Address:

Describe Event (Expected # of Participants; If Parade: Route, # of cars/floats):

Date(s):

Alternate/Rain Dates: 

Begin/End Times: 

GENERAL LIABILITY INSURANCE MUST BE PROVIDED

(City of Plattsburgh MUST be named as the additional insured)

(Insurance MUST cover vehicles if used)

SOLICITATIONS are at designated intersections only

________________________________

    Signature/Title

Contact: _____________________________________________________________________________

                Name                                                 Address                                                    Phone

======================================================================================

APPROVALS:

Insurance (Y) (N)                                Police Dept.: (Y) (N)                   Clerk:  (Y) (N)

Inital/Date _________                            __________                                _________