SETUP STARTING TIME EVENT STARTING TIME EVENT ENDING TIME CLEANUP ENDING TIME NAME OF PERSON-IN-CHARGE WHO WILL BE PRESENT AT THE EVENT?

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1 Use of Facilities Application & Agreement 250 Sierra College Dr. Grass Valley, CA Phone Fax Facility & Event TODAY S DATE APP. MUST BE SUBMITTED AT LEAST 10 DAYS BEFORE EVENT FACILITIES REQUESTED SITE OF USE Rocklin Campus Roseville Gateway Center Nevada County Campus Tahoe Truckee Center VOID WITHOUT APPROVAL STAMP DATE(S) REQUESTED DESCRIPTION OF ACTIVITY SETUP STARTING TIME EVENT STARTING TIME EVENT ENDING TIME CLEANUP ENDING TIME HOW MANY PARTICIPANTS EXPECTED? HOW MANY SPECTATORS EXPECTED? WILL YOU CHARGE ADMISSION OR ASK FOR DONATIONS? YES NO IF YES, HOW MUCH PER PERSON? WILL YOUR ORGANIZATION OPERATE A CONCESSION STAND OR SELL ANY TYPE OF PRODUCT OR SERVICE? YES NO IF YES, COMPLETE SOLICITING & SALES SECTION. Applicant & Organization YOUR NAME NAME OF PERSON-IN-CHARGE WHO WILL BE PRESENT AT THE EVENT? YOUR TITLE CELL PHONE OF PERSON- IN-CHARGE? ORGANIZATION NAME ORGANIZATION ADDRESS, CITY, STATE, ZIP DAYTIME PHONE FAX CELL PHONE YOUR ADDRESS DRIVER LICENSE NUMBER ORGANIZATION WEBSITE ADDRESS IS YOUR ORGANIZATION NON-PROFIT? YES NO IF YES, ENTER IRS NON-PROFIT ID # Special Setups & Services ARE YOU REQUESTING ANY SPECIAL SETUPS OR SERVICES? YES NO IF NO, SKIP THIS SECTION. SPECIFY HOW MANY OF EACH ITEM YOU ARE REQUESTING? 8 FT FOLDING TABLES FOLDING CHAIRS PODIUMS OTHER WILL YOU REQUIRE FOOD SERVICES? YES NO IF YES, CONTACT SODEXHO AT (EXCLUSIVE CONTRACTOR) SPECIFY ANY OTHER SPECIAL SETUP, FURNITURE ARRANGEMENT, ETC. BE SPECIFIC, ATTACH SKETCH IF NECESSARY. SKETCH ATTACHED District Approvals for Use of Facilities INITIALS POLICE SERVICES APPROVED OFFICERS DECLINED REQUIRED SPECIAL CONDITIONS OR RESTRICTIONS INITIALS PE & ATHLETICS APPROVED DECLINED INITIALS DIVISION DEAN APPROVED DECLINED OFFICE USE ONLY ESTIMATED CHARGES CERTIFICATE OF INSURANCE ADD L INSURED ENDORSEMENT EXEMPT STATUS VERIFIED APPROVING SIGNATURE (IF DECLINED DO NOT SIGN) DATE SIGNED Approval is contingent upon applicant furnishing a Certificate of Liability Insurance in the amount of $1,000, along with an Additional Insured Endorsement naming Sierra College as additional insured prior to event. Approval is revoked if this condition is not met.

