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2004-19 " ,j, ;¡ j '" . #' 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 # ), I ~ ,....;¡, ~ 1 . . . . , 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: