The URL can be used to link to this page

Home My WebLink AboutFacility Use ApplicationI "inn City of National City Facility Use Application Rev.1/25/11 140 E. 12th 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 Martin Luther King Jr. Building North Room South Room Entire Facility N Q CD Co CA -Cl )ate(s) of Use: li l e2D t t Day(s) of Use: 5 cry rime of Use: From: t ffil - °AM/PM To: AM/PM - INCLUDE SET-UP & CLEAN UP TIME ype of Function/Activity: ame & Address of Organization/Group: Non- profit organizati s the event open to the public? lLoc Tax ID# nticipated Maximum Attendance: ercentage of National City Residents "j')o)W rs ` 4- Pt vo Till Admission be charged9 � iOAmount�� quipment Requested:tM6#"of chairs t - of banquet tables uk w11 Pbdi��op dn� go Will this be a Fund Raising Event? Stage "PLEASE ATTACH SEATING DIAGRAM Audio & Visual Equipment Required? (Please Specify) , bn ► IO Gc7 *- �cQ � ei 2 2 a A A �cc, Ise of Kitchen: es No Use of Gas for Range d Oven: Yes No ; the Use of Alcohol equested? t 't ete-- h f r 4Rit - yrrwsl c-- Till other paid services be used (I. e, commercial ca erer, J, Band, etc)? Yes No lame: lame: I Phone: Vat-`'I��-t-kl?..g 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 1 HE RULES AND REGULATIONS FOR THE FACILITY REQUESTED, AND I AGREE FOR MY ORGANIZATION/ GROUP TO CONFORM TO ALL OF ITS PROVISION. DATE COMPLETED: PRINT NAME: SIGNATURE: ADDRESS OF APPLICANT: CITY, STATE, AND ZIP CODE: PHONE: DAY FAX NUMBER: CONTACT PERSON ON THE DAY OF THE EVENT: 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. PHONE: ( ) CELL: ( ) Community services staff Only - Rental Amount Received: Receipt Number Deposit Amount: Deposal Key Returned: Check 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: Person in charge of activity: Address: oamitst i`(kcj-vva & e 1461(3Al( f1useAvV. Telephone: Cp`q ft02,91 L E-Mail: City Facilities and/ or property requested: + An ` \-ka Date(s) of use: HOLD HARMLESS AGREEMENT As a condition of the issuance of a temporary use pennit 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. A of applicant Date Certificate of Insurance Approved by ,,^t 1 Name and Title Safety/ Security -vas K. Please describe your procedures for crowd control and internal security: fl11)5 WWIL tC t wft L `-cen (IC pA. Wait w do -Eck -cut lJ qt (tc-OS (Yhp 9)v&9 ,k)D IniLtok -1c°1 r `Pf" MO SO Pt? ?\4?-e-t it:0)Jc OecvDt- TesiDvv`- rvlift `-br oms ‘tin 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: b y.( cie 64-to 00 4Q-c.ee/IC -IL Ve Security Director (Name): Phone: Monitoring Alcohol Consumption Please describe your producers for monitoring alcohol consumption: 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: SUMMARY OF CHARGES Fees and Costs: Service Clubs: $100/month Other Organizations: see prices below Martin Luther King Jr. Community Center Activity South Room North Room Entire Hall Dining: 0-73 $23.45/hr 0-149 150-221 222-294 Dance/ Assembly: 0-100 101-157 158-300 301-472 473-630 $23.45/hr $29.32/hr $70.36/hr $87.95/hr $70.36/hr $87.95/hr $117.26/hr $117.26/hr Casa de Salud, El Tovon Recreation, Camacho Recreation & Kimball Recreation Center $23.45/hr *Please note Camacho Gym falls under 801 Policy Fee Kimball Senior Center 0-149 $70.36/hr 151-221 $87.97/hr Kitchen: $10.00/hr $50.00 Minimum — (only to be used in conjunction with the use of the hall) $60.00 Kitchen Deposit — (required, can not be waived, and refundable upon approval from Public Works staff) $22.00/hr. during working hours and $35.00/hr. for overtime hours hrs Total$ Custodial charge shall be charges for set up, clean up and duration of event based on the events' estimated attendance as follows: 1-100 person / lhr. set up and lhr. clean up 101-157 2hr. set up and 2hr. cleanup 158-300 3hr. set up and 3hr. clean up 301-472 4hr. set up and 4hr. clean up 473-630 5hr. set up and 5hr. clean up **PLEASE NOTE: ADDITIONAL CHARGE FOR TABLES AND CHAIRS $1.00 PER TABLE, $.75 PER CHAIR** Building use fee: $50.00-required, non waivable and non-refundable INSURANCE WILL BE REQUIRED, FOR ALL RENTALS. APPLICATION INSTRUCTIONS Please complete and sign the application for Facility Use. Submit a certificate of Liability Insurance in the amount of $1,000,000 naming the "City Of National City" as Additional Insured. If alcohol is sold or served, host liquor or liquor liability coverage with minimum limits of $1,000,000 must be provided. Please provide a letter addressed to the Director of Community Services, explaining the purpose of the event, date, time, number of anticipated participants, request for waiver of fees, and any other information that may support the use of the facility. Once your application has been approved by the Community Services Director it must be approved by City Council at a City Council Meeting. (note: City Council meetings are held twice a month on the first and third Tuesday of the month.) It is recommended that the applicant attend this meeting to answer any Council questions. You will receive a copy of your application with your total amount. If you have not received this before your Council meeting please contact the Community Services office. The above letter must be delivered to: Community Services Department 140 East 121 Street, Suite B National City, CA 91950 If you have any questions, please call the Community Services Department at (619) 336-4290