Customer ID # 4210 Technology Drive, Room 230 FACILITY USE PERMIT NUMBER Fremont, CA 94538 Phone (510) 668-1609 Fax (510) 659-2505 FACILITY USE PERMIT FORM Please read all the attachments carefully and make sure that you follow all the rules and regulations Emergency Beeper for custodial services - (510) 377-3389 NOT VALID UNTIL APPROVED BY DISTRICT *REQUIRED FEES AND DOCUMENTS: Non-refundable $15.00 Application Fee A current Certificate of Insurance for $1 million naming Fremont Unified School District as additional insured. Proof of non-profit status from IRS or California Secretary of State, if applicable. Section I - This section is to be completed by the applicant, and delivered to the school with the required fees and documents.* (For cancellations/changes, a Facility Use Permit Change Form must be completed and submitted with a $15 change fee, five (5) working days prior to the scheduled event. Changes made verbally or via email are not accepted. SCHOOL FACILITIES REQUESTED: GYM # MUR # CAFETERIA # LIBRARY # CLASSROOM # SPECIALTY CLASSROOM # KITCHEN (no applicances) BASEBALL/SOFTBALL FIELD FOOTBALL FIELD SOCCER FIELD OTHER DATES REQUESTED: From To TIME: From To DAY OF USE: MON TUE WED THUR FRI SAT SUN (Please attach a complete schedule of all dates and hours for requests for use on multiple dates. There is a minimum 3-hour rental charge per use permit. Rental fees will be billed in one-hour increments.) NUMBER ATTENDING TYPE OF ACTIVITY (PURPOSE) (At least 1 custodian per 150 participants for evening and weekend activities, in accordance with SEIU Local 1021 Agreement, Section 7.9. Site administrator shall determine if additional custodian is necessary per Board Policy 1336. There is a minimum 2-hour charge for custodial. Custodial charges are doubled on holidays, 3-day holiday weekends, and over 12:00 midnight.) TYPE OF GROUP: NON-PROFIT COMMUNITY COMMERCIAL CHURCH OTHER (Non-profit organizations must attach proof of non-profit status from IRS or California Secretary of State.) NAME OF ORGANIZATION (LEGAL NAME) (Name must be the same on the Certificate of Insurance and proof of non-profit status, if applicable, to avoid any delay in processing.) ADDRESS DAY PHONE FAX EMAIL FREMONT UNIFIED SCHOOL DISTRICT HOLD HARMLESS AND INDEMNIFICATION AGREEMENT. The undersigned agrees to defend, indemnify and hold harmless the Fremont Unified School District, its Board of Trustees, Officers, Agents and Employees, individually and collectively, from and against all costs, losses, claims, demands, suits, actions, payments and judgements arising from personal or bodily injury, property damage and otherwise, brought or recovered against any of the above that may arise from or be alleged to be caused by the undersigned's use or occupancy of district facilities, furniture or equipment. The undersigned further agrees to provide a Certificate of Insurance for general liability coverage in the amount of $1,000,000.00 naming Fremont Unified School District as additional insured. The undersigned agrees to abide by and to enforce the policies, rules, and regulations of the Fremont Unified School District governing the use of school facilities, furniture and equipment. The undersigned agrees to uphold the State and Federal Constitutions and certifies to the best of his/her knowledge, that school property will not be used for the commission of any unlawful act. AUTHORIZED REPRESENTATIVE(PRINT) SIGNATURE DATE NOTES: Approved Facility Use Permit must be on hand at all times during use of school facilities for inspection by district staff. After activity, group needs to sign the Labor Charges Form to confirm use of facility. Facility Use Permit - LL rev 6.6.18 Page 1 of 6
4210 Technology Drive, Room 230 Fremont, CA 94538 Phone (510) 668-1609 Fax (510) 659-2505 FACILITY USE PERMIT NUMBER NOT VALID UNTIL APPROVED BY DISTRICT Section II - This section is to be completed by the school, and forwarded to Community Services with Section I FACILITY IS AVAILABLE & APPROVED: (Yes/No) DATES NOT AVAILABLE (If applicable): If No, please fill in the reason CUSTODIAL SUPPORT: (Yes/No) If Yes, fill in the number of custodians and hours below (At least 1 custodian per 150 participants for evening and weekend activities, in accordance with SEIU, Local 1021 Agreement, Section 7.9. Site administrator shall determine if addditional custodian is necessary per Board Policy 1336.) NOTE: Custodial fees may be waived on weekdays at the discretion of the principal if custodians are on duty. NUMBER CUSTODIANS X HOURS FOR EACH CUSTODIAN = TOTAL CUSTODIAL HOURS PER USE REMARKS PRINCIPAL'S SIGNATURE DATE Section III - This section must be completed and signed by Community Services before permit is valid. A Facility Use Permit Number will be assigned. APPROVED: (Yes/No) CLASS: (check one) I II III INSURANCE EXPIRES ON: APPLICANT WILL BE BILLED AS FOLLOWS: CUSTODIAL (There is a minimum 2-hour charge for custodial. Custodial charges are doubled on holidays, 3-day holiday weekends, and over 12:00 midnight.) HOURS CUSTODIAL @ $ /HOUR X (# OF CUSTODIANS) PER