ) Please list any professional event organizer or event service provider hired by you that is authorized to work on your behalf to produce this event. Xxxxx Xxxx Name: 000 Xxxx Xx Xxxxxxxx XX 00000 Address: (city) (state) (zip code) Contact person “on site” day of event or facility use 000-000-0000 Pager/Cell #: (Note: This person must be in attendance for the duration of the event and immediately available to city officials) ✔ Is your organization a “Tax Exempt, nonprofit” organization? If YES, you must attach a copy of your IRS 501C Tax Exemption Letter to this Special Event Permit application (providing proof and certifying your current tax exempt, nonprofit status). ✔ Are admission, entry, vendor or participant fees required? If YES, please explain the purpose and provide amount(s).: General Admission fee for event. Participant fees charge for entrants - Fundraiser for AAU Wrestling Please provide a detailed description of your proposed event. Include details regarding any components of your event such as use of vehicles, animals, rides or any other pertinent information about the event: Bev's Poker Run This is an AAU wrestling tournament taking place at Outlaw Square with wrestlers participating from around the annual motorcyle event that region. This is a fund raiser fundraiser for Relay Deadwood AAU Wrestling Club. Bleachers will be placed at Outlaw Square for Lifepublic seating at the event. Motorcyle Parking This is being requested a ticketed event with wrestliing club charging admisssion. Security gates will be placed along Main Street and down the curbside of Deadwood St. on June 25, 5 pm until 10 pm from Xxx Rocksino side to Pioneer Way and back across Deadwood St. to Wall St. as secure the last part of the event takes place at the Saloon #00 - 000 Xxxx Xxvenue. Parking Wrestling mats will be placed on east side the turf of main street onlyOutlaw Square. Regiistration will begin at NOON - wresting matches will begin at 6 pm. Requesting Deadwood St closure begining at 6 am Does the event involve the sale or use of alcoholic beverages? If YES, please provide your liquor liability insurance information to the last page of this application. ■ Will items or services be sold at the event? If YES, please describe: Yes, event shirts will be sold by wrestling club ■ ■ Does this event involve a moving route of any kind along streets, sidewalks or highways? If YES attach a detailed map of your proposed route, indicating the direction of travel and provide written narrative to explain your route. Does this event involve a fixed venue site? If YES, attach a detailed site map showing all streets impacted by the event. In addition to the route map required above, please attach a diagram showing the overall lay-out and set-up locations for the following items: ⮚ Alcoholic and Non-alcoholic Concession and / or Beer Garden Areas. ⮚ Food Concession and / or Food Preparation Area(s). Please describe how food will be served at the event: If you intend to cook food in the event area, please specify the method to wrestling club will be used: selling pizza slices and can soda ELECTRIC CHARCOAL OTHER (specify): ⮚ First Aid Facilities and Ambulance locations. ⮚ Tables and Chairs. ⮚ Fencing, Barriers and / or Barricades. ⮚ Generator Locations and / or Source of Electricity. ⮚ Canopies or Tent Locations. ⮚ Booths, Exhibits, Displays or Enclosures. ⮚ Scaffolding, Bleachers, Platforms, Stages, Grandstands or Related Structures. ⮚ Vehicles and / or Trailers. ⮚ Trash Containers and Dumpsters. (NOTE): You must properly dispose of waste and garbage throughout the term of your event and immediately upon conclusion of the event, the area must be returned to a clean condition. Number of trash cans: N/A 8 on site Trash Containers w / lids: N/A Describe your plan for clean-up and removal of waste and garbage during and after the event or use of facility: Wrestling club will clean up Square - Square staff will stack garbage bags as usual for city pick up ⮚ Other Related Event Components not covered above. Please describe your procedures for both Crowd Control and Internal Security: N/A Outlaw Square Staff will handle security Please describe your Accessibility Plan for access at your event by individuals with disabilities: N/A Outlaw Square is ADA compatible ■ Have you hired any Professional Security organization to handle security arrangements for this event? If YES, please list: Security Organization: Security Organization Address: (city) (state) (zip code) Security Director (Name): Business phone: ■ Is this a night event? If YES, please state how the event and surrounding area will be illuminated to ensure the safety of the participants and spectators: Outlaw Square lighting will be used Please indicate what arrangements you have made for providing First Aid Staffing and Equipment? Number N/A Ambulance(s) – How provided? Number N/A NA Emergency Medical Technicians – How provided? APPLICANT specifically acknowledges and agrees that it shall be solely responsible for any damage to personal property located in or stored in or upon DEADWOOD’s property pursuant to the activity for which approval is being sought and that DEADWOOD shall not be responsible for any damage or loss to or of APPLICANT’s property which results from any cause or reason with regard to personal property owned by APPLICANT stored or located on DEADWOOD’s property pursuant to approval of the activity for which approval is being sought herein. Acknowledge acceptance with initial: cs WM APPLICANT agrees to hold DEADWOOD XXXXXXXX harmless and indemnify DEADWOOD XXXXXXXX from any sums of money which DEADWOOD XXXXXXXX might have to pay to any person as a result of property damage, personal injury or death resulting from APPLICANT’s use of the City property pursuant to approval of the activity for which approval is being sought herein. Acknowledge acceptance with initial: cs WM Please describe your plans to notify all residents, businesses and churches impacted by the event: Residence Residents and businesses will be notified through public hearing notice announcements Attendees will use Deadwood Public Parking ■ Are there any musical entertainment features related to your event or facilities rental? If YES, please state the number of bands and type of music. Number of Stages: Number of Bands: Type of Music: ■ Will sound amplification be used? If YES, please indicate: Start Time: Time:12 pm AM / PM – Finish Time: Time:10 pm AM / PM ■ Will sound checks be conducted prior to the event? If YES, please indicate: Start Time: AM / PM – Finish Time: AM / PM Please describe the sound equipment that will be used for your event: ■ Will any fireworks, rockets or other pyrotechnics be used? If YES, please attach a copy of your permit (issued by the State Fire Xxxxxxxx’x office) to this application. ■ Will any signs, banners, decorations or special lighting be used? If YES, please describe: Will this event be promoted, advertised or marketed in any manner? If YES, please describe: Through posters and Wrestling club promoting through flyers, social media Will there be any live media coverage during your event? If YES, please explain: Applicant acknowledges and agrees to allow the City to publish the Contact Person and media referral telephone numbers on the internet in conjunction with the Calendar of Upcoming Events in the City of Deadwood. If you have a home page and want us to link with our Calendar, please provide the Internet address for your homepage: xxxxxx00.xxx Refer all event public inquiries and / or media inquiries for this event to: Xxxx Xxxxxxx NAME: 000-000-0000 PHONE: Hub Insurance Name of Insurance Company: Xxxxx Xxxxxxx Agent’s Name: Business Phone: Policy Number: Policy Type: Address: (city) (state) (zip code) For final permit approval, you will need commercial general liability insurance that names “the City of Deadwood, its officers, employees and agents” as an additional insured. Insurance coverage must be maintained for the duration of the event. To determine the amount of insurance coverage necessary, please contact the Finance Office at (000) 000-0000 – Fax # (000) 000-0000. The City must be named as an “additional insured.” Please obtain the required insurance and mail an original insurance certificate to: City of Deadwood, Finance Office, 000 Xxxxxxx Xxxxxx, Deadwood, SD 57732. Name of Insurance Company: Agent’s Name: Business Phone: Policy Number: Policy Type: Address: (city) (state) (zip code) Please obtain the required insurance and mail an original insurance certificate to: City of Deadwood, Finance Office, 000 Xxxxxxx Xxxxxx, Deadwood, SD 57732.

