Loading...
HomeMy WebLinkAboutFacility Use ApplicationOAUPOHNIA�'. NATIONAL, CITY onion >` �acanrone?co City of National City Facility Use Application Rev.6/28/11 'th H it ,t 1 0) 9 Ni{�i '�'ity, 91 5 (619)336-4580 U 1B E4t (6,1901.6-439f T. 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 1TortliRoom South Room ire Facility Date(s) of Use: n 151 aol Day(s) of Use: Time of Use: From: Y : U © AI TM To: g o o 1lb INCLUDE SET-UP & CLEAN UP TIME Type of Function/Activity: c \nV En Lr Is the event open to the public? \ Q j Name & Address of Organization/Group: k104Irn P 0.41 CIVOKIA St lr eJ l Ql11 11 Non- profit organization Y' - No Tax ID # 95- I 0 3 ' WC. Anticipated Maximum Attendance: 700-$ cf.Hih o l%u; Percentage of National City Residents g o " / 0 0. 67 act f Will Admission be charged? I) 0 Amount $ _ _ Will this be a Fund Raising Event? n t� Equipment Requested: 00 # of chairs `10- `l5 # of banquet tables _1—. Stage Podium/Microphone cCra on, lap pealle e5 Audio & Visual Equipment Required? (Please Specify) nA cropho.. Use of Kitchen: Yes X No Use of Gas for Range and Oven: Yes )( No Is the Use of Alcohol Requested? NO Will other paid services be used (I. e, commercial; caterer, DJ, Band, etc)? ¥ Yes No J����, L cF u// . he prat -lc -led Por-ennphyerS ( Name: tin 4nouM ei% f w e 0g aPp uA phon :• **PLEASE ATTACH SEATING DIAGRAM Name: Phone: How many times in the last twelve months have you requested to use a City Facility? I 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: PRINT NAME: SIGNATURE: ADDRESS OF APPLICANT: `io II ``,,�� CI�M�—'J'' AA0 J ('Alk &vct CITY, STATE,"AND ZIP CODE: {�7m\LA y (° f Cf\ . I (9SO PHONE: DAztU 4041i 9331 FAX NUMBER:(JR Uk� 1— TOi CONTACT PERSON ON THE DAY OF THE EVENT:11(cI LLUU IL, U60 PHONE: (ieD t}�1- c133 g1 CELL: (.lira no— ((p ( 111 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. Public Works Staff Only - Rental Amount Reccived: Receipt Number: Deposit Amount: Deposit/ 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: kl fthur 3 Qi1 q l han QY 4 ent1 .QA Ot Person in charge of activity: 3(n �`r41, R E X)JU , 9)\11U) , nDi sl i &� /�g`� Q C.C) Address: AO( t�i it ek() �jA d)lvd, k to1' is d \I t, CA.Ct l50 TelephoneU.Q\ )(111— 1339 E-Mail: j l tjl4\SO Ct 1104 1CIN' @ Mt&.C�'(. City Facilities and/ or property requested: \ (� Date(s)ofuse:..Asy J iC O\a (if11 t '.C%ocm\ U4 004p n 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. /8 12 ate Certificate of Insurance Approved by Name and Title Safety/ Security Please describe your procedures for crowd control and internal security: eil Yfa�G and vobvnleers rsMftie ., o�ik LC'o,.,i-, __as'�Prilf cant/ 1e /(/aiiona/ e, frf t1`iaw,-her 9 QjcrMrvterre w,// be ,ohs, -i 74° con{ -re/ Crowd etAd Ina/n Ltc,'n' crater7-o f e evan f• YES X NO Have you hired any Professional Security organization to handle CSecurity arrangements for this event? If YES, please list: Security Organization: n / * Security Organization Address: Security Director (Name): H * Phone: Monitoring Alcohol Consumption Please describe your producers for monitoring alcohol consumption: Organization must designate a person to ensure that ala hoI is being served to persons 21 years of age or older. The designated alcohol server muss 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 l st: Security Organization: Security Organization Address: Security Director (Name): Phone: C REw R PATHWAYS TO SUCCESS" JOB SEEKERS, BRING PLENTY OF RESUMES! Hosted by FEE Job Fair: 10A ®1 P TAKE ADVANTAGE OF: • FREE RESUME REVIEW • CAREER SERVICES • EDUCATIONAL WORKSHOPS FEATURING REPRESENTATIVES FROM: • Automotive Industries • Healthcare Services • Hospitality Sector • Maritime Industries Martin Luther King, Jr. Community Center Location of job fair Please call for more information Sponsored by 91�1id�if}.. NABT1t SOOTH OOHNTY puniness 6Epvmeo, la 6 140: East 12th Street, National City, CA 91950 (619) 477-9339 wwwnationatcitychamber.org 111E CiL JIWr www. f acebook.com, NationalCityChamber National City Chamber of Commerce 901 National City Blvd. National City, CA 91950