CITY OF CARROLLTON
P. O. BOX 156
CARROLLTON, KY 41008
Request To Use Point Park
I. APPLICANT INFORMATION:
NAME:__________________________________
ADDRESS:__________________________________________________________
__________________________________________________________________
PHONE:_____________________________________
II. DETAILS OF REQUEST:
PURPOSE:_________________________________________________________
NAME OF ORGANIZATION/SPONSOR:_____________________________________
FOR PROFIT? _______YES OR NON-PROFIT? ________YES
[IF NON-PROFIT: PLEASE INCLUDE IRS LETTER GRANTING TAX EXEMPT STATUS]
REQUESTED DATE(S):_________________________________________________
USE PAVILION? YES__________ NO___________
USE BOAT RAMP? YES__________ NO___________
HOURS BOAT RAMP NEEDED: ___________A.M. TO ____________A.M.
___________P.M. TO ____________P.M.
EXCLUSIVE USE OF BOAT RAMP? YES___________ NO_________
SHELTER HOUSE HAS HANDICAP ACCESSIBLE RESTROOMS FOR MEN AND WOMEN. [PORT-O-LETS AT YOUR EXPENSE. PLEASE MAKE NECESSARY ARRANGEMENTS.]
III. CERTIFICATE OF INSURANCE
A CERTIFICATE OF INSURANCE FOR $500,000 MUST BE PROVIDED SEVEN (7) DAYS PRIOR TO THE ACTUAL USE OF THE POINT PARK. THE CERTIFICATE MUST LIST THE CITY A CERTIFICATE HOLDER AND AS AN ADDITIONAL INSURED.
IV. CHARGES
THE CITY CHARGES A FEE OF $1,000 TO THOSE ORGANIZATIONS
THAT ARE FOR PROFIT. THIS FEE IS REQUIRED FOURTEEN (14) DAYS PRIOR TO THE ACTUAL USE OF THE PARK. CHECKS ARE TO BE MADE PAYABLE TO "CITY OF CARROLLTON".
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V. DEPOSIT
THE CITY REQUIRES A DEPOSIT OF $250 FOR DAMAGES AND/OR COSTS INCURRED FOR YOUR EVENT, TO BE PROVIDED SEVEN (7) DAYS PRIOR TO THE ACTUAL USE OF THE POINT PARK, PAYABLE TO "CITY OF CARROLLTON" AND DELIVERED TO THE CITY CLERK-TREASURER. THE DEPOSIT WILL BE RETURNED UPON INSPECTION BY THE CITY PUBLIC WORKS SUPER IF THE PARK IS RETURNED BACK TO NORMAL AFTER ALL EQUIPMENT, ETC. IS REMOVED FROM THE PARK.
VI. SIGNATURE
I HAVE READ AND UNDERSTAND THE ABOVE RULES AND REGULATIONS AND WILL COMPLY WITH ALL REQUESTS BY THE TIME(S) SET FORTH.
____________________________
SIGNATURE OF APPLICANT
________________
DATE
**BELOW FOR OFFICE USE**
______________________________________________________________________________________________________________________________________
( ) PERMISSION GRANTED TO USE POINT PARK FOR ABOVE DATE(S)
( ) $1,000 FEE RECEIVED
( ) $ 250 DEPOSIT RECEIVED
( ) CERTIFICATE OF INSURANCE RECEIVED
( ) PERMISSION DENIED TO USE POINT PARK
( ) REASON(S) PERMISSION DENIED:
( ) CITY CLERK-TREASURER:___________________________________
OR: ASSISTANT CITY CLERK:___________________________________
OR: MAYOR:___________________________________
( ) DATE:____________________________