APPLICANT AND SPONSORING ORGANIZATION INFORMATION. ■ Commercial (for profit) Noncommercial (nonprofit) Saloon #10 Sponsoring Organization: Xxxx Xxxxxxx Chief Officer of Organization (NAME): Xxxx Xxxxxxx X. Xxxxxx Applicant (NAME): Business Phone: ( 000-0000 ) Address: 000 Xxxx Xx Xxxxxxxx, Xxxxxx Xxxxxxxx XX 00000 (city) (state) (zip code) Daytime phone: ( ) Evening Phone: ( ) Fax #: ( ) Please list any professional event organizer or event service provider hired by you that is authorized to work on your behalf to produce this event. Name: Address: (city) (state) (zip code) Contact person “on site” day of event or facility use 000-000-0000 Pager/Cell #: (Note: This person must be in attendance for the duration of the event and immediately available to city officials) ✔ Is your organization a “Tax Exempt, nonprofit” organization? If YES, you must attach a copy of your IRS 501C Tax Exemption Letter to this Special Event Permit application (providing proof and certifying your current tax exempt, nonprofit status). ✔ Are admission, entry, vendor or participant fees required? If YES, please explain the purpose and provide amount(s).: Please provide a detailed description of your proposed event. Include details regarding any components of your event such as use of vehicles, animals, rides or any other pertinent information about the event: Bev's Poker Run is There will be a rolling Parade with different kinds of Fire Apparatus(Emergency Vehicles), starting at the annual motorcyle event that is Deadwood Fire Hall going down Main Street and ending at the Welcome Center. Since the vehicles in the Parade are Emergency Vehicle limited assisted will be needed to block streets on Main Street. After Parade there will be a fund raiser for Relay for Lifereception at the Deadwood Fire Hall. Motorcyle Parking is being requested on June 25, 5 pm until 10 pm from Xxx St. to Wall St. as the last part Requesting closure of the event takes place at the Saloon #00 - 000 Xxxx Xx. Parking will be on east side of main street onlyQwest parking lot. Does the event involve the sale or use of alcoholic beverages? If YES, please provide your liquor liability insurance information to the last page of this application. ■ Will items or services be sold at the event? If YES, please describe: ■ ■ Does this event involve a moving route of any kind along streets, sidewalks or highways? If YES attach a detailed map of your proposed route, indicating the direction of travel and provide written narrative to explain your route. Does this event involve a fixed venue site? If YES, attach a detailed site map showing all streets impacted by the event. In addition to the route map required above, please attach a diagram showing the overall lay-out and set-up locations for the following items: ⮚ Alcoholic and Non-alcoholic Concession and / or Beer Garden Areas. ⮚ Food Concession and / or Food Preparation Area(s). Please describe how food will be served at the event: If you intend to cook food in the event area, please specify the method to be used: ELECTRIC CHARCOAL OTHER (specify): ⮚ First Aid Facilities and Ambulance locations. ⮚ Tables and Chairs. ⮚ Fencing, Barriers and / or Barricades. ⮚ Generator Locations and / or Source of Electricity. ⮚ Canopies or Tent Locations. ⮚ Booths, Exhibits, Displays or Enclosures. ⮚ Scaffolding, Bleachers, Platforms, Stages, Grandstands or Related Structures. ⮚ Vehicles and / or Trailers. ⮚ Trash Containers and Dumpsters. (NOTE): You must properly dispose of waste and garbage throughout the term of your event and immediately upon conclusion of the event, the area must be returned to a clean condition. Number of trash cans: N/A Trash Containers w / lids: Describe your plan for clean-up and removal of waste and garbage during and after the event or use of facility: N/A ⮚ Other Related Event Components not covered above. Please describe your procedures for both Crowd Control and Internal Security: N/A Rolling Parade, traffic will stopped for a short time as Parade goes from Fire Hall to Welcome Center, on Main Street and ends there. Please describe your Accessibility Plan for access at your event by individuals with disabilities: N/A ■ Have you hired any Professional Security organization to handle security arrangements for this event? If YES, please list: Security Organization: Security Organization Address: (city) (state) (zip code) Security Director (Name): Business phone: ■ Is this a night event? If YES, please state how the event and surrounding area will be illuminated to ensure the safety of the participants and spectators: Please indicate what arrangements you have made for providing First Aid Staffing and Equipment? Number N/A Ambulance(s) – How provided? Number N/A Emergency Medical Technicians – How provided? APPLICANT specifically acknowledges and agrees that it shall be solely responsible for any damage to personal property located in or stored in or upon DEADWOOD’s property pursuant to the activity for which approval is being sought and that DEADWOOD shall not be responsible for any damage or loss to or of APPLICANT’s property which results from any cause or reason with regard to personal property owned by APPLICANT stored or located on DEADWOOD’s property pursuant to approval of the activity for which approval is being sought herein. Acknowledge acceptance with initial: cs ALH APPLICANT agrees to hold DEADWOOD harmless and indemnify DEADWOOD from any sums of money which DEADWOOD might have to pay to any person as a result of property damage, personal injury or death resulting from APPLICANT’s use of the City property pursuant to approval of the activity for which approval is being sought herein. Acknowledge acceptance with initial: cs ALH Please describe your