HomeMy WebLinkAboutFacility Use Application- CAIIfORNIA -
NATI ONAL CITY
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City of National City
Facility Use Application
Rev.1 /25/ 11
140 E. 12`h Street, Ste. B
National City, CA 91950
(619)336-4290
Fax (619)336-4292
After hours dispatch:
(619)336-4411
TO ALL APPLICANTS: It is strongly recommended that an applicant requesting use of City Facility attend
The City Council meeting when the item is scheduled for consideration in order to answer any questions from
The City Council
Facility Requested: please circle
r King Jr. Building
South Room Entire Facility
RECEIVED
MAR 0 H
;OMMUMTY SERSC►ES DEF
�!A PONA? . r (Y, CA
Date(s)y 5 MAY 2011
of Use:. � Y ...+01 1 Da (s) of Use:: 2
Time of Use: From: 4.00 AMO
To: 9.00 AM Ivt - INCLUDE SET-UP & CLEAN UP TIME
Type of Function/Activity: SUHi SENIOR SCHOLARSHIP ASSEMBLY Is the event open to the public?
YES
Name & Address of Organization/Group: SWEETWATER HIGH SCHOOL
Non- profit organization
Anticipated Maximum Attendance:
150
No Tax ID 1 95-600-3082
Percentage of National City Residents 90%
Will Admission be charged? NO Amount $ Will this be a Fund Raising Event? NO
Equipment Requested: 150 /1 of chairs 10 # of banquet tables YES Stage
YES Podium/Microphone
**PLEASE ATTACH SEATING DIAGRAM
Audio & Visual Equipment Required? (Please Specify)
Use of Kitchen: Yes INo Use of Gas for Range and Oven: Yes 7 No
Is the Use of Alcohol Requested?
Will other paid services be used (1. e, commercial caterer, DJ, [hand, etc)? Yes No
Name: Phone:
Name:
Phone:
1
How many times in the last twelve months have you requested to use a City Facility? 0
It is expressly understood and agreed that the applicant assumes all risk for loss, damage,
Liability, injury, cost or expense that may arise during or be caused in any way by such use
or occupancy of the facilities of the City of National City and/or Community Services
Department.
The applicant further agrees that in considerations of being permitted the use of the
facilities agreed to, they will save and hold harmless the said City ofNational City, its
officers, agents, employees and volunteers from any loss, claims, and liability damages,
and/or injuries to persons and property that in any way may be caused by applicant's use or
occupancy.
1, the undersigned, hereby certify to abide by the regulations governing said facility and
agree to abide by all City of National City ordinances and facility rules and policies, and be
representative of the user organizations. Further, i agree to be personally responsible for
any damage/loss sustained by the ground, building, furniture or equipment or unusual clean
up occurring through the occupancy of said facilities.
Application recognizes and understands that use of the City's facility may create a possessory interest subject
to property taxation and that applicant may be subject to the payment ofproperty taxes levied on such
interest. Applicant further agrees to pay any and all property taxes, if any assessed during the use of the City's
facility pursuant to sections 107 and 107.6 of the revenue and taxation code against applicant's possessory
interest in the City's facility.
I CERTIFY THAT 1 HAVE RECEIVED A COPY OF THE RULES AND REGULATIONS FOR
THE FACILITY REQUESTED, AND 1 AGREE FOR MY ORGANIZATION/ GROUP TO
CONFORM TO ALL OF ITS PROVISION.
DATE COMPLETED: 07 MARCH 2011
PRINT NAME: S G e
SIGNATURE(
ADDRESS OF APP T: 2900 HIGHLAND AVENUE
CiTY, STATE, ANE P CODE: NATIONAL CITY, CA 91950
PHONE: DAY 619.250.5904 FAX NUMBER: 619-342.1645
CONTACT' PERSON ON THE DAY OF THE EVENT: SAM GONZALES
PHONE: WO 250.5904
HAVE YOUR COPY OF
APPLICATION iN
POSSESION DURING USE
Please type or print clearly with a
Ballpoint pcn. Complete
application must be submitted
and paymcnt submitted in
advanced of the event.
CELL: 019) 250.5904
Community Services StatYOnly-
Rcntal Amount Received: Receipt Ntunber:
Deposit Amount: Deposit/ Key Returned:
Chock Key issued: YES NO
CITY OF NATIONAL. CITY
PUBLIC PROPERTY USE HOLD HARMLESS
AND INDEMNIFICATION AGREEMENT
Person requesting use of City property, facilities or personnel are required to provide a
minimum of $1,000,000 combined single limit insurance for bodily injury and property
damage which include the city, its officials, agents and employees named as additional
insured and to sign the hold harmless agreement. Certificate of insurance must be
attached to this permit.
Organization: SWEETWATER HIGH SCHOOL
Person in charge of activity: DAVID MITROVICH
Address: 2900 HIGHLAND AVENUE, NATIONAL CITY, CA 91950
Telephone: (619)250.5904
E-Mail: SA_m_GONZALES@SWEETWATERSCHOOLS_ORG
City Facilities and/ or property requested: MLK CENTER
Date(s) of use: 25 MAY 2011
HOLD HARMLESS AGREEMENT
As a condition of the issuance of a temporary use permit to conduct its activities
On public or private property, the undersigned hereby agree(s) to defend, indemnify and
hold harmless the City of National City and its officers, employees and agents from and
against any and all claims, demands, costs, losses, liability or damages for any personal
injury, death, or property damage, or both, or any litigation and other liability, including
attorneys fees and the costs of litigation, arising out or related to the use of public
property or the activity taken under the permit by the permit or its agents, employees or
contractors.
07 MAR 2011
Signature ppl icant Date
Certificate of Insurance Approved by
Name and Title
3
Safety/ Security
Please describe your procedures for crowd control and internal security:
SCHOOL ADMINISTRATORS AS WELL AS SCHOOL
CAMPUS SECTJRITY WILL BE ON DUTY TO WORK
CROWD CONTROL AND SEATING_
YES 1NO Haveyou hired anyProfessional Securityorganization to handle
Security arrangements for this event? If YES, please list:
Security Organization:
Security Organization Address:
Security Director (Name): Phone:
Monitoring Alcohol Consumption
Please describe your producers for monitoring alcohol consumption:
ALCOHOL CONSUMPTION WILL NOT BE TOLERATED
Organization must designate a person to ensure that alcohol is being served to persons 21
years of age or older. The designated alcohol server must also be 21 years of age or older.
Name:
Contact phone number the day of event:
YES NO Have you hired any Professional Security organization to handle
Security arrangements for this event? If YES, please list:
Security Organization:
Security Organization Address:
Security Director (Name): Phone: