2004-19
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CITY OF CLERMONT
FACILITY USE FORM
APPLICANT
.
Name: Disney's Wide World of Sports
(Must be 18 Years or Older)
Address:
P.O. Box 10,000 Lake Buena Vista. FL 32830
Telephone #: (Daytime) 407-938-3436
(Evening)
407-945-2568 (pager)
Event Contact:
Eric Wiley
(Telephone)
407-938-3436
ACTIVITY
Date(s) Requested: July 9-16 (9D Baseball): July 16-24 (lID Baseball)
Site/Facility Requested: Hancock Park
ArealRoom Requested: (4) 200' Softball Fields with clay
Rental Time: From
7:00 am
To
II :00 pm
Event Time: From
8:00 am
To
10:00 pm
Type of Activity:
AAU Baseball Tournaments (National Championships)
Estimated # of Participants
160
Estimated # of Vehicles
50-75
. Will food be served? We would like for your concessions to be open. You may keep all the proceeds
from purchases.
Do you have any special request? i.e. Equipment. Lining the field, lighting, bases, set-up etc:
Lining of fields. lighting, bases maintenance or on-site sUl'ervisor and custodial staff. PIA
microphone for announcers. Table and chairs for scorekeepers on each field.
Do you intend to sell any food, goods, or services at the event? You can sell
If yes, please explain:
FEES
(To be fiJled out by stafl)
Rental Fee $
Security Fee $
Total Fees and Deposit Required: $
Fees Received: $ Date: Receipt #
. Fees Received $ Date: Receipt #
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PAYMENT AND RESERVATIONS:
This form accompanied by total fees and appropriate insurance and waivers, must be signed by the
applicant and approved by the Parks and Recreation Department before a reservation can be guaranteed.
Applications and fees must be received 14 calendar days prior to required use. Payment may be made in
the form of cash, Money Orders, or Check. Make Payments to: City of Clermont.
HOLD HARMLESS/INSURANCE AGREEMENT
The user will indemnify and hold harmless the City of Clermont from and against aH claims, damages,
losses, and expenses, including reasonable attorney's fees, arising out of, or resulting from the occupancy
of the Park by the User, its agents, servants, invitees, and guests under this license.
The user will take all reasonable precautions for the safety of, and will provide reasonable protection to
prevent damage, injury, or loss to all persons and property in the Park.
The User will comply with all laws, ordinances, regulations, or other orders regarding the safety of
persons or property, or their protection form damage, injury or loss.
The applicant shall supply, when required, a Certificate of Insurance reflecting mmlmum coverage
$500,00 Comprehensive, General Liability Insurance, without deductibles, per occurrence. The City of
Clermont shaH be named as an additional insured, which shall be noted on the Certificate of Insurance.
The Certificate shall indicate that the applicant's insurance policy shall not be cancelled without thirty
days prior written notice to the City of Clermont.
The undersigned agrees to abide by the regulations governing the said facility and is responsible for
charges incurred and must supply the Certificate of Insurance to the City of Clermont no later than
fourteen (14) calendar days prior to the ProgramÆvent Date. Also, the undersigned agrees to be
responsible for damage to facilities and conduct of persons in the program and/or event. Parking is
permitted only in designated areas of the park. There is no parking allowed at any place of business or
residence near the park unless written permission is granted by the owner in advance.
~~~~~
3/8/04
Date
Applicants Signature
Special Requests/Set-Up
Lining of Fields, Lighting, bases, maintenance and on-site supervisor, custodial, PIA microphone for
announcers. We will need tables and chairs for scorekeepers on each field and turface bags.
AAU National Office will provide Certificate of Insurance for Tournaments.
Special Requirements:
(To be fiJled out by staft)
DEP ARTMENT USE ONLY
Application Approved:
Certificate of Insurance Required:
Payment Received
Department Authorization:
Facility Contact
Initial:
No
No
No
Date:
Phone
Yes
Yes
Yes
Initial: