Pierce application for use template pdf

Page 1

Pierce College Equestrian Center Application For Use (Save form with YOUR ORGANIZATION in Document Name)

A Non-Refundable $300 Booking Fee is required at time of estimate to hold your date Permit for Use will include Additional Payment Terms including a security deposit due 30 days prior to your event.

Application Date: Requested Event Date(s): Begin mm/dd/yy:       End mm/dd/yy:       Name of Event:       Organization Name / Promoter DBA:       Daily Open and Close Time(s)       Management Arrival Date:       Time:      Management Departure Date:       Time:       Mailing Address:       Zip:       Contact person:       Phone Land Line:      Cell phone:      Email address:       Organization Website:       Estimated Number of Participants:       Estimated Number of Spectators:       Estimated # trailer parking       Estimated # passenger vehicle parking       Estimated Overnight RV use       Estimated Number of Overnight Horses:       Estimated Number of Day Haul-In Horses:       Estimated Number / Cattle or other animals: #       Type:       A Certificate of Insurance and an accompanying endorsement that includes the following is required: General Liability – Comprehensive or Commercial Form, minimum limits each occurrence $1,000,000, General Aggregate $2,000,000. Certificate must endorse Pierce College and Los Angeles Community College District as additionally insured. A copy of insurance must be submitted 2 weeks in advance of event. Proof of Worker Compensation Insurance (if applicable) and Automobile liability insurance required. All parties doing business with the LACCD and Pierce College must have Vendor Information on file. Required additional information for Vendor Form: Legal Name of Promoter / Organization       Tax Status of Promoter / Organization (partnership, non-profit, etc.)       Taxpayer I.D. (SS# or EIN#)

Review Date:      By:       Submitted Date:       To:       5/1/2014 Version PCEC Application for Use


Turn static files into dynamic content formats.

Create a flipbook
Issuu converts static files into: digital portfolios, online yearbooks, online catalogs, digital photo albums and more. Sign up and create your flipbook.