Active-Club-App-Agreement-2023 fillableACTIVE CLUB BUILDING
FACILITY USE APPLICATION AND AGREEMENT
The PortOrchardActive Club Building isownedandoperatedbythe CityofPortOrchardforcommunityuse.
Individualsornon profit organizations may request to use this facility by submitting the following application and
agreeing to the terms in the Agreement, attached hereto. Please refer to Municipal Code 275.
The information on this form is considered a public record and is subject to
public disclosure laws in Chapter 42.56 RCW.
Name of organization:
Type of organization: (Washington nonprofit, Corporation, LLC, etc.)
Contact Person*:
Address:
(not at same address)
Alternate Contact Person:
Address:
Requested Date(s) of use:
Room #
Type of activity:
(Hereinafter "USER")
Phone:
Email:
Phone:
Email:
Time to
Time to
Include set-up & clean-up
Estimated attendance:
*If the organization is a legal entity registered with the Washington Secretary of State (e.g. Washington nonprofit, Corporation, LLC, etc.), the contact
person must be a person with signatory authority to sign this Application and Agreement, according to the Bylaws of the entity
AGREEMENT FOR USE OF ACTIVE CLUB BUILDING
Terms of Use:
1. The User agrees that it has received a copy of the rental fee schedule (exhibit A) and a copy of the Active Club
Building (hereinafter "facility") Rules and Regulations (exhibit B). The User agrees that it has read the Active Club
Building Rules and Regulations and has reviewed the rental fee schedule, and agrees to all of the terms and
conditions therein. If rental fees are not paid within thirty (30) days of invoice, the City can revoke room privileges
until paid in full. If revoked due to non-payment, the payment could be subject to collections.
2. The User agrees that it will provide chaperones, over the age of 18, for all youth activities that User will be
sponsoring on or about the premises of the facility. The User further agrees that the City is not engaged in, nor has
the City assumed any responsibility for supervision of any kind over any of the User's activities conducted on or
about the premises of the facility.
3. The User agrees that the City is not responsible for, and has not conducted any criminal background checks
pursuant to RCW 43.43.830 et seq., on persons who are involved in directing, chaperoning, or supervising youth
activities on behalf of the User; and further agrees to hold the City and its elected officials, employees, and agents
harmless and to defend the City against any and all claims, lawsuits, damages, costs, and fees of whatsoever kind
PLEASE TURN OVER
that may arise from activities the User sponsors on behalf of youth on or about the premises of the facility.
4. The User agrees that the City is not responsible for, and has not conducted any criminal background checks
pursuant to RCW 43.43.830 et seq., on persons who are involved, on behalf of the User, in directing, chaperoning,
or supervising activities involving developmentally disabled persons or vulnerable adults; and further agrees to hold
the City and its elected officials, employees, and agents harmless and to defend the City against any and all claims,
lawsuits, damages, costs, and fees of whatsoever kind that may arise from activities the User sponsors on behalf of
developmentally disabled persons or vulnerable adults on or about the premises of the facility.
5. The User shall indemnify and hold the City and its agents, employees, and/or officers, harmless from and shall
process and defend at its own expense any and all claims, demands, suits at law or equity, actions, penalties, losses,
damages, or costs, of whatsoever kind or nature, brought against the City arising out of, in connection with, or
incident to the User's use of the facility; provided, however, that if such claims are caused by or result from the
concurrent negligence of the City, its agents, employees, and/or officers, this indemnity provision shall be valid and
enforceable only to the extent of the negligence of the User; and provided further, that nothing herein shall require
the User to hold harmless or defend the City, its agents, employees and/or officers from any claims arising from the
sole negligence of the City, its agents, employees, and/or officers. The provisions of the section shall survive the
expiration or termination of User's use of the facilities.
6. The User agrees that the City is not responsible for damage to or theft of items belonging to User that User brings
to the facility for its activities, including items that User is allowed to store on the premises of the Active Club
Building.
7. The User agrees that this Application and Agreement is solely for the benefit of the City and the User, and no
third parties are entitled to any rights hereunder; nor may User assign its rights, duties and obligations to any third
party.
8. The User agrees that it is solely responsible for possession of the keys to the facility given to User by the City for
its activities. User agrees that if it loses or misplaces keys given to it by the City that User will be responsible for
the costs involved in re -keying the doors, having sufficient keys made for use and re -issuance to all authorized users
by the City, and for any other reasonable costs associated therewith.
9. The User understands and agrees that it is responsible for compliance with all federal, state and local laws, rules
and regulations in regards to activities it conducts or sponsors on or about the premises of the facility. The User
understands that the City may not discriminate nor endorse discrimination in the use of its facilities. The User
understands and agrees that it will not discriminate against any person on the grounds of race, religion, creed, color,
national origin, sex, sexual orientation, marital status, disability, age or other basis prohibited by state or federal law
in the conduct of its activities while on or about the premises of the facility.
