NV
SAVE HARMLESS AGREEMENT AND COVENANT NOT TO SUE
I, _________________________________ in consideration of being permitted to use facilities of the
NAME
Nenahnezad Chapter between the date of ________________, 2015 & ________________, 2015 in
DATE
DATE
connection with ____________________________________ do hereby covenant and agree that
TYPE OF EVENT
except for injuries and/or damages sustained by persons or property due to willful misconduct or
gross negligence the Nenahnezad Chapter, their officials, employees, members or representative shall
not be liable for any loss, arising from an use of the premises of the Nenahnezad Chapter, of any part
thereof, or by any building, structure or improvement thereon, or in any equipment to be used
therein, or because of the name, being out of repair or arising from any act or omission of the
enumerated entities to be liable for any loss, damage, or injury from any cause whatsoever to the
property of person of the undersigned or any of its employees, agents, or other person entering upon
or using said premises or any part thereof, or to any property stored or placed thereon.
Not withstanding anything to the contrary herein contained and irrespective of any insurance carried
by the undersigned for the benefit of the above enumerated entities, except for injuries and/or
damages sustained by persons or property due to willful misconduct or gross negligence the
undersigned agrees to protect, indemnify, covenant not sure and hold the above enumerated entities
and said premises harmless from any and all damages and liabilities of whatsoever nature arising out
of or in connection with the Nenahnezad Chapter or in the use of occupancy of the premises or
arising from any state or condition of said premises or any part thereof.
____________________________________________________
_________________________
SIGNATURE OF REPRESENTATIVE
DATE
CONCURRED
___________________________________________
CHAPTER ADMINISTRATOR
___________________________________________
DATE
NV
CHAPTER FACILITIES USAGE AGREEMENT FORM
NAME OF ORGANIZATION/INDIVIDUAL(S)
DATE:
_______________
NAME: _____________________________________________
ADDRESS: ____________________________________________
City: State: Zip: _______________________________________
PHONE NUMBER: (_________) ________________________
OPEN DOORS @ _____:_____ AM/PM
Date of EVENT/ACTIVITIES: _____________________________
TIME:
_____:_____AM/PM
Facility to be USED:
Multi-Purpose Hall _____
Dining Hall _____
½ Multi-Purpose Hall _____
Kitchen _____
*** PLEASE INDICATE # OF TABLES & CHAIRS NEEDED
Veterans Park _____
TABLES: ___________ CHAIRS: ___________ ***
Facilities rented: $ _________________
Cleaning Deposit: $ _______________
Cancellation Fee: $ _________________
Total: $ _______________
Damage Deposit: $ __________________
DATE
/
/
/
/
/
/
/
/
MONEY ORDER #
#
#
#
#
AMOUNT
$
$
$
$
BALANCE
INITIAL
$
$
$
$
I agree to abide all rules pertaining to the Chapter facilities usages as described in the Chapter
policies and to compensate the Chapter all required charges and fees in good faith before using
facilities. I further understand that all damages, which occur to the Chapter as a result of the activity
and injuries to and participate of this activity, will be the liability of the organization(s) listed above.
SIGNATURE(S): _________________________________
DATE: ____________________
It is the responsibilities of the user to make arrangement with the Chapter staff to open facilities
during non-office hours.
APPROVAL: ___________________________________
CHAPTER ADMINISTRATOR
DATE: ____________________
NV
NENAHNEZAD FACILITY RENTAL RATES
RENTAL
 MULTI-PURPOSE HALL
$400.00
o SOCIAL GATHERINGS5 & RALLYS
(Song-n-Dances & Pow-Wows)
TAX
$20.00
AMOUNT
$420.00
 MULTI-PURPOSE HALL
$10.00
$210.00
$200.00
o OTHER ACTIVITIES
(Birthdays; Baby Showers; Receptions, etc.)
 ½ OF MULTI-PURPOSE HALL
$150.00
$7.50
$157.50
 DINING HALL
$75.00
$3.75
$78.75
 KITCHEN (Food Handlers Permit)
$75.00
$3.75
$78.75
o PLEASE NO CHILDREN ALLOWED IN THE KITCHEN-SAFETY REASONS!!
 VETERANS PARK
$75.00
$3.75
$78.75
OTHER ADDITIONAL FEES (REFUNDABLE) :
All above requires a $50.00 cleaning deposit. A damage deposit of $300.00 is required for high risk
activities. (I.e. Song-n-Dances & Pow-Wows)
SPECIAL RATES :
All recognizes non-profit group with a 501 Status (Tribal Department, Churches, Registered Veterans
Organization, etc.) 50.00 + 2.50 (tax) = $52.50 rental rate. EXCEPT high-risk activities when regular
policy would adhere. NO EXCEPTIONS ! ! ! !
