Contact Person: Youth (5-17 years) City & Zip code: address:

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1 PROFESSIONAL OR COMMERCIAL INSTRUCTION PERMIT APPCAITON City Beverly Hills Community Services Department, Recreation & s Division 455 N. Rexford Drive, Room 260, Beverly Hills, CA Phone: Fax: Submission Dates: Applications will be accepted beginning January 3, 2017 will be valid upon issuance until December 31, 2017 (calendar year). Permit valid only as assigned at Roxbury, La Cienega, or Coidwater Canyon. Instruction at any or park facility is not permitted. Permit will be issued valid for Individual/Small Group instruction (no more than 2 students excluding instructor for any session). PERMIT FEE: Payment a permit fee is required prior to issuance an annual permit. Fee is $250 per calendar year. Fees are not pro-rated or refundable. APPCANT INFORMATION Business Name: Type Instruction Address: Phone/Cell: Website Address: Contact Person: Youth (5-17 years) City & Zip code: address: Adults (18+ years) Location Instruction Designate one park ONLY Cienega Roxbury Drive 8400 Gregory Way Beverly Hills, CA Beverly Hills, CA Monday Sunday, 6am-dusk Monday Sunday, 6am-dusk Canyon 1100 N. Beverly Drive Beverly Hills, CA Monday Friday 6am - dusk Estimated average number hours per month you intend to conduct business: List Instructors for this business (maximum 3 plus permittee) Completed applications are to be submitted to address below (Monday Friday, 9am 4pm) City Beverly Hills 455 N. Rexford Drive, Room 260 Beverly Hills, CA 90210

2 I, representing Permittee, certify information on this application is correct that I have read agree to abide by Pressional Commercial Instruction Permit Rules Requirements all or conditions as outlined in Ordinance # Signature Date Print name For Office Use Only: APPPCATION RECEIVED BY Title DATE: o Pro Insurance: Expiration Date o Additionally Insured Endorsement: Expiration Date o Workers Compensation Coverage Exemption Form, if applicable o Defense, Indemnity Hold Harmless Agreement o Beverly Hills Business License: Business Name o Permit Fee: Amount: Check Credit $ Card Date

3 CITY OF BEVERLY HILLS PROFESSIONAL AND COMMERCIAL INSTRUCTION PERMIT REQUIREMENTS AND RULES Permit Requirements Applicant must provide D documentation Completed signed application Agreement. Pro Endorsement Workers Copy Payment following prior to form, including Permit execution: Defense, Indemnity, insurance as stated under Instructor Insurance Requirements. Form provided. Exemption Form, if City Beverly Hills must be Compensation Coverage current required permit fee. Business License applicable Hold Additional Harmless Insured A City authorized compensation in permit is required parks pursuant conduct fitness, to to Ordinance athletic or recreational instruction, for Permit Rules 1. Definitions: Individual /Small Group: Not more than 2 Instructor: An instructor, Approved approved participants by contractor, under supervision responsibility excluding City that works Permittee. instructor(s). as an employee or 2. Individual/Small in conducted ard Group fitness, athletic, or following parks: recreational instruction or dog training, may be La Roxbury Cienega Coldwater Canyon (Monday thru Friday only) 3. No pressional or instruction in following facilities: Arnaz Mini, Drive Mini Hamel Mini, Maltz Mini, Mini, Rexford Mini, or Beverly Canon Gardens, Beverly Gardens,, La Cienega Tennis Center, Will or Beverly Hills Reeves Greystone Crescent Community Dog commercial., may occur Rogers Memorial parks Oakhurst Mini, 4. Permits for fitness, calendar year basis. (January athletic,r recreational compensation are issued 1 December 31) on a 5. A maximum 3 Approved Instructors are allowed per permit, in addition to Permittee. 6. Permits issued permittee fec fails to: all maintain a a maintain a by permit pay execute abide applicable current required tness cathletie4structi current fees charges; 40c City valid liability Indemnity Hold valid City Beverly Hills park rules. general oparsatigc1 shall insurance as required Harmless Agreement; Business License become by City: invalid if Page _

