RECEIVED
License for Use of the Office of the City Clerk
Fortuna Veterans Memorial Building MAY 05 2026
1426 Main St
Fortuna, CA 95540
For and in consideration of the mutual covenants herein contained, Sunset Post 220 TY OF FORTUNA Veterans of Foreign Wars and Walker Bailey Post 205 of the American Legion, herein after referred to as the "Licensor" do hereby authorize the following organization/ person:
Name: Pluele A. PetiT, Boark menber- Funkruising Chair
Organization: Humboldt Domestic Violence services
Mailing Address: P.D. BOX 969, Eureka, CA 95502
Phone: 707.444.9255
Member: _Organization Member #
hereinafter referred to as "Licensee" to use those portions of the Veterans Memorial Building at 1426 Main St., Fortuna, CA, herein designated, upon and subject to the following terms, convents and conditions, to wit:
1. Purpose for building use: Bingo Fundraiser
2. Period of use: Start date/time 69/11/26-5:00 pm End date/time: 09/11/24 - 10.10pm
3. Rental Fee Charge: $400°° _Paid on date:
4. Extra Day Needed: n/t Paid on date: 2/A
5. Cleaning/key/damage deposit: $400°° _ Paid on date
6. Liability insurance policy (starting start/end) verified on date: 5/2824
7. Number of Guests 200
8. Is Alcohol being Served _ Sold r _ One Day License
* Deposits may be forfeited if cancelled within 15 days of rental date. *Hall not available on 1st Thursday (Legion) and 2nd Monday (VFW) of the month. * Make payments payable to: Fortuna Veterans House Committee clean and orderly condition.
Licensee further agrees for itself and all of its members, guests, invitees and other persons using the facility in connection with Licensee's activity, and to hold Licensor harmless from any and all claims, demands, or liability for damages of any nature whatsoever arising out of or in any manner or way connected with Licensee's use and or occupation of such premises.
Walker Bailey Post 205
Sunset post 2207
Licensor Signature tri Cook
Licensee Signature culetto te. Pedia
Questions? Contact Rental Manager: Lori Cook [email protected] (707)-382-1405 January 1, 2026
License for Use of the
Fortuna Veterans Memorial Building
1426 Main St
Fortuna, CA 95540
Fortuna Veterans Building Cleaning Requirements Checklist:
1. Restrooms (all 3): Sweep and pickup litter, damp mop, empty trash and install new liners as provided.
2. Floors (Main Hall/Dining Room/Kitchen/Foyer (lobby): Floors swept to remove dirt and litter including glitter from decorations. Spot-clean all spills and sticky areas. Damp mop with clean water so not to leave dirty mop streaks. Use two squirts of provided 'Dawn' cleaner with bucket of clean water. Wring out mops and change bucket water frequently to eliminate mop streaks. Leave damp mops on ramp railing at rear of building. VISIBLE
FOOD AND BEVERAGE SPILLS, LITTER, GLITTER, STICKY CANDY, STICKY
SPOTS, OR DIRTY MOP STREAKS MAY RESULT IN FORFEITURE OF CLEANING DEPOSIT.
3. Furniture (Long tables, round tables, chairs): Should be cleaned with damp cloth. Stack the round tables and chairs in their appropriate racks and returned to storage area. Long tables stacked and organized in storage area and not blocking access to cleaning supplies.
4. Kitchen Area: Countertops and carts should be wiped down and cleaned. Appliances including refrigerator, ice machine, stove top, grill, ovens, and warmers should be wiped down and cleaned of spills and grease. 'Coke cooler' should be emptied, drained (outside), and cleaned. Sink drain screens cleaned of any waste and sinks rinsed and cleaned. If you use the provided coffee makers) they should be left rinsed and clean.
5. Refrigerator: Leave running. Fan above stove: Shut-off. Ice machine: Leave running.
Leave ice scoops on the top and NOT IN THE MACHINE.
6. Outside grounds: The front porch, steps, front ramp, and rear ramp should be swept, and any spills, gum, candy, or litter removed. Sand buckets are provided for cigarette butts.
The grounds (grass areas) in front, sides, and rear should be free of any litter. A vacuum cleaner is available for the carpets in the front entry and the kitchen area.
