March May Thank you to our new Waste Hauler Sponsors: Advanced Disposal & FCC S.A.

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Scot Aldous Bates
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KEEP POLK COUNTY BEAUTIFUL, INC. GREAT AMERICAN CLEANUP March May 2018 The Great American Cleanup is a nationwide cleanup initiative led by Keep America Beautiful.

This cleanup event is held throughout the months of March, April and May.

1 KEEP POLK COUNTY BEAUTIFUL, INC. GREAT AMERICAN CLEANUP March May 2018 The Great American Cleanup is a nationwide cleanup initiative led by Keep America Beautiful. This cleanup event has taken place across the country for the past 32 years. Last year, thousands of volunteers throughout Polk County joined in the cleanup effort. This cleanup event is held throughout the months of March, April and May. The first 2,000 volunteers, who pre-register will receive a free T-Shirt and ticket to Bok Tower Gardens (while supplies last). Cleanup volunteers are provided with garbage bags, gloves and safety vests. Additional beautification supplies are available by request. All dumpster and beautification requests must be submitted in writing to the KPCB office no later than 3 weeks BEFORE your requested cleanup date to be considered for the GAC cleanup. This cleanup is a county wide effort. Residents who have personal garbage and large items that need to be disposed of should contact their local waste hauler to make arrangements for pick up. This is a great opportunity for students to earn community service hours! Volunteers are encouraged to choose a location in their local community to help clean and beautify. Lakes, roadways, rivers and parks are great locations for volunteers to participate in the Great American Cleanup. Volunteers may also join in one of our community coordinated cleanups or recycling events. CLEAN IT UP TO GREEN IT UP (Curbside Cleanup) & TIRE RECYCLING EVENTS ARE CURRENTLY BEING SCHEDULED. CONTACT OUR OFFICE FOR CLEANUP EVENT INFORMATION! Thank you to our new Waste Hauler Sponsors: Advanced Disposal & FCC S.A. Located at: The Log 45 4 th Street S. P.O. Box 123 kpcbeautiful@yahoo.com

2 Great American Cleanup Pre-Registration Please make sure to fill this form out completely. Supplies are on a FIRST COME FIRST SERVE BASIS Organization/Group Contact Name Contact Contact Phone (We will be using your to add you to our Contact Database. This is used by KPCB, Inc. for cleanup and event information distribution only) Type of GAC Event (i.e. cleanup, beautification, education, etc.): Location of Event: Event Date: Time of Event: : to : Estimated number of volunteers to participate in event: Dumpster Request: Yes No Purpose (cleanup, tires, etc.) All dumpster requests must be submitted in writing for review and approval no later than 2 weeks before their requested cleanup date. If approved, requestor will be required to sign KPCB Dumpster/Roll-off agreement (attached). Request must state location for dumpster placement and must have approval by property owner for placement. Only one Bok Tower Pass and T-shirt per volunteer. These are limited supplies and are not promised. KPCB, Inc. will do its best to provide you with all supplies requested. Item Trash Bags Supplies Requested Vests ( need to be worn when working on roadside 1 per 3 volunteers) Gloves (1 glove per volunteer-unless request is for additional) Water ** If Available *Beautification Tools (i.e. rakes, shovels, etc.) Please Specify: Bok Tower Gardens Admission Passes ** Please only request if you intend to use, these are limited total # requested *Items must be returned to the KPCB office no later than 1 week from cleanup completion date These are limited supplies intended for borrowing purposes only T-Shirt Request YM SM M LG XLG 2XL 3XL TOTAL: Please return any unused items to the KPCB office. KPCB is a non-profit organization with limited resources. Located at: The Log 45 4 th Street S. P.O. Box 123 kpcbeautiful@yahoo.com

3 KEEP POLK COUNTY BEAUTIFUL, Inc. DUMPSTER AGREEMENT Thank you for partnering with Keep Polk County Beautiful (KPCB) to help clean up your neighborhood/ city/ local community. To ensure that your cleanup efforts are successful, please take the time to read and understand your responsibilities within this agreement. Keep Polk County Beautiful will provide with number of roll off dumpster(s) for TRASH ONLY services on the date(s) of for the purpose of neighborhood/city/ community cleanup/ beautification in the neighborhood/city/ community. All requests to deliver and remove the project dumpster(s) must be made through your KPCB contact directly. Please do not ask the driver for extensions of time or special pick up requests. No tires, paints, batteries, household chemicals, vehicular fluids or electronics should be placed in the project dumpster. These items are not permitted at the landfill, or are accepted at a much higher per ton charge. If these items are found in the dumpster when it is transported to the landfill, will be responsible for any additional charges imposed by the landfill for the disposal of the above noted items. Please make sure all members of your group understand what items cannot be placed in the project dumpster. Project Address: (include a copy of written permission from the property owner and include any placement directions) Again, thank you for your efforts to help keep Polk County beautiful. Neighborhood/ Community / Organization Requesting Dumpster Service Contact Name (Print) Phone Signature Neighborhood Representative (Date) Keep Polk County Beautiful Representative (Date) Katie Yoxall, Executive Director Located at: The Log 45 4 th Street S. P.O. Box 123 kpcbeautiful@yahoo.com

4 Cleanup Volunteer Safety Waiver & Photo Release USE DAY OF EVENT ONLY/ THIS IS NOT A PRE-REGISTRATION SHEET The Volunteer understands that he/she is engaging in activities that may expose him/her to dangers both from known risks and unanticipated risks. By signing this form the Volunteer discharges and holds harmless the Board of Directors, Keep Polk County Beautiful, Inc., officers, servants, agents or employees (hereinafter referred to as RELEASEES) from any and all liability, claims, losses, suits, damages, and demands of whatever kind or nature arising or resulting from property damage, bodily or personal injury and/or death that may be caused by s negligence or otherwise. By signing this form the Volunteer also understands that, its partners, and affiliates may use all photographic images, video or audio recordings, video or audio reproductions, films, radio or television broadcasts and any other reproductions of the activities without limitations. Permission is granted for use in any medium now known or hereafter developed, including printed media, video, still photography and the Internet. Date: Location of Event: Name of Volunteer Address & Phone Number Signature(Parent signature if volunteer under 18)

bags of recyclables collected # of flowers or shrubs planted # of appliances collected # of trees planted # of furniture items collected # of tires collected Please check all that apply: Roadside

5 WRAP-UP REPORT Please submit your wrap-up report on time. It is very important for Reporting Purposes. _ Organization/Community Group Date of Event _ Contact Person Phone Address Event Information Number of volunteers Number of bags of litter collected # of hours project took to complete # of bags of recyclables collected # of flowers or shrubs planted # of appliances collected # of trees planted # of furniture items collected # of tires collected Please check all that apply: Roadside Cleanup Railroad Cleanup Waterway Cleanup School/ Campus Cleanup Church Cleanup Park Cleanup Other Approximately how many Miles of Cleanup Description of project/ Location: Please fill out event WRAP-UP report and mail back to Please include any pictures of your event no later than June 1 st. P O Box 123 kpcbeautiful@yahoo.com

6 Pre-Registration Sheet (Optional Form) For YOUR Use & Records Volunteer Name Phone # / Address Shirt Size Bok Tower Pass Check

1. Fill out the attached registration form (2 pages) and FAX to (561) , or mail to:

SITE MANAGER GUIDELINES International Coastal Cleanup 2009 In order to participate please follow these instructions: 1. Fill out the attached registration form (2 pages) and FAX to (561) 686-6642, email