DAY/WEEK/MONTH/EVENT HOURS CUSTODIAL @ $ /HOUR X (# OF CUSTODIANS) PER DAY/WEEK/MONTH/EVENT RENTAL (There is a minimum 3-hour rental charge per use permit. Rental fees will be billed in one-hour increments.) HOURS RENT @ $ /HOUR FOR (FACILITY) FOR (# OF DAYS) HOURS RENT @ $ /HOUR FOR (FACILITY) FOR (# OF DAYS) HOURS RENT @ $ /HOUR FOR (FACILITY) FOR (# OF DAYS) CAFETERIA PERSONNEL AND KITCHEN CHARGES WILL BE BILLED BY CHILD NUTRITION SERVICES. UPFRONT PAYMENT OF ALL FEES IS REQUIRED AT LEAST TWO WEEKS BEFORE THE FIRST DAY OF THE MONTH. FOR MULTIPLE USES, UPFRONT MONTHLY PAYMENT SHOULD BE PAID AT LEAST TWO WEEKS BEFORE THE FIRST DAY OF EACH MONTH. OTHER CHARGES REMARKS SIGNATURE (Community Services) DATE For Office Use Only: Date Received Check # Amount Receipt # Insurance Police Dept. Non-Profit Organization Possessory Report School Efile Custodial Hrs. Acct.Receivable Possessory Binder Facility Use Permit - LL rev 6.6.18 Page 2 of 6
4210 Technology Drive, Room 230, Fremont, CA 94538 Phone (510) 668-1609 Fax (510) 659-2505 INSTRUCTIONS FOR OBTAINING A FACILITY USE PERMIT 1. Obtain a Facility Use Permit Form from any school office, the Community Services Office, or download from the district web site: http://www.fremont.k12.ca.us//domain/67. 2. Complete APPLICANT s portion (Section I) of the Facility Use Permit Form. Incomplete form(s) will be returned and will result in delay of processing. Name of the organization must be the same on the Certificate of Insurance and proof of non-profit status, if applicable, to avoid any delay in processing. 3. Attach a Certificate of Insurance for General Liability of $1 million naming Fremont Unified School District as additional insured with the Facility Use Permit Form. The Certificate of Insurance must be received in the Community Services Office before a Facility Use Permit can be approved. If insurance requirements are not met, the Facility Use Permit will be denied. Approved Facility Use Permits will be cancelled if the Certificate of Insurance on file expires and a renewed policy is not provided to the Community Services Office. 4. Include a letter issued by the IRS or California Secretary of State confirming non-profit status (if applicable). 5. Submit the Facility Use Permit Form, $15.00 application fee, insurance certificate, and proof of non-profit status (if applicable) to the selected school for completion of SCHOOL s portion (Section II), and for principal s pre-approval including custodial support needs if required. Schools determine availability of facilities. 6. Contact the City of Fremont if you have 300 or more participants as you may need a special event permit. 7. The school will forward the Facility Use Permit Form to the Community Services Office for final approval or denial. Completed Facility Use Permit Form must be received by Community Services fifteen (15) working days prior to the scheduled event. 8. Community Services will verify the Facility Use Permit Form, Certificate of Insurance and non-profit status letter (if applicable) and assess all applicable fees. Applicants will be billed based on the Facility Use Permit for facility rental and custodial hours. There is a minimum 3-hour rental charge per use permit and a minimum 2-hour charge for custodial. Rental fees will be billed in one-hour increments. Custodial charges are doubled on holidays, 3-day holiday weekends and over 12:00 midnight. Facility users will be charged for any damage or vandalism caused by their use of school facilities. 9. Copies of approved Facility Use Permit will be distributed to all concerned. Process is not complete until a Facility Use Permit Number has been assigned by Community Services. Facility users may call the school a few days ahead of use to confirm approval of their Facility Use Permit and that a custodian has been scheduled. IMPORTANT - Approved Facility Use Permits must be on hand at all times during use of school facilities for inspection by district staff. NOTE: To add additional hours, dates or facilities, a new Facility Use Permit Form is required and $15 application fee is applicable. For cancellations/changes, a Facility Use Permit Change Form must be completed and submitted with $15 change fee, five (5) working days prior to the scheduled event. Changes made verbally or via email are not accepted. Community Services/Instructions for Use of School Facilities rev 032618 P3 Page 3 of 6
