HomeMy WebLinkAboutUkiah Unified School District (UUSD) 2023-07-13 COU No 2223-223
MEMORANDUM OF UNDERSTANDING
BETWEEN CITY OF UKIAH AND UKIAH UNIFIED SCHOOL DISTRICT
2023 SUMMER CAMP PROGRAM
This Memorandum of Understanding("MOU"), is made by and between the Ukiah Unified
School District, a public local educational agency ("LEA"), hereinafter referred to as "District,"
and the City of Ukiah ("City"), a public entity.
RECITALS:
1. The District and the City have a long-standing joint use agreement("2014 Joint Use
Agreement"), which benefits the community as a whole by providing for the joint use of
playgrounds and outdoor playing fields in order to reduce capital and operational costs to
both governmental jurisdictions and provide recreational areas. (Attachment A.)
2. In response to the COVID-19 pandemic's deleterious effects on school age youth in the
form of lost instruction and needed supports for social and emotional well-being, among
other needs, federal and state agencies have provided one time funding to LEAS,
including the District, to address learning recovery by providing programs to expand
instructional learning,provide summer school or other activities in accord with the
respective funding rules.
3. The District will receive a grant from the California Department of Education for
Expanded Learning Opportunities in accord with Education Code section 45320 et seq.
4. The District and City intend to collaborate in the District's Summer Camp ("Camp")
program to provide Expanded Learning Opportunities to student participants
("Participants"), which includes a morning session of class work at students' assigned
school site overseen by the District, and recreation time provided to Participants by the
City in the afternoon, called the "Safari"program. Recreational activities may be
provided at either the Participants' assigned school site,Ukiah High School ("High
School"), including at the High School Pool ("Pool"), or the City's Todd Grove Park
Pool (also "Pool").
AGREEMENT:
1. Description of Program. Starting at 8:00 a.m., the District will provide in-school
instruction and classes Monday-Friday(excepting holidays) to students ("Participants")
at one of four schools: Calpella Elementary, Frank Zeek Elementary, Grace Hudson
Elementary, and Pomolita Middle. The morning, District-run program will include
summer camp with a teacher and paraprofessional to engage in fun learning activities that
address academics, including reading, writing, math, and science. At noon, for those
Participants who also signed up for the Safari (afternoon)program, the City will assume
supervision of Participants and provide them with a fun recreation-based program. The
District will provide a lunch to all students in the afternoon Safari program who would
like school-provided nutrition, and the City will supervise Participants during lunch and
during all other afternoon recreational programming. A minimum of one day a week,
Participants from the three elementary schools will be transported to the High School to
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engage in recreational activities. Participants in the program at Pomolita Middle School
may walk to the City's Todd Grove Park to engage in recreational activities. Participants
at the High School or Todd Grove Park with written permission from a Parent/Guardian
may engage in Pool activities.
2. Facilities Use. The City has provided Facilities Use Agreements (Attachment B)
permitting it to run the Safari program at the High School, specifically supervision and
oversight of all pool-related activities, and in which District students may participate as
part of the Camp.
3. Term. The term of this Agreement shall commence on June 13, 2023 and continue
through July 28, 2023. This includes one training and set-up day on June 13, 2023, 30
program days (June 14, 2023 through July 27, 2023, with no program on June 19, 2023 or
July 4, 2023), and one clean-up day on July 28, 2023 (32 days total).
4. District Obligations/Fees. In exchange for allowing Camp students to attend the City's
Safari program in the afternoon, and for providing all supervision and oversight of
students at all times between noon and 5:30 p.m., or until the last student has been picked
up, the District shall pay the City$35,000 per week($7,000 per day)per school site
within 30 days' of receipt of an invoice from the City, to be invoiced by the City no later
than August 15, 2023. The District shall provide transportation, as it is available to
students, to and from the High School.