plans to notify all residents, businesses and churches impacted by the event: Residence and businesses will be notified through public hearing notice N/A ■ Are there any musical entertainment features related to your event or facilities rental? If YES, please state the number of bands and type of music. Number of Stages: Number of Bands: Type of Music: ■ Will sound amplification be used? If YES, please indicate: Start Time: AM / PM – Finish Time: AM / PM ■ Will sound checks be conducted prior to the event? If YES, please indicate: Start Time: AM / PM – Finish Time: AM / PM Please describe the sound equipment that will be used for your event: ■ Will any fireworks, rockets or other pyrotechnics be used? If YES, please attach a copy of your permit (issued by the State Fire Xxxxxxxx’x office) to this application. ■ Will any signs, banners, decorations or special lighting be used? If YES, please describe: Will this event be promoted, advertised or marketed in any manner? If YES, please describe: Through posters and social media Advertising through Deadwood FD Will there be any live media coverage during your event? If YES, please explain: Applicant acknowledges and agrees to allow the City to publish the Contact Person and media referral telephone numbers on the internet in conjunction with the Calendar of Upcoming Events in the City of Deadwood. If you have a home page and want us to link with our Calendar, please provide the Internet address for your homepage: xxxxxx00.xxx Refer all event public inquiries and / or media inquiries for this event to: Xxxx Xxxxxxx Xxxxx Xxxxxx NAME: 000-000-0000 PHONE: City of Deadwood Name of Insurance Company: Agent’s Name: Business Phone: Policy Number: Policy Type: 000 Xxxxxxx Xxxxxx Deadwood SD 57732 Address: (city) (state) (zip code) For final permit approval, you will need commercial general liability insurance that names “the City of Deadwood, its officers, employees and agents” as an additional insured. Insurance coverage must be maintained for the duration of the event. To determine the amount of insurance coverage necessary, please contact the Finance Office at (000) 000-0000 – Fax # (000) 000-0000. The City must be named as an “additional insured.” Please obtain the required insurance and mail an original insurance certificate to: City of Deadwood, Finance Office, 000 Xxxxxxx Xxxxxx, Deadwood, SD 57732. Name of Insurance Company: Agent’s Name: Business Phone: Policy Number: Policy Type: Address: (city) (state) (zip code) Please obtain the required insurance and mail an original insurance certificate to: City of Deadwood, Finance Office, 000 Xxxxxxx Xxxxxx, Deadwood, SD 57732.

APPLICANT AND SPONSORING ORGANIZATION INFORMATION. ■ Commercial (for profit) Noncommercial (nonprofit) Saloon #10 Outlaw Square Sponsoring Organization: Xxxx Xxxxxxx Chief Officer of Organization (NAME): Xxxx Xxxxxxx Applicant (NAME): Xxxx Xxxxxx aka Xxxxx Xxxx Business Phone: ( (000-) 000-0000 ) Address: 000 Xxxx Xx Xxxxxxxx, Xxxxxxxx XX 00000 (city) (state) (zip code) Daytime phone: ( (605) Evening 717-6848Evening Phone: ( (605) Fax 641-9162Fax #: ( ) Please list any professional event organizer or event service provider hired by you that is authorized to work on your behalf to produce this event. Name: Address: (city) (state) (zip code) Contact person “on site” day of event or facility use Xxxxx Xxxx Pager/Cell #: 000-000-0000 Pager/Cell #: (Note: This person must be in attendance for the duration of the event and immediately available to city officials) ✔ ■ Is your organization a “Tax Exempt, nonprofit” organization? If YES, you must attach a copy of your IRS 501C Tax Exemption Letter to this Special Event Permit application (providing proof and certifying your current tax exempt, nonprofit status). ✔ ■ Are admission, entry, vendor or participant fees required? If YES, please explain the purpose and provide amount(s).: Please provide a detailed description of your proposed event. Include details regarding any components of your event such as use of vehicles, animals, rides or any other pertinent information about the event: Bev's Poker Run is the annual motorcyle event that This is a fund raiser POST RACE party for Relay the Mickleson Trail participants and supporters. The Outlaw Deck @Silverado will be pouring beer to the participants wearing their racing bibs Badlands Security will be checking ID's and wristbanding those over 21, participants will be using Deadwood Chamber event cups. Open Contain request for LifeZone 4(Outlaw Square) only. Motorcyle Parking is being requested on June 25, Event will be from 2 to 5 pm until 10 pm from Xxx St. to Wall St. as the last part of the event takes place at the Saloon #00 - 000 Xxxx Xxwith band performing. Parking Shade tents will be on east side of main street onlyplace throughout the Square. Security will also monitor Outlaw Square borders so no alcohol leaves the premises. Does the event involve the sale or use of alcoholic beverages? If YES, please provide your liquor liability insurance information to the last page of this application. ■ Will items or services be sold at the event? If YES, please describe: ■ ■ Does this event involve a moving route of any kind along streets, sidewalks or highways? If YES attach a detailed map of your proposed route, indicating the direction of travel and provide written narrative to explain your route. Does this event involve a fixed venue site? If YES, attach a detailed site map showing all streets impacted by the event. In addition to the route map required above, please attach a diagram showing the overall lay-out and set-up locations for the following items: ⮚ Alcoholic and Non-alcoholic Concession and / or Beer Garden Areas. ⮚ Food Concession and / or Food