Orange County Community College Central Scheduling Office 115 South Street Middletown, New York 10940 Phone: (845) 341-4720 Fax: (845) 341-4721 Name of Organization: (Name of Organization) Billing Address: (Billing Address) Name of Applicant: (Name of Applicant) Name of Contact Person: (Name of Contact Person) Telephone: (Day) (Telephone: (Day) (Evening) (Evening) Facility Requested: (Facility Requested) Title of Event: (Title of Event) Day & Date(s) of Event: __________________________________________________________ (Date (s) of Event) Description of Event: (Description of Event) Hours Requested for Facility: (Hours Requested for Facility) Actual Time of Event:_ (Time of Event) Supervisor of Event: (Supervisor of Event) Sponsor of Event: (Sponsor of Event) Approximate Attendance: (text) Special Needs? (Special Needs) (If you need any special set up, please include a floor plan.) Will event be open to the general public? (Will event be open to the general public) (Y/N) Admission cost? $ (Admission cost) If admission is charged, how will the proceeds be used? (If admission is charged, how will the proceeds be used) Will you be using food services? (Will you be using food services) (Y/N) If Yes, contact Bob Glohs, Food Service Manager at (845) 341-4862, prior to submitting application. Our Food Service Department has first refusal of service rights. Who is your Insurance Agent? (Who is your Insurance Agent) Please provide a certificate of your insurance coverage which lists Orange County Community College as an additional insured. Our requirements are for a general liability of three million dollars. This certificate of insurance is essential to complete this application. In case of any illness and/or injury to any participant, please notify the Safety/Security office by calling (845) 341-4710 and/or the campus nurse at (845) 341-4870. All advertisements, promotions, and/or publications regarding this event must be approved by Vincent Cazzetta, Vice President of Institutional Advancement, (845) 341-4726. Your group will accept full responsibility for ticket sales/distribution, and publicity. Please read policy statements on the reverse side and sign the application before returning it to the Central Scheduling Office. Application must be submitted at least thirty (30) working days before the event. If the form is not completed properly, (i.e. special needs not listed), your reservation may be affected. Note: Maintanance fees may be applied if clean up is required and not paid for in advance APPLICATION FOR USE OF FACILITIES BY OUTSIDE ORGANIZATION Event Date: (text) Board of Trustees Smoking Policy Orange County Community College is a smoke free campus, therefore, smoking is prohibited in all campus buildings. The no smoking policy applies to all instructional classrooms, hallways, doorways, lobbies, restrooms, locker rooms, offices, conference rooms, equipment rooms, meeting rooms, auditoriums, lounges and the cafeteria. Alcohol and Food Policy No alcohol is permitted on campus without a certificate of approval from the President. Food and Alcohol services can only be provided by the Orange County Community College. This includes the sale of chips, soda, and the dispensing of alcohol. Cost Estimate If there is a cost associated with your event, you will receive a written estimate prior to the date of your event and an actual invoice with charges incurred after the event. Upon signing this application, I verify that my organization accepts the cost estimate. I understand this is an estimate only and my organization is responsible for any unanticipated costs. I have read and will abide by the College Board of Trustees policy statement and accept full responsibility for any damage done to college facilities and equipment. Confirmation for use of Orange County Community College facilities will be forwarded upon FULL completion of application. I understand that the college can revoke permission for use of facilities at any time and that the deposit is non-refundable in cases of cancellation. ________ (Name of Applicant (please print) Name of Applicant (please print) (Signature of Applicant (Click to sign)) Signature field is unsigned Signature of Applicant Date: (text) ORANGE COUNTY COMMUNITY COLLEGE Room Reservation Procedures Thank you for choosing Orange County Community College for your event. To use the college facilities, follow these steps: 1. Contact the Central Scheduling Office at (845) 341-4720. 2. Complete the APPLICATION FOR USE OF FACILITIES BY OUTSIDE ORGANIZATIONS. a. Be sure to list special needs, such as scoreboard operator for athletic events, lighting technician for stage events, or slide projector, etc. This includes the setting up of tables and chairs. b. Insurance Certificates for Use of Facilities Each request by an outside organization for use of Orange County Community College facilities must provide an original certificate of insurance for $3 million naming the College as an additionally insured. Insurance certificates with ALL of the following information will be accepted: o An original copy from a recognized, state approved vendor. No photocopies or blanket coverage is accepted. o The certificate must clearly state name of event, the specific activities to take place, campus location, and hours of event, including set up and clean up time. o The certificate must be for three ($3) million dollars and the college named as an additionally insured. 3. Sign and return the formal written application to: Orange County Community College Central Scheduling Office 115 South Street Middletown, New York 10940 Once your Application is approved: o You will receive a telephone call to confirm your use of facilities. o The Central Scheduling Office and/or Building Supervisor or College Representative is your liaison for the event. o After the facility application is processed, a cost estimate will be provided based on the information specified on the application submitted. o The College will bill you after the event based on actual costs incurred, minus the 30% deposit previously made. o Any additional requests regarding the set up of your event made within ten (10) days of the event date will be included in the invoice for the use of facilities.