Fillable APPLICATION FOR FACILITY USE (Yuba College)

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APPLICATION FOR FACILITY USE (Yuba College)

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Yuba College Application for Facility Use | 2088 North Beale Road, Marysville, CA 95901 | Telephone: (530) 741-6766 FAX: (530) 749-3867 | Rev. 9.17.15
APPLICATION FOR FACILITY USE
Internal and Community Requests
Event Description:
Name of Event: ________________________________________________________ Date(s) of Event: _____________
Number of people expected: ____________
Admission Fee: $____________
Audio/Visual Needs: _______________________________
Will you serve food? Yes No
Has parking citation been suspended? Yes No
Will you require Internet access? Yes No
Will you require restrooms unlocked? Yes No
Will the Media be present? Yes No
Facilities Accessed by: _________ Event Begins: _________ Event Ends: ___________ Facilities Vacated by: __________
AM/PM AM/PM AM/PM AM/PM
Facility Requested:
Marysville Campus
Sutter County
Center
Athletics Facilities
Meeting
Rooms/Areas
Theatre
Learning
Resource Ctr.
Other
Meeting Rooms
☐ Gym
☐ Field
☐ Baseball
☐ Softball
☐ Track
☐Football/Soccer
☐ Field Lights
☐ Track
☐ Football
☐ Soccer
☐ Cafeteria
☐ Multi-
Purpose Room
(316)
☐ Classroom
Rm. # ________
☐ Computer
Lab
Rm. # ________
☐ Conference
Room
Rm. # ________
☐ Theatre
☐ Piano(s)
☐ Library
Computer
Training Lab
(1131)
☐ TV Studio
(Room 1158)
☐ Journalism
Lab (Room
1171)
☐ LA/FA
Conference
(Room 1194)
☐ Mat Room
☐ Fire Training
Tower and
Grounds
Nursing
Simulation Lab
☐ Quad
☐ Parking Lot
☐ Veterans
Resource Center
(725)
☐ Other
Identify _______
______________
______________
☐ Cafeteria
☐ Cafeteria
Overflow
☐ Classroom
Rm. # ________
☐ Computer
Lab
Rm. # ________
☐ Conference
Room
Rm. # ________
Room Set Up: ☐ classroom ☐ reception ☐ graduation ☐ lecture other _______________________
(Attach floor plan if applicable)
Requester Information:
REQUESTED BY _____________________________________________________________ _______________________________
Name of Organization Contact Person
ADDRESS _______________________________________________________________________________________________
_____________________________ _____________________________ _______________________________
Telephone Number Fax Number Email
_____________________________ 501-C 3 (Check One) ☐ Yes ☐ No
IRS Tax Number Checking “Yes” above requires that you attach official verification of non-profit status
(Attach W-9 Form) from the IRS or Franchise Tax Board
Yuba College Application for Facility Use | 2088 North Beale Road, Marysville, CA 95901 | Telephone: (530) 741-6766 FAX: (530) 749-3867 | Rev. 9.17.15
Facility Fees:
Referencing Yuba Community College District AP 6700, identify the GROUP to which your Organization belongs:
☐
Group I
Labor and Utilities Charges Apply
☐
Group II
Labor, Utilities and Supplies
Charges Apply
☐
Group III
Labor, Utilities, Supplies and Fair
Rental Value Apply
Flat Fee
Hourly Fee
X Hours of Event
Total Amount
☐ Labor GL Code:
$
$
$
☐ Utilities GL Code:
$
$
$
☐ Supplies GL Code:
$
$
$
☐ Rental GL Code:
$
$
$
Estimated Grand Total
$____________
* Final billing will include actual charges. All fees assessed to an organization are due to Yuba College 30 days following the event. Please
make checks payable to Yuba College. This Application for Facility Use form, including the Proof of Insurance, is due twenty (20) business
days prior to event. Cancellations must be submitted 48 hours prior to the event.
Prior Approvals:
Need for CUSTODIAL, MAINTENANCE OR GROUNDS STAFF must have prior approval of the M&O Supervisor, 741-6775.
Signature ______________________________________________ Date ____________________________
Use of ATHLETICS FACILITIES must have prior approval of the Athletics Director, 741-6779.
Signature ______________________________________________ Date ____________________________
Use of the THEATRE must have prior approval from the College Marketing and Promotion Coordinator, 741-6829.
Signature ______________________________________________ Date ____________________________
Use of LEARNING RESOURCE CENTER FACILITIES must have prior approval from the Dean of Humanities, 741-6794.
Signature ______________________________________________ Date ____________________________
Use of the PUBLIC SAFETY FACILITIES must have prior approval from Public Safety Director (749-3879) or Nursing and Allied
Health Director, 741-6785.
Signature ______________________________________________ Date ____________________________
Use of the VETERANS RESOURCE CENTER must have prior approval from the Veterans Resource Technician, 741-8780.
