The URL can be used to link to this page

Home My WebLink AboutC18-074 Town of Eagle - Brush Creek PavilionTOWN OF EAGLE --SHORT FORM EVENT HOLDER CfUESTIONNAIRE (Same as on Pavilion Contract): f tp pe- P, ; otC.C., _Z e_p rC Event Holder Name a rL*7. ►otHie ott.,;ti e d e kt A ew Mailin.g Address P ° 0. AkX 9So . Fea.c lop e o �r/G 2 Event Contact Person: Akn•C''f q ' Authorized to sign aII documents Daytime Phone Number: 7 740 . 3 86 0 S Event Information o d /b,`� A .' e Date(s): /" Time of Event (Beginning and Ending) Location of Event: avilion ❑ Studio Coverage Type: ❑ Entire Event Coverage ❑ Vendor Coverage ❑ Instructor Coverage Detailed Description of Event: 4 e h Hdd se—or f-/�SF.rr is �il� r �•scG. IMGL Irl d I R tit PL I'I Total Attendance (per day) including all participants, volunteers and employees: Day I 30 _'56) Day 3 p ;70 Day 5 Day 7 Day 2 5C) — %' 6 Day 4 Day 6 Day 8 Event Exposures 1. Have you held this event or a similar event in the past? 2. If yes, have accidents, incidents, claims or losses arisen from such event'e 3. Is there an admission fee charged? 4. Will food/non-alcoholic beverages be served? -- e- a o/La-eS • /J* -'t AL- J 5. Will food/non-alcoholic beverages be sold? 6. Will there be a caterer? 7. Please list/describe entertainment activities that will be occurring, if any: k. t. Total Attendance ALL Event Da s: / 9' C Yes 1>19 Yes Yes Yes No Yes Yes S. Do you have any parties requiring to be named as Additional Insured? Yes If yes, please review contracts and attach a separate sheet listing names and addresses of all parties requiring to be named as additional insured The event premium includes a premium charge for the ovnmer/lessor as additional insured. Event Holder agrees to add the Facility owner as an add tion � . Event Holder Signature: Date: 03/20/2018 TOWN STAFF TO COMPLETE Please complete, sign and return this form to CIRSA if your entity has decided to accept this special event quote. A certificate of insurance will be issued upon receipt of this document by CIRSA. Based upon the Class I, II, or III rates provided the quote is $ for the above special event. (Attach Premium Sheet) Your Entity is responsible for collecting the premium from the event holder The undersigned is authorized to accept this quotation on behalf of the 'Town of Eigle. Town Staff Signature: Title: J C18-074 Bate: Liquor Liability Exposures: No alcoholic beverages will be served or sold at this event. 1. Type of alcoholic beverages available (please choose all that apply): ❑ Beer ❑ Wine/Champagne ❑ Mixed Drinks/Full Bar 2. How long will alcoholic beverages be available for consumption? 3. Will you charge a fee or collect a ticket'? Yes No 4. Do you receive a donation? Yes No 5. Estimated sales receipts for alcoholic beverages: $ 6. Do you have a caterer or vendor serve or sell the alcoholic beverages? Yes No 7. If yes, have you received a Certificate of Insurance from the caterer or vendor showing Yes No they have liquor liability insurance? 8. How many different locations will alcoholic beverages be available? 9. Are you required to obtain or have a liquor license for your event? Yes No 10. What Management Practices do you have in place to monitor and control the consumption of alcoholic beverages? - Alcoholic beverages must be purchased and consumed in a confined area where Yes No persons below the legal drinking age are not permitted. - Everyone must show identification to receive an alcoholic beverage. Yes No - Individuals over the legal drinking age receive a wristband or other form of Yes No identification. - There is a limit of two servings provided to any one individual per visit to the Yes No concession. - Staff monitors the consumption and is instructed not to serve anyone who is Yes No apparently intoxicated. - The concession or bar is closed at least one hour prior to the end of the event. Yes No 10 Thi brush C'rVgA pavilion and §tudio 909 Capitol Street - Eagle, Colorado 81631 The Town of Eagle200 Broadway - PO Box 609 - Eagle, Co 81631 Phone: 970-328-6354 • Fax: 970-328-5203 • www.townofeagle.org - carla0a)townofea�l�g CHECK FACILITY(S) XBrush Creek Pavilion ❑ Studio ❑ Barn Stage (available uTith Pavilion rental) ❑ Lawn (available with Pavilion or Studio rental) EVENT AND CONTACT INFORMATION (PARTIES RESPONSIBLE FOR CHECK-IN AND CHECK-OUT) Applicant Name: -7'Vot n e 64 d r1 C11 ► ' tl� eL7'e C,o a �l' ee e o 5� 4[ E-mail Address: Dl`M hC rf V ►" "b Q4- re 01011 N - O -S I\4aihng Address: o X le C b � I Physical Address: D � G 'ae ed _f1G ? J U Phone: 110. Fork: Cell: Alternate Contact:. LA, t 1 V1+ N Phone: - J Lt • M (Cell: LVENT INFORMATION Event Date: Ir Number of People: Event Name: i se-vot o be Time of Event: _ *t'l• A.%- — Type of Event: 1) b hL C ►'1'�Y7 +CK"�` h [> k ko Liquor ❑ Liquor Served ° ° ❑ Liquor Sold (Special Event License Required) �bL�LGP/L SIGNATURE• DATE: 03/20/2018 CHECK-OUT & CHECK-IN AT 8:00 A.M. AT THE PAVILION OR STUDIO Make Check or Money Order for deposit fee, rental fee, and insurance payable to: Town of Eagle Cashiers Check, Money Order, Company Check, Personal Check, or Cash Only. NO CREDIT CARDS ACCEPTED. Photo ID and proof of Eagle residency required (utility bill, lease, etc.) Minimum age of 21 for lessee of the Pavilion and Studio. All non-profit organizations (NP) must provide proof of non-profit status. OFFICE STAFF USE ONLY R_,vj'F: DUE DATE DA'fl- PATI) CHECK# Securitv Deposit S Rental Fee $ Insurance $ USAGE AGREEMENT A Damage/Security Deposit will be returned to the Lessee upon completion of the event and inspection