HomeMy WebLinkAbout031521_ca04Consent Agenda
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: Willie Bence, Emergency Management Director
DATE: March 15', 2021
SUBJECT: Facility Use Agreement for Chimacum Multi -Purpose Room
STATEMENT OF ISSUE:
In response to the COVID-19 pandemic, Jefferson County Public Health (JPH) and the Department of
Emergency Management (DEM) are looking to operate a Community Mass Vaccination Clinic in order to
distribute vaccine to Jefferson County residents.
ANALYSIS:
Chimacum School District has offered JPH/DEM use of their Multi -Purpose Room for use in a Vaccination
Clinic. It's central location, ample parking, and other amenities make it an ideal location for this purpose.
RECOMMENDATION:
The BOCC sign the Facility Use Agreement to allow JPH/DEM utilization of the Chimacum Multi -
Purpose room for a Mass Vaccination Clinic.
Philip Morley,
4260F
CHIMACUM SCHOOL DISTRICT
Facility Use Agreement
The Chimacum School Board of Directors wishes to encourage use of school facilities by the community as long as use is of lawful purpose and does
not interfere with the conduct of the district's educational programs, the primary purpose of which the buildings and grounds are intended.
Community use of facilities is subject to the terms of District Policy and Procedures 4260 and the current schedule of fees. Fees may be charged for
the use of school facilities to ensure that funds intended for education of children are not used for other purposes. Permission to use a particular
facility may be denied based on a belief that the activity proposed may not be in the district's interests or due to the level of previously scheduled use.
No person shall be denied the full enjoyment of the facilities because of race, creed, color, sex or origin.
Name of Organization: Jefferson Count
Contact Name: Willie Bence
Number of Participants:50+
Address:.
31 Elkins Road, Port Hadlock, WA 98339
Daytime Phone:
360-316-6008
Nature and Purpose of Activity:
Mass Vaccination Clinic
Specific Facility / School Requested:
Multi -Purpose Room
[ ) Classroom [ ] Athletic Field [ ] HS Commons [ ] Gym - Middle School
[ ] Auditorium [ ] Multipurpose Room [ ] MS Commons [ ] Kitchen K-2 or 3-5
[ ] Stage [ ] Auditorium [ ] Gym — Primary School [ ] Kitchen 6-8 or 9-12
[ ] Band Room [ ] Library (K-2; 3-8; 9-12) [ ] Gym - High School [ ]
Dates to be Used: 3/21 • others
�
Day of Week:
Saturday, Sunda
Start Time: 0800
End Time:
1700
Will Custodial services be needed? (Custodial services are restricted
Admission Charged?
YES
NO
to unlocking doors, operating lights, providing heat, setting up chairs
YES
NO
and performing routine clean-up.)
Equipment Needed: [ ] Chairs [ ] Tables [ ] Flag [ ] Podium [ ] Screen [ ] Microphone(s) [ ] Projector [ ] Piano
FACILITY RENTAL FEES will be determined by the latest established rental rates. Payment is due to the district within thirty (30)
days of receipt of invoice. Charges may be levied to cover the cost of additional services not covered in the original agreement or for
damages or agreement violations. The district reserves the right to require and charge for custodial and/or other authorized district
employees to be on the premises.
AGREEMENT AND INSURANCE
The person or organization entering into a rental agreement with the Chimacum School District (District) for the use of facilities or equipment
described above certifies that the information given in this application is current. The undersigned further states that he/she has the authority to make
this application for the applicant and agrees that the applicant will observe all rules and regulations. The applicant further agrees to reimburse the
District for any damages arising from the applicant's use of said facilities. Any accident involving injury to participants or damages to facilities or
equipment occurring during the use of school district facilities or equipment will be reported to District authorities immediately.