5. City Obligations. The City will provide supervision and oversight of all Participants
between the hours of noon to 5:30 p.m. City shall exercise due diligence to ensure the
safety of the Safari program Participants, including, but not limited to, providing at least
the minimum number of certified and trained lifeguards required for the number of
students engaged in any and all pool activities. City agrees all students enrolled in the
Safari program as of June 21, 2023 shall be permitted to attend. As of June 21, 2023, the
City shall enroll no more students in the Safari program. The District has no supervisory
or oversight obligations over Participants from noon to 5:30 p.m. each day, unless and
until Participants board District-provided transportation.Under no circumstances shall
the City be responsible for transportation of participants in the program.
6. Assignment and Sublease. City shall not assign their interest in this MOU.
7. Conflict in Agreements. The 2014 Joint Use Agreement and the Facilities Use
Agreements are incorporated into this MOU by reference. Where conflicts exist, the
terms of this MOU prevail over all other agreements, and the Facilities Use Agreement
shall prevail over the 2014 Joint Use Agreement where conflicts exist between the two.
8. Termination. Failure to comply with any provision of this MOU within a period of ten
(10) days following receipt of a written notice of noncompliance from either party shall
constitute a material breach of the Agreement and furnish grounds for termination of this
Agreement.
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9. Inspection and Maintenance. District and its authorized representatives shall have the
right, at any reasonable time during the term of this MOU, to enter upon the High School
and the pool to inspect the property and maintain the grounds as needed.
10. Attorneys' Fees. In any legal action to enforce any of the terms of this Agreement, each
party shall bear its own attorney's fees and costs, and neither party shall be liable for any
such fees and costs incurred by the other party.
11. Time of Essence. Time is of the essence in the interpretation and application of this
Agreement.
12. General Provisions.
A. Independent Contractor. City shall be acting as an independent contractor and
shall have control of the High School Pool and surrounding premises in accord
with the Facilities Use Agreement. Neither party is to be considered an agent or
employee of other, nor are employees of one agency entitled to participate in any
pension plan, insurance, bonus, or similar benefits the party provides to its
employees.
B. No Discrimination. Neither the District nor the City, nor their respective
employees, shall discriminate on the basis of race, religion, color, ancestry, sex,
disability, national origin, or any other prohibited grounds against any person
seeking employment or services from the Camp.
C. Notices. Except as otherwise expressly provided herein, any written notice
required by this Agreement shall be deemed given and received when personally
served or 48 hours after being placed in the United States mail, with proper first-
class postage prepaid, and addressed as follows:
For District: Attention: Steve Barekman, Chief Business Officer, Ukiah Unified
School District, 511 S. Orchard Ave, Ukiah, CA 95482
For City: Attention Jake Burgess, City of Ukiah, Recreation Supervisor, City of
Ukiah Civic Center, 300 Seminary Avenue, Ukiah, CA 95482.
Any party hereto may give notice of an address change under the provisions of
this paragraph and thereafter all notices shall be given to that address.
D. Parag_raph Headings. Paragraph headings are included for the convenience of the
parties and are not intended to define or limit the scope of this Agreement.
E. Duplicate Originals. This Agreement may be executed in one or more duplicate
originals bearing the original signature of both parties and when so executed any
such duplicate original shall be admissible as proof of the existence and terms of
this Agreement.
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This Agreement is effective upon the date that both parties have executed this Agreement.
City of Ukiah Ukiah Unified School District
Sage Sangiacomo Steve Barekman
City Manager Chief Business Official
Date: J U l 13, 2023 Date: o G. t4.Zo L3
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ATTACHMENT A
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COU No. 1415-142
AGREEMENT FOR JOINT USE OF FACILITIES
This Agreement is made and entered on thq,, (�day of O. C)Af_ , 2014, in Ukiah,
California, by and between the City of Ukiah ("City"), and Ukiah Unified School District
("District"). District and City may each be referred to individually as "Party" or jointly as
"Parties."
RECITALS
A. City operates a year round community recreation program that includes a variety of
classes and sports programs. These programs include youth basketball, girls' softball, adult co-ed
volleyball and softball, men's and women's softball, sport and specialty camps/leagues/clubs,and
a variety of special interest classes for adults and children such as dance, fitness, arts and crafts,
music, language, and cooking classes ("City recreation programs").
