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09/07/00 10:41 FAX 541 682 6386 Campbell Center l~ol -To : ~ O~^, , t , 1 CIT1I OP EUGENE - RECREATION FACILITY RENTAL APPLICATION ~ ~ y g8 Z (r ~J 6ERV~CE3 Vame of Applicant /Responsible Parry: ~ t N 4ddress: G'S~v! " ~ G1i'l~,~ ~.CtY/1~ Home Phone: ~ity/StateTLip Code: ~ N ~ L ~ Work Phone: - e ~ ~ell# : Fax: - e?lternate Contact Person: ~ a4 ~~J~ Daytime Phvne: -~r~1C~ % _ name of Organization if Applicable ~'l - ~-1~1'q~lt ~.J ;~~p Zental: Private ii i Affiliated Community Partner Other. ` ?aciliry name~~Y'fl ~ ~ I ~ h l~ Dates requested 1 Q - OO ~ ~ ~ of activity ~GClyiulr~ie ~~6i7Z% P.~ t-C l~(,~-~G-fZJ,r~ Time of event-. - ~ open to the public? t 3 (including set-up and c can-up) expected Attendance- Adults `'S b Youth Will beer or wine be served? Yes To U Total Attendance: (no hard liquor is permitted) mill sales/tnoney transfers take plate on the premises? Time alcohol served I~+pe of sales (LimitEd to tht~ hours) good served will be: (Circle one) home preparrd potluck pro-packaged/commerarial catered 8001111~ACE AMO EQUIPMENT NFFDS: Main I-iall/Gymnasium Kitchen Number of Tables _~Vieeting Room umber of chairs ether. RE6UUlTIONS A!~ POLICIES: 1. Reservation will not be confirmed until deposits are paid in full. $50 cleaning deposit for genera] rentals; X100 cleaning deposit for alcohol, profit or commercial rentals. 2. Proof of liability insurance in the form of a Certificate of Insurance must be provided in the minimum amount of X500,000 when alcohol is being served and when catered or home prepared food is served. Ocher activities or uses may rrcluire a Certificate of Insurance as determined by the facility supervisor and or risk manager. 3. Security personnel may be required for certain uses or actinides as determined by the fadliry supervisor If this is required, you'1 be notified of any fees that may/will be charged to you. 4. Rental fees must be paid in full and a Certificate of Insurance on file with [he Ciry two weeks prior date is hereby indicated as to the rental date or rental agteelnent(s) will be terminated_ If the City terminates the rental as a result of your failing to meet the deadline, you will not be refunded your deposit 5. A deposit may be returned under the following conditions: a. ff cancellation occurs PRIOR TO (date). b. The facility is left updamaged and all conditions of the rental agreement(s) have been met. c. The renter will be billed for damages or losses in excess of the deposit. 6_ The rental supervisor reserves the right to monitor, intervene or terminate the event at any time_ 7. The City of Eugene or it's representatives are not responsible for any lost, stolen or damaged pmperty_ 8. At least one rental supervisor is requited to be on duty: this fee is included in the rental charge_ 9. Renter is responsible for knowing and adhering to all appropriate park and or recreation facility rules. 10. Applicant must sign in agreement to Indemnity Agreement on back page. Applicants Initials (continued on other side) OfFlCE USE ONLT REnral Approved by: f"iQ.reJr1 X 53 ~ g Dat,r: q - Dd Room Space Fen ~ Supervisor' Main I3a11/Gym ~ ~ Noces: ~'1~m0~2 0.~nc~ -~[a.~C bC~.ck ~o ~QCP.YI X ~o~ Meeting Room(s) Kitchen ~ 1 F ID ~,r = 5C~ ~ O 1 I - 4 5? ZZ La,c>S~ Other Insuranr~ required: Yes No Insurance received: ~ Total Rectal Fees: ~~o~'~` Rental Fee: Received by: Date: Deposit Fee: ~ Received by: Date: Deposit Returned Received by: DatE: (after hour problems call 682-5111 or 682-5112) (OVER FOR MORE INFORMATION/SIGNATURE LINE)