In accordance with Chapter 28A.335 RCW, private nonprofit groups serving youth are required to provide proof of bodily injury coverage of no less
than $50,000 per occurrence/$100,000 aggregate. For -profit, business groups are required to provide proof of general liability coverage of no less
than $1 million dollars per occurrence. The District must be named as additionally insured on said policy. Coverage cannot be cancelled or reduced
without thirty (30) days written notice to the District.
(initial) The applicant agrees to fully comply in accordance with the adoption of policies for the management of concussion and head injury
in youth sports; as amended in RCW 4.24.660 and chapter 28A.600 RCW if applicable. Access to school facilities may not be granted until all
requirements are complete and approved by the school district and/or designee.
The applicant agrees that the District and its agents or employees will not be liable for any damage to person or property by reason of negligent acts
of applicant, its agents, employees, invitees, or subcontractors. Applicant agrees to protect, indemnify for legal costs and other expenses, and hold
harmless, the Chimacum School District and its officers, employees, directors and agents from claims, liabilities, or suits, arising out of injury to
person or property from negligent acts of applicant, directly or indirectly attributable to the user's activities and/or use of premises except for sole
ne li ence of the district.
I have read the rules and regulations above and on the reserve side of this form and agree with the conditions and charges as
established.
Signature of Applicant:
Date:
**See Reverse Side**
4260F
CHIMACUM SCHOOL DISTRICT
Facility Use Agreement
Rules and Regulations
• Applications for use of facilities must be filed with the District Office at least five (5) school days prior to the event.
• Applicant/organization is responsible for the safety and conduct of its participants and spectators.
• All non-profit youth sports group, verifies all coaches, athletes and their parent/guardian have complied with
mandated policies for the management of concussions and head injuries as prescribed by HB 1824, section 2.
• Satisfactory sponsorship and adequate adult supervision must be provided by the applicant. Security may be required
for some activities.
• All events will be required to meet the occupancy load and fire and safety regulations of the County of Jefferson and
State of Washington.
• Use of alcohol, tobacco, and/or drugs is prohibited.
• Profane language and/or other objectionable conduct may result in barred use of facilities.
• Firearms or other dangerous weapons are prohibited on school grounds as defined by law.
• Games of chance, lotteries, and giving of door prizes are not allowed except where permitted by law and then only
with proper clearances.
• Access to facilities and services, except as otherwise addressed in these rules, shall be limited to that specified on the
application.
• Alterations to the field/facility are prohibited without prior approval. This may include such things as hanging signs,
erecting backstops, placing goals, using masking tape on walls, floor, etc.
• District -owned equipment shall not be removed from the facility or loaned to any individual or organization unless
prior approval by the District has been granted. Groups or individuals cannot use district -owned expendable supplies.
• Applicants are responsible for special set-up requirements and clean-up, unless specifically requested in the
application. Users shall be responsible for returning the facility to its original condition immediately following the
event.
• Appropriate gym shoes are required for all activities on the uncovered floor of gymnasiums.
• The applicant/organization shall not practice discrimination of any kind.
• Cancellations by applicants require at least a 24-hour notice otherwise related actual costs shall be borne by the
applicant.
• Facility use is cancelled when facility/building is closed due to an emergency.
• The district reserves the right to refuse or revoke any authorization issued for the use of school building or grounds,
and if rental has been paid, to refund such rental, less expenses incurred by the district in connection therewith.
• School district keys shall not be loaned out or given to anyone other than applicant.
FOR SCHOOL DISTRICT USE ONLY
Approved: [ ]
Denied: [
]
Category: I [ ] II [ ]
III [ ] Other [ ]
Single Event: [ ]
School Year: [
]
Summer: [ ]
Certificated of Insurance: Requested [ ] Received [ ]
Days: [ ]
Evening: [
]
Saturday: [ ]
Sunday:[ ]
Holiday: [ ]
Letter of Compliance with HB 1824
Requested [ ] Received [ ]
Facility Rental Fee Per Hour
$
Total Hours of Use
Other Charges: Custodial, Food Service Staff
$
Date Billed
Total Billed
$
Signature of Facilities Coordinator
Date