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Cutler-Orosi Joint USD |  1000 |  E  1330  Community Relations

Use Of School Facilities   

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STATEMENT OF INFORMATION

The undersigned, as duly authorized representative for , states that, to the best of his/her knowledge, the school property for use of which application is hereby made will not be used for the commission of any crime or any act which is prohibited by law.

The undersigned further declares that , the organization on whose behalf he/she is applying for the use of school property, upholds and defends the Constitutions of the United States and the State of California.

(Signed) (Date)

(organization if applicable)

Exhibit CUTLER-OROSI JOINT UNIFIED SCHOOL DISTRICT

version: April 6, 2006 Orosi, California

_________________________________________________________

CUTLER-OROSI JOINT UNIFIED SCHOOL DISTRICT

APPLICATION AND PERMIT FOR USE OF FACILITIES

APPLICANT: NAME:

(Organization, Group, Individual) (Representative)

ADDRESS OF APPLICANT: TELEPHONE:

SITE REQUESTED (Please ?) ? Cutler Elem. ? Golden Valley Elem. ? El Monte Jr.H. ? Palm Elem.

? Orosi High ? Lovell High ? Yettem High ? District Office

FACILITIES (Please ?) ? GYM ? MULTIPURPOSE ROOM ? KITCHEN ? GROUNDS ? CONFERENCE

ROOM

? LIBRARY ? CLASSROOM (S)# ? OTHER

DATES OF USE

DAY(S) OF WEEK

START TIME

STOP TIME

TOTAL HOURS

PERSON IN CHARGE

PURPOSE OF ACTIVITY:

EQUIPMENT NEEDED:

EXPECTED ATTENDANCE: WILL FOOD OF ANY KIND BE SERVED? ? YES ? NO

Applicant has received or will receive for the activities herein listed - contribution, cash collection, registration fees, admission fees, tuition, donation, or other receipts? ? YES ? NO Amount $

Receipt will be used for:

ADVISOR/ORGANIZATION WILL BE RESPONSIBLE FOR

ASSISTING IN CLEANUP AT THE END OF ACTIVITY

BY SIGNING BELOW, I REPRESENT THAT I HAVE READ AND AGREE TO ABIDE BY THE RULES AND REGULATIONS AS WELL AS THE TERMS OF AGREEMENT AS STATED ON THE BACK OF THIS FORM

In executing this declaration I certify that I have been duly authorized by the herein set forth applicant to act in its behalf in making application for use of facilities. I will provide a Certificate of Insurance as required on the reverse.

SIGNATURE OF REPRESENTATIVE/ADVISOR: DATE:

SIGNATURE OF SITE ADMINISTRATOR: DATE:

RULES AND REGULATIONS ON BACK!

TERMS: fees payable at end of month. PAYMENTS - payable to COUJSD

Failure to comply with the terms of this agreement will be cause to deny permission for future use.

*

RECOMMENDATIONS/APPROVAL DO NOT WRITE BELOW THIS LINE

*

Check "NO" on item 1 "ONLY" If District Event, school related group, or non-profit Student oriented group.

1. Use Fees: ? YES ? NO Amount $ 2. Copies sent to the following on (date):

Labor: ? YES ? NO Amount $ ? Advisor ? Site Administrator ? Site Custodian

Total Amount To be Billed Amount $ ? Food Service Director ? Custodial Supervisor

? Maintenance Supervisor ? Other

APPROVAL: DATE:

*

3. Custodial Time: Start Time: Completion Time: Total Hours Worked:

Work Completed By: Date:

APPROVAL: DATE:

1. Use of school facilities shall NOT interfere with the regular schoolwork or the activities of the school. School activities will take precedent over non-school groups.

2. The hours specified on a permit shall determine the length of time the school property may be used, and special permission must be obtained from the Permit Approver's office issuing the permit before any extension of time may be allowed.

3. Gambling, fighting, or use of profane language is not permitted on school property.

4. No alcoholic beverage may be consumed on grounds or in buildings, nor will smoking be permitted in school building. (Business and Professional Code 25608)

5. The responsible party will maintain proper order. Further permits may not be granted to groups damaging buildings or grounds, or violating these rules and regulations.

6. No part of building will be used other than that requested.

7. The user agrees to pay for damages beyond normal wear, and to pay for the loss/damage of School equipment or materials.

8. The use of scotch tape, thumbtacks, staples, or nails on any wood or painted surface is not permitted. Decorations will be removed and the premises left responsibly clean. (Special decorations shall be approved by the Superintendent or Permit Approver before setting up.)

9. No cars or trucks are to be parked on the school grounds except in parking lots.

10. All fire laws shall be observed. All decorations must be flame retardant treated.

11. No food or beverages may be served in the gymnasium.

12. Cafeteria/Kitchen use: The user agrees that a District Cafeteria staff member must be present, for which a charge will be made to cover labor expense.