Preparation Area(s). Please describe how food will be served at the event: If you intend to cook food in the event area, please specify the method to be used: ELECTRIC CHARCOAL OTHER (specify): ⮚ First Aid Facilities and Ambulance locations. ⮚ Tables and Chairs. ⮚ Fencing, Barriers and / or Barricades. ⮚ Generator Locations and / or Source of Electricity. ⮚ Canopies or Tent Locations. ⮚ Booths, Exhibits, Displays or Enclosures. ⮚ Scaffolding, Bleachers, Platforms, Stages, Grandstands or Related Structures. ⮚ Vehicles and / or Trailers. ⮚ Trash Containers and Dumpsters. (NOTE): You must properly dispose of waste and garbage throughout the term of your event and immediately upon conclusion of the event, the area must be returned to a clean condition. Number of trash cans: N/A 8 Trash Containers w / lids: 0 Describe your plan for clean-up and removal of waste and garbage during and after the event or use of facility: Outlaw Square staff will clear the Square - COD will pick up trash in morning. ⮚ Other Related Event Components not covered above. Please describe your procedures for both Crowd Control and Internal Security: N/A Badlands Security handling crowd and Outlaw Square handling Internal Please describe your Accessibility Plan for access at your event by individuals with disabilities: N/A Outlaw Square is ADA compliant ■ Have you hired any Professional Security organization to handle security arrangements for this event? If YES, please list: Security Organization: Badlands Security Security Organization Address: 00000 Xxxxx Xxxx Xxxxx Xxxxxxx XX 00000 Xxxxx Xxxxxxx 000-000-0000 (city) (state) (zip code) Security Director (Name): Business phone: ■ Is this a night event? If YES, please state how the event and surrounding area will be illuminated to ensure the safety of the participants and spectators: Please indicate what arrangements you have made for providing First Aid Staffing and Equipment? Number Nn/A a Ambulance(s) – How provided? Number Nn/A a Emergency Medical Technicians – How provided? APPLICANT specifically acknowledges and agrees that it shall be solely responsible for any damage to personal property located in or stored in or upon DEADWOOD’s property pursuant to the activity for which approval is being sought and that DEADWOOD shall not be responsible for any damage or loss to or of APPLICANT’s property which results from any cause or reason with regard to personal property owned by APPLICANT stored or located on DEADWOOD’s property pursuant to approval of the activity for which approval is being sought herein. Acknowledge acceptance with initial: cs wm APPLICANT agrees to hold DEADWOOD harmless and indemnify DEADWOOD from any sums of money which DEADWOOD might have to pay to any person as a result of property damage, personal injury or death resulting from APPLICANT’s use of the City property pursuant to approval of the activity for which approval is being sought herein. Acknowledge acceptance with initial: cs wm Please describe your plans to notify all residents, businesses and churches impacted by the event: Residence and businesses Deadwood City parking lots will be notified used Notification through public hearing Public Hearing notice ■ Are there any musical entertainment features related to your event or facilities rental? If YES, please state the number of bands and type of music. Number of Stages: 1 Number of Bands: 1 Type of Music: Country/Rock/Pop ■ Will sound amplification be used? If YES, please indicate: Start Time: Time:2 pm AM / PM – Finish Time: Time:5 pm AM / PM ■ Will sound checks be conducted prior to the event? If YES, please indicate: Start Time: Time:1 pm AM / PM – Finish Time: Time:1:30 pm AM / PM Please describe the sound equipment that will be used for your event: Powerhouse Sound is production company ■ Will any fireworks, rockets or other pyrotechnics be used? If YES, please attach a copy of your permit (issued by the State Fire Xxxxxxxx’x office) to this application. ■ Will any signs, banners, decorations or special lighting be used? If YES, please describe: Will this event be promoted, advertised or marketed in any manner? If YES, please describe: Through posters and social media Will there be any live media coverage during your event? If YES, please explain: Applicant acknowledges and agrees to allow the City to publish the Contact Person and media referral telephone numbers on the internet in conjunction with the Calendar of Upcoming Events in the City of Deadwood. If you have a home page and want us to link with our Calendar, please provide the Internet address for your homepage: xxxxxx00.xxx Refer all event public inquiries and / or media inquiries for this event to: NAME: Xxxxx Xxxx Xxxxxxx NAMEPHONE: 000-000-0000 PHONE: Name of Insurance Company: Hub International Agent’s Name: Xxxxx Xxxxxxx Business Phone: Policy Number: Policy Type: Address: (city) (state) (zip code) For final permit approval, you will need commercial general liability insurance that names “the City of Deadwood, its officers, employees and agents” as an additional insured. Insurance coverage must be maintained for the duration of the event. To determine the amount of insurance coverage necessary, please contact the Finance Office at (000) 000-0000 – Fax # (000) 000-0000. The City must be named as an “additional insured.” Please obtain the required insurance and mail an original insurance certificate to: City of Deadwood, Finance Office, 000 Xxxxxxx Xxxxxx, Deadwood, SD 57732. Name of Insurance Company: Agent’s Name: Business Phone: Policy Number: Policy Type: Address: (city) (state) (zip code) Please obtain the required insurance and mail an original insurance certificate to: City of Deadwood, Finance Office, 000 Xxxxxxx Xxxxxx, Deadwood, SD 57732.

