HomeMy WebLinkAboutFacility Use ApplicationCity of National City
Facility Use Application
Rev.6/28/11
2100 Hoover Avenue
National City, CA 91950
(619)336-4580
Fax(619)336-4594
After hours dispatch:
(619)336-4411
TO ALL APPLICANTS: It is strongly recommended that an applicant requesting use ofityacility;'attend
the City Council meeting when the item is scheduled for consideration in order to answe y gUfstions from
the City Council.
Facility Requested: please circle
her King Jr. Building
South Room -,ntire Facility
Date(s) of Use: AID\M.*i baev )7, 20 I( Day(s) of Use: 40 V k-� ar' )%, I I
Time of Use: From: 41: AM/PM To: R" 1.30 AM/PM — INCLUDE SET-UP & CLEAN UP TIME
•
q s✓
Type of Function/Activity: CO r~u n Y ,'t'sc +SSA Is the event open to the public?
Name & Address of Organization/Group: 1dyld T & , J i, P 4ca ha
Qlwcweod G�e.rda5 f %t en', (cv 2S25-"A/ Ave91957�
,.
Non- profit organization No Tax ID # Ma�n.onde GTt�,CA
Anticipated Maximum Attendance: ..r) Percentage of National City Residents ICJ 7.
Will Admission be charged? )CIO Amount $ 10' Will this be a Fund Raising Event?
Equipment Re Requested: nro 2C%b'( # of chairs '_-. f_�s�S
q r \ 3 �� # of banquet tables
/ a
Stage
tk teez� L c� i.��
**PLEASE ATTACH SEATING DIAGRAM
Podium/Microphone
ma po vlt/fain (' Audio & Visual Equipment Required? (Please Specify)
,/}rlfic GnvfAfloln
Use of K%itchen: Yes ✓ No Use of Gas for Range and Oven: Yes ✓ No
Is the Use of Alcohol Requested?
Will other paid services be used (I. , commercial caterer, DJ, Band, etc)? Yes ✓ No
Name:
Name:
Phone:
Phone:
How many times in the last twelve months have you requested to use a City Facility?
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 of National 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.
I, 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 of property 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 I HAVE RECEIVED A COPY OF THE RULES AND REGULATIONS FOR
THE FACILITY REQUESTED, AND I AGREE FOR MY ORGANIZATION/ GROUP TO
CONFORM TO ALL OF ITS PROVISION.
DATE COMPLETED: CI ' 13 - If
PRINT NAME:
SIGNATURE:
644.
l6/lSZ
LA(
ADDRESS OF APPLICANT: 07 / Tslahot Ave -true- it 4 3
CITY, STATE, AND ZIP CODE: SG t1 7 t 'teC:
U
PHONE: DAY FAX NUMBER:
CONTACT PERSON ON THE DAY OF THE EVENT:
Lich /
PHONE: ( ) CELL ( j i - 177
HAVE YOUR COPY OF
APPLICATION IN
POSSESION DURING USE
Please type or print clearly with a
Ballpoint pen. Complete
application must be submitted
and payment submitted in
advanced of the event.
Community Services Staff Only -
Rental Amount Received: Receipt Number:
Deposit Amount: Deposit/ Key Returned:
Check Key issued: YES NO
CITY OF NATIONAL CITY
PUBLIC PROPERTY USE HOLD HARMLESS