B. District organizes golf, swimming, and baseball classes and teams and has
occasional use for public meeting spaces in addition to those available on its campuses ("District
recreation programs").
C. Sections 10900 et. seq. of the Education Code ("Community Recreation Act")
authorize cities and school districts to maintain and operate joint use playgrounds and outdoor
playing fields in order to reduce capital and operational costs to both governmental jurisdictions
and provide recreational areas for the community as a whole.
D. Section 10910 of the Education Code provides that the governing body of any
school district may use or grant the use of grounds of the school district to any other public
authority for the purposes of joint use, whenever such use does not interfere with school uses.
E. The Parties have determined that it is in their mutual interest, subject to the terms
and conditions as further stated herein, to exchange the use of certain facilities owned and
maintained by them to support the recreation programs they each organize and conduct.
AGREEMENT
In consideration of the above-recited facts and the terms and conditions as further stated
herein the Parties hereby agree as follows:
1. The initial term of this Agreement shall be ten (10) years, beginning on
. rye 0 ZP/ ("Commencement Date") and expiring on December 31,
("Expiration D e"), unless extended or earlier terminated as provided in this Agreement.
a. This Agreement may be terminated at any time by either Party,upon written
notice to the other Party thirty (30) days prior to termination. Upon receipt of notice, the Parties
agree to use their reasonable efforts to allow a transition from the shared use of facilities that
allows their respective programs to continue without undue disruption.
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COU No. 1415-142
b. This Agreement may be extended by mutual agreement for two (2) ten
(10)-year extension terms, which, including the initial term, comprises a total of thirty (30) years
or longer, under the same terms and conditions of this Agreement. The Parties shall meet no later
than ninety (90) days prior to the expiration of the initial term or any extension to determine
whether to extend or terminate the Agreement.
2 Subject to the terms and conditions set forth in paragraph 4, the District shall make
available to City for its use in conducting City recreation programs its gymnasiums, multipurpose
rooms, class rooms, tennis courts, swimming pool facilities, and football, softball, soccer and
baseball fields.
3. Subject to the terms and conditions set forth in paragraph 4, the City shall make
available to District for classes, sports teams and public meeting spaces, its Conference Center,
golf course, swimming pool facilities, Anton Stadium, park facilities, Todd Grove Clubhouse,
Grace Hudson Museum meeting room, and Civic Center Council Chamber.
4. Except where special conditions are otherwise stated, the Parties shall make their
facilities available to each other in accordance with the following terms and conditions:
a. Each Party shall have the use of the facilities without charge, except that
each Party may charge the other a facilities maintenance fee, if the time and expense to clean and
prepare the facility for reuse exceeds a reasonable amount normally expected from routine use of
the facility. As to each facility the Parties shall agree to leave the facility clean and each Parry is to
have performed general maintenance reasonably expected of the Party using the facility pursuant
to this agreement and the amount reasonably expected of the owner of the facility. Any bill under
this subparagraph for a facilities maintenance fee shall itemize the time,hourly rates and expenses
included in the bill. Each Party using the facility of the other shall pay all costs associated with
repairing any damage to the facility caused by that use, normal wear and tear excepted. If either
Party discovers such damage,it shall immediately notify the other and arrange a joint inspection of
the damage. Each Party shall provide written notice to the other party of the name and contact
information for the staff member who will participate in the joint inspection.
b. Any Party's use of the other Party's facilities under this Agreement shall not
interfere with the normal use of the facility by the owner. Each Party shall have first priority for
the use of the other Party's facility, after the facility owner, barring any third party user who has
been previously scheduled. The Parties shall work cooperatively to schedule the use of such
facilities under this Agreement to avoid unnecessary inconvenience to each other and third party
facility users (i.e. community groups, private rentals, club/team activities, and sport groups). In
scheduling the use of facilities by third party facility users,the District and the City shall take into
consideration their past use of District and City facilities and use reasonable efforts to continue that
past use. The District and City shall provide reasonable notice of their intended use of the facilities
to each other.
