ࡱ> Z\Y .bjbjcTcT .F>>Z&v 8=YD3(a3c3c3c3c3c3c3|58jc3P@c3x3   pa3 a3  q1%3@n`2M330328Z8(%38%3( c3c3 38 :   Pioneers of the Past Pioneers of the Future 250 N. Main Street Ph. (541) 839-4258 PO Box 765 Fax (541) 839-4680 Canyonville, OR 97417 e-mail  HYPERLINK "mailto:city@cityofcanyonville.com" city@cityofcanyonville.com APPLICATION FOR PARK AND/OR COMMUNITY FACILITIES RESERVATION AND USE PRINT NAME OF PERSON (S) OR GROUP____________________________________________________________ MAILING ADDRESS_______________________________________________________________________________ PHONE NUMBER____________________________NUMBER OF PARTICIPANTS___________(See below for 100 or more) for the __________________day(s) of ____________________, 20_____, commencing at __________________AM/PM and ending at _____________________ AM/PM. Please be sure to rent the park an additional day if you will need it to clean. The undersigned shall not use or permit the same to be used for any other purpose than the following activities: __________________________________________________________________________________________________ I/We wish to reserve the following City of Canyonville owned facilities (NOTE Reservations are not secured UNTIL confirmed by the City when all fees and/or deposits, applications, and/or insurance is received. THE RENTER IS RESPONSIBLE FOR PICKING UP THE KEYS FROM CITY HALL NO LATER THAN 5:00 P.M. ON FRIDAY BEFORE THE EVENT. PLEASE ALSO NOTE CITY HALL CLOSURES ON HOLIDAYS. THE CITY WILL NOT BE AVAILABLE TO PROVIDE KEYS IN THE EVENT THAT YOU DO NOT PICK THEM UP DURING REGULAR BUSINESS HOURS: PIONEER PARK: (Governed by General Park Conditions of Use) Public Restroom Facilities (More than 100 participants require the organizer to provide their own additional paper towels, soap and toilet paper for the public restrooms.) Grass Only Pavilion (See Exhibit D) Pavilion Only Electrical Outlet Water Faucet Stage Facility (See Exhibit A) Stage Front NOTE: THERE ARE NO ELECTRICAL OUTLETS ON THE STAGE FRONT IF YOU WILL NEED ELECTIRCITY YOU WILL HAVE TO RENT THE BACK STAGE AND CHECK BELOW ALSO. Back Stage Dressing Room Back Stage Restroom Facilities Portable P/A System (Separate Accommodations MUST be made with ______________________________________________________) Stage Lighting Equipment (Separate Accommodations MUST be made with _________________________________________________) All Stage Facilities & Equipment (Separate Accommodations MUST be made with ____________________________________________) Main P/A and Stage Lighting System (Separate Accommodations MUST be made with ________________________________________) Firemans Booth (See Exhibit B) Booth Only Kitchen, refrigerator and/or freezer. Grill and/or Ovens (Separate Accommodations MUST be made with _________________________________________) All Booth Facilities (Separate Accommodations MUST be made with __________________________________________________) COUNCIL ROOM: (See Exhibit C) Council Room Only Tables Chairs P/A Speaker System Overhead projector Dry Erase Boards TV/VCR combo Public Restroom Facilities Check if any of the following apply: Sale of Food Sale of Other Merchandise Public Consumption of Alcohol (See Exhibit E.) This does not apply to a champagne toast by only the bride and groom of a wedding party nor to the reasonable consumption of alcoholic beverages by family members and/or their guests at a strictly private function. Public will be invited Motorized Conveyance(s) will be used Live Animal(s) will be used If any of the above are checked, proof of liability insurance covering the event is required. The commercial general liability insurance policy MUST include the City of Canyonville as additional insured on the coverage. Coverage shall not be less than $1,000,000 combined limit per occurrence, for bodily injury, or property damage.  The City of Canyonville shall deliver the premises herein reserved in a good, neat, and clean condition and the undersigned shall not permit any alteration or undue wear or deterioration upon the same. The undersigned shall return said premises to the City of Canyonville in a good, neat, and clean condition, reasonable wear thereof excepted. Failure to do so will result in cleaning by the City of Canyonville at the rate of _____ per man-hour for which the reserving party shall be liable. (Minimum charge for such cleaning shall be ______). The clean-up deposit will be returned to the user if the clean-up meets the standards set by the City. The City shall not be responsible for any loss or damage whatsoever of any kind to the undersigned, or its invitees, upon the premises herein reserved, and the undersigned shall save and hold harmless the City of Canyonville from any loss or liability whatsoever arising out of the use of such premises except to the extent such claims or damages are caused by negligence on the part of City. Applicant understands and agrees that insurance carried by the City DOES NOT PROTECT THE