Signature ______________________________________________ Date ____________________________
Use of the PARKING LOT must have prior approval from the YUBA COLLEGE PRESIDENT, 741-6707.
Signature ______________________________________________ Date ____________________________
Official Use Only
Verified Non-Profit: Yes No Proof of Insurance: Yes No Indemnification: Yes No
Event Approved: Yes No Signature: ______________________________________ Date: ________________
Posted on Calendar on: _________ Confirmation Email Sent on: ________ Payment of $________ Received on ___________
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Yuba College Application for Facility Use | 2088 North Beale Road, Marysville, CA 95901 | Telephone: (530) 741-6766 FAX: (530) 749-3867 | Rev. 9.17.15
Yuba College Theatre Technical Request Form
Internal and Community Requests
User Information:
Technical Contact (Name and Phone Number): ______________________________________________________________
E-mail: ___________________________________________
(This person will be responsible for communication the technical needs of the show and must be present on site for all contracted times. Also, adult
supervision is required for all productions that include children less than 18 years old.)
Date(s) of rehearsal: _______________________ # of people expected (directors, performers, musicians): ______________
Rehearsal begins at (am/pm): _______________ Rehearsal ends at (am/pm): ______________
Special Needs:
☐ Orchestra pit ☐ Steinway piano (Addl Charge) ☐ Choral risers ☐ Choral Shell
☐ Dressing Rooms ☐ Green Room ☐ Theatre Shop (storage) ☐ Box Office
Facility Needs:
_____#Tables _____Chairs _____Lectern _____Chalk board
Will you be selling tickets? ☐ Yes ☐ No
Will you require Box Office Cashier to sell tickets? ☐ Yes ☐ No
Will you sell refreshments at intermission? ☐ Yes ☐ No
Will you be using your own technicians (for sound and lighting)? ☐ Yes ☐ No
Lighting:
☐ I do not have any special lighting requirements and will use the house lighting (standard, no color lighting)
☐ I have some simple requirements and have attached additional information.
☐ I will require follow spots
☐ I have in depth lighting needs and will arrange meeting the Yuba College Theatre Tech to further discuss
Sound:
☐ I will require one microphone for announcements
☐ I will require ____________ mic(s) for instrument and/or vocal reinforcement
☐ I will require playback of ____CD ____MP3 Player ____Laptop/computer
Audio Visual:
☐ I do not require any equipment use
☐ I will require projection, computer and projection screen (PowerPoint files must be received at least 24 hours prior to use)
☐ I will require audio/video playback on ____DVD ____VCR ____Computer
If this form is not received twenty (20) business days prior to your event, technical support may not be provided.
Vehicles can unload in the area surrounding the theatre but must relocate to permanent parking in the east or west parking lots
(with the purchase of a daily pass) as soon as unloading occurs.
No food or beverages are allowed in the theatre auditorium or on stage
User must disclose (at time application is submitted) of any additional rental or props to be placed in or around the Yuba College
Theatre such as tent, scenic drops, tables, flower delivery, etc. If Yuba College agrees to rental, the items must be removed
immediately after event concludes or receive approval to pick it up after the event.
If you have volunteers to offset the theatre staff with ushering, box office, or parking, please have them available for a training
session prior to the event.
If the college staff is to sell tickets, please provide a list of instructions (i.e., ticket price, who to make check out to, will call ticket
pick up, etc.). Also have change ($1 and $5) available to use as base cash.
Please provide programs to the box office so the ushers can hand them to the guests when they go inside the auditorium
If reserved seating is used, please provide several copies of the seating chart for ushers to assist patrons during event.
Applicant Signature: ____________________________________________ Date: _______________________________
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Yuba College Application for Facility Use | 2088 North Beale Road, Marysville, CA 95901 | Telephone: (530) 741-6766 FAX: (530) 749-3867 | Rev. 9.17.15
STATEMENT OF INFORMATION
Community Requests Only
The Yuba Community College District makes available, under the California Civic Centers Act, use of its facilities
and grounds. Some specialized facilities are designed for instructional use only and are not available to outside
groups. According to Education Code 82537 (c), no use shall be granted in a manner that constitutes a monopoly
for the benefit of any person or organization. Furthermore, according to Education Code 82537 (d), no use shall
interfere with the required purposes of the college facilities and grounds.
Application for facility use must be received twenty (20) business days prior to event and use of facilities
is subject to availability.
A certificate of liability insurance, naming the Yuba Community College District as “Additional Insured,”
for Bodily Injury Liability Limits of at least $1 million and Property Damage Liability Limits of at least $1
million shall be in force and on file with the college 48 hours before the actual dates of use.
Cancellation must be submitted 48 hours prior to the event.
All fees assessed to an organization are due to Yuba College 30 days following the event. Please make
checks payable to Yuba College.