C. Each Party shall exercise due care in providing adequate and legally
required supervision of its use of facilities under this Agreement. With respect to all facilities the
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COU No. 1415-142
use and supervision of the activity shall comply with any requirements imposed by state law or
local regulation or policy. The facility owner shall complete a use of facility document and provide
the Party using the facility with a contact person and phone number who can be reached at any time
while the facility is being used. All use of facility documents must be signed by an authorized
representative.
When either Party uses the swimming pool facilities of the other Party, the Party
using the swimming pool facility shall provide not less than two lifeguards who must be on duty
throughout the entire time that the pool is used by that Party, with the exception of the Ukiah
Municipal Pools where City of Ukiah lifeguards must be on duty. The cost of these lifeguards will
be absorbed by the City of Ukiah. The lifeguards must have current certifications required by state
law and any locally adopted regulation or policy. The number of lifeguards required shall be
dictated by the American Red Cross Guidelines and is currently at a ratio of one guard per
twenty-five swimmers. If the lifeguards are not supplied by the facility owner,the Party using the
facility must file current lifeguard certifications with the owner before using the facility.
d. No Party or any of its officers,agents,volunteers,contractors,or employees
shall be responsible for any damage or liability occurring by reason of any acts or omissions on the
part of the other Party under or in connection with any obligation delegated to the Parties under
this Agreement. Each Party shall indemnify,defend and hold harmless the other Party,its officers,
agents, volunteers, contractors, and employees from any and all liability, loss, expense (including
reasonable attorneys' fees and other defense costs), or claims imposed for damages of any nature
whatsoever, including but not limited to,bodily injury, death,personal injury, or property damage
occurring by reason of any acts or omissions on the part of the Party's own officers, agents,
volunteers, contractors, invitees, and employees under or in connection with any obligation
delegated to such Parry under this Agreement. This indemnity shall survive termination of this
Agreement.
e. Prior to using any facility under this Agreement and as a condition
precedent to its right to use such facilities, each Party shall provide the other Party with proof of
general comprehensive or commercial liability insurance satisfactory to the other Party with policy
limits of not less than $5,000,000 per occurrence and a general aggregate of limit of not less than
$5,000,000. Each policy shall name the other Party as an additional insured as to any use of
facilities under this Agreement. Coverage under a memorandum of coverage issued by a joint
powers agency to which the Parry belongs may be used to comply with the insurance requirements
in this subparagraph e. Each Party shall provide Workers'Compensation and Employers'Liability
insurance, as required by the State of California. The insurance coverage requirements in this
Section 4.e. shall be subject to review and adjustment to reflect coverages recommended by the
Parties' insurance advisors over the term of this Agreement. Any such adjustments shall be set
forth in a written amendment to the Agreement, agreed to by both Parties.
f. Each Party shall pay the utility costs for its own site.
g. Each Party shall be responsible for its separate trash collection provided to
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COU No. 1415-142
the site when the use generates an amount of trash in excess of that normally expected from routine
use of the facility.
5. Whenever notice is permitted or required under this Agreement, it shall be deemed
given when personally served by personal delivery or overnight courier or when delivered by fax
or email, but only if receipt of the fax or email is acknowledged, or 48 hours after deposited in the
United States mail with proper first class postage affixed thereto and addressed as follows:
UKIAH UNIFIED SCHOOL DISTRICT CITY OF UKIAH
Attention: Superintendent Ukiah Civic Center
511 S. Orchard Ave. Attention: City Manager
Ukiah, CA 95482 300 Seminary Avenue
FAX: Ukiah, CA 95482
Email: FAX:
Email:
or at such other address as such party may previously have advised the other party by notice
similarly given.
6. This constitutes the whole agreement between the Parties concerning its subject
matter and supersedes and replaces any prior agreements, statements or understandings that may
have existed between the Parties.
7. This Agreement may be executed in one or more duplicate originals and when so
executed each such duplicate original, bearing the original signatures of the Parties, shall be
admissible in any administrative or judicial proceeding as proof of its terms.