10. The User agrees that it will not use the Active Club Building to further the election or defeat of any candidate for
public office or to support or oppose any ballot proposition.
11. The User understands and agrees that use of the facility is permissive by the City, and that misuse of or damage
to the facility of any kind will be grounds for the City's termination, whether temporary or permanent, of the User's
use of the facility and this Application and Agreement.
12. The User understands and agrees that this Agreement is the complete expression of the terms of use of the
Active Club Building and any oral representations or understandings not incorporated herein are excluded.
13. The User understands that if the City is made aware that additional keys are being made to avoid check-out at
City Hall, termination of the group's meetings could occur.
14. The User understands that the following conditions apply regarding animals in the facility: a) the User shall
clean up after all animals brought in by the User or the User's associates and ensure that the facility is clean of all
feathers and/or animal feces prior to leaving the facility; b) any complaints received regarding animals present in the
facility shall be investigated by the Public Works Director and/or his/her Designee; and c) upon finding that the User
has failed to clean up after its animal(s), the User shall be barred from bringing its animal(s) to the facility.
User's Signature: Date:
Print Name: Title:
PLEASE DO NOT FILL IN THE INFORMATION BELOW THIS LINE
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Application received
Application
PUBLIC WORKS OFFICE USE ONLY
Date
Date
Application approved
Signature
Use approved for: Room 1 Room 2
Occupancy 100 Occupancy 47
Date
Room 3 Kitchen
Occupancy 20
Total fees: $ Receipt #: Deposit: $
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EXHIBIT B
Active Club Building Facility Rules and Regulations
A completed application must accompany all facility use requests and must be submitted to the
Port Orchard Public Works Office prior to the event date. Applicable fees and/or deposit must be
made at the time of application.
Cancellation of reservations must be made five working days prior to scheduled date of use.
Failure to do so forfeits rental fee and/or deposit.
User groups who use the facility on a regular basis (i.e. daily, weekly, monthly) must re -apply
annually. Facility reservations will be valid from January through December.
It shall be the responsibility of the organization and/or the spokesperson for the organization (as
noted on the application form) to notify the City of any changes pertaining to current contact(s) or
scheduling. A new application may be required at the time of such changes.
If a regular user group fails to pick up keys to use the facility for three consecutive scheduled dates,
without notifying the Public Works Office, the reservation will be canceled.
Active Club Building facility keys must be picked up at the Public Works Office, 216 Prospect
Street, prior to use and returned immediately after usage. Users scheduled for weekday evenings
must pickup keys prior to 4:30 PM the day of use. Weekend users must pick up keys prior to
Friday at 4:30 PM.
Youth groups, nonprofit groups, and citizen groups are allowed to bring their animals to the
Active Club Building as part of their meetings. Groups that include animals as a part of their
meetings are responsible for any additional housekeeping activities directly related to the
presence of animals (i.e. cleaning up of animal droppings, excess fur, hair, feathers, etc.).
No group or user is authorized to maintain keys for the building or any individual room. Keys
shall not be duplicated.
Adequate supervision and/or chaperons must be provided by the applicant.
No alcoholic beverages are allowed on City property.
No smoking within 25 feet of Active Club Building entrances (POMC 9.44.070).
No cooking or food preparation is allowed in the Active Club Building. A small community
kitchen area is available for facility users, but is limited to refrigeration or re -heating of
previously prepared food items. Users are required to clean all dishes, sink & countertops, stove,
and microwave areas after each use.
The misuse of facilities or non-compliance to these rules may result in denial of future use.
EXHIBIT A
Active Club Building Fees
Continual Use Group Room Rates
Youth Groups
Including but not limited to Girl & Boy Scouts, Campfire Free of Charge
Girls, Cub Scouts, youth sports leagues and 4-H.
Senior Groups 50% Discount
Senior Groups must consist of 5 1 % of the group being 55
years of age or older.
All other regularly scheduled groups $8.00/hour
Other groups, organizations or social events scheduled on an
on -going basis such as daily, weekly and monthly.
Cleaning Fee — Youth Groups Free of Charge
Cleaning Fee — Senior Groups (one-time, non-refundable) $37.50 (includes 50% discount)
Cleaning Fee — all others (one-time, non-refundable) $75.00
One-time Use Rates
Youth Groups Free of Charge
Senior Groups 50% Discount
All other one-time users $25.00/up to 4 hours
$50.00/up to 8 hours
Cleaning Deposit — Youth Groups Free of Charge
Cleaning Deposit — Senior Groups (refundable) $37.50 (includes 50% discount)
Cleaning Deposit — all others (refundable) $75.00