2 Soliciting & Sales (COMPLETE THIS SECTION ONLY IF YOU WISH TO SOLICIT OR SELL) WHAT TYPE OF SOLICITATION OR SALES ARE YOU REQUESTING? POSTING ADS PETITION SIGNATURES SERVICE SALES PRODUCT SALES VOTER REGISTRATION SURVEY/POLL RECRUIT TO WORK OTHER (PLEASE SPECIFY) WHAT METHOD OF SOLICITATION OR SALES ARE YOU REQUESTING? POST ANNOUNCEMENTS PUBLIC SPEAKER HANDOUT TO PASSERS BY WALK-UP TABLE PRODUCT DEMONSTRATION CONCESSION STAND FREE SAMPLE GIVEAWAY OTHER (PLEASE SPECIFY) WHAT PRODUCTS OR SERVICES ARE BEING OFFERED? WILL ANY SOLICITING OR SALES BE PERFORMED BY ANYONE WHO IS NOT A MEMBER OR YOUR ORGANIZATION? YES NO IF YES, THE PERSON OR OTHER ORGANIZATION MUST COMPLETE THEIR OWN USE OF FACILITIES APPLICATION. IS THIS SOLICITATION OR SALES IN CONJUNCTION WITH ANOTHER EVENT ON CAMPUS? YES NO IF YES, WHAT EVENT? DO YOU HAVE A BUSINESS LICENSE?? YES NO IF YES, ISSUED BY WHAT CITY OR COUNTY? District Approval for Soliciting & Sales Benefit exists? YES NO Disrupts operation? YES NO Relates to mission? YES NO Risks harm/liability? YES NO Appears lawful? YES NO Conflicts w/operation? YES NO APPROVING SIGNATURE (IF DECLINED DO NOT SIGN) LICENSE NUMBER? OFFICE USE ONLY SPECIAL CONDITIONS OR RESTRICTIONS DATE SIGNED VOID WITHOUT APPROVAL STAMP CONDITIONS FOR USE OF DISTRICT FACILITIES: FACILITY USER agrees that the District makes no representations or warranties as to the condition of the facilities which the FACILITY USER is entitled to use, and FACILITY USER agrees to take such property and facilities AS IS. FACILITY USER acknowledges that it shall be FACILITY USER s responsibility and obligation to assure that the property and facilities are in proper and safe condition to be used for the purpose anticipated; and FACILITY USER acknowledges that it shall be obligated to inspect such property and facilities before they are used and to take affirmative steps where necessary to warn users or rectify hazards in order to prevent injuries to property and persons. APPLICANT FOR FACILITY USE agrees to refuse the use of the property if unsatisfactory conditions are not rectified prior to scheduled use. FACILITY USER further acknowledges receipt of a copy of the District s RULES AND REGULATIONS FOR USE OF FACILITIES. By the Applicant s signature below, the FACILITY USER agrees to abide by all rules and regulations governing the use of the District s facilities and the conduct of all meetings. FACILITY USER further acknowledges that facility use is contingent upon full compliance with these rules as well as any site rules specified by the site administrator. ALL PERMISSIVE USERS, WHOSE USE IS NOT MANDATED BY THE CIVIC CENTER ACT, AGREE BY THEIR SIGNATURE BELOW TO HOLD THE SIERRA JOINT COMMUNITY COLLEGE DISTRICT, ITS GOVERNING BOARD AND THE INDIVIDUAL MEMBERS THEREOF AND ALL DISTRICT OFFICERS, AGENTS AND EMPLOYEES FREE AND HARMLESS FROM ANY LOSS, DAMAGE, LIABILITY, OR EXPENSE THAT MAY ARISE OUT OF, OR IN ANY WAY BE CONNECTED WITH, THIS FACILITY USE AGREEMENT. HOWEVER, THIS AGREEMENT DOES NOT PERTAIN TO LOSSES OR INJURIES WHICH ARE THE RESULT OF THE SOLE NEGLIGENCE OF THE DISTRICT. NOTIFICATION OF TAXABILITY OF POSSESSORY INTEREST: Pursuant to California Revenue and Taxation Code Section 107 et. seq., the right to possession of the property leased may subject the lessee to property taxation. Applicant must submit this form to the Facilities & Operations Office ten (10) working days prior to the date of use to insure time for processing. Applicant acknowledges that the District s willingness to rent this facility is contingent upon approval by the Division Dean (if applicable) and by the District Facilities & Operations Office. User will be mailed a copy of the Agreement for the Use of Facilities when permission is granted. A copy of the agreement shall be carried by the user as proof of permission for facility use. Approval is contingent upon applicant furnishing a Certificate of Liability Insurance in the amount of $1,000, along with an Additional Insured Endorsement naming Sierra College as additional insured prior to event. Approval is revoked if this condition is not met. APPLICANT AGREES TO ABOVE CONDITIONS: APPLICANT SIGNATURE DATE SIGNED APPLICANT NAME (PRINTED LEGIBLY) TITLE (PRINTED LEGIBLY) NAME OF ORGANIZATION