8. In the event of a dispute under this Agreement, each Party shall bear its own
attorneys' fees and costs.
9. The persons executing this Agreement on behalf of the Parties warrant that(i) such
person is duly authorized to execute and deliver this Agreement on behalf of said Party, (ii)by so
executing this Agreement, Party is formally bound to the provisions of this Agreement, and (iii)
entering into this Agreement does not violate any provision of any other agreement to which either
Party is bound.
10. There shall be no discrimination against any person on account of race, color,
religion, sex, marital status, national origin, or ancestry in performance of the obligations under
this Agreement.
WHEREFORE, this Agreement is made and entered on the date first written above.
DIST ICT UKIACH-
By : By: F-- CH-A ME E RS
Its: Its: TY MPm/A6-EP-
Page 4 of 4
ATTACHMENT B
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YNI-1 JUN Q 7 2023
o UKIAH UNIFIED SCHOOL DISTRICT
APPLICATION AND AGREEMENT FOR USE OF FACT L ...
District/Certificate Holder: Applicant:City of Ukiah - Day Camp
Ukiah Unified School District Company/Organization: City of Ukiah
Address: 51.1 South Orchard
Avenue,Ukiah CA 95482 Non-profit or anization, Yes o
Phone: (707)-472-5012 Requester's Name:Cassandra Borgna
Email: kristinakeenc@uusd.net (Must he an officer or authorized
re resentathv of corn are /or anfzatiwz
Address:
411 W. Clay St., Ukiah, CA
Phone:707-272-2257 Email:cborgna@city fukiah.com
Facilities Requested.
School Site: Ukiah High School
Facility/Room Requested:Pool, locker room and ad'aeent weight room
Pleas ate exact dates and time(s) reff
.
Micne-thlleUse
✓V aily Useeekly Use 7monthly Use
Month Date(s) Year Day of Week Time Expected %of District
(from/to) Attendance Students
June 12- Monday-Friday lop-i6a per day 100%
July 28,2a2s
Event/Program: After Summer School Saran fray Camp Program)
If this request is by the City of Ukiah,no other information is needed,skip to the signature section and sign.
Will a donation,fee or charge be collected from participants? Yes No
If yes, how will the proceeds be used?
Is the use non-exclusive and open to the public? Yes No
1. Indemnification:To the fullest extent permitted by law Applicant shall hold harmless,defend and indemnify
the District,its governing board,officers,agents and employees,from and against any liability,claim,
action,cost,damage or loss,including reasonable costs and attorneys' fees,for injury,including death,to
any person or damage to any property arising out of the activities of Applicant or its agents,officers,
employees,invitees or guests in or about the Facilities,whether or not there is concurrent passive or active
negligence on the part of District,but excluding liability due to the sole negligenceor willful misconduct of
District.This obligation shall continue beyond the term of this Agreement as to any act or omission that
occtnTed during or under this Agreement,This indemnification obligation is not limited in any way by any
limitation on the amount or type of damages or compensation payable to Applicant or its employees or
agents under workers' compensation acts,disability benefit acts,or other employee benefit acts.
2. insurance:Attach a Certificate of Insurance with Additional Insured Endorsements specined in the
Insurance Required of Applicant Section clearly evidencing all coverage,limits,and endorsements required.
Said certificates shall be submitted prior to the execution of this Agreement. This policy shall not be canceled or
materially changed without first giving thirty(30)days prior written notice to District.Upon District's written
request,certified copies of insurance policies shall be submitted within thirty(30)days of the District's request.
Applicant's indemnity and other obligations shall not be limited by the foregoing insurance requirements. If
applicant,for any reason,fails to maintain insurance coverage as required,the right to use the Facilities shall be
deemed revoked.
3. Fees:Applicant understands that direct costs/fair rental value fees will be assessed in accordance with the
District's policies and regulations. An application fee and %deposit on estimated use
fees are due upon submittal of this Application and Agreement for Use of Facilities.Applicant agrees
Page 1 of 2
to remit payment in full within thirty(30)days after District's issuance of an invoice.
