GARDEN GROVE UNIFIED SCHOOL DISTRICT (2)

Home Browse Search

INSURANCE NOT REQUIRED S WORK MAY PROCEED GARDEN GROVE UNIFIED SCHOOL DISTRICT 10331 Stanford Avenue, Garden Grove, California 92840 CLERK OF THE COUNCIL APPLICATION AND AGREEMENT USE OF SCHOOL FACILITIES N-2022-249 D/ATE'p:A 0: 3�pKY1(TiM��tP) 4M> ALL PERMITS ARE SUBJECT TO SCHOOL SCHEDULE m l 1 ATTEST: DATE: 08/03/22 Liability Insurance Certificate required in the amount G of $1,000,000.00 naming Garden Grove Unified School cd District as additionally insured with endorsement and as Certificate Holder. ML, Must show Certificate Holder's address as listed above. O INSURANCE CERTIFICATE EXPIRES: Vo SCHOOL REQUESTED Rosita Elementary School V DATES OF USE: 10/01 /22 TO 10/01 /22 HOURS OF USE: uo CLERK OF • CITY OF 3:00 pm TO: 10:00 pm TYPE OF FACILITY REQUESTED: North & East side parking lots ROOM NUMBERS: NA SPECIAL SET-UPS: none PROPOSED USE: extra parking ATTENDANCE 100 CHARGES: Please note: If custodial time reports received in the Community Services Office reflect additional use time over the hours of use noted above, you will be billed for the additional coverage on a separate invoice. Payment for estimated charges is due 10 days in advance of event. Estimated costs: $a Comments: ORGANIZATION: NAME OF ORGANIZATION City of Santa Ana AUTHORIZED OFFICER OR AGENT Kristine Ridge ADDRESS 20 Civic Center Plaza E-MAIL kridge@santa-ana.org TELEPHONE (714) 647-5222 CITY Santa Ana ZIP CODE 92702 FACILITIES USER'S DUTY TO INSPECT, WARN AND RECTIFY: Facilities User agrees that the District makes no representations or warranties as to the condition of the facilities which the User is using and the User agrees to take such property and facilities "AS IS." Facilities User agrees to be responsible for determining that the facilities are in proper and safe condition to be used for the purpose anticipated; Facilities User agrees to inspect such property before they are used and to take affirmative steps where necessary to wam users or rectify hazards in order to prevent injury to property and persons. User agrees to refuse the use of the property if unsatisfactory conditions we not rectified prior to scheduled use. The applicant hereby agrees, in accordance with California Education Code, Title 1, Part 23, Chapter 4, Article 2, 38134 (i), to hold the Garden Grove Unified School District, the Board of Education, individual members thereof, and all district employees free and harmless from any loss, damage, cost, claims, actions/judgments, or expense, regardless of cause, which may arise during or because of such use or occupancy of the school property, facilities, furniture or equipment. The applicant furthermore certifiesthat the organization shall be personally responsible for any damage or unnecessary abuse of school buildings, grounds, or equipment while occupied by the organization. The organization agrees to abide by and enforce all rules and regulations of the Garden Grove Unified School District governing the non -school use of buildings, grounds, and equipment. Furthermore, the undersigned states that, to the best of his or 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 that is prohibited by law. The undersigned further declares that the applicant 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. This statement is made under penalty of perjury. All applicants are encouraged to preview the District facility prior to reserving to determine appropriateness for the intended activity. The Board of Education reserves the right to terminate any facility use permits upon written notice by the Board, or its designated representative, to the person, organization, or group in whose name the facility use permit is issued. I have read and understand regulations stated above. Signature of Croup Representative Date Approved by 9702.100* (OHS Revised 01/13) District Office Use Only Date