FACILITY USER except in cases of CITY negligence, and City insurance will deny liability in any other case. Should suit, action or other proceedings be brought to enforce any of the terms and provisions hereof, the City, may recover, in addition to costs and disbursements provided by statute, such additional sum as the Court shall deem a reasonable attorneys fee. Applicant agrees to pay in advance any fees or deposits required by City in accordance with its schedule of fees in effect as of the date of this application, and to ensure compliance with all the following General Park Conditions of Use (See Attached Exhibits Regulating Each Facility Separately): 1. NO OPEN FIRES WITHOUT A PERMIT FROM THE FIRE DEPARTMENT 2. NO DRIVING OR PARKING ON GRASS AREAS WITHOUT CITY STAFF APPROVAL 3. ALL DOGS MUST BE ON LEASH OF NO MORE THAN 10 FEET UNLESS THEY ARE CARRIED 4. ALL DOGS MUST BE CLEANED UP AFTER BY THEIR OWNERS 5. NO ALCOHOL SALES PERMITTED 6. NO OVERNIGHT CAMPING EXCEPT ON THE STREET (Exception: during Pioneer Days the gravel pit area can be used if OKd by ODOT). 7. NO SELLING OF MERCHANDISE IS ALLOWED WITHOUT SPECIAL EVENT STATUS AND PROPER BUSINESS LICENSE 8. NO OPERATION OF THE STAGE MAIN P/A AND/OR LIGHTING SYSTEM OR THE GAS GRILL IN THE CONCESSION BOOTH EXCEPT BY AN ASSIGNED, TRAINED INDIVIDUAL. Signature of Applicant__________________________________________________________Date__________________ Applicant certifies he has the authority, either personally or as the authorized agent of the organization, to sign this application and the attached indemnification agreement.  OFFICE USE ONLY DEPOSIT_________________RECEIPT #___________________Form of Insurance Received______________________________________________________________ DATE STAMP_________________ CITY OF CANYONVILLE HOLD HARMLESS AGREEMENT I____________________________________________, acting in my capacity as ___________________________of___________________________________________ Title Organization agree to indemnify and hold harmless the City, its agents, employees, or any other person against loss or expense, including attorneys fees, by the reason of bodily injury, property damage or personal injury arising of the negligence of myself, my employees, or my organization. This agreement applies to my own or my organizations use of City equipment or facilities or another loss or obligation which, I or my organization may incur by reason of use of such equipment or facilities. It is further understood that I shall, at the option of the City, defend with appropriate legal counsel and bear all costs and expenses, including expenses of counsel, in defense of any suit arising hereunder. I certify that I have authority to execute this agreement on behalf of the indicated organization. ________________________________________________________________________ Signed _____________________________ Date _______________________________________________________________________________________ _______________________________________________________________________________________ Mailing address ________________________________________________________________________ Phone#  Pioneers of the Past Pioneers of the Future 250 N. Main Street Ph. (541) 839-4258 PO Box 765 Fax (541) 839-4680 Canyonville, OR 97417 e-mail  HYPERLINK "mailto:city@cityofcanyonville.com" city@cityofcanyonville.com GENERAL FACT SHEET ON USE OF CITY FACILITIES In all cases where organizations or individuals are reserving a facility owned and operated by the City, the following general rules will apply: 1. All organizations regardless of purpose must pay required refundable deposits, if applicable. 2. All organizations must obtain the required commercial general liability insurance and include the City as additional insured (coverage shall not be less than $1,000,000 combined limit per occurrence, for bodily injury or property damage) if any of the following apply: Sale of Food Sale of Other Merchandise Public Consumption of Alcohol. This does not apply to a champagne toast by only the bride and groom of a wedding party. Public will be invited Motorized Conveyance(s) will be used Live Animal(s) will be used 3. If multiple organizations are involved each organization must meet the requirements. 4. All organizations must complete the Park and/or Community Facilities Reservation and Use form and abide by its terms and of its attached exhibits where applicable. No exceptions will be made to these policies except upon Council approval at a regular meeting.     Winword park application for park and-or community facilities reservation and use.dot updated 6-4-07 D  B C D ^ _ ` rtf\ YZ[$%c[!̫̘̽}}sjjhI5CJ\jhICJUhI5CJ\ hICJ hICJ hICJ hICJhI0J5OJQJ\#jhI5OJQJU\jhI5OJQJU\hI5OJQJ\ hICJhI$jhI5CJU\mHnHu hICJ hICJ('D`   e f t[ & F$a$$a$$d &d N P $$d &d N P a$[fq| H# & Fh`h & Fh`h & F#4A\] Y[56c/d b ` 0^`0 & Fh^h & Fb [! """ """""""""""""G#H####%%c&$a$ 0^`0[! 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