Fillable Contribution Program Application 8 5 2019 2012 BC Option 1 front

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Contribution Program Application 8 5 2019 2012 BC Option 1 front

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Costa Mesa Sanitary District
...an Independent Special District
Board of
Directors
James Fer
ryman
Robert Ooten
Arlene Schafer
Mike
Scheaf
er
Arthur
P
er
ry
Staff
Scott C.
Carr
oll
General
Manager
Robin B.
Hamers
District Engineer
Alan R.
Burns
District
Counsel
Marcus D.
Davis
District T
reasur
er
www
.cmsdca.gov
District of Distinction
2009-2019
290 Paularino Ave. / Costa Mesa, CA 92626 • (949) 645-8400 /
fax:
(714) 540-1392
Protecting our community’s health and the environment by providing solid waste and wastewater collection services.
CMSD Contribution Program
(Adopted by Board action on November 20, 2014)
Overview
The Costa Mesa Sanitary District (CMSD) is committed to contributing to special events that will benefit the
entire community and the District. CMSD will review requests for contributions on a case-by-case basis, but
higher emphasis is placed on events that benefit the District’s purposes, especially those that promote schools,
education, youth programs, and protection of the environment. To be eligible for a contribution, the
contribution must further the District’s statutory purposes of solid waste collection, recycling, source
reduction, or wastewater collection. When submitting a request, please consider answering the following
questions:
1. How will CMSD’s contribution to your event benefit and serve the statutory purposes of solid waste
collection, recycling, source reduction, or wastewater collection? For example, a request that meets
CMSD’s criteria would help promote one or more of CMSD’s solid waste or wastewater programs,
such as organics recycling, hazardous waste collection, sharps/medication disposal, grease recycling,
large item collection, sewer lateral maintenance, sewer spill prevention, etc.
2. How will a contribution to your event advance CMSD’s purposes? Examples include allowing CMSD
staff to host a community booth at the event or allowing CMSD to disseminate messaging to promote
its solid waste or wastewater programs through various media (such as event programs, flyers,
signage/banners, social media posts, advertisements, etc.).
Mobile Generator Rentals
If your event needs alternative power, CMSD will consider loaning one or more of its mobile generators in lieu
of a monetary contribution for your event, provided the criteria of this program are met. Generators available
are 45 horsepower, 60 hertz, 208/240/416/480 voltage with a 3-Position selector switch.
If approved to receive one or more CMSD mobile generators, you will be required to perform at least one of
the following activities at your event or a similar activity that satisfies the criteria of this program:
• Prominently display signs at your event that encourage recycling. Developing signs will be at your own
expense and signs must be approved by CMSD.
• Make recycling cans available to encourage people to discard recyclable items.
• Advertise a CMSD program in your pamphlet, flyer, and/or event program.
• Advertise a CMSD program on your event website and/or any other social media page.
• Allow a CMSD booth to be present at your event for CMSD staff to disseminate information about
CMSD programs.
To submit a request to CMSD to be a contributor for your event, please complete the attached application and
submit it to District staff at least ten days prior to the CMSD regular Board of Directors meeting that precedes
your event date. All requests must be considered and approved by the Board of Directors prior to the event
date.
Applications may be submitted by fax, e-mail, mail or in-person. Applicants will be contacted and provided
information as to when the Board of Directors will review their applications. Applicants are encouraged (but
not required) to attend the Board meeting.
Note: CMSD will not contribute to events that are politically oriented or discriminatory towards or
against a specific public opinion, group or person, nor will it contribute to a commercial or for-profit
entity. Only non-profit entities and other government entities will be considered for the Contribution
Program.
1
CMSD Contribution
Program Application
290 Paularino Avenue, Costa Mesa, CA 92626 • (949) 645-8400 •
fax:
(714) 540-1392 • www.cmsdca.gov
EVENT INFORMATION & HISTORY
Event Name:
Contact Name:
Contact Phone:
Contact Email:
Has your organization
previously received a CMSD
contribution for this event?
YES NO
Has your organization
previously been denied a CMSD
contribution for this event?
YES NO
If yes, what was the date of the last event contribution by CMSD? If yes, please list the reason(s) your request was denied.
For monetary contributions, please state your requested amount:
$____________
How many attendees are expected at the event?
____________
How will this contribution benefit, serve, and advance CMSD’s statutory purposes of solid waste collection, recycling, source reduction,