APPLICANT AND SPONSORING ORGANIZATION INFORMATION. ■ Commercial (for profit) Noncommercial (nonprofit) Saloon #10 Outlaw Square Sponsoring Organization: Xxxx Xxxxxxx Xxxxxx aka Xxxxx Xxxx Chief Officer of Organization (NAME): Xxxx Xxxxxxx Xxxxxx aka Xxxxx Xxxx Applicant (NAME): Business Phone: ( 000-0000 ) Address: 000 Xxxx Xx Xxxxxxxx, Xxxxxxxx XX 00000 (city) (state) (zip code) Daytime phone: ( ) Evening Phone: ( ) Fax #: ( ) Please list any professional event organizer or event service provider hired by you that is authorized to work on your behalf to produce this event. Name: Address: (city) (state) (zip code) Contact person “on site” day of event or facility use 000-000-0000 Pager/Cell #: (Note: This person must be in attendance for the duration of the event and immediately available to city officials) ✔ Is your organization a “Tax Exempt, nonprofit” organization? If YES, you must attach a copy of your IRS 501C Tax Exemption Letter to this Special Event Permit application (providing proof and certifying your current tax exempt, nonprofit status). ✔ Are admission, entry, vendor or participant fees required? If YES, please explain the purpose and provide amount(s).: Please provide a detailed description of your proposed event. Include details regarding any components of your event such as use of vehicles, animals, rides or any other pertinent information about the event: Bev's Poker Run is the annual motorcyle This event that is a fund raiser for Relay for Lifeconcert as part of the Independance Celebration weeeknd to be held on Sunday, July 2 at Outlaw Square. Motorcyle Parking is being requested Concert will be a free event with the show beginning at 7:30 pm until 9 pm Requesting Deadwood Street closure on June 25July 2, 5 2023 - 8 am until 11:30 pm Requesting opening container zones 1 & 2 from 3 pm until 10 pm from Xxx St. to Wall St. as the last part of the event takes place at the Saloon #00 - 000 Xxxx Xx. Parking will be on east side of main street only. Does the event involve the sale or use of alcoholic beverages? If YES, please provide your liquor liability insurance information to the last page of this application. ■ Will items or services be sold at the event? If YES, please describe: Band merchandise ■ ■ Does this event involve a moving route of any kind along streets, sidewalks or highways? If YES attach a detailed map of your proposed route, indicating the direction of travel and provide written narrative to explain your route. Does this event involve a fixed venue site? If YES, attach a detailed site map showing all streets impacted by the event. In addition to the route map required above, please attach a diagram showing the overall lay-out and set-up locations for the following items: ⮚ Alcoholic and Non-alcoholic Concession and / or Beer Garden Areas. ⮚ Food Concession and / or Food Preparation Area(s). Please describe how food will be served at the event: If you intend to cook food in the event area, please specify the method to be used: Sergeant Xxxxxxx Kettle corn - shaved Ice ELECTRIC CHARCOAL OTHER (specify): ⮚ First Aid Facilities and Ambulance locations. ⮚ Tables and Chairs. ⮚ Fencing, Barriers and / or Barricades. ⮚ Generator Locations and / or Source of Electricity. ⮚ Canopies or Tent Locations. ⮚ Booths, Exhibits, Displays or Enclosures. ⮚ Scaffolding, Bleachers, Platforms, Stages, Grandstands or Related Structures. ⮚ Vehicles and / or Trailers. ⮚ Trash Containers and Dumpsters. (NOTE): You must properly dispose of waste and garbage throughout the term of your event and immediately upon conclusion of the event, the area must be returned to a clean condition. Number of trash cans: N/A 8 on site Trash Containers w / lids: n/a Describe your plan for clean-up and removal of waste and garbage during and after the event or use of facility: OUtlaw Square staff will clean up Square grounds, gather trash bags from cnas and stack on corner of Square for city crew pick up ⮚ Other Related Event Components not covered above. Please describe your procedures for both Crowd Control and Internal Security: N/A Crowd control will be handled by Badlands Security and Outlaw Square staff Please describe your Accessibility Plan for access at your event by individuals with disabilities: N/A Outlaw Square is ADA compatible ■ Have you hired any Professional Security organization to handle security arrangements for this event? If YES, please list: Badlands Security Security Organization: 00000 Xxxxx Xxxx Security Organization Address: Belle Fourche SD (city) (state) (zip code) Xxxxx Xxxxxxx Security Director (Name): Business phone: ■ Is this a night event? If YES, please state how the event and surrounding area will be illuminated to ensure the safety of the participants and spectators: Outlaw Square and production company lighting will be used Please indicate what arrangements you have made for providing First Aid Staffing and Equipment? Number N/A Ambulance(s) – How provided? Number N/A Emergency Medical Technicians – How provided? APPLICANT specifically acknowledges and agrees that it shall be solely responsible for any damage to personal property located in or stored in or upon DEADWOOD’s property pursuant to the activity for which approval is being sought and that DEADWOOD shall not be responsible for any damage or loss to or of APPLICANT’s property which results from any cause or reason with regard to personal property owned by APPLICANT stored or located on DEADWOOD’s property pursuant to approval of the activity for which approval is being sought herein. Acknowledge acceptance with initial: cs WM APPLICANT agrees to hold DEADWOOD harmless and indemnify DEADWOOD from any sums of money which DEADWOOD might have to pay to any person as a result of property damage, personal injury or death resulting from APPLICANT’s use of the City property pursuant to approval of the activity for which approval is being sought herein. Acknowledge acceptance with initial: cs WM Please describe your plans to notify all residents, businesses and churches impacted by the event: Residence and businesses Businesses will be notified informed through public hearing notice notices Attendess will use Deadwood parking lots ■ Are there any musical entertainment features related to your event or facilities rental? If YES, please state the number of bands and type of music. Number of Stages: 1 Number of Bands: 1 Type of Music: Classic Rock ■ Will sound amplification be used? If YES, please indicate: Start Time: Time:7:30 pm AM / PM – Finish Time: Time:9 pm AM / PM ■ Will sound checks be conducted prior to the event? If YES, please indicate: Start Time: Time:3 pm AM / PM – Finish Time: Time:4 pm AM / PM Please describe the sound equipment that will be used for your event: Powerhouse sound will provide our sound production for the event ■ Will any fireworks, rockets or other pyrotechnics be used? If YES, please attach a copy of your permit (issued by the State Fire Xxxxxxxx’x office) to this application. ■ Will any signs, banners, decorations or special lighting be used? If YES, please describe: Will this event be promoted, advertised or marketed in any manner? If YES, please describe: Through Event will be marketing through radio commericals, social media, website, flyers and posters and social media Will there be any live media coverage during your event? If YES, please explain: Applicant acknowledges and agrees to allow the City to publish the Contact Person and media referral telephone numbers on the internet in conjunction with the Calendar of Upcoming Events in the City of Deadwood. If you have a home page and want us to link with our Calendar, please provide the Internet address for your homepage: xxxxxx00.xxx Xxxxxxxxxxxx.xxx Refer all event public inquiries and / or media inquiries for this event to: Xxxxx Xxxx Xxxxxxx NAME: 000-000-0000 PHONE: Hub International Name of Insurance Company: Xxxxx Xxxxxxx Agent’s Name: Business Phone: Policy Number: Policy Type: Address: (city) (state) (zip code) For final permit approval, you will need commercial general liability insurance that names “the City of Deadwood, its officers, employees and agents” as an additional insured. Insurance coverage must be maintained for the duration of the event. To determine the amount of insurance coverage necessary, please contact the Finance Office at (000) 000-0000 – Fax # (000) 000-0000. The City must be named as an “additional insured.” Please obtain the required insurance and mail an original insurance certificate to: City of Deadwood, Finance Office, 000 Xxxxxxx Xxxxxx, Deadwood, SD 57732. Name of Insurance Company: Agent’s Name: Business Phone: Policy Number: Policy Type: Address: (city) (state) (zip code) Please obtain the required insurance and mail an original insurance certificate to: City of Deadwood, Finance Office, 000 Xxxxxxx Xxxxxx, Deadwood, SD 57732.