of the Facility. If damage has occurred, the deposit, less cost of the repairs and/or cleanup will be returned. (See Cleanup checklist.) If these costs are greater than the deposit the Sponsor/Lessee will be billed for the balance. The deposit fee will not be refunded if the Lessee changes the event within thirty (30) days of the event. An Insurance Certificate is required. Adequate insurance is to cover injuries, and/or damages for this specific use in force in amounts acceptable to the Town of Eagle, will remain in force during the term of this Agreement, and shall name the Town as an "additional insured". The Lessee has inspected the facility and is familiar with the present condition thereof and agrees to accept the premises in such condition at the commencement of the lease term unless noted above. Brush Creek Playground and soccer field will remain open to the public during all events. The Town of Eagle reserves the right at any time to enter onto the premises to review Lessee actions and/or for any other reasonable purpose. The Lessee shall not assign rior sublet the premise or any portion thereof. The Lessee shall provide for appropriate policing of the premises to maintain public peace and order, litter and trash control, enforcement and adherence to terms of the lease. The Lessee will be responsible for the conduct and control of participants and will ensure that all federal, state, and county regulations are followed. In the event alcoholic beverages are sold by whatever means on the premises by the Lessee, its agents, or invites, Lessee shall obtain and pay for all permits or special event license for the sale of intoxicating beverages as required by lav prior -to commencement of such event. Such permit or license shall then become an attachment to this agreement. Lessee further indemnifies the Town of Eagle from any and all liability, direct or indirect, incurred as a result of the service, supplication, or consumption of such beverages on premises by Lessee, its agents, or invitees. The Lessee is not a department, agent, or division of the Town of Eagle, but instead is a completely independent organization or individual responsible for its own actions, control, management, and operations. It is understood and agreed that the Town of Eagle does not participate in the actions, control, management or operations of the Lessee. The Lessee, for itself and all its legal representatives, executors, agents, employees and assigns, as well as for all of those attending or participating in the function which is the subject of this agreement, agrees to defend and hold harmless the Town of Eagle, and each of its officers, directors, managers, employees, agents, drivers, equipment operators, representatives, consultants, lessees, subcontractors, successors and assigns for and against any claim for damages as a result of or in any way arising from the actions, control management or operations of the Lcssee. In addition, Lessee agrees to and does hereby waive, release, and covenant not to sue the Town of Eagle and each of its officers, directors, managers, employees, agents, drivers, equipment operators, representatives, consultants, lessees, subcontractors, successors and assigns (collectively, the "Releases") from the use of the facility, whether such losses, damages, or injuries result from the negligence of, or in any other unintentional tort committed by the Releases or from, some other cause. Date: 03/20/2018 1� B00&l � Lessee Signature: "." e1B2�"=aa=a.�°� �=a�=' Print Name: Kelley Collier Make Check or Money Order for deposit fee, rental fee, and insurance payable to: The Town of Eagle, PO Box 609, Eagle CO 81631 WAIVER, RELEASE AND COVENANT NOT TO SUE THIS DOCUMENT AFFECTS YOUR LEGAL RIGHTS. READ IT BEFORE SIGNING. IF YOU DO NOT UNDERSTAND ANY PART, WE URGE YOU TO CONSULT YOUR ATTORNEY. In consideration of the pertuission granted by the Releases (as defined below) to use the Brush creek Pavilion and its Programs, by signing this WAIVER, RELEASE AND COVENANT NOT TO SUE, I Kelley Collier whose physical address is 500 Broadway, Eagle, CO 81631 , for myself, my spouse, my minor children, and my heirs, legal entities, hereby release the Town of Eagle and each of its officers, directors, managers, employees, agents, representatives, consultants, drivers, equipment operators, lessees, subcontractors, successors and assigns (collectively, the "Releases") from any liability, claims, demands, actions, and causes of action whatsoever arising out of any physical or property damage, loss, or injury while upon the premises of the Brush Creek Pavilion, whether such loss, damage, or injury results from the negligence of or any other tort committed by the Releases or from some other cause. I understand and recognize that there are specific risks of physical or property damages, losses, injury or even death that may result from my participation or attendance at the Brush Creek Pavilion. I voluntarily assume the risks associated with such participation or attendance. This Waiver, Release, and Covenant Not to Sue is effective immediately and shall survive the terix ination of my rights to use the Brush Creek Pavilion. Z, the undersigned, have read this WAIVER, RELEASE AND COVENANT NOT TO SUE, and understand all of its terms. I execute it voluntarily and with full knowledge of its significance. IN WITNESS WHEREOF, I have signed this Waiver, Release and Covenant not to sue this day of 03/20/2018 PRINT NAME: Kelley Collier Cy�EL �aL'LcP/� SIGNED: 3 20 , at Eagle, Colorado. Deputy County Manager