Rancho Santiago Community College District (23)

Home Browse Search

N-2020-081 APPLICATION/PERMIT FOR USE OF DISTRICT FACILITIES Santa Ana College INSL'P.r'.7;C" ON FILE 1530 W. 17th Street Santa Ana, CA 92706 (714)564-6227 1 City of Santa Ana (Name of Organization, Group, Etc.) a 2. Address 20 Civic Center Drive -o Fax #: WORT' ,.'pD UNTIL °IRES CLERK OF COUNCIL DATE: Return ORIGINAL executed copy to COTC, M-30 -- is FLl\CHU �:1\ Diarkt Date • Application / represented officially by Santa Ana Police Department city Santa Ana ame of owner, producer, etc. MUST BE PRESENT FOR ENTIRE EVENT) Zip 92702 Telephone# 7/r/-6'V7-,S-316' E-Mail Address: 6fQWA02A SM)f—A-AAIA, 024 1 Hereby requests the use of the following facilities subject to the rules and regulations on reverse side and N N the attached insurance requirements (exhibit a), which are made part of conditions under which permission 4= will be granted. The district reserves the right to cancel this permit upon 24-hour notice Room Date(s) Begin Time End Time See attached for full details 3. Type of Activity (banquet, meeting, forum, etc.) Food Drive Est. Attendance Admission Fees $ O Tax Exempt ID No. Net Proceeds will be used for (be specific): not applicable 4. Set -Up Required (auditorium, tables, etc.): See attached - handled by Santa Ana Police Department 5. District Safety/Security Protection Required (.t.ppk.o .e„,.nee) Yes X No FACILITY USER agrees that the District makes no representations or warranties as to the condition of the facilities that the FACILITY USER is entitled to use, and FACILITY USER agrees to take such property and facilities "AS IS." FACILITY USER acknowledges that it shall be FACILITY USER's responsibility and obligation to assure that the property and facilities are in proper and safe condition to be used for the purpose anticipated. The City/Applicant shall Indemnify and hold harmless The District, its officers, agents, employees, members or representatives from and against damages, liabilities, losses, costs, and expenses, including reasonable attorney fees, to the property or persons (user's agents, employees, representatives, guests and invitees included) that may arise from use or occupancy of school property, which arise out of the City's use or occupancy of school property under this agreement. except where caused by the active negligence, sole negligence, or willful misconduct of the District. I do hereby certify that the information stated in the foregoing application is true, that I have read the rules and regulations on the reverse side of this application. I do further certify that the organization on whose behalf I am making application for use of school property does not, to the best of my knowledge, advocate the overthrow of the Government of the United States or the State of California by force, violence or other unlawful means. This statement is made under the penalties of perjury. In executing this declaration, I certify that I have been duly authorized by the herein set forth applicant/organization to act in its behalf in making application for use of said facilities. L�,(�2juJ� SIGNATURE See attached DATE ..................................................................DO NOT WRITE BELOW THIS LINE ................................................................................... TERMS: 50% of fee payable with application, balances due FEES: seven working days prior to use. PAYMENTS: Payable to Facility $_(approximate) Rancho Santiago Community College District. Failure to comply with the terms will be cause to deny permission. Department Representative District Representative _ Permit for use: Granted Denied Date: Custodial $ _ (approximate) Safety Officer $ (approximate) Miscellaneous $ Deposit $ _ BALANCE DUE $ Revised 3/16/17