4210 Technology Drive, Room 230, Fremont, CA 94538 Phone (510) 668-1609 Fax (510) 659-2505 RULES AND REGULATIONS FOR USE OF SCHOOL FACILITIES Facility Use Permits will be canceled for non-compliance of rules and regulations. 1. Facility Use Restrictions: School facilities shall NOT be used by an individual or group for the commission of any crime or any act prohibited by law. Use of school facilities or grounds which is inconsistent with their use for school purposes or which interferes with the regular conduct of school or school work is prohibited. 2. Discrimination: Any use which is discriminatory on the basis of sex, race, age, disability, sexual orientation or religious denomination will not be permitted. 3. Alcohol: Alcoholic beverages and/or any restricted substances are NOT permitted in or on any Fremont Unified School District s property. 4. Smoking: Smoking and/or the use of tobacco products is NOT permitted at any time in the buildings or grounds of Fremont Unified School District. 5. Fire Hazard: Barbeques, fireworks, burning of any incendiary or smoke producing materials/equipment is NOT allowed. This includes candles and incense. 6. Permit Approval: Approval of Facility Use Permit is granted only by the Community Services Office. Facility users should not proceed with printing announcements, flyers, etc. until they have received their copy of the approved Facilities Use Permit. 7. Sub-Leasing: Sub-leasing is prohibited. 8. Admission to Facility: A school representative will open the facility only when given evidence of an approved Facility Use Permit. An authorized adult representative of the organization must be present. Only facilities listed on the Facility Use Permit will be available for use. Facility users are to restrict participants to the area assigned on the Facility Use Permit. All participants and spectators must be supervised at all times and must remain in the area assigned. 9. Conduct: Facility users shall not disturb the quiet enjoyment of students, employees, or guests of Fremont Unified School District. Further, user group shall not disturb the quiet enjoyment of adjacent properties. 10. Cleanup/Damages: Facility users will protect the school from damage and mistreatment and are responsible for the condition in which they leave the facility. Dumpsters are for SCHOOL USE ONLY, they are not to be used by facility users. Other arrangements must be made for removal of trash. When repair, cleanup, or trash removal is required, the facility user will be charged. 11. Facility Alteration: Fremont Unified School District s facilities may not be altered in any manner without prior written approval from the school and the Facilities/Maintenance, Operations and Grounds Department. 12. Decorations: Decoration of school facilities is prohibited unless prior written approval is given by the school. 13. Kitchen: Use of kitchen facilities requires supervision by Child Nutrition Services staff. 14. Play Equipment: Dunk tanks, inflatable pools, bounce houses, etc. are prohibited unless prior written approval is given by Risk Management. 15. Swimming Pools: Use of swimming pools requires supervision by certified lifeguards. 16. Field Use: Athletic groups will not use turfed fields when it rains on the day of use or 48 hours preceding use. 17. Pesticides and Herbicides: Pesticides and Herbicides are prohibited on school grounds. Community Services/Rules and Regulations for Use of School Facilities - rev 032618 - P4 Page 4 of 6
Community Services Office NOTICE TO ALL FACILITIES USERS No Smoking Rules Effective September 1, 1993 Board Policy 3515.3 Tobacco Policies THE FREMONT UNIFIED SCHOOL DISTRICT BOARD OF EDUCATION ADOPTED A NEW TOBACCO POLICY AT ITS MEETING OF APRIL 28, 1993. PLEASE SHARE THIS POLICY WITH ALL OF THE PEOPLE INVOLVED WITH YOUR ORGANIZATION. THIS POLICY PROHIBITS SMOKING AT ANY TIME, IN ANY BUILDING, ON ANY GROUNDS, FIELDS, PARKING LOTS, ETC. OF THE FREMONT UNIFIED SCHOOL DISTRICT. SMOKING IS ALSO PROHIBITED IN ANY DISTRICT-OWNED VIHICLE. Following is the Board adopted policy which took effect 9/1/93. Facilities Use BP 3515.3 Smoking As of September 1, 1993, smoking and/or the use of tobacco products shall not be permitted at any time in the buildings or on the grounds of the Fremont Unified School District. Smoking and/or the use of tobacco products is also prohibited in any districtowned vehicle. Legal Reference: Health and Safety Code Section 25941 Policy Adopted: March 19, 1986 Policy Revised: April 28, 1993 Public Safety - State Fire Marshal Title 19, S. 23. Community Services\Facilities Use Permit P5 rev 061218 Page 5 or 6
NOTICE TO: RE: All Applicants Requesting Use of School District Facilities POSSESSORY INTEREST TAXES AND SCHOOL CONSTRUCTION 1. Groups and individuals that use or lease school district facilities may be liable to pay possessory interest taxes. Possessory interest taxes are a form of property tax that applies to parties who obtain beneficial use of tax-exempt public facilities. The possessory interest tax is administered by the Alameda County Office of The Treasurer and Tax Collector. Any additional questions you may have regarding the possessory interest tax should be directed to them at (510)272-3787. 2. Over the next several years, the school district will be doing extensive construction at most of our schools. This has been made possible with bond funding. You will notice signs at the schools telling you what is being done. We ask that you warn your groups to be EXTREMELY CAUTIOUS in the areas where construction is taking place. Keep track of your group and whoever is with them. See that they are not in the construction areas. This is for YOUR group s safety. Community Services\Facilities Use Permit P6 rev 061218 Page 6 or 6