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City of Philadelphia Demonstration Permit Application ‘Step. 1-Evet Information Nome cttvent Magen ou we Demacenrie Altres Coivettiont Zolef Even Daw) O7/25/i2 annual iven? 0 Yea No g Description of Propet Aciviy: Tis ps A Phar iE Deweusra Aten < 1 cs SL © reanans Camorparés sein vorets. Tess £0iT tue Aso Cha SpeclicLocation Requested (elude Roe of March it Appiable} TH’ Camemczartoal ute mer ms Tue _Courrysap tasio€ Gry Hae (Reruns) ar P0dam, TEE MpacH tote Ger Ar _tsoan, We nce Towns Bocas sx. 73 kus Fates Grune foe me acer serupSanTine 860404 Event Sart Time Y:0o4am ae vent End Time, COMM Brexkdown Time 700 241 stated Attendance/Number of Parcipants;__ ZO Wi THis vente Advertised? © Yes 7YNo Yes List Media Outlets Will You Erect Staging of Any Kind? o Yes No If Yes, Pease Indicate Number & Size of Stage(s): Ce AAC wuirekesren Mal Possigey REvring sou iC cry re Mossigee. ‘Will You Use Amplified Sound Equipment of Any Kind? yes No Tees Please Describe Sound Equipment: Mic Rowton ann DN courateteeR WITH. A FeQER 200 ware Ampere. “AMPLIFIED SOUND SUBJECT TO CITY OF PHILADELPHIA NOISE ORDINANCE Wat You Erect TentsCanopes of Any Kind?” Yes No TF Yes Please Indicate Number & Sie of Tents: Ove 0 Tw canopies = /0 Fr */O er “TENTSICANOPIES LARGER THAN 400 SQ.FT. REQUIRE PERMIT FROM DEPT. OF LICENSES & IVSPECTIONS* Will You Ute Generator or Any Portable Eecisy Sour? 9 Yer No Yen Please Deseibe Becta Equipment to be “ELECTRICAL WORK OF ANY KIND REQUIRES A PERMIT FROM DEPT. OF LICENSES & INSPECTIONS" often, ; City of Philadelphia ee Demonstration Permit Application Sp 2 Orpnaon oman Equniry Conurriew tog Benue Savoees Sa lees Zt Day of Event Contact Person Ema Address: Po Es ‘Step PLEASE READ & SIGN If APPROVED, A COPY OF THE PERMIT MUST REMAIN ONSITE FOR REVIEW [APPLICANT IS REQUIRED TO SECURE ALL NECESSARY SUPPORT SERVICES FOR THE EVENT APPLICANT IS REQUIRED TO SECURE ALL NECESSARY PERMITS, ‘THE SALE AND CONSUMPTION OF ALCOHOL Is PROHIBITED. ‘CANCELLATION MUST BE MADE IN WRITING AT LEAST 48 HOLRS PRIOR TO EVENT DATE [A CERTIFICATE OF GENERAL LIABILITY INSURANCE, WITH A $1 MILLION LIMIT OF LIABILITY, NAMING THE CITY OF PHILADELPHtA TS OFFICERS, AGENTS AND EMPLOYEES AS ADDITIONAL INSURED, [8 REQUIRED FOR ANY VENT TAKING ON PLACE ON CITY PROPERTY AND FOR ANY EVENT THAT REQUIRES CITY EQUIPMENT ANDIOR SERVICES. SHOULD THE COST OF OBTAINING INSURANCE PROVE TO BE AN UNDUE FINANCIAL BURDEN, THE SPONSORING ORGANIZATION MAY SUBMIT AN INSURANCE WAIVER AFFIDAVIT IN LIEU OF AN INSURANCE, (CERTIFICATE. BY SIGNING AND SUBMITTING THIS DEMONSTRATION PERMIT APPLICATION, THE APPLICANT AND SPONSORING ORGANIZATION AGREE TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF PHILADELPHLA, ITS OFFICERS, AGENTS AND EMPLOYEES FAOM AND AGAINST ANY AND ALL LOSES, COSTS (INCLUDING BUT NOT LIMITED TO LITIGATION, SETTLEMENT COSTS AND COUNSEL FEES), CLAIMS, SUITS, ACTIONS, DAMAGES, LIABILITY AND EXPENSES OCCASIONED WHOLLY OR IN PART BY EVENT APPLICANT'S ANDIOR EVENT SPONSOR'S ACT, OMISSION, NEGLIGENCE OR FAULT. OR THE ACT, OMISSION, NEGLIGENCE OR FAULT OF EVENT [APPLICANTS ANDOR EVENT SPONSOR'S AGENTS, SUBCONTRACTORS, SUPPLIERS, EMPLOYEES GR SERVANTS. IN CONNECTION WITH THE PERMIT. sien ot apocrine, SS7even Lae Aplin Signature: _ pite;_o@/eihe AFFIDAVIT IN SUPPORT OF WAIVER OF INSURANCE REQUIREMENTS UNDER ‘THE CITY OF PHILADELPHIA REGULATION GOVERNING (STRAT BR L. Steves rns herby state: 11am he applicant ora office ofthe applicant, for a permit conductor bald <é:monsiraton, as defined inthe document entitled “City of Philadelphia Reguletion Governing Permits for Demonstrations on City Property.” A copy of the application for the permits attached hereto, 2 Jam requesting thatthe City of Philadelphia (he “City” waive the insurance autenent@)of ae Alar) ga tu pnwcerne Aeeees Costes re 1 3. Ihave contacted the City’s Division of Risk Management, as well as insurance ‘agencies regarding policy prices, and have determined tet the insurance requirements

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