HomeMy WebLinkAboutFacility Use Applicationcity ormitioo city
Faciiity Use, Application
Rev:6128111
2100 Heaver .Avcntie
National city, CA 91950
(150$1,6-450
Fax (619)336-4594
After halm dispatch:
(619)33641.411
-7)
TO ALL APPLICANT.St,If is strongly teeemmendedithat an le-titivatinguse a:City giei1ity-ettens;I
I1In-City Connell 4meeting When -tit ate iKsoltndtilettrfor consideration in order Viattswany fqwee-tionalva.
the City Council.
fealitY-Ret111 please circle
!vlartin Latta King Jr.
off ooni -Spelt Roori
0
Date(s) of Use:
Tinin-Of Use; Froth:,
Dity(s) Oat": -
Tv;
Type -of FanetionlAetivitr1/4 Is ate event open to the -ptt
Wane & Address aotganitationlfttIP
Non- profit ntp*Oti:01
Antieipatett,Mexlintat Atteadenea SI&'--PereePtage etNatieW CinSittleas
wiil Abtassion be eheigest Anna 56 Wiffihis be aPuntigaittaVent2 Wo
ajapinentatqueateet of etaire
Paittathdetophone
, - -
,AttclibaNisael Equipment Regained-2 c,
La.ptvpj „pros...down Oet4g :.42.0#.4-4, 414. Ito-:)0
WSVCif Kiffikeffi X Yes No lisextreaa ferat' nwand,Ovent,
Is the Use otmohaittquonal
Will other Oa servieesbe,esettiN e, Poluttier$41 nteri J, an-2-
. ,
Nana Phone
iikOMASt AtrAtithtett ,01.4,GRAm
rqffipe.jS Wwsj Qutpc+9+ Rhone
144 irrop444fis
How many -times -in the last twelve months have you requested to use a City Facility?
It is expressly understood and agreed that the applicant assumes all risk for loss, damage, V
Liability, injury, cost or expense that may arise during or he caused in way by such use H
or occupancy of the facilities of the City of National City and/or Community Services
Department.
The applicant nttthcragIceathathl'eeflaideraus of being permitted the use of
facilities agreed to, they will save and held harmless the said city of National City, its
cows, agents, employees and volunteers from any loss, claims, and liability damages,
and/or injuries to roans and proper.* that in any Way may be caused by applicant's or
ocettPaneY=
the undersigned, hereby certify to Shy the
agree to abide by all City ofNational City Ordinances and facility and policies, and be
representative of the user Organizations. Farther, I agree to bcperapnallrresponsible- for
any damagelloss sustained by the ground, building, furniture or equipment or unusual clean
up occurring through the occupancy of said, facilities.
Application r.ettalzes. andandergaudsthat. use of Cbritacility may create &possessor), interest subject
to property taxation and that applicant may besubject to the -payment-ofproperty taxes on such
interest. Applicant further agrees pay any and all property taxes, tryanyas-olid4c4attiwthe*6orthe eitP
facilitYlattsUant tnaeetielKIM'and 107.6 of the reVeS1Wandlakarlba-IleileataitistVlitiOnes possessory
interest in the rattily,
CEldtErniAtutAirE ItEcEntn,A coMolotimatims Abto ittOVIATION$FPR
InnAntatvitEQUESTED, AND I AGREE:FOR:MY QAP:aq ATIPWQROPPI-O,
CoNtreRm TO &LLOFTS PRO VISION
DATE COMPUTED L* *
PRINT NAM- % 1.101
StOlsaTTIRE:
ADDRESS or APEticAND
CITY, StatilyANOzoC
PHONE: DA\&U UTY1351FAX K 7>"
CONTAMBERSONDN TORDAVOE THE EVENTI7
EltdREtirciti CELL:
HAW YOUR On :OF
ArrI4CATION IN
PDS SESION DURING IS
•
Please type :of TOW clearly with a
WalinolatPcn,41.41cm
application must be submitted
and,payment-aubmitted,in
advanced , of the event,
NbItiVala Spirt
Rental AmPuntReCelYed; RectO
Amount tif.p$PK4kRaltiatt
*kasit
ChCck
ItkriSS:dt
CITY OF NATioNAL GiTy
PUBLIC PROPERTY USE 110LBIIARIVELESS
SFICATION AGREEMENT
Person requesting use of City property, fatilities,Or'perSonnel are'requitedio-provide-
mitilinunrof!tpoopoo: combined single limit insurance for bodily injurrand-.:.property
damage which intiti4.4he,e1:% its officials. agents and employees named as additional
insured and to sign the hold harmless agreement; Certificate-OfInsurance;must,be
attached to this permit.
Person in charge ofactiv
Address: a \Cthtm
Teiepho E-Mail:
City Facilities and/ or property requested:
Dates of use: - SW&
HOLD 410aMS AGREEMENT
MigXPISMPO of the bae904MPRWIYWPPIldtg;9190.00* *MAP"
QtilittbSoravAtdoonify, the undersigned hattlys**(0-104:0004, indemnify and
hold harmless theof sologgjiy4t4*445WPRIPI9YM1t4a9P4•WIYand
,
against any-4.0W)tatio4:4004.40altiWk liability ordamages for -any personal
itinsiMvPri*.,PPPAY*IPAM'C'I PP% or Witttgfej 4g4A*Nliggy* includingditotaAfoa,14144-40:bitS of ittlgatintiiiiiii4outot,telated to the nsC,Of public
PIPPawfklmtkiatYlgkmqmOgrOiwmigit$rfkmioifipKiWe"vookyo!vr
-contractors.
Certineate,efinsurance ApprovedV
eand Title
Safety/ Security
Vieq§e tieseriheyontprotedures for crowd eontrol,nnd internal security:.
X1 NO Have you hired any Prefessienal Security-orptliza -Wu to handle
SeetwityntrdepinetiL4 tor this tAle rit?-0Wkpie-ftle ;list
*cu6tj Ortotstio:
acireitrokmtzgribILMOrms;
statrityrittmtut Nam* PliOne:
Monitoring Alcohol Consumption
Please describe your podnogra for monitoring alcohol cpwmptiom
Orgflizatitthi0Wt4o4fito 6:spotott uli*Utft-thati 'alcohol is MITtat:0;pOte:2
ramotogp,thatiSttititstaniolokat serverlpot also be 21 years of or olden.,
14.4010 A* '4
cofitaeffihat:niiiiibiii\Sdayore'
hita nyTrnfoasio ' YES- NO:HaVt you 4 1 ribr ougasuzintou to handle
Security arrangements fern vehr if yEs,ilioaselist
Security , ailfStiofe
SePPrittY`OrganjzatThn Address:
anglify Diruotot €144414)±: P11940;
KITCHEN
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COLOR GUARD
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STAGE/AV SET UP
MAIN REGISTRATION