HomeMy WebLinkAboutPACKET Special Events Committee 1992-09-24SPECIAL EVENTS
SEPTEMBER 24, 1992
8:30 A.M.
AGENDA
1. Review of the 1992 season.
4PPLICATION
(Please type or print all information)
DATE OF REQUEST: j / " /
/- - .7; ./', ,°•
TYPE OF EVENT (Check the applicable one): ATHLETIC SPECIAL L
BRIEF DESCRIPTION (Foot Race, Parade, etc.):
ORGANIZATION INFORMATION
ORGANIZATION NAME t�/ / (
ADDRESS: c' f= � .'� L L c
CITY & STATE: 6 7— /6- `C `(s 4-' f / <FG9/
CONTACT PERSON. /`' i // ) 7- 1 TITLE /7`4= PHONE (_)
DESCRIPTION OF THE EVENT
DATE(S): Beginning: / / / / TIME Beginning:
Ending: 7/ ' Ending:
NOTE If times will vary on subsequent days, attach explanation.
LOCATION: (,C/ds7 ,/ A‘p
(State Highway and Mileage) js Lr_e 4 >
PROPOSED ROUTE(S): ,�c' PROPOSED DETOUR(S):
J�,S L.�:, v j 51- ,/%/ ern --
44 G(' 41 �' 4... ' Zs 4
l*S RI H)C S F H ft ___THG 01,WA is C-77-' C!--( ,
/)
/c4
Xrc
PHONE (? d-1-0 &- .j > }`/
k X
•)(
PM _
PM _
DESCRIPTION OF EVENT IN DETAIL (include number of participants, description of the activity to be conducted on the
er`hW , 'number an i type animals, description of any vehicle or materials to be used. Use additional sheets if
c aary. Attach a mapr,
SEP 1982
Tk q rs n afire to pay the total actual cost to the State Patrol and the Department of Highways for conducting
ancl ated• the event described herein and to submit payment in advance for the estimated cost of such
` cIosuresandHo~pa , ide liability insurance in an amount to be determined by the Chief of the State Patrol. The under-
signed understands that any costs in excess of the estimated cost must be paid to the Colorado State Patrol following the event
and that if the estimated cost exceeds the actual cost, the balance will be refunded.
I, the undersigned, further certify that the statements contained heroin or attached hereto are true, accurate, and complete to
the best f my knowledge and belief.-7 /( ( ( t' ce e r e- { _'-' 4-- C.— .,../1/-1_ 4"."/. zzr--7,-.1-- ------c , -,.:".
ZATION
SIGNATURE
DATE
INSURANCE INC.
P.O. Box 6192 . Providence, RI 02940
Certificate No.
06985
Name and Address of Promoter
AMER 1.6AD I, INC,
No vALio WITHOUT CERTIFICATE NUMBER
ADDITIONAL DECLARATIONS
AMA Sanction #
i1O2205
FALI,L; NY 1.2 L'it) 1.6 205
R0064
CHEDULE A
CONUNT-LON:,, 0n-07-08-09-10 L1-92
Type of Meet ate(s) of Meet
Location of Meet
(j)
The insurance afforded is only with respe o e above meet on the day(s) indicated for the following coverages, subject
to the payment of the meet premium (including policy fee), The policy limit of liability is as stated subject to all the terms
in this policy having reference thereto including those, if any listed under special conditions below,
INSURANCE COMPANY POLICY NUMBER LIMIT OF LIABILITY MEET PREMIUM
American Empire Surplus
Lines insurance Company
2GL05642
$ I , Onn , ono
Per Occurrence
Bodily Injury, Property
Damage, Personal Injury
Special Conditions:
1. I (')r\'; Ai, 1 ; 1.; r.1):• %WE :
1 (18/ I ri
i\f‘IV,11.1(iA1)1; I Nc., Al\ 1 2,5,
1.;•1"r',:,, (n,„\ rL •
0( A IlI1i 11' i'111.: 1 N5U1-21,,FY-;
1.NC, '10 A (;o KUL)
7
i; 'Hf "J11,; • 'i;;11:1 V't
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Naughton Insurance, Inc,