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HUNTINGTON BEACH CITY SCHOOL. DISTRICT <br />8750 Dorsett Dr., Huntington Pleacn, CA 92545 (714) 904.886e <br />CARD of Ttu$TEFS <br />To: <br />Applicadts for it HBCSD Facility Use Permit _...— <br />Shari X0wRlke <br />Nuldent <br />From: <br />Administrative Services Department <br />Ann Sullivan <br />U, <br />F'AC7LXTY USE 13ERMITS IND.ENMFICATION AND INSURANCE <br />vloo President <br />REQUIREMENT LANGUAGE <br />'9ridget Raub <br />Clark <br />Tlrank <br />you fax applying for a facility use permit with the Huntington Beach City School <br />District. Please submit the required insuranca documents as Indicated below, <br />Paul Marrow, Cd.D, <br />Member <br />1, <br />A two-tlafe Cerlj<ierlte of Igatrrance_L(L0jJ for your organization, The <br />Diana Marks <br />certificate must: <br />Metnbor <br />+ Show at least $2,000,000/occurrence of general liability insurance. <br />AQUU2Z116MIf <br />• Name as CERTIFICATE HOI,DIEFI; <br />OregoryHaulk <br />Superintendent <br />ont <br />Huntington Beach. CitySchool District <br />8750 Dorsett Drive <br />lonn for Shepard <br />Huntington Beach, CA 92646 <br />Assistant Superintendent <br />Educational Services <br />• Naine I•T.tuitington Beach City School District as ddit naI i sty •by <br />P¢trici¢ I•lagor <br />written 011d.ogiamm<i to the policy. This will require a 2"a page - naming <br />Altai®tantSttparintandaut <br />1IBCSD on the COI iYsei,f, j&vf&Flit, <br />Raman >resourcrs <br />You M, Archibald <br />• Ensure the policy period covers the entire period for which you. are roquesting <br />Assistant Superinterident <br />use. <br />Administrative Services <br />+ insurance policy rnustverify that sewual,abuse and molesjatipnare not <br />o ded and must Have coverage at a minihnutn of $I,000,Q001ocourrerxce dud <br />a $2,000,000/aggregate uador the general liability policy. This must be shown. <br />as a covered exposure on the Certificate of insurance, <br />+ NOTE; I ims made policies are NOT accented in NBCSDI, <br />+ If you must purchase sexaal abuse and molestation coverage through another <br />insurance carrier, a separate Cerftijttal oflInsurance rind additional <br />Insured written a dorsement as described above must be providad, <br />2, <br />Commercial vendors must provide proof of workers'oompensationcoverage. <br />3. <br />'Food Vendors must also provide automobile liability insurance in addition to the <br />general liability insurance, naming the FJBCSD as additional insured per the above, <br />An Orange County Health Permit must be on display while on opt' eampuses, <br />4. <br />Nan -profit organizations trust provide proof of your organization's non-profit <br />status, i,o., letter from the IRS, letter from, the State of Callfornia Board of <br />Equalization, oto• <br />"We Are An Equal Opportunity Prnployer" <br />