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i <br /> . . , � . • <br /> PART IV. REQUIRED FACILITIES.AND INSURANCE INFORMATION <br /> Who is your liability carrier£or this event? Hiscox Insurance • <br /> Attach proof of liability insurance in the amount of One Million Dollars ($1,000,000.00.) All <br /> policies shall name the City o}'Zephyrhills as an additional insured for the even� <br /> Uwe agree to obtain and maintain the required liability insurance and to secure all necessary <br /> local, state and federal permits and to comply with all terms and conditions applicable to the <br /> conduct af special events, as set forth in Urdinance No. 943-06 as amended. <br /> Uwe certify that the information contained in this.application is true and accurate to the best of <br /> my/our knowledge. As applicant for the event, Uwe agree to release and hold harmless the City <br /> of Zephyrhills from liability of any kind for any and all damages arisiwg out of any loss or <br /> injury resulting from the conduct of tlus event. This release includes a release for any and all <br /> losses or injury arising while conducting an event using City of Zephyrhills facilities or <br /> property and for any and all losses or injtuy to persons attending this special event. <br /> Uwe certify that individuals will not be barred from participation in this event due to race, <br /> creed,color,national origin, sex, age,or physical impairraent. <br /> By: s��� Date' S[$,/16 <br /> , <br /> � Title• Co Owner <br /> Printed Name• Sonya Bradley <br /> 5 <br />