4, Compliance with District Policies and Regulations:Applicant shall comply with District policies and
regulations concerning including,but not limited to,the prohibitions against unlawful discrimination and use
of tobacco and alcohol on District property.Applicant shall inform its staff and event/program participants
that tobacco and alcohol use are prohibited and shall strictly enforce the policy.Applicant shall not make any
modifications or alterations to the facilities without the advanced,specific,written authorization of District.
5, S"12ervision: Applicant shall be responsible for providing adequate personnel to supervise all persons who enter
the Facilities during Applicant's authorized use periods.
G. Applicant is responsible to repair or replace anything damaged during their use.The District will inspect facility
after use to determine damages,if any.
Insurance Required of Applicant
As evidenced by Certificate of Liability Insurance,Additional Insured Endorsement and other Amendatory Endorsements:
Certificate Holder:
Ukiah Unified School District
511 South Orchard Avenue
Ukiah,CA 95482
Commercial General Liabilitv or Personal Liability on an occurrence form with a minimum limit of$1,000,000 each
occurrence 1$2,000,000 general aggregate for all groups except:
a) Seasonal Sports/Recreation Leagues,Sober Grad Organizations,or Private Events with 500+
attendees:Minimum limit of S2,000,000 each occurrence/$2,000,000 general aggregate.
b) Year Round Sports/Recreation Leagues:Minimum limit of$5,000,000 each occurrence 1$5,000,000
general aggregate
c) Use of Swimming Pool Minimum limit of$6,000,000 each occurrence 1$6,000,000 general aggregate.
Additional Insured Endorsement:This is a separate form attached to the certificate.The endorsement must name
Ukiah Unified School District,it's elected or appointed officials,employees,agents and volunteers as Additional
insured(or Additional Covered Party)under the general liability policy.Forms CG 2026 or CG 2011 or equivalent
required.For purposes of the CG 2011 only,this Agreement shall be deemed to be a lease.Blanket Additional
Insured forms are acceptable when accompanied with an approved Facility Use Agreement.
Evidence of Primary Insurance(either by endorsement or the actual page(s)of the policy typically found in the
"Other Insurance"section of policy):Applicants insurance shall be primary insurance as respects to Ukiah Unified
School District,it's elected or appointed officials,employees,agent,;and volunteers.Any insurance or self-insurance
maintained by Ukiah Unified School District,its elected or appointed officials,employees,agents and volunteers
shall be excess and shall not contribute with it.
The individual signing below on belt if 9f Applicant warrants that he/she has read the foregoing terms and
conditions, that he/she is authorizcd to e2icgjjj his document, and that this document constittates a legally
binding obligation of the individual/or anization which he/she represents
Date:June 5, 2023 Applicant Signature: n�r�—�
Applicant Address411 W. Clay St., Ukiah, CA Telephone( 07 1272`2257
I'nr Office Use O oe
Approved/�enied By: Date: &.E'3•Q�,3
Administrator
Approved E]Dcnied By: Bate:
Business Office
Facility Availabie❑Yes ❑No
Estimated Fees:
Application Fee:$25,00(non-rerundable); Deposit- (applies toward fees); Date Paid: ,20_
District Cost:❑ Fair Rental Value Free:❑ Labor Charge,❑Yes ❑No
School Employee Support Required for this Rental: ❑Yes ❑No
Insurance Certificate Checklist:
Limits Adequate❑ page 2 of 2
Additional Insured Endorsement❑
Primary Wording Provided 11
UKIAH UNIFIED SCHOOL DISTRICT
APPLICATION AND AGREEMENT FOR USE OF FACILITIES
District/Certificate Holder: -Applicant-City of Ukiah - Day Camp
Ukiah Unifled School District Company/Organization: City of Ukiah
Address:511 South Orchard
Avenue,Ukiah CA 95482 Non-profit or anizatlon? es ✓ o
Phone: (707)472-5012 Requestor's Name:Cassandra Borgna
Email: kristinakeene@uusd.net (Must be an officer or authorized
representative of cam an lar anization
Address:
411 W. Clay St., Ukiah, CA
Phone-707-272-2257 Email: cborgna@cityqukiah.com
Facilities Requested.