7. Cleaning supplies: Dust mops should be shaken clean outside and returned to the closet.
Do not use dust mops on wet floors! After the floors are cleaned the mops should be rinsed in clean water, wrung out, and left on the back porch to air dry.
Trash cans: Empty all trash cans in the rear dumpster and lock the dumpster as you leave.
Use the available trashcan liners.
9. THE BASIC GUIDELINE: LEAVE THE BUILDING AND GROUNDS CLEAN AND ORGANIZED AND AVAILABLE FOR IMMEDIATE USE.
I (Licensee) (Print) PAulette A. Pettis agree that the Rules and Regulations' and 'Cleaning Requirements Checklist' has been read and understood and that failure to comply may result in the forfeiture of my Cleaning Deposit. (Signature Prulette d. Pestil Dated 04/30/2014
Effective: Jan 1. 2024
License for Use of the
Fortuna Veterans Memorial Building
1426 Main St
Fortuna, CA 95540
Standard Charges and Rules and Regulations for the Building Are As Follows:
1. Rental Fees: Public: $800. (12-hour rental)
Special rates can apply to local Veteran Organization members in good standing.
2. Security Deposit $800 (to cover cleanup, damage, late fees). Security deposit and signed rental agreement will hold the date for you.
Reservations are made on a first-come, first-served basis. Security deposits will be deposited into the House Committee Bank Account.
3. Early key pick at 4PM the day prior to your event for setup: $200 (based upon availability) Early key pickup is negotiable with Rental Manager.
4. Late cleanup or key return: $50/Hour. Lost key: $100 minimum or as determined by Rental Manager. If the Veteran Hall janitor has extra work to complete the cleaning for the next renter there will be a charge of $60 per hour deducted from the deposit refund amount.
5. Proof of liability insurance will be required by all persons renting the building including members of veteran's organizations who use the building outside of organizational functions.
6. The Fortuna Veterans Memorial Building is a County-owned building that exists for the benefit of local veterans. The County allows us to rent the building to pay for utilities and upkeep as well as support local veterans and community service projects. We try to commit to the dates you have secured for your event. RARELY, BUT OCCASIONALLY.
AN UNEXPECTED VETERAN EVENT (A CELEBRATION OF LIFE FOR EXAMPLE) MAY CONFLICT WITH YOUR SCHEDULED EVENT. THE VETERAN EVENT WILL BE THE PRIORITY. The House Committee will work with you to reschedule your event.
7. Rent and a One-Million-Dollar ($1,000,000) liability insurance binder will be paid and delivered to the Rental Manager prior to the use of the building. The insurance certificate holder should be 'Fortuna Veterans Memorial Building, 1426 Main Street, Fortuna, CA 95540* . The policy effective dates should include the date you receive the keys for setup/decorating through the date you plan to vacate the building after cleaning and return the keys. The security deposit will be refunded if the building and grounds are property cleaned and organized prior to 12 noon the following day and there is no damage. Refunds are mailed by check within 72-hours of key return.
8. Signs on the front of the building will be hung by hooks or ties only. No nails, tacks, or screws will be used on the floors, walls, ceilings of the interior or exterior of the building.
9. Veteran's Canteen is for the use of the veteran members and guests.
10. Tables and chairs are not to be removed from the building without prior approval.
11. You will get 3 keys: 1) Front and rear doors 2) Gate on front loading ramp and 3) Dumpster key hanging by back door. Backing vehicles to the steps of the building is not allowed and may result in forfeiture of deposit. Please use the gate on the front ramp.
12. No Glitter or Confetti of any kind is Allowed.
13. Cost for Broken Tables $200 Each, Chairs $100 Each.
Effective: Jan 1, 2024
Eligibility to Conduct Bingo Games in the City of Fortuna Fortuna Municipal Code States the Following:
5.16.030 Eligibility to conduct bingo games.
No person, organization, or other legal entity shall be permitted to conduct bingo games in the city unless such persons, organizations, or other legal entities possess a valid certificate or letter from the Franchise Tax Board and the Internal Revenue Service stating that they are exempted from the payment of the bank and corporation tax by Section 23701(d) of the Revenue and Taxation Code and that a contribution or gift to them would be a charitable contribution under Section 170(c)(2) of the Internal Revenue Code of 1954, and possess a valic permit issued pursuant to the provisions of this chapter. (Ord. 77-373 § 3).