3 GENERAL RULES GOVERNING USE OF SIERRA COLLEGE FACILITIES 1. Requests for use of District facilities must be made at least ten (10) days in advance of the first date of use being requested. Requests shall be on forms provided by the District. 2. Permission to use facilities shall be granted by the Dean of SC-NCC or Supervisor-Campus Administrative Services. 3. Any persons applying for use of District property on behalf of any groups shall be a member of the groups and, unless he or she is an officer of the group, must present written authorization to represent the group. Each person signing an application shall, as a condition of use, agree to be held financially responsible in the case of loss or damage to District property. 4. Applications for use of facilities will not be accepted from individuals for use of a personal nature. 5. Applications will be accepted only from persons representing a group or organization. 6. The applicant should not assume that permission has been granted to use facilities until the permit is approved by signature by the Dean of SC-NCC or Supervisor-Campus Administrative Services. 7. A certificate of insurance and additional insured endorsement from the organization's insurance company, indicating the organization members are insured for injury caused by organization activities while on campus, must be received in the SC-NCC Administration Office at least ten (10) days prior to the activity. 8. The college reserves the right to cancel facility use permits at any time without notice. 9. The college reserves the right to reject at any time an application for use of college facilities from any organization that proposes an activity which the college determines would not be in the best interest of the college or community. 10. No use or activity shall be permitted which reflects in any adverse way on any person for reasons of sex, race, creed or color. 11. Groups or organizations shall not use the name of the Sierra College District to sell a commercial product or to promote personal services for financial gain. 12. No goods, services, promotional or advertising material shall be sold on the college premises without prior approval from the District. 13. Use of college facilities may be restricted on holidays or on long weekends caused by holidays. 14. All use permits are issued for specific locations and times. Buildings and locations not included in the permit shall not be entered or damaged. 15. The use of college facilities for dances shall be restricted to events sponsored by the college. 16. Permission to use District facilities shall not be granted for a period to exceed one semester. Long-term facility use permits are not valid on holidays unless specified in writing when the permit is granted. No person or organization may be granted a monopoly on any facility. 17. A 50% deposit of the estimated charges for use of facilities shall be required at least ten (10) days prior to the use. The balance shall be due immediately upon receipt of the invoice from the Sierra College Business Services Office. 18. The user agrees to comply with all ordinances, laws, rules and regulations affecting the use and occupancy including all local fire, health and safety laws, ordinances and regulations. 19. The District may require security personnel as a condition of use whenever it is deemed to be in the District's best interests. 20. Youth groups on campus are required to have adult supervision at all times. They are not to disturb campus activities or interfere with the function of the campus. 21. Sierra College student activities require an appropriate member of the college staff on duty to supervise activities. 22. No person applying for use of District property shall be issued a key to District facilities. 23. Organizations using college facilities must pay $1.00 per day per vehicle for parking Monday through Saturday, 7:00 a.m. to 11:00 p.m. Visitor parking spaces are available near the Administration and P Buildings. For questions regarding parking, contact Campus Police Services or read the instruction signs posted on campus.

