1. REQUESTEE DETAILS
- 1.1 Full Name: Celeste Lyra Bulfinch
1.2 Date of Birth: 14/OCT/1994
1.3 Phone Number: 4933803
1.4 Agency/Organization (If applicable): LSEMS
1.5 Please attach a photocopy of your driver's license 1.6 If requesting on behalf of a government agency/organization, please attach a copy of your employee credentials (( /badge )): 1.7 Please attach a copy of your event planning license, obtained via City Hall (If applicable):
2. EVENT DETAILS
- 2.1 Event location: Del Perro Pier
2.2 Event date: 05/JUL/2026
2.3 Start time (( UTC )): 20:00
2.4 Estimated finish time (( UTC )): 21:30
2.5 Estimated number of participants: Unknown
2.6 Details of planned event (Please provide a map with planned road closures, if they are required, an example can be seen here):- Need Del Perro Pier barriered off for Triathlon as to prevent competitors from being run over, will need to direct observers and competitors to park in the parking lot on Del Perro pier. Map here
- [x] Yes, we have one or more individuals that are BLS certified.
[] No, we do not have any individuals that are BLS certified.
If yes, please list the individual(s): All of LSEMS
3. INDEMINIFICATION AND HOLD HARMLESS AGREEMENT
In consideration of the granting of the road closure permit, except for the active negligence or willful misconduct of City or any of its Boards, Officers, Agents, Employees, Assigns, and Successors in Interest, the permittee undertakes and agrees to defend, indemnify, and hold harmless City and any and all of City's Boards, Officers, Agents, Employees, Assigns, and Successors in Interest, from and against all suits and causes of actions, claims, losses, demands, and expenses, including, but not limited to, attorney's fees and costs of litigation, damage or liability of any nature whatsoever, for death or injury to any person, including permittee's employees and agents, or damage or destruction of any property of either party hereto or of third parties, arising in any manner by reason of the negligent acts, errors, omissions or willful misconduct incident to the performance of this Agreement on the part of the permittee.
- 3.1 Signature: Celeste Bulfinch
3.2 Date Signed: 27/JUN/2026




POLICE SERGEANT I