APPLICANT AND SPONSORING ORGANIZATION INFORMATION. ■ Commercial (for profit) Noncommercial (nonprofit) Saloon #10 AAU Wrestling Sponsoring Organization: Xxxx Xxxxxxx Chief Officer of Organization (NAME): Xxxx Xxxxxxx Xxxxxx aka Xxxxx Xxxx Applicant (NAME): Business Phone: ( 000-0000 ) Address: 000 Xxxx Xx Xxxxxxxx, Xxxxxxxx XX 00000 (city) (state) (zip code) Daytime phone: ( ) Evening Phone: ( ) Fax #: ( ) Please list any professional event organizer or event service provider hired by you that is authorized to work on your behalf to produce this event. Xxxxx Xxxx Name: 000 Xxxx Xx Xxxxxxxx XX 00000 Address: (city) (state) (zip code) Contact person “on site” day of event or facility use 000-000-0000 Pager/Cell #: (Note: This person must be in attendance for the duration of the event and immediately available to city officials) ✔ Is your organization a “Tax Exempt, nonprofit” organization? If YES, you must attach a copy of your IRS 501C Tax Exemption Letter to this Special Event Permit application (providing proof and certifying your current tax exempt, nonprofit status). ✔ Are admission, entry, vendor or participant fees required? If YES, please explain the purpose and provide amount(s).: General Admission fee for event. Participant fees charge for entrants - Fundraiser for AAU Wrestling Please provide a detailed description of your proposed event. Include details regarding any components of your event such as use of vehicles, animals, rides or any other pertinent information about the event: Bev's Poker Run This is an AAU wrestling tournament taking place at Outlaw Square with wrestlers participating from around the annual motorcyle event that region. This is a fund raiser fundraiser for Relay Deadwood AAU Wrestling Club. Bleachers will be placed at Outlaw Square for Lifepublic seating at the event. Motorcyle Parking This is being requested a ticketed event with wrestliing club charging admisssion. Security gates will be placed along Main Street and down the curbside of Deadwood St. on June 25, 5 pm until 10 pm from Xxx Hickoks side to Pioneer Way and back across Deadwood St. to Wall St. as secure the last part of the event takes place at the Saloon #00 - 000 Xxxx Xxvenue. Parking Wrestling mats will be placed on east side the turf of main street onlyOutlaw Square. Regiistration will begin at NOON - wresting matches will begin at 6 pm. Requesting Deadwood St closure begining at 6 am Does the event involve the sale or use of alcoholic beverages? If YES, please provide your liquor liability insurance information to the last page of this application. ■ Will items or services be sold at the event? If YES, please describe: Yes, event shirts will be sold by wrestling club ■ ■ Does this event involve a moving route of any kind along streets, sidewalks or highways? If YES attach a detailed map of your proposed route, indicating the direction of travel and provide written narrative to explain your route. Does this event involve a fixed venue site? If YES, attach a detailed site map showing all streets impacted by the event. In addition to the route map required above, please attach a diagram showing the overall lay-out and set-up locations for the following items: ⮚ Alcoholic and Non-alcoholic Concession and / or Beer Garden Areas. ⮚ Food Concession and / or Food Preparation Area(s). Please describe how food will be served at the event: If you intend to cook food in the event area, please specify the method to wrestling club will be used: selling pizza slices and can soda ELECTRIC CHARCOAL OTHER (specify): ⮚ First Aid Facilities and Ambulance locations. ⮚ Tables and Chairs. ⮚ Fencing, Barriers and / or Barricades. ⮚ Generator Locations and / or Source of Electricity. ⮚ Canopies or Tent Locations. ⮚ Booths, Exhibits, Displays or Enclosures. ⮚ Scaffolding, Bleachers, Platforms, Stages, Grandstands or Related Structures. ⮚ Vehicles and / or Trailers. ⮚ Trash Containers and Dumpsters. (NOTE): You must properly dispose of waste and garbage throughout the term of your event and immediately upon conclusion of the event, the area must be returned to a clean condition. Number of trash cans: N/A 8 on site Trash Containers w / lids: N/A Describe your plan for clean-up and removal of waste and garbage during and after the event or use of facility: Wrestling club will clean up Square - Square staff will stack garbage bags as usual for city pick up ⮚ Other Related Event Components not covered above. Please describe your procedures for both Crowd Control and Internal Security: N/A Outlaw Square Staff will handle security Please describe your Accessibility Plan for access at your event by individuals with disabilities: N/A Outlaw Square is ADA compatible ■ Have you hired any Professional Security organization to handle security arrangements for this event? If YES, please list: Security Organization: Security Organization Address: (city) (state) (zip code) Security Director (Name): Business phone: ■ Is this a night event? If YES, please state how the event and surrounding area will be illuminated to ensure the safety of the participants and spectators: Outlaw Square lighting will be used Please indicate what arrangements you have made for providing First Aid Staffing and Equipment? Number N/A Ambulance(s) – How provided? Number N/A NA Emergency Medical Technicians – How provided? APPLICANT specifically acknowledges and agrees that it shall be solely responsible for any damage to personal property located in or stored in or upon DEADWOOD’s property pursuant to the activity for which approval is being sought and that DEADWOOD shall not be responsible for any damage or loss to or of APPLICANT’s property which results from any cause or reason with regard to personal property owned by APPLICANT stored or located on DEADWOOD’s property pursuant to approval of the activity for which approval is being sought herein. Acknowledge acceptance with initial: cs WM APPLICANT agrees to hold DEADWOOD XXXXXXXX harmless and indemnify DEADWOOD XXXXXXXX from any sums of money which DEADWOOD XXXXXXXX might have to pay to any person as a result of property damage, personal injury or death resulting from APPLICANT’s use of the City property pursuant to approval of the activity for which approval is being sought herein. Acknowledge acceptance with