All facilities must be returned to the original condition in which they were rented.
No nails, screw, staples, tack, tape or other fasteners shall be used on doors, windows, or walls of the
facilities.
The district, at its discretion, shall have the right to cancel and terminate use of facilities immediately
upon discovery of any violation of the regulations, conditions, or provisions of facility use on the part of
the requesting group. Facilities shall be protected from damage and mistreatment, and precautions for
cleanliness maintained. Restrictions regarding smoking, eating, and drinking in rooms and buildings shall
be observed. The group-authorized representative assumes this responsibility. Should district property
be damaged or abused, the cost of the repair shall be paid by the group involved immediately upon
demand by the district. In this event, the district shall have the right to make an assessment for damages
and to deny any future requests by the group.
All juvenile organizations or groups must have adult sponsorship and supervision.
Possession or consumption of alcoholic beverages, drugs, or narcotics, or the possession of firearms and
weapons of any kind, are not permitted on college property.
Applicants issued an approved application shall fully comply with all ordinances, laws,
and regulations pertaining to the use and occupancy of district facility, including all fire, health, and
safety measures. No activity shall be conducted which constitutes a violation of any Federal, State, or
Local Law.
Since the college has limited availability of space for facility rental, the district reserves the right to
refuse use if the requested space is needed for any educational purpose.
All visitors to the campus must purchase a daily parking pass from 6am to 6pm, Monday through Friday.
Your signature verifies acknowledgement of policies, procedures and fees and that _________________________________
will defend, indemnify and hold harmless the District, its officers, employees and agents from any and all injuries, losses or
damage, including damage to District property, which may result from or arise in any way out of their use of the facilities,
regardless of cause.
Applicant Signature: ________________________________________________ ___ Date: ________________________
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Yuba College Application for Facility Use | 2088 North Beale Road, Marysville, CA 95901 | Telephone: (530) 741-6766 FAX: (530) 749-3867 | Rev. 9.17.15
YUBA COMMUNITY COLLEGE DISTRICT
INDEMNIFICATION AND HOLD HARMLESS AGREEMENT
Community Requests Only
Name of APPLICANT: _______________________________________________________________________________
Date of Event: _______________________________________________________________________________
APPLICANT shall be responsible for, and DISTRICT shall not be answerable or accountable in any manner for any loss or
expense by reason of any damage or injury to person or properties, or both, arising out of the acts of APPLICANT, its agents,
officers, employees, guests or invitees, or resulting from APPLICANT’s activities on the District Facilities or from any cause
whatsoever arising out of or in connection with this License or any other use or operations on the District Facilities.
APPLICANT shall indemnify and defend DISTRICT, its directors, officers, agents, employees, and invitees against and will
hold and save them and each of them harmless from any and all actions, claims, liens, damages to persons or properties,
penalties, obligations or liabilities that may be asserted or claimed by any person, firm, association, entity, corporation,
political subdivision, or other organization arising out of or in connection with APPLICANT’s activities on the District
Facilities, and any other use of and operations on the District Facilities pursuant to the APPLICANT’s use of District Facilities,
whether or not there is concurrent passive negligence on the part of DISTRICT, its agents, employees or officers, but
excluding such actions, claims, damages to persons or properties, penalties, obligations, or liabilities arising from the sole
negligence or willful misconduct of DISTRICT, and in connection therewith:
(i) Actions Filed. APPLICANT shall defend any action or actions filed in connection with any of said claims, liens,
damages, penalties, obligations or liabilities, and will pay all costs and expenses, including attorneys’ fees incurred
in connection therewith.
(ii) Judgments Rendered. APPLICANT shall promptly pay any judgments rendered against APPLICANT or DISTRICT
covering such claims, liens, damages, penalties, obligations and liabilities arising out of or in connection with such
use of and operations on the District Facilities referred to herein and agrees to save and hold DISTRICT harmless
therefrom.
(iii) Costs and Expenses; Attorneys’ Fees. In the event DISTRICT is made a party to any action or proceeding filed or
prosecuted against APPLICANT for such damages or other claims arising out of the use of and operations on the
District Facilities referred to herein. APPLICANT agrees to pay DISTRICT any and all costs and expenses incurred by
them in such action or proceeding together with reasonable attorneys’ and expert witness fees.
APPLICANT further agrees to indemnify, defend and hold harmless DISTRICT, its directors, officers and employees and each
of them from any claim or cause of action arising out of or related to the legality or legal interpretation of this License,
including, without limitation, DISTRICT’s authority to enter into this Agreement and/or authority to grant APPLICANT the
use of District Facilities.
Authorized Contracting Representative of APPLICANT:
____________________________________________
Printed Name
____________________________________________
Signature
____________________________________________
Title
____________________________________________
Date
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APPLICATION FOR FACILITY USE (Yuba College)

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Completed 15 September 2020

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