1. All fees must be paid in full before using the facilities. Fee collected help defray operation costs of
building. MONEY ORDERS ONLY ! ! ! (NO CASH OR PERSONAL CHECKS)
2. Chapter will not hold rental based on post-dated checks.
3. There will be a cancellation fee of $25.00 on all cancellations.
4. All rental/reservation requires a $50.00 holding deposit in order to reserve the facility.
5. Chapter RESERVES THE RIGHT TO REFUSE SERVICE to Non-Voters who solicits rental
through Chapter voters.
6. CLEANING & DAMAGE DEPOSIT WILL BE REFUNDED AFTER 5 WORKING DAYS.
(Must pass check-list inspection & return cleaning check-off list within 5 days after event)
7. Policy will be amended in January of each year to reflect changes in taxes, etc.
NV
CLEANING LIST
***PLEASE BRING YOUR OWN CLEANING SUPPLIES & TRASH BAGS***
(Buckets, Rags & Bleach)
(haul your own trash)
 MULTI-PURPOSE HALL :
o Floors are to be swept and mopped at the end of event.
o Tables and chairs that are used, please wipe them and place back in proper space, at the
end of your event.
o Empty trash cans and re-line them.
 RESTROOMS (MEN & WOMEN) :
o Floors are to be swept and mopped.
o Proper care should be given to commodes to avoid backing up problems.
o Empty trash cans and re-lined.
o Wipe the sinks and counters.
 DINING AREA:
o Floors must be swept and mopped.
o Tables and chairs that are used please wipe them.
o Empty trash cans and re-line them.
 KITCHEN:
o Floors must be swept and mopped.
o Counter tops and all appliances used must be wiped cleaned (NO GREASE).
o Empty trash cans and re-line them.
ALL RENTERS:
1. When using the Multi-Purpose Hall, PLEASE do not remove anything off the wall!!!
(FLAGS, PICTURES, CLOCKS, etc.)
2. Please turn off ALL the lights after events.
3. Please take all the trash from inside and outside with you after events. DO NOT PUT YOUR
TRASH IN THE CHAPTERS DUMPSTER!!!
4. A chapter staff will check the building after event. If the place is NOT clean, tables are NOT
wiped or the trash is NOT taken and also if there is damage done to any chapter property
outside, your cleaning/damage deposit will not be REFUNDED. If everything is done
correctly, your cleaning/damage will be refunded within five (5) working days.
*** FURTHER UNDERSTAND THAT ALL DAMAGES THAT OCCURS TO THE
CHAPTERS PROPERTY AS A RESULT OF THE ACTIVITIES (INSIDE THE
BUILDING AND OUTSIDE ON CHAPTER GROUNDS) OR INJURIES TO ANY
PARTICIPANTS OF THE ACTIVITY WILL BE THE LIABILITY OF THE
ORGANIZATION/NAME(S) STATED ON THE AGREEMENT FORM.***
FACILITY CLEANING & CHECK OFF LIST
MULTI-PURPOSE HALL:
___
___
___
___
___
Trash cans are empty & re-lined
Tables & chairs are wiped & placed back properly
Floor is swept & spot mopped
Cooling/heating system has been turned OFF
Light switches are ALL off
KITCHEN:
___
___
___
___
DINING HALL:
___
___
___
Trash cans are empty & re-lined
Tables & chairs are wiped
Floor is swept & mopped
RESTROOMS: (MEN & WOMEN)
Trash cans are empty & re-lined
Refrigerator is cleaned and ALL food removed
Floor is swept & mopped
Counter tops and ALL appliances are wiped
___
___
___
___
Trash cans are empty & re-lined
Sinks & counters are wiped
Floor is swept & mopped
Toilets are cleaned & flushed
●
●
●
VETERANS PARK:
___
___
___
___
Trash cans are empty & re-lined
Picnic tables are wiped
Grill ashes are emptied
All decorations are taken down & Tape removed
I certify that the above cleaning list has been completed
YOU ARE RESPONSIBLE FOR TAKING
YOUR TRASH AND DISPOSING OF IT
PROPERLY. DO NOT PUT YOUR TRASH
IN THE CHAPTER’S DUMPSTER.
THANK YOU!!
●
●
●
________________________________________
___________________________
Signature
Date
**Facility Cleaning Checklist must be returned within (5) working days in order to receive a refund of cleaning deposits.
**Refund of deposits contingent on cleanliness of building.
*** DO NOT WRITE BELOW THIS LINE * ADMINISTRATIVE USE ONLY!!! ***
-YES___ The building was cleaned upon inspection
_____________________________________________
Chapter Administrator
-NO___ The building was not cleaned upon inspection
**See Additional Notes
___________________________
Date
Additional Notes:
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________