initial: cs WM Please describe your plans to notify all residents, businesses and churches impacted by the event: Residence Residents and businesses will be notified through public hearing notice announcements Attendees will use Deadwood Public Parking ■ Are there any musical entertainment features related to your event or facilities rental? If YES, please state the number of bands and type of music. Number of Stages: Number of Bands: Type of Music: ■ Will sound amplification be used? If YES, please indicate: Start Time: Time:12 pm AM / PM – Finish Time: Time:10 pm AM / PM ■ Will sound checks be conducted prior to the event? If YES, please indicate: Start Time: AM / PM – Finish Time: AM / PM Please describe the sound equipment that will be used for your event: ■ Will any fireworks, rockets or other pyrotechnics be used? If YES, please attach a copy of your permit (issued by the State Fire Xxxxxxxx’x office) to this application. ■ Will any signs, banners, decorations or special lighting be used? If YES, please describe: Will this event be promoted, advertised or marketed in any manner? If YES, please describe: Through posters and Wrestling club promoting through flyers, social media Will there be any live media coverage during your event? If YES, please explain: Applicant acknowledges and agrees to allow the City to publish the Contact Person and media referral telephone numbers on the internet in conjunction with the Calendar of Upcoming Events in the City of Deadwood. If you have a home page and want us to link with our Calendar, please provide the Internet address for your homepage: xxxxxx00.xxx Refer all event public inquiries and / or media inquiries for this event to: Xxxx Xxxxxxx NAME: 000-000-0000 PHONE: Hub Insurance Name of Insurance Company: Xxxxx Xxxxxxx Agent’s Name: Business Phone: Policy Number: Policy Type: Address: (city) (state) (zip code) For final permit approval, you will need commercial general liability insurance that names “the City of Deadwood, its officers, employees and agents” as an additional insured. Insurance coverage must be maintained for the duration of the event. To determine the amount of insurance coverage necessary, please contact the Finance Office at (000) 000-0000 – Fax # (000) 000-0000. The City must be named as an “additional insured.” Please obtain the required insurance and mail an original insurance certificate to: City of Deadwood, Finance Office, 000 Xxxxxxx Xxxxxx, Deadwood, SD 57732. Name of Insurance Company: Agent’s Name: Business Phone: Policy Number: Policy Type: Address: (city) (state) (zip code) Please obtain the required insurance and mail an original insurance certificate to: City of Deadwood, Finance Office, 000 Xxxxxxx Xxxxxx, Deadwood, SD 57732.

APPLICANT AND SPONSORING ORGANIZATION INFORMATION. ■ Commercial (for profit) Noncommercial (nonprofit) Saloon #10 The Xxxxx Group (for Shell Oil) Sponsoring Organization: Xxxx Xxxxxxx Xxx XxXxxx Chief Officer of Organization (NAME): Xxxx Xxxxxxx Xxxxxx Applicant (NAME): Business Phone: ( 000-0000 ) Address: 000 Xxxx Xx Xxxxxxxx, XX 00000 Xxxxxx Xxxxxxxxxx Court St. Louis MO 63144 (city) (state) (zip code) Daytime phone: ( ) Evening Phone: ( ) Fax #: ( ) Please list any professional event organizer or event service provider hired by you that is authorized to work on your behalf to produce this event. Xxxxxxxxx Xxxxx Locations Name: 725 Windemere Curve Plymouth MN 55441 Address: (city) (state) (zip code) Contact person “on site” day of event or facility use 000-000-0000 Pager/Cell #: (Note: This person must be in attendance for the duration of the event and immediately available to city officials) ✔ Is your organization a “Tax Exempt, nonprofit” organization? If YES, you must attach a copy of your IRS 501C Tax Exemption Letter to this Special Event Permit application (providing proof and certifying your current tax exempt, nonprofit status). ✔ Are admission, entry, vendor or participant fees required? If YES, please explain the purpose and provide amount(s).: Please provide a detailed description of your proposed event. Include details regarding any components of your event such as use of vehicles, animals, rides or any other pertinent information about the event: Bev's Poker Run is We will be conducting photography of two Class 8 semi trucks for the annual motorcyle event that is a fund raiser 2024 Shell Xxxxxxx SuperRigs calendar. We will not know whether they will be with or without trailer until the evening prior to the shoot day so we are planning for Relay for Lifeboth. Motorcyle Parking is being requested The first shot with Truck 1 will be conducted from 6:30-8:00 am under the Historic Main Street sign on June 25, 5 pm until 10 pm from Xxx St. to Wall St. as Lower Main Street. We are in talks with the last part Deadwood police regarding traffic control and the closure of the event takes place small section of the street we need for the shot. We are awaiting their recommendation. If the truck includes a trailer, we will need to have it drive down to Pioneer Way to Pine Street to turn onto Main Street and come back up to Lower Main Street because we need it facing north. The second shot with Truck 2 will be conducted from 7:45-9:30 am in front of Saloon No. 10 and include a re-enactment of a card game with Wild Xxxx Xxxxxx in front of the truck. We will begin setting that shot up at the Saloon #00 - 000 Xxxx 7:30 am. We have received written approval from Xxxxxx Xx. Parking 10 and the Deadwood Alive cast. We are in talks with the Deadwood Police to block off parking spaces around the shot location and will also have traffic diverted during the shoot. We are awaiting their recommendation. The truck will be approaching from the north and come down Lower Main Street to get into position. I will be providing a second application to shoot truck walk-around videos, video testimonials with each driver, and driver portrait shots, from 9:30 am to 1:00 pm in the parking lot of the Welcome Center. This photo shoot is not dependent on east side that as we are also looking at other locations for the video In addition, the Welcome Center has informed us that the trucks can park there prior to the shots until they are able to move into position. They can do some final cleanup of main street onlytheir trucks after