From: ISD 191 Community Education
200 W Burnsville Parkway, Suite 100
Burnsville, MN 55337
Your insurance on file expires on 7/1/2019. If your policy expires before or during your event, please send an updated certificate.
Permit # 1901-0453
Facilities Agreement
Last Edited: 4/25/19 at 11:19am

Contact/Billing Person: Carrie Westrum
Office Phone: (858) 707-4193 Email: bac1959.secretary@gmail.com
 
EVENT NAME: Traveling Volleyball
To: BAC (entered by MS)


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Summary  Facilities Rental: $ 0.00 Estimated Total Charges: $ 0.00
Other Needs: $ 0.00
Extra Charges: $ 0.00 Balance Due: $ 0.00
Total Amount Paid: $ 2590.08
Remaining Balance Due: $ 0.00
Other Conditions:
The undersigned is the BAC Secretary of BAC (entered by MS) , the organization requesting use of the ISD 191 Community Education facilities as noted in this contract. I have the authority to legally bind this organization and hereby obligate the organization shall maintain Commercial General Liability (CGL) insurance and, if necessary, Commercial Umbrella insurance with a limit of not less than $1,000,000 each occurrence/$2,000,000 Aggregate. The CGL insurance shall be written on ISO occurrence form CG 00 01 04 13 (or its equivalent), and shall cover liability arising from premises, operations, products/completed operations, personal and advertising injury, and liability assumed under an insured contract. District 191 shall be included as an additional insured on a primary/noncontributory basis under the CGL policy. Organization shall provide District 191 with a certificate of insurance evidencing the above coverage. Organization shall indemnify the school district and hold it harmless from any liability arising from use of the school district property.

Meetings and events not involving athletic activities or the use of industrial equipment and with expected attendance of less than 150 people may not be required to carry independent Certificates of Liability Insurance (COLI). This decision will be determined on a case-by-case basis at the discretion of the 191 Facilities Department at the time of the Facility Use Request submission.

The organization has familiarized itself with the Facilities Use Policy of School District 191 and agrees to comply with all conditions of that policy, including the following: 1). MN Statute 624-701 prohibits the possession of alcohol on any public elementary or secondary school property. Any person that has possession of alcohol on school grounds is guilty of a misdemeanor. 2). ISD 191 has a smoke free policy. No smoking is allowed anywhere on school district property or in school district buildings. 3). Groups must limit themselves to the space reserved. Members of groups found in unauthorized areas may result in the group having their permission to use facilities rescinded. 4). All rooms are to be left clean and arranged in the same manner they were found. The organization will be responsible for any and all damages to the school district property arising from its use. 5). Payment must be received in the Community Education office before the date of the event. Make checks payable to: ISD 191. Please sign one copy of contract and return with payment. 6). Due to allergies/health concerns, latex balloons ARE PROHIBITED in all buildings in the district at ALL times.

The organization accepts that the school district may have to preempt its scheduled use of district facilities, in which case understands the district will give as much advance notice as possible and that any money the organization has paid for use of the facilities will be refunded.

I understand that representatives of our organization will conduct themselves in a mature and responsible fashion in their dealings with children, staff and parents and that failure to do so may result in suspension or loss of the organization's facility use privileges.

NOTICE OF CANCELLATION IS REQUIRED AT LEAST 7 BUSINESS DAYS IN ADVANCE OR THE USER WILL BE CHARGED THE FEES LISTED ON THE PERMIT. EXCESSIVE CHANGES MAY ALSO RESULT IN ADDITIONAL FEES.

THIS CONTRACT MUST BE SIGNED,DATED AND RETURNED TO BE VALID & HONORED. PLEASE BE SURE WE HAVE AN EMERGENCY CONTACT NUMBER ON FILE FOR YOUR GROUP/ACTIVITY.

Custodial Cell Phone Numbers:
Burnsville High School - 612-490-3168
Cedar School- 612-490-2494
Diamondhead Education Center - 612-490-3059
Eagle Ridge - 612-490-3060
Edward Neill - 612-490-0476
Gideon Pond - 612-490-3227
Harriet Bishop - 612-490-3067
Hidden Valley - 612-490-2496
Metcalf - 612-490-2382
MW Savage - 612-490-0560
Nicollet - 612-490-3259
Rahn - 612-490-0041
Sioux Trail - 612-490-1450
Sky Oaks - 612-490-3069
Vista View - 612-490-3192
William Byrne - 612-490-3131

 

Signature
 

Signature
Kristi Myers
ISD 191 Community Education
Attachments:
Carrie Westrum
BAC (entered by MS)