Fillable Outside Application Fillable Form 000 APPLICATION FOR USE OF FACILITIES BY OUTSIDE ORGANIZATION

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Outside Application Fillable Form 000 APPLICATION FOR USE OF FACILITIES BY OUTSIDE ORGANIZATION

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Orange County Community College
Central Scheduling Office
115 South Street
Middletown, New York 10940
Phone: (845) 341-4720 Fax: (845) 341-4721
APPLICATION FOR USE
OF FACILITIES BY
OUTSIDE ORGANIZATION
Event Date: ___________
Name of Organization: __________________________________________________________
Billing Address: ________________________________________________________________
Name of Applicant: _____________________________________________________________
Name of Contact Person: ________________________________________________________
Telephone: (Day) _________________________ (Evening) _____________________________
Facility Requested: _____________________________________________________________
Title of Event: __________________________________________________________________
Day & Date(s) of Event: __________________________________________________________
Description of Event: _____________________________________________________________
Hours Requested for Facility: _______________ Actual Time of Event:_____________________
Supervisor of Event: _______________________Sponsor of Event: _______________________
Approximate Attendance: __________ Special Needs? _________________________________
(If you need any special set up, please include a floor plan.)
Will event be open to the general public? ______ (Y/N) Admission cost? $_________________
If admission is charged, how will the proceeds be used? ________________________________
Will you be using food services? ________ (Y/N) If Yes, contact Bob Glohs, Food Service Manager at (845)
341-4862, prior to submitting application. Our Food Service Department has first refusal of service
rights.
Who is your Insurance Agent? ______________________________________________________
Please provide a certificate of your insurance coverage which lists Orange County Community College
as an additional insured. Our requirements are for a general liability of three million dollars. This
certificate of insurance is essential to complete this application.
In case of any illness and/or injury to any participant, please notify the Safety/Security office by calling
(845) 341-4710 and/or the campus nurse at (845) 341-4870.
All advertisements, promotions, and/or publications regarding this event must be approved by Vincent
Cazzetta, Vice President of Institutional Advancement, (845) 341-4726.
Your group will accept full responsibility for ticket sales/distribution, and publicity.
Please read policy statements on the reverse side and sign the application before returning it to the
Central Scheduling Office. Application must be submitted at least thirty (30) working days before the
event. If the form is not completed properly, (i.e. special needs not listed), your reservation may be
affected.
Note: Maintanance fees may be applied if clean up is required and not paid for in advance
Page 1 of 3
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Board of Trustees Smoking Policy
Orange County Community College is a smoke free campus, therefore, smoking is prohibited in all
campus buildings. The no smoking policy applies to all instructional classrooms, hallways, doorways,
lobbies, restrooms, locker rooms, offices, conference rooms, equipment rooms, meeting rooms,
auditoriums, lounges and the cafeteria.
____________________________________________________________________________
Alcohol and Food Policy
No alcohol is permitted on campus without a certificate of approval from the President. Food and
Alcohol services can only be provided by the Orange County Community College. This includes the
sale of chips, soda, and the dispensing of alcohol.
Cost Estimate
If there is a cost associated with your event, you will receive a written estimate prior to the date of your
event and an actual invoice with charges incurred after the event.
Upon signing this application, I verify that my organization accepts the cost estimate. I understand this
is an estimate only and my organization is responsible for any unanticipated costs. I have read and will
abide by the College Board of Trustees policy statement and accept full responsibility for any damage
done to college facilities and equipment. Confirmation for use of Orange County Community College
facilities will be forwarded upon FULL completion of application. I understand that the college can
revoke permission for use of facilities at any time and that the deposit is non-refundable in cases of
cancellation.
_________________________________ _________________________________
Name of Applicant (please print) Signature of Applicant
Date: ___________________________
Page 2 of 3
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Page 3 of 3
ORANGE COUNTY COMMUNITY COLLEGE
Room Reservation Procedures
Thank you for choosing Orange County Community College for your event.
To use the college facilities, follow these steps:
1. Contact the Central Scheduling Office at (845) 341-4720.
2. Complete the APPLICATION FOR USE OF FACILITIES BY OUTSIDE ORGANIZATIONS.
a. Be sure to list special needs
, such as scoreboard operator for athletic events, lighting
technician for stage events, or slide projector, etc. This includes the setting up of tables and
chairs.
b. Insurance Certificates for Use of Facilities
Each request by an outside organization for use of Orange County Community College
facilities must provide an original certificate of insurance for $3 million naming the College
as an additionally insured.
Insurance certificates with ALL of the following information will be accepted:
o An original copy from a recognized, state approved vendor. No photocopies
or blanket coverage is accepted.
o The certificate must clearly state name of event, the specific activities to take
place, campus location, and hours of event, including set up and clean up
time.
o The certificate must be for three ($3) million dollars
and the college named as
an additionally insured.
3. Sign
and return the formal written application to:
Orange County Community College
Central Scheduling Office
115 South Street
Middletown, New York 10940
Once your Application is approved:
o You will receive a telephone call to confirm your use of facilities.
o The Central Scheduling Office and/or Building Supervisor or College Representative is your
liaison for the event.
o After the facility application is processed, a cost estimate
will be provided based on the
information specified on the application submitted.
o The College will bill you after the event based on actual costs incurred, minus the 30% deposit
previously made.
o Any additional requests regarding the set up of your event made within te
n (10) days of the
event date will be included in the in
voice for the use of facilities.
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Outside Application Fillable Form 000 APPLICATION FOR USE OF FACILITIES BY OUTSIDE ORGANIZATION

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Completed 12 February 2020

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