Fillable Riverside Community College District (Norco College)

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Riverside Community College District (Norco College)

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Will admission fees, contributions or membership dues be collected?
Riverside Community College District
Facilities Utilization Office
Riverside City College Norco College Moreno Valley College
4800 Magnolia Ave. 2001 Third Street 16130 Lasselle Street
Riverside, CA 92506-1299 Norco, CA 92860-2600 Moreno Valley, CA 92551-2045
(951)222-8498 (951)372-7158 (951)571-6351
REQUEST FOR USE OF COLLEGE FACILITIES
Facility Requested
Date(s) of Use
Time(s) Facility
Must Be Opened
Actual Time of
Event
Actual Time
Event Ends
Time(s) Facility
Must Be Closed
Description of
Activity
(Attach if needed)
Yes No
Anticipated Attendance
Please Note:
1. APPROVAL IS NOT GRANTED UNTIL SIGNED COPY STAMPED
'APPROVED' IS RETURNED TO THE REQUESTOR.
2. Please submit this form at least 2 weeks prior to event,
changes accepted until 7 days prior to event.
3.Cancellation must be made 48 hrs prior to event to
avoid penalties.
4. Deposit due five days prior to use. (Prices subject
to change each year.)
Name of Requestor
Representative Name
and Title
Mailing Address
City, State & Zip
Phone Number E-Mail Address
Equipment/ Setup Requested (Include number of all pertinent items)
REQUEST WILL NOT BE ACCEPTED WITHOUT SETUP DETAIL
# Of Chairs # Of Tables Lectern/ Podium
Setup Description
(Attach if needed)
The above signed is subject to all the conditions and fees set forth by Administrative Procedure (AP) 6700 governing the use of
Riverside Community College District Facilities and to any special conditions stated below:
2011-01-07
Please fill out all fields before submitting. Incomplete requests will not be processed.
Department
INTERNAL USE ONLY (Signature does not indicate event approval )
Facilities
Date
Date
Parking Spaces
Signed By
11/23/2010 Ver 1.1
RIVERSIDE COMMUNITY COLLEGE DISTRICT
ADDENDUM TO REQUEST FOR USE OF COLLEGE FACILITIES
HOLD HARMLESS AGREEMENT & INSURANCE REQUIREMENTS
FOR USE OF COLLEGE FACILITIES
1. User hereby agrees to indemnify, defend, and hold harmless the District and its officers,
employees, students and agents, individually and collectively, from and against all losses,
damages, claims, liabilities, expenses, costs, obligations and causes of action, of whatever
kind, arising in any manner whatsoever, out of, or in connection with, the use of District
facilities, identified in the Request for Use of College Facilities, for the active negligence and
willful acts or omissions of User’s Trustees, officers, vendors, sub-contractors, agents and
employees.
2. User’s obligation to indemnify, defend and hold harmless as noted above shall continue
notwithstanding the expiration or revocation of the permission to use the District’s facilities.
3. User shall secure and maintain during the duration of this permission to use the District’s
facilities, public liability and property damage insurance to protect it from claims for damages
for personal injury, including death, as well as from property damage which may arise from or
which may be alleged to arise from the permission granted by the District. Such insurance
shall be in the minimum amount of $1,000,000 per incident and $2,000,000 aggregate.
Insurance requirements may be met by a program of self-insurance, through a policy(ies) of
insurance with an AM Best rated insurance company with an A+ rating, coverage through a
Joint Powers Authority, or any combination thereof.
User shall supply District with a Certificate of Insurance covering the entire time that User will
be using District facilities, evidencing the required coverage and naming “Riverside
Community College District” as an additional insured.
4. The insurance required shall not be a limitation on User’s agreement to indemnify,
defend and hold the District harmless and if the District becomes liable for an amount in
excess of the insurance, User will indemnify and hold the District harmless for the entire
amount in excess of the insurance.
This Addendum is incorporated into the REQUEST FOR USE OF COLLEGE FACILITIES signed by
the User.
Organization Name ______________________________________________________________
Printed Name & Title of Authorized Person: ___________________________________________
Signature of Authorized Person ______________________________________
Date Signed: _____________________________
Rev March 2015
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Riverside Community College District (Norco College)

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Completed 2 February 2021

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