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Home My WebLink AboutFacility Use ApplicationENGINE.ERDIG DEPT. NM AUG -t City of National City FaciiyJsc �a1c ion Rev.6/28Il 1 22100 Hoover Avenue Orat�I : r$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 of City Facility attend the City Council meeting when the item is scheduled for consideration in order to answer any questions from [he City Council. Facility Requested: please circle Martin Luther Kin Buil North Room ntire Facility Dates) of Use: E„ , f ex- y 1Ue_y.Day(s) of Use: Tinie of Use: From: L ` /PM To: 1 • Al s' INCLUDE SET-UP & CL.EAN UP TIME rrx ernae.r-s 4 Type of Function/Activity: wee.K.Ly nes,. } Is the event open to the public? _ uCet... Narne & Address of Organization/Group:__P. . l o X COC., 2ona j C R 1c 8 Non- profit organizatio No Tax ID # ciS "'4 q 3 I Anticipated Maximum Attendance: g2}- 25 Percentage of National City Residents Will Admission be charged? f4 Amount $ Equipment Requested: 3 '') # of chairs icrophone 337 Will this be a Fund Raising Event? # of banquet tables f 4 0 Stage **PLEASE ATTACH SEATING DIAGRA� Audio & Visual Equipment Required? (Please Specify) Use of Kitchen: Yes X No Is the Use of Alcohol Requested? d Use of Gas for Range and Oven: Yes X No Will other paid services be used (I. e, commercial Name: S I t Qom ' U it01 Name: Phone: Phone: �J, Hand, etc)? 1 Yes No (,t') 3'71- 9siqo PRINT NAME: TA Q �iCl �, S SIGNATURE: ADDRESS OF APPLICANT: 34t P Lamp PLa►.Ce. CITY, STATE, AND ZIP CODE; N LZ$ t i�}r . CA RV; ; S 0 Pi EC}N%: DA s •�,. ' FAX NUMBER: 143g - $ Si S How rnany times in the last twelve months have you requested to use a City Facility? It is expressly understood and agreed that the applicant assumes ail t-isk 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 arad hold harmless the said City of National City_ its officers, agents, employees and volunteers from any Ioss, 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 fadlities. 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 Ifl7 and I07.6 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 TIIE FACILITY REQUESTED, AND I AGREE FOR MY ORGANIZATION/ GROUP TO CONFORM TO ALL OF ITS PROVISION. 14120 HAVE YOUR COPY OF DATE COMPLETED: 1.4 APPLICATION IN II POSSESION DURING USE Pease type or print clearly with a Ballpoint pen. Complete application must be submitted and payment submitted in advanced of the event. CONTACT PERSON ON THE DAY OF THE EVENT: retin t bSI Trts dtro PHONE:i I 4741. 417S CELl:, 19 9 4 �{ — Public Works SteiTOniy- itental Amount Received: Receipt Number. Deposit Amount: Deposit/ Key Returned: Check Key issued' ?'n3.S 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 $1,000E000 combined singic 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: NS Q..* t f]r‘Q. L. ct o Club Person in charge of activity: e1 l lick R ti et .9 Address: 3414 E I ear -tor, C.e... , NQ## i eta./ Telephone: (fs c9an4-O a VIE -Mail: irtictsyntorga. Yl,p..S aylea1,L City Facilities and/ or property requested: t'i LK CS ou r*t ii cirr) i-e. Date(s) of use: g1.511L1 g"' 1.5 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. Signature of pplicaut L---1—t-'\....__CZ--".------ Certificnte of Insurance Approved by . Name and Title Safety/ Security Please describe your procedures for crowd control and internal security: Paz, 4-10 � Ct.- Poce t s a. ( C._110. v ter. 0 4 e_ Ctv YESO Have you hired any Professional Security organization to handle N XSecurity arrangements for this event? if YES, please list: Security Organization: Security Organization Address: Security Director (Name): Phone: Merl t rir g Alcohol Consumption. Please describe your producers for monitoring alcohol consumption: i4O W ti is fi e. Q F. 4224-k- 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. Nauie:j A Contact phone numb r 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: $ J 00/month Other Organizations: see prices below Martin Luther King Jr. Community Center Activity South Room North Room Entire. Hall uilnog 0-73 $23.45fhr______ 0-149 $70.36/hr 150-221 $87.951hr 222-294 $117.261hr Dance/ Assembly: 0- I 00 $23.451kr 1 0 1-157 $29.32/hr 158-300 ---- $70.36/hr 301-472 $87.95fbr 473-630--___ $117.26/hr Casa de Salud, El Tovon Recreation, Camacho Recreation & Kimball Recreation Center $23.45Ihr *Please note Caniacho 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) $22.0O/hr. during working hours and $35.001hr. for overtime hours lu.s Total$ Custodial charge shall be charges for set up, wean up and duration of event based on the events' estimated attendance as follows: 1-100 person liar. set up and 1hr. clean up 101-157 2hr. set up and 2hr. clean up 158-300 3hr. setup and 3hr. clean up 301-472 4hr. set up and 4hr. clean up 473-6 0 51hr_ 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.tH1-required, non waivable and non-refundable INSURANCE WILL BE REQUIRED, FOR ALL RENTALS. North Hall Exit Exit Exit Martin Luther King Community Center 140 E. 12th Street National City, Ca. 9195C 71 ft South _ East West L----> 1.1 4, .r ;Liu Si43 a 65 ft Exit Exit Exit Entrance - Two Double Doors Occupancy. Dance 470 Dine 225 South Hal: Martin Luther King Community Center 140 E. 12th. Street National City, Ca. 91950 Southfj East West' 4 North Exit 25ft Exit o. I•Luv t s vvtc-3., 67 Ft Entrance Double Doors Occupancy: Dance 160 Dine 75