13. No Tobacco or Tobacco Products may be used on District Grounds. ( BP, AR 3513.3)

14. Rooms and adjacent areas must be cleaned and be litter free.

STATEMENT OF INFORMATION AND TERMS OF AGREEMENT

1. THE UNDERSIGNED AGREES TO DEFEND, INDEMNIFY AND HOLD HARMLESS THE CUTLER-OROSI JOINT UNIFIED SCHOOL DISTRICT, ITS BOARD OF TRUSTEES, AGENTS AND EMPLOYEES, INDIVIDUALLY AND COLLECTIVELY, FROM AND AGAINST ALL COSTS, LOSSES, CLAIMS, ACTIONS, AND JUDGMENTS ARISING FROM PERSONAL INJURIES, PROPERTY DAMAGE OR OTHERWISE THAT MAY ARISE DURING OR RESULT IN ANY WAY FROM, OR BE CAUSED BY, THE UNDERSIGNED'S USE OF OCCUPANCY OF DISTRICT FACILITIES, FURNITURE OR EQUIPMENT, INCLUDING PREMISISES LIABILITY REGARDLESS OF CAUSE. THE UNDERSIGNED FURTHER AGREES TO PROVIDE A CERTIFICATE OF INSURANCE FOR LIABILITY COVERAGES SATISFACTORY TO THE DISTRICT.

2. Prior to Facility Use Permit being granted, the Applicant is required to provide a Certificate of Insurance for both property and liability insurance. The district requires a 30 day notice of any change or cancellation of any insurance coverage provided. The insurance provided herein shall be primary for all levels/groups and name the its district and its Agents/Employees as additionally insured if the use is for a level 3 group.

3. By signing this form, the Representative herby certifies that he/she will be personally responsible on behalf of the applicant for any damages sustained by the school building, furniture, equipment, or grounds occurring through the occupancy or use of said building and or grounds by the applicant, normal wear and tear excepted.

4. By signing this form, I hereby certify that I have received and read the rules, regulations, conditions and terms and that I and the applicant which I represent, will abide by them and will conform to all applicable provisions of the Constitution and laws of California and to all other rules and regulations of the Board of Education and its authorized agents which may be communicated to the applicant.

5. The undersigned states that to the best of his/her knowledge the school property for use of which application is hereby made will not be used for the commission of any act intended to further any program or movement the purpose of which is to accomplish the overthrow or the Government of the United States by force, violence or other unlawful means and that to the best of his/her knowledge it is not a communist action organization required by law to be registered with the Attorney General of the United States.

FACILITY USE SCHEDULE (Does not include labor charge)

Level 1 Level 2 Level 3 Level 1 Level 2 Level 3

OHS Gym* $0.00 $95.00 $125.00 Soccer Field/Grounds $0.00 $5.00/hr $20.00/hr

OHS Gym Locker Room* $0.00 $65.00 $105.00 Classroom (regular)* $0.00 $20.00 $30.00

Multipurpose Room* $0.00 $60.00 $100.00 Classroom (computer)* $0.00 $20.00/hr $60.00/hr

Football Field w/lights* $0.00 $125.00 $160.00 Kitchen* $0.00 $75.00 $125.00

Football Field w/no lights* $0.00 $65.00 $100.00 Baseball Field w/lights* $0.00 $40.00 $80.00

Restrooms* $0.00 $20.00 $20.00 Baseball Field w/o lights $0.00 $10.00/hr $40.00/hr

Board Rooms* $0.00 $20.00 $40.00 *Requires Labor Charges

Labor Charge have a minimum of 2 hour charge. The Labor Charge is $50.00/hr.

The rates are subject to modification by the Board of Education. The district reserves the right to waive the fees for nonprofit student oriented activities and accept in lieu of contributions for fees from groups or community organizations.

Exhibit CUTLER-OROSI JOINT UNIFIED SCHOOL DISTRICT

version: April 6, 2006 Orosi, California

_________________________________________________________

HOLD HARMLESS AND INDEMNIFICATION AGREEMENT

Notwithstanding any insurance coverage which maybe in effect, and in addition to any additional undertakings referred to herein, applicant agrees at all times to protect indemnify, and hold Cutler-Orosi Joint Unified School District, its Board of Trustees, officers, members, representatives, agents, guests, invitee, and/or employees free and harmless, and to provide legal defense, from any and all liabilities, claims, losses, judgments, damage, demands or expenses resulting from the applicants use or occupancy of the district's facilities and/or the active or passive negligence of the Applicant or of the district, its Board of Trustees, officers, members, representatives, agents, guests, invitee, and/or employees, specifically including, without limitation, any liability, claim, loss, judgment, damage, demand, or expense, arising by reason of:

1. The loss of or damage to any of the district's facilities including any building, structure, or improvement thereon, or any equipment to be used therein;

2. The injury to or death of any person including, but not limited to, the officers, members, representatives, agents, guests, invitee, and/or employees of the Applicant or of the district; or

3. Damage to any property arising from the use, possession, selection, delivery, return, condition or operation of the district's facilities.

Applicant further agrees to reimburse the district for all liabilities, claims, losses, judgments, damage, demands, expenses, fines, penalties, including reasonable attorneys' fees imposed or incurred by the district because of the Applicant's use or occupancy of the district's facilities and/or active or passive negligence of the Applicant or of the district, its Board of Trustees, officer, members, representatives, agents, guests, invitee, and/or employees.

Print Name

Signature Date

Exhibit CUTLER-OROSI JOINT UNIFIED SCHOOL DISTRICT

version: April 6, 2006 Orosi, California