or wastewater collection?
Note: Examples of eligible requests are provided on Page 1. General publicity, logo display, event tickets, and certificates of appreciation are not
considered an advancement of CMSD’s purposes. Please contact CMSD staff if you need assistance with meeting these criteria.
Are you requesting to use CMSD generators at your event?
YES NO
If yes, how many?
________ Generators
Please attach any additional information about the event, including schedules, programs, past
attendance data, and/or sponsorship forms.
2
Generator Use Agreement
Requirements & Procedures
290 Paularino Avenue, Costa Mesa, CA 92626 • (949) 645-8400 •
fax:
(714) 540-1392 • www.cmsdca.gov
Requirements and Procedures
•
Contact CMSD staff to make sure the generators are compatible to your event’s needs.
•
omply with all of the operations
requirements for the equipment.
•
The applicant will use the generator for the purpose for which it was designed and not for any other purpose.
•
Unless the applicant obtains prior written consent from CMSD, the applicant will not alter, modify, or attach anything
to the generator unless the alteration, modification, or attachment allows for safe operations and is easily removable
without damaging the functional capabilities or value of the equipment.
•
Applicant will keep the generator in good appearance and operating condition when it is returned to CMSD. If the
applicant causes damage to the generator, then the applicant will reimburse CMSD for the actual expense of said
repair.
•
Applicant agrees to procure and maintain (at its own expense) insurance for any and all damage to or loss of the rented
generator and any accessories or related equipment whether caused by fire, theft, flood, vandalism, or any other cause,
except that which shall be determined to have been caused by fault or deficiency of the generator.
•
Applicant will be responsible for towing the generator to and from the event, at its own expense.
•
Before towing the generator to the event, applicant will walk around the generator with CMSD staff to locate visible
exterior damages to the equipment. Applicant will not be responsible for existing damages.
•
Before towing the generator, CMSD staff will demonstrate the operations of the equipment to the applicant and will
run the equipment to determine that it is in good operations. Applicant will not tow generators that are operating in
bad condition.
•
Applicant and CMSD staff will check the fuel level before generator is towed to event.
•
Applicant agrees to indemnify and hold harmless CMSD and its officers, employees, and agents from any and all claims,
liabilities, and damages caused by the use of the generator, including, but not limited to, during transportation to and
from the site, save and except that caused by CMSD’s sole active negligence or the condition of the generator at the
time it is provided to applicant.
•
Applicant shall provide CMSD an endorsement showing CMSD as an additional insured on the general liability policy or
similar proof of additional insured status as the General Manager may accept in his/her discretion.
Check at least one activity below that you will perform at your event in exchange for renting CMSD generator(s).
CHECK AT LEAST ONE REQUIREMENT
Displaying signs that encourage recycling.
Making recycling cans available to encourage people to discard recyclable items.
Advertising a CMSD program in the event pamphlet, flyer, and/or event program.
Advertising a CMSD program on the event’s website and /or any other social media page.
Allowing a CMSD booth to be present at the event, where CMSD staff can disseminate information about CMSD
programs.
Other. Please explain:
3
CMSD Contribution Program
Eligibility Application
290 Paularino Avenue, Costa Mesa, CA 92626 • (949) 645-8400 •
fax:
(714) 540-1392 • www.cmsdca.gov
The section below is only required for Mobile Generator Use:
I have thoroughly read Page 3 of this application and understand the requirements and procedures for using CMSD
generator(s) in exchange for CMSD contributing to the event. I agree to abide by all requirements and will follow the
procedures.
By signing below, each party represents and warrants that they have the authority to sign on behalf of the organization
represented.
APPLICANT CMSD
______________________________ ______________________________
Name of Organization General Manager Signature
______________________________ ______________________________
Applicant Name Date
______________________________
Applicant Signature
______________________________
Date
SUBMIT COMPLETED APPLICATION TO:
Costa Mesa Sanitary District
Attention: District Clerk
290 Paularino Avenue
Costa Mesa, CA 92626
or
Fax: (714) 540-1392
Email: nmiddenway@cmsdca.gov
4
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Contribution Program Application 8 5 2019 2012 BC Option 1 front

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Completed 12 July 2020

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