GANADO CHAPTER FACILITY USAGE FORM
NAME:
ADDRESS:
TYPE OF EVENT:
Is this a NON-PROFIT Organization?
YES / NO
DATE OF USAGE:
TIME (FROM):
ORGANIZATION:
CONTACT NUMBER:
(TO):
THE REQUESTING PARTY AGREES TO THE FOLLOWING CONDITIONS
1. Chapter facility will be cleaned (sweep, mop, wipe tables/chairs and put away, empty all trash, pick up trash
outside around the building, etc.) at the end of the event and before leaving the facility. All trash must be
disposed of and trash bags must be provided by the requesting party.
2. Chapter properties/equipment(s) is not to be removed from the building.
3. The Chapter staff will schedule you on our calendar with the required documents:
a. an approved Facility Usage application by the chapter staff
b. a proof of liability insurance coverage*
c. a money order payable to: GANADO CHAPTER - P.O. BOX 188 - GANADO, AZ 86505
*Definition of ‘Liability Insurance’
Any type of insurance policy that protects an individual or business from the risk that they may be sued and held legally liable for something
such as malpractice, injury or negligence. Liability Insurance policies cover both legal costs and any legal payouts for which the insured
would be responsible if found legally liable. Intentional damage and contractual liabilities are typically not covered in these types of policies.
http.//www.investopedia.com/terms/i/liability_insurance.asp
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CATEGORY
LOCAL COMMUNITY/NON-PROFIT ORGANIZATIONS
DISTRICT/AGENCY COUNCIL/INTERGOVERNMENTAL/TRIBAL ENTITIES
OUTSIDE GANADO ORGANIZATIONS (CAMPAIGNS, ETC.): $60.00 + $3.00 TAX
KITCHEN USE: $50.00 + $2.50 TAX
D. PRIVATE RECEPTIONS, PARTIES, ETC. (MEMBER): $40.00 + $2.00 TAX
KITCHEN USE: $30.00 + $1.50 TAX
E. PRIVATE RECEPTIONS, PARTIES, ETC. (NON-MEMBER): $60.00 + $3.00 TAX
KITCHEN USE: $50.00 + $2.50 TAX
F. RODEO GROUNDS/SALE YARD (MEMBER): $200.00 + $10.00 TAX
G. RODEO GROUNDS/SALE YARD (NON-MEMBER): $300.00 + $15.00 TAX
(PENDING, LAND STATUS)
A.
B.
C.
FEE SCHEDULE
FEE WAIVED
FEE WAIVED
$63.00
$52.50
$42.00
$31.50
$63.00
$52.50
$210.00
$315.00
I
, the requesting party, am responsible for any damages/loss of the Chapter properties
and equipment(s), and the Ganado Chapter Officials and Administration will not be responsible for injuries, loss of articles,
or accidents. I will keep all children on the premises under control. I understand the above written conditions and agree to
abide to it.
1. ___ I have read and understand the conditions and agree to abide by it.
2. ___ Conditions have been explained to me in the Navajo language.
Signature:
Date:
Time:
MUST BE COMPLETED BY CHAPTER STAFF
I have checked the above applicant as category
. Applicant shows proof of payment by Money Order? YES / NO
Signature (approved by):
Revised 02/13/15 Eva
Date:
QUESTIONS? CALL: (928)755-5920 / 5921
Time:
FAX: (928)755-5927
FACILITY USAGE POLICY
1.
Chapter Staff will verify if you are a Chapter Member, by checking the list provided or calling the Election
Office.
2. WEEKENDS – Chapter key is not to be given to the Requesting Party. However, we will have someone
available to open the Chapter at the time indicated on the facility usage form. Doors will be pre-locked so
someone needs to be here at all times.
3. WEEKDAYS – Chapter scheduled for usage after 5:00pm, someone needs to be here before the Chapter
Staff leave at 5pm.
4. Call the Chapter to inform the staff that you will not be utilizing the facility as scheduled.
5.
There is no refund for cleaning. However, the Facility Usage Requestor must do all necessary clean-up of
all trash in/around the building, sweep/mop floors, and wipe tables/chairs. Note: Facility Usage Policy is
to be abided by the agreeing party.
 All chairs and tables are to be wiped and put away properly
 Lobby and restrooms must be swept and mopped
 Trash (lobby and restrooms) must be disposed of by the requesting party. The
Chapter does not provide trash bags, so you need to bring your own trash bags
 Janitorial supplies must remain in the building
 All lights are to be shut off in the lobby and restroom areas, except for the outside
lighting, turn on upon leaving
6. HOLIDAYS – THE FACILITY WILL BE CLOSED.
***When using the Facility during the weekend,
any decorating must be done on the day you
are requesting for the facility.