BUILDING USE REQUEST & AGREEMENT Form
It is agreed between Jennings County United Way, Inc. hereinafter referred to as PROPERTY OWNER and the ORGANIZATION REQUESTING USE below, hereinafter referred to as USER, that, if this request is approved, the PROPERTY OWNER, shall allow the USER access and the use of the FACILITY as conditioned and described below, subject to all the policies and procedures of PROPERTY OWNER. DAMAGES Are the responsibility of the USER to repair or replace. PROPERTY OWNER is not responsible to provide any special equipment or personnel unless the same has been specifically agreed to by the PROPERTY OWNER and the USER in advance. FACILITY: Jennings County United Way Building, 707 N State St., North Vernon, IN 47265. This is not a rental agreement. If request is approved, the personal access code will be sent via text to the RESPONSIBLE PERSON.
Organization Requesting Use
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USER
Organization's Permanent Business Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Organization's Phone Number
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Area Code
Phone Number
Purpose of Use
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(Type of Activity)
Date(s) of USE & start time
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Month
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Day
Year
Date
1
2
3
4
5
6
7
8
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12
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Hour
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10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Duration
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(number of hours)
Recurring USE request? Day of the week or month
(ex: Weekly on Thursdays, 1st of the month, or 3rd Mon monthly etc)
Authorized Person Responsible
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First Name
Last Name
Person Responsible's Cell Phone Number
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Area Code
Phone Number
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The undersigned PERSON RESPONSIBLE has been given authority by the organization to act for the USER in this agreement. USER will see that the FACILITY is not misused or abused, that there is always proper adult supervision, that the FACILITY is used in conformity with all policies and regulations of the PROPERTY OWNER, and that all other terms of this BUILDING USE AGREEMENT are adhered to and followed.
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PERSONAL ACCESS CODE, ENTRY & SECURITY – Personal Access Codes are issued to the individual PERSON RESPONSIBLE and are not to be shared or used outside of the USE date/time. Anyone disclosing a personal access code will be denied access in the future. The PERSON RESPONSIBLE with the access code may enter and exit through the backdoor, all other guests must use the front door. Upon departure, ensure lights are off. The front door must be secured from inside, then the PERSON RESPONSIBLE will exit the back door, and physically ensure the lock has properly engaged and the building is secure before departure. The PERSON RESPONSIBLE must remain in the building while in use.
The FACILITY will be left clean and in the same condition as it was upon arrival. Restroom and kitchen area will be cleaned if used. Tables, chairs, and any other items used will be cleaned and returned to their original places prior to leaving the building. Report any damage before leaving the building.
FOOD & TRASH - There is no cleaning service. USER is responsible for cleaning tables and chairs, vacuuming and removal of trash. Food may not be left in the refrigerator unless prior arrangements are made.
OFFICE & SUPPLIES- The office and office supplies are off limits, as are computers, printers, file cabinets etc. Ordinary supplies (paper towels, tissue paper etc.) may be replaced by donation.
HOLD HARMLESS AGREEMENT
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USER agrees to save, indemnify, and keep harmless PROPERTYOWNER against any and all liability, claims, judgments, or demands, including demands arising from injuries or death of persons and damage to property, arising directly or indirectly out of obligations herein undertaken or out of the operations conducted by USER. It is the intention of the parties that the indemnity provided for by this agreement provides for indemnity to the fullest extent provided for by law.
Signature of RESPONSIBLE PERSON for USER
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