4 7. Permittees /or Approved instructors must visibly wear a City-issued badge display issued free sting sign at all times while conducting pressional orcommercial fitness, athletic or recreational instruction have City issued Permit available for immediate inspection by City staff upon request. (Permits City-issued badges signs are non-transferable.) 8. Permittees must stay within a restricted amount space as designated by City cannot use any equipment that would extend ir area such as but not limited to, long ropes, cones or obstacle courses, agility ladders, etc. 9. Permittees /or Approved Instructors shall follow City staff instructions in siting or relocating commercial fitness or athletic instruction in order to avoid damage to City facilities or turf areas, to avoid interference with maintenance activities closures including but not limited to closures related to inclement wear 10. Permittees, Approved instructors participants shall not store fitness equipment or personal belongings within 10 feet any tree trunk. 11. Permittees /or Approved Instructors must site pressional or commercial fitress-oc athietle instruction, classes or camps at least 200 feet away from all City operated or sanctioned activities like such as American Youth Soccer Organization, Little League, Adult Sports League Programs. 12. Permittees /or Approved Instructors shall not use amplification equipment, boom boxes, bull horns or whistles. 13. Permittees Approved instructors shall not conduct pressional or commercial fitness-oc athietle instruction, in any City park between 9pm 6am. 14. Permittees /or Approved instructors shall not require park users to relocate to accommodate instruction. 15. Permittees /or Approved instructors shall relocate to accommodate City permitted activities, including City approved Community Events City approved Filming. 16. No Permittee or Approved instructor shall display, place or distribute, or cause display, placement or distribution, any commercial advertising or signage, including but not limited to cards, flyers, brochures, signs or banners, in any City park, park facility, or park parking lots. 17. equipment installations, including but not limited to light poles, drinking fountains, public art, bleachers, picnic tables, benches, railings, fencing, signs, bike racks, barbeque grills, playground equipment, steps, or stairs, frees, bushes, foliage shall not be used for exercise activity. 18, Permittees /or approved instructors clients shall under no circumstances use outdoor exercise equipment, exercise machines, or exercise equipment area to conduct instruction. 19. Pursuant to Ordinance, no person shall place any equipment or object used for fitness or athletic activity weighing more than twenty-five pounds within any City park without prior authorization by Director. 20. A City-issued field permit, consistent with City s field permitting guidelines, is required for 6effiRec6ial use a field. Page_,

5 Staff initial: 21. A court reservation permit is required for commercial use basketball, volleyball or greens for instruction. fomesatiei 22. No person shall store athletic, sports or or equipment within any park nor left unattended. 23. Permittees Approved Instructors shall at all times be respectful park users, city staff, or instructors ir clients, residents businesses. 24. City will issue permits on a first-come, first- serve basis reserves right to limit number permits issued. Permit Revocation Penalties: Conditions for Issuance Permit Procedure for Suspension or Revocation P-tJsuant to Section will be-pursuant to Ordinance No. BHMC, any person violating any wle for this permit shall be guilty a-misdemeanor which shall be punishable by a fine not exceeding dollars per violation, or imprisonment in County jail for a period not exceeding months, or by both-fine imprisonment, or shall be-guilty an infraction which shall be punishable by a fine not exceeding dollars.-attached Destruction, removal or injury to any park facility or park foliage may require restitution in an amount necessary to reimburse Department for investigative costs for value item or material destroyed, defaced, removed or damaged as well as labor required to replant or restore area, item or material affected. iv person regulai --permit administrative citations. The City may revoke, suspend or deny issuance a permit if permittee or applicant has violated applicable Federal, State, or City laws, or rules or regulations. I have read permit requirements rules will abide by m, as will any approved instructor under my responsibility. Name Signature Date Page _.