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PART IV. REQUIRED FACILITIES,AND INSURANCE INFORMATION <br /> Who is your liability carrier far this event? 5 �C �i � ��r L I % i (�U L_� � � �N <br /> Atlach proof of tiabitity i�:sura�ice in the amouxt of One Million Dollars ($1,00O,OOQ00.) All <br /> policies shall name t/:e City of Zephyrhills as an additional insured for fhe even& <br /> C I J� �j I L � .'T► P o L f �-Y � o n1 ►� i L� �4 i �.���"►12f-1 I L LS <br /> l�� I�Po f�� � <br /> I/we agree to obtain and maintain the required liability insurance and to secare all necessary <br /> lacal, state and federal permits and to comply with all terms and conditions applicable to the <br /> conduct of specia].events, as set forth in Ordinance No. 943-06 as amended. <br /> Uwe cerhfy that the information cantained in this application is true snd accurate to the best of <br /> my/our knowledge. As applicant for the event,I/we agree ta release and ho[d harmless the City <br /> of Zephyarhills from liubiUty of any kind for any and all damages arising out of any toss or <br /> iinjury resniting from the conduct of this eveut. This release inclndes a release for any and all <br /> losses or injury arising while conducting an event using City of Zephyrhilis facilities or <br /> property and for any and all losses or injury to persons attending this special event. <br /> I/we certify that individnals wi�[ not be barred fram participation in this event due to race, <br /> creed,color,national orig'rn, sex, age,or physical innpairraent. <br /> � / <br /> BY� ( � �t � v�� Date• � Z- Z� � 2' <br /> ` � <br /> Title: � - <br /> Printed Name• � , �� V ( � �����5 <br /> S <br />