they drive in. They can also stay overnight on Saturday night if needed. Does the event involve the sale or use of alcoholic beverages? If YES, please provide your liquor liability insurance information to the last page of this application. ■ Will items or services be sold at the event? If YES, please describe: ■ ■ Does this event involve a moving route of any kind along streets, sidewalks or highways? If YES attach a detailed map of your proposed route, indicating the direction of travel and provide written narrative to explain your route. Does this event involve a fixed venue site? If YES, attach a detailed site map showing all streets impacted by the event. In addition to the route map required above, please attach a diagram showing the overall lay-out and set-up locations for the following items: ⮚ Alcoholic and Non-alcoholic Concession and / or Beer Garden Areas. ⮚ Food Concession and / or Food Preparation Area(s). Please describe how food will be served at the event: If you intend to cook food in the event area, please specify the method to be used: None ELECTRIC CHARCOAL OTHER (specify): ⮚ First Aid Facilities and Ambulance locations. ⮚ Tables and Chairs. ⮚ Fencing, Barriers and / or Barricades. ⮚ Generator Locations and / or Source of Electricity. ⮚ Canopies or Tent Locations. ⮚ Booths, Exhibits, Displays or Enclosures. ⮚ Scaffolding, Bleachers, Platforms, Stages, Grandstands or Related Structures. ⮚ Vehicles and / or Trailers. ⮚ Trash Containers and Dumpsters. (NOTE): You must properly dispose of waste and garbage throughout the term of your event and immediately upon conclusion of the event, the area must be returned to a clean condition. Number of trash cans: N/A Trash Containers w / lids: Describe your plan for clean-up and removal of waste and garbage during and after the event or use of facility: Not applicable. ⮚ Other Related Event Components not covered above. Please describe your procedures for both Crowd Control and Internal Security: N/A We are working with the Deadwood Police to block spaces and provide traffic control Please describe your Accessibility Plan for access at your event by individuals with disabilities: N/A ■ Have you hired any Professional Security organization to handle security arrangements for this event? If YES, please list: Security Organization: Security Organization Address: (city) (state) (zip code) Security Director (Name): Business phone: ■ Is this a night event? If YES, please state how the This event and surrounding area will be illuminated to ensure the safety of the participants and spectators: Please indicate what arrangements you have made for providing First Aid Staffing and Equipment? Number N/A Ambulance(s) – How provided? Number N/A Emergency Medical Technicians – How provided? APPLICANT specifically acknowledges and agrees that it shall be solely responsible for any damage to personal property located in or stored in or upon DEADWOOD’s property pursuant is not open to the activity for which approval is being sought and that DEADWOOD shall not be responsible for any damage or loss to or of APPLICANT’s property which results from any cause or reason with regard to personal property owned by APPLICANT stored or located on DEADWOOD’s property pursuant to approval of the activity for which approval is being sought herein. Acknowledge acceptance with initial: cs APPLICANT agrees to hold DEADWOOD harmless and indemnify DEADWOOD from any sums of money which DEADWOOD might have to pay to any person as a result of property damage, personal injury or death resulting from APPLICANT’s use of the City property pursuant to approval of the activity for which approval is being sought herein. Acknowledge acceptance with initial: cs Please describe your plans to notify all residents, businesses and churches impacted by the event: Residence and businesses will be notified through public hearing notice ■ Are there any musical entertainment features related to your event or facilities rental? If YES, please state the number of bands and type of music. Number of Stages: Number of Bands: Type of Music: ■ Will sound amplification be used? If YES, please indicate: Start Time: AM / PM – Finish Time: AM / PM ■ Will sound checks be conducted prior to the event? If YES, please indicate: Start Time: AM / PM – Finish Time: AM / PM Please describe the sound equipment that will be used for your event: ■ Will any fireworks, rockets or other pyrotechnics be used? If YES, please attach a copy of your permit (issued by the State Fire Xxxxxxxx’x office) to this application. ■ Will any signs, banners, decorations or special lighting be used? If YES, please describe: Will this event be promoted, advertised or marketed in any manner? If YES, please describe: Through posters and social media Will there be any live media coverage during your event? If YES, please explain: Applicant acknowledges and agrees to allow the City to publish the Contact Person and media referral telephone numbers on the internet in conjunction with the Calendar of Upcoming Events in the City of Deadwood. If you have a home page and want us to link with our Calendar, please provide the Internet address for your homepage: xxxxxx00.xxx Refer all event public inquiries and / or media inquiries for this event to: Xxxx Xxxxxxx NAME: 000-000-0000 PHONE: Name of Insurance Company: Agent’s Name: Business Phone: Policy Number: Policy Type: Address: (city) (state) (zip code) For final permit approval, you will need commercial general liability insurance that names “the City of Deadwood, its officers, employees and agents” as an additional insured. Insurance coverage must be maintained for the duration of the event. To determine the amount of insurance coverage necessary, please contact the Finance Office at (000) 000-0000 – Fax # (000) 000-0000. The City must be named as an “additional insuredpublic.” Please obtain the required insurance and mail an original insurance certificate to: City of Deadwood, Finance Office, 000 Xxxxxxx Xxxxxx, Deadwood, SD 57732. Name of Insurance Company: Agent’s Name: Business Phone: Policy Number: Policy Type: Address: (city) (state) (zip code) Please obtain the required insurance and mail an original insurance certificate to: City of Deadwood, Finance Office, 000 Xxxxxxx Xxxxxx, Deadwood, SD 57732.