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City of Auburn New York Print Form Department of Public Works 358 Genesee Street Auburn New York 13021 315 255-4120 Reset Form Showmobile/Sound System Request Form Organization Requesting Units Event Date/Time AM Should be set up by PM Program starts at Program ends at Items requested Showmobile- Monday-Friday Fee 350/day Showmobile- Saturday-Sunday Fee 650/day Sound System - Fee 50/day 1 Microphone Description of where unit is to be set up Auburn as additional insured with liability limits of at least 1 000 000 and property limits of at least 500 000 prior to the date of the event. Please insure that a 110 volt receptacle is within 300 feet of set up point if electrical equipment is requested example lights etc* Setup available as 32 x 16 or 32 x 24 Please sign this form and return to the Department of Public Works/Recreation* If your request is approved a copy will be returned to you as proof of yours reservation and shows that you are the person in charge of the facility at the date s and hours listed* You are exclusively permitted use of the above equipment at the date s and hours listed* At least seven days advance notice is necessary to reserve these units. PERSON IN CHARGE FROM REQUESTING ORGANIZATION Name Address City State Zip Code Telephone Signature Date of Request DO NOT WRITE BELOW THIS LINE Approved by Date Approved Amount due Amount paid Date paid Receipt No* Revised 8/16/13. Please insure that a 110 volt receptacle is within 300 feet of set up point if electrical equipment is requested example lights etc* Setup available as 32 x 16 or 32 x 24 Please sign this form and return to the Department of Public Works/Recreation* If your request is approved a copy will be returned to you as proof of yours reservation and shows that you are the person in charge of the facility at the date s and hours listed* You are exclusively permitted use of the above equipment at the date s and hours listed* At least seven days advance notice is necessary to reserve these units. PERSON IN CHARGE FROM REQUESTING ORGANIZATION Name Address City State Zip Code Telephone Signature Date of Request DO NOT WRITE BELOW THIS LINE Approved by Date Approved Amount due Amount paid Date paid Receipt No* Revised 8/16/13.

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