City of Merced Parks and Community Services *On Call (209) 564-9103 632 W 18th Street For Rental Problems
Merced, CA 95340
(209) 385-68
55 fax (209) 726-5327
APPLICATION AND AGREEMENT FOR USE OF FACILITIES
Applicant’s Name:
RHONDA BATSON
Address:
PO BOX 1107
City:
MERCED
Zip Code:
95341
Name of Organization:
NAACP
Day Phone (Area Code):
(209) 883-6226
Evening Phone (Area Code):
Room to be reserved - Please Circle:
Sam Pipes Conference Room Merced Community Senior Center Nature of Event:
Annual Banquet
Event Date:
10/16/21
Time:
2:00 PM TO 10:00 PM
Estimated Attendance
Adults Minors Total 320
Public Event?
Yes No
E
vent used to
raise money?
Yes No
Admission
Charged?
Yes No
Equipment Requirements:
Chairs - Theatre Style
Chairs and Tables – Classroom Style
Chairs and Tables – Banquet Style with Dance Floor
Stage
Kitchen Facilities
Portable Coffee Maker(s)
P.A. System
U.S. Flag
California Flag
Other: Event time is 6:00 PM to 10:00 PM. Renter has requested additional reservation time for set up.
Total use time is 8 ho urs.
ADDITIONAL DATES:_______________________________________________________________________________ APPLICANT’S AGREEMENT
I have read this agreement and accept the facility for which this application is made in an “AS IS” condition. In consideration of the minimal fees paid for use of the facility, the applicant is to indemnify, defend and hold harmless the City of Merced, its officers, officials, employees, agents, and volunteers (“City and City Personnel”) from all actions, liabilities, claims, damages to persons or property, losses, costs, penalties, obligations, errors, or omissions that may be asserted or claimed by any person, firm, or entity arising out of or in connection with the activities conducted by the applicant, whether or not there is concurrent passive or negligence on the part of City or City Personnel.
NOTICE TO APPLICANT:
All rentals must be cancelled no later than 2 weeks before the event date, except the Senior Center, which must be cancelled at least 30 days before the event. A “Refund Appeal” must be filled out when requesting a refund and may be subject to a 25% assessment fee for administrative costs. Failure to do so will result in forfeiture of deposit and all rental fees.
S
igned_________________________________________ Date_______________________________________ -OFFICE USE ONLY-
FEES
Contracted Hours $ 8 @ $ 125 = $__1,000_________ Deposit (refundable) $__ 300.00_________
Set-up Fee $__ 100.00_________
Kitchen Fee $__________________
Cleaning Fee $__ 366.00_________
TOTAL $__1,766.00________
Department Authorized Signature:
_
_______________________________________Date: _______________ Approved Denied
Set up Diagram (at least 2 weeks prior to event if applicable) C ertificate of Insurance in compliance with City of
M erced.
Contracted Security/Dance Permit
ABC License (if liquor is to be sold)
Added to Computer By: _____________________
Please make check payable to City of Merced.
R eturned checks will result in cancellation of event
and/or additional charges.
STANDARD RENTAL FEES
ATTACHMENT 2