5.16.040 Permit - Required - Application.
A. No person or organization shall conduct a bingo game without obtaining a permit from the city council to do so.
B. Written application for a permit required by this chapter shall be made by affidavit under penalty of perjury and filed with the city clerk.
Please provide the following information to the City of Fortuna to process your Bingo Application:
Name of Organization: Humboldt Domestic Violence Services Name(s), Signature(s) and Addresses(s) of Organization Officers):
1.) Printed Name of Officer: Katy Garrison, Chairperson 1898 Kelli Way, Fortuna,
Signature of Officer: Rely Sarison
Printed Name of Officer: Ray Lovell, Treasurer
Signature of Officer: _3.)
Printed Name of Officer: Andrea Swanlund, Secretary
1710 Xavier Court, Fortuna,
Signature of Officer:
Days and Hours of Operation of Bingo Games: Friday, June 5, 2026 5:00 pm - 10:00 pm *If Bingo is being hosted in a City of Fortuna Venue, please write the name of the venue.
N/A
Address of premises where bingo games will be conducted.:
Fortuna Veterans Memorial Building
1426 Main St., Fortuna, CA 95540
Statement of ownership or lease of premises:
Attached document
Purpose for which such premises are used by the organization:
Fundraiser for Humboldt Domestic Violence Agency, Eureka, CA Statement of ownership of bingo equipment used in the operation of bingo games:
Rented equipment
Statement of consent for chief of police to inspect any bank accounts containing profits derived from bingo games:
Name of each person, corporation, partnership, or other legal entity which has a financial interest in the conduct of bingo games for your organization:
Humboldt Domestic Violence Services (HDVS), P O Bx969, Eureka, CA 95502 Name of person responsible for the operation of the bingo game:
Paulette Pettis, committee chairperson
Emely Fuentes Neilson, Executive Director, HDVS Executive Director Your organization must provide copies of certificates or letters evidencing exempt status under Section 23701(d) of the Revenue and Taxation Code and Section 170(c)(2) of the Internal Revenue Code of 1954, received from the Franchise Tax Board and the Internal Revenue Service.
Tax ID 94-2429700 with attached document
*The City a may request further information as may be required by the city council. (Ord. 77-373 §§ 18, 19). In addition, you application will be presented for Council consideration at a publicly noticed Public Hearing. You will be contacted regarding the date of your hearing. Permits are non-transferable and may be revoked or For additional information or any questions regarding this form, please contact the City Clerk at 707-725- 7600 or you can email directly to [email protected]. -2-
Humboldt Domestic Violence Services
94-2429700
Your organization is not required to file federal income tax retums unless it is subject to the tax on unrelated business income under section 511 of the Code. If your organization is subject to this tax, it must file an income tax return on the Form 990-T, Exempt Organization Business Income Tax Return. In this letter, we are not determining whether any of your organization's present or proposed activities are unrelated trade or business as defined in section 513 of the Code.
Section 6104 of the Internal Revenue Code requires you to make your organization's annual return available for public inspection without charge for three years after the due date of the retum. The law also requires organizations that received recognition of exemption on July 15, 1987, or later, to make available for public inspection a copy of the exemption application, any supporting documents and the exemption letter to any individual who requests such documents in person or in writing. Organizations that received recognition of exemption before July 15, 1987, and had a copy of their exemption application on July 15, 1987, are also required to make available for public inspection a copy of the exemption application, any supporting documents and the exemption letter to any individual who requests such documents in person or in writing.
For additional information on disclosure requirements, please refer to Intemal Revenue Bulletin 1999 - 17.
Because this letter could help resolve any questions about your organization's exempt status and foundation status, you should keep it with the organization's permanent records.
If you have any questions, please call us at the telephone number shown in the heading of this letter.
This letter affirms your organization's exempt status.
Sincerely,
John E Popleto
John E. Ricketts, Director, TE/GE
Customer Account Services