Facility User Intake

Host Organization Information

Host organization is the entity accepting all financial responsibility for the event, and shall either provide the required insurance or ensure that it is provided by the Event Organizer.

Host Organization Name*

Host Organization Mailing Address*

Host Organization Physical Address (if different)

Host Organization Telephone Number*

Host Organization Website Address

Type of Organization*

Tax Exempt/Non-ProfitCBUOther For-Profit CorporationOther LLC

Specify Tax Exemption Type, If Applicable, e.g. 501(c)(3)

Event Organizer

Event Organizer is the person/entity given authorization by the applying organization to request use of the CBU facility.

Only the authorized Event Organizer and Secondary Organizer will be able to make changes to this application.

Event Organizer Name and Title*

Event Organizer Mailing Address*

Event Organizer Primary Telephone Number*

Event Organizer Cell Phone Number

Event Organizer Fax Number

Event Organizer Email Address*

Secondary Organizer

It is recommended that Event Organizer provide contact information for a Secondary Organizer.

Only the authorized Event Organizer and Secondary Organizer will be able to make changes to this application.

Secondary Organizer Name and Title

Secondary Organizer Mailing Address

Secondary Organizer Primary Telephone Number

Secondary Organizer Cell Phone Number

Secondary Organizer Fax Number

Secondary Organizer Email Address

On-Site Contact

On-Site Contact Name and Title*

On-Site Contact Mailing Address*

On-Site Contact Primary Telephone Number*

On-Site Contact Cell Phone Number

On-Site Contact Fax Number

On-Site Contact Email Address*

About the Event and Requested Facilities

Event Description (Include description of event activities and reason for holding event at CBU)*

Does the Event Include Fundraising?*

YesNo

Does the Event Include a Religious Service?*

YesNo

Date of Proposed Use*

Single Day or Multi-Day Event (Include Set Up and Tear Down Time)*

Single Day Event (Whole Day)Single Day Event (Set Hours)Multi-Day Event

If Multi-Day Event, How Many Days?

Will Event Include an Admission Fee?*

If Yes, How Much Is the Admission Fee?

Anticipated Attendance (Per Day)*

Previous Year's Attendance (Per Day)

Event Set Up Start (Day and Time)*

Event Set Up Completion (Day and Time)*

Event Tear Down Start (Day and Time)*

Event Tear Down Completion (Day and Time)*

Will Vendors Be Providing Service to the Event?*

YesNo

Vendor locations must be shown on the location/venue site plan and full disclosure of vendor names and services must be submitted no later than fifteen (15) days prior to the event. Food vendors must have a valid permit from the Department of Environmental Health, County of Riverside, Business Tax Certificate, and Liability Insurance. The university retains the right to refuse participation of any vendor.

Vendor information submitted for review must include: Company Name, Company Contact, Company Address, Company Physical Address (if different), Company Telephone Number, Vendor Service Provided

Please Disclose Vendor Information, If Applicable

Staging Details that will be used at the event (please mark all that apply)*

Location / Venue Site Plan

All applicants are required to submit a detailed site plan. The required plan is to be submitted on 8 ½” x 11” or 8 ½” x 14” white paper and must include a directional indicator showing N, S, E, and W. The plan must also include a key to indicate people, vehicles, first aid station(s), vendor location(s), cooking station(s), food table(s), platform(s), barricades, etc. It need not be to scale but must accurately represent the desired layout using approximate measurements and/or on-site landmarks. If a computer program is used to generate the site plan/map, the font used must be no smaller that size 10.

Submit site plan file to conferencesandevents@calbaptist.edu or cpolk@calbaptist.edu.

Insurance

The Host Organization and/or Event Organizer must provide a General Liability Insurance Certificate providing evidence of general liability insurance coverage in the minimum amount of $1,000,000 combined single limit, $2,000,000 aggregate AND $1,000,000 Auto Liability if the event includes any moving vehicles including golf carts AND an additional insured endorsement naming “California Baptist University, its trustee, officers, agents, servants, affiliates and employees as additional insured.” This document must be submitted no later than fifteen (15) days prior to the event start date. All vendors participating in the event must provide insurance as well as all contracted service for the event including but not limited to, security services, rentals, etc.

Indemnification Agreement

The Host Organization and/or Event Organizer must submit an indemnification agreement containing language as follows:

“(Insert name) agrees to indemnify, defend and hold CBU its trustee, officers, agents, servants, affiliates and employees completely harmless from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fee, directly resulting from the negligence, actions or omissions of (Insert name/event) and to reimburse CBU for such expense incurred.”

Medical Plan

All events are required to have a medical aid plan to provide service in case of injury or serious illness. At a minimum, this plan must provide for the Event Organizer, Secondary Organizer, and/or Contact to assess the circumstances, call 9-1-1, call CBU Safety Services, and remain with the injured/ill person until arrival of CBU Safety Services staff. Depending upon type of event and/or projected attendance, the Host Organizer may be required to have a First Aid Station on site and to show the location of that service on the Site Plan/Map.

If providing this service through an ambulance company, please provide the following information and attach copies of their Business Tax Certificate, Liability Insurance, and California State License.

If complying with this requirement through contract with a doctor, RN, and/or EMT Staff, please provide the following information and attach a copy of their identification credentials.

Submit evacuation plan file to conferencesandevents@calbaptist.edu or cpolk@calbaptist.edu.

Please provide a detailed description of your emergency evacuation plan. *

In This Section

Host Organization Information

Event Organizer

Secondary Organizer

On-Site Contact

About the Event and Requested Facilities

Location / Venue Site Plan

Insurance

Indemnification Agreement

Medical Plan

Contact Conferences and Events