4 24. All groups shall be responsible for the condition in which they leave the facilities. Facilities shall be left in a clean condition. Any clean-up charges or cost of repair or replacement of any college-owned property which has been damaged or abused beyond normal wear shall be paid by the organization involved. 25. No furniture or equipment, including tables in the Cafeteria, is to be moved unless requested on the application and approval has been granted by the District. 26. Food and/or drink are prohibited in all buildings except the Cafeteria. Kitchen facilities may be used only under the supervision of the Dean of SC-NCC or Supervisor-Campus Administrative Services. 27. No structures, electrical modifications or mechanical apparatus may be erected or installed on District property without specific written approval by the Dean of SC-NCC or Supervisor-Campus Administrative Services. 28. All decorative materials, including, but not limited to, draperies, hangings, curtains, and drops shall be made or treated with flame-retardant processes approved by the State Fire Marshal. 29. Future facility requests may be denied on grounds including, but not limited to, abuse or misuse of District property and failure to pay promptly for any damage to District property. 30. No alcoholic beverages, intoxicants, or controlled substances, in any form, shall be brought onto the property of the District. Persons under the influence of alcohol, intoxicants or controlled substances shall be denied participation in any activity. 31. Smoking is prohibited inside and within 30 feet of any college facilities. Gambling is prohibited by law and, therefore, is not permitted on college property. 32. Possession or carrying of firearms and weapons of any type on the college premises shall be prohibited, except for peace officers when required by local police regulations. 33. College premises shall not be used as a political campaign headquarters. 34. Animals are not permitted on campus or in college buildings or pool area with the exception of seeing-eye dogs. 35. Where required, proof of copyright and royalty clearance pursuant to Title 17, U.S. Code, shall be submitted. For Rocklin Campus information please contact the Facilities & Operations Dept. at (916)

5 As of January 1, 2006 Use of Facilities Fee Schedule Sierra Joint Community College District For Non-Profit Organizations Base Charge Hourly After Base Use includes Classrooms with a maximum capacity of 35 or less $62 / $105 $28 / $36 Use of chalkboards, media equip. Classrooms with a maximum capacity of $87 / $122 $36 / $44 Use of chalkboards, media equip. Classrooms with a maximum capacity of $122 / $152 $44 / $53 Use of chalkboards, media equip. Cafeteria (maximum capacity max. capacity) $433 / $519 $95 / $122 Use of tables, chairs & restrooms Any food catering to be arranged by User. Rotary Playing Fields $20 per hour Additional fees will be charged for events requiring additional services. First rate shown is for shared use of building second rate shown is for the exclusive use of the buildings. If more than one room is reserved by the same organization, in the same building charge will be base plus $20 for each additional room. Custodians are assigned on an as needed basis. Custodial charges vary depending upon individual assigned and whether or not Overtime is involved. Hourly rates can range between $16 /hour to $32/hour. An estimate will be given at the time the use is approved. Use of facilities are limited on Sundays and holidays.

6 As of January 1, 2006 Use of Facilities Fee Schedule Sierra Joint Community College District For -Profit Organizations Base Charge Hourly After Base Use includes Classrooms with a maximum capacity of 35 or less $122 / $209 $53 / $70 Use of chalkboards, media equip. Classrooms with a maximum capacity of $173 / $243 $70 / $87 Use of chalkboards, media equip. Classrooms with a maximum capacity of $243 / $301 $87 / $105 Use of chalkboards, media equip. Cafeteria (maximum capacity ) $866 / $1,038 $223 / $268 Use of tables, chairs & restrooms Any food catering to be arranged by User. Rotary Playing Fields Varies Additional fees will be charged for events requiring additional services. First rate shown is for shared use of building second rate shown is for the exclusive use of the buildings. If more than one room is reserved by the same organization, in the same building charge will be base plus $20 for each additional room. Custodians are assigned on an as needed basis. Custodial charges vary depending upon individual assigned and whether or not Overtime is involved. Hourly rates can range between $16 /hour to $32/hour. An estimate will be given at the time the use is approved. Use of facilities are limited on Sundays and holidays.