Laserfiche WebLink
<br /> <br />Special Event Permit Application Page 6 <br /> <br /> <br /> <br />13. INSURANCE <br />You must provide proof of insurance coverage for your event. Attach to this application <br />either an insurance policy or a certificate of insurance including the policy number, <br />amount, and the provision that the City of Lino Lakes is included as an additional insured. <br />Please note: insurance requirements depend upon the risk level of the event. Also, if your <br />event can be classified as first amendment expressive activity, insurance requirements <br />can be waived under certain circumstances. <br /> <br /> <br /> <br />THE MINNESOTA DATA PRACTICES ACT requires that we inform you of your rights about the private data we are <br />requesting on this form. Private data is available to you, but not to the public. We are requesting this data to determine your <br />eligibility for a license from the City of Lino Lakes. Providing the data may disclose information that could cause your <br />application to be denied. You are not legally required to provide the data, however, refusing to supply the data may cause your <br />license to not be processed. Under MS 270.72, the City of Lino Lakes is required to provide the Minnesota Department of <br />Revenue your MN Tax ID Number or Social Security Number if it is given. This information may be used to deny the issuance, <br />renewal or transfer of your license if you owe the Minnesota Department of Revenue delinquent taxes, penalties, or interest. The <br />Department of Revenue may supply information to the Internal Revenue Service. In addition, this data can be shared by Lino <br />Lakes City Staff, the State of Minnesota Driver License Section, Anoka County Auditor, Bureau of Criminal Apprehension, <br />Anoka County Warrant Office. Your signature on this application indicates you understand these rights. Your residence address <br />and telephone number will be considered public data unless you request this information to be private and provide an <br />alternative address and telephone number. Please sign below to indicate that you have read this notice: <br /> <br />Signature Date <br />I request that my residence address and telephone number be considered private data. <br />My alternative address and telephone number are as follows: <br /> <br />Address___________________________________________________ Telephone_________________________ <br /> <br /> <br />ANY FALSIFICATION OF ANSWERS TO THE PROCEEDING QUESTIONS WILL RESULT IN <br />DENIAL OF THE APPLICATION. <br /> <br /> <br /> <br />Signature of Applicant Date <br />