School Site: caWla Elementary school
Facility/Room Requested: Cafeteria,entire outside campus(fields,blackto s�pjavaroundsl and
an emergency use room in case needed
Pleas icate exact date a d time(s)r ed.
In One-time Use wily U uest
sc Weekly Use P/lMonthly Use
Month Date(s) Year Day of Week Time Expected %of District
(fromlto) Attendance Students
June 12- Monday-Friday 11:30am- 135 100%
July 28,2023 6;30pm
Event(Program: Afar Summer School salart(nay Camp Program)
If this request is by the City of Ukiah,no other infom3ation is needed;skip to the signature section and sign.
Will a donation,fee or charge be collected from participants? Yes No
1f yes,how will the proceeds be used?
Is the use non-exclusive and open to the public? Yes No
1, Indemnifjcation:To the fullest extent permitted by law Applicant shall hold harmless,defend and indemnify
the District,its governing board,officers,agents and employees,from and against any liability,claim,
action,cost,damage or loss,including reasonable costs and attorneys'fees,for injury, including death,to
any person or damage to any property arising out of the activities of Applicant or its agents,officers,
employees,invitees or guests in or about the Facilities,whether or not there is concurrent passive or active
negligence on the part of District,but excluding liability due to the sole negligence or willful misconduct of
District.This obligation shall continue beyond the term of this Agreement as to any act or omission that
occurred during or under this Agreement.This indemnification obligation is not limited in any way by any
limitation on the amount or type of damages or compensation payable to Applicant or its employees or
agents under workers'compensation acts,disability benefit acts,or other employee benefit acts
2. Insurance:Attach a Certificate of Insurance with Additional Insured Endorsements specified in the
Insurance Required of Applicant Section clearly evidencing all coverage,limits,and endorsements required.
Said certificates shall be submitted prior to the execution of this Agreement. Tbis policy shall not be canceled or
materially changed without first giving thirty(30)days prior written notice to District.Upon District's written
request,certified copies of insurance policies shall be submitted within thirty(30)days of the District's request.
Applicant's indemnity and other obligations shall not be limited by the foregoing insurance requirements. If
applicant,for any reason,fails to maintain insurance coverage as required,the right to use the Facilities shall be
deemed revoked.
3. Fees: Applicant understands that direct costs I fair rental value fees will be assessed in accordance with the
District's policies and regulations. An application fee and %deposit on estimated use
fees are due upon submittal of this Application and Agreement for Use of Facilities.Applicant agrees
Page 1 of 2
to remit payment in full within thirty(30)days after District's issuance of an invoice.
4. Compliance with District Policies and Rcgglations:Applicant shall comply with District policies and
regulations concerning including,but not limited to,the prohibitions against unlawful discrimination and use
of tobacco and alcohol on District property.Applicant shall inform its staff and event/program participants
that tobacco and alcohol use are prohibited and shall strictly enforce the policy.Applicant shall not make any
modifications or alterations to the facilities without the advanced,specific,written authorization of District_
5. Supervision: Applicant shall be responsible forproviding adequate personnel to supervise all persons who enter
the Facilities during Applicant's authorized use periods.
6. Applicant is responsible to repair or replace anything damaged during their use.The District will inspect facility
after use to determine damages,if any.
Insurance Required of Applicant
As evidenced by Certificate of Liability Insurance,Additional Insured Endorsement and other Amendatory Endorsements:
Certificate Bolder:
Ukiah Unified School District
511 South Orchard Avenue
Ukiah,CA 95482
Commercial General Liability or Personal Liability on an occurrence form with a minimum limit of$1,000,000 each
occurrence/$2,000,000 general aggregate for all groups except:
a) Seasonal SportsfRecreation Leagues,Sober Grad Organizations,or Private Events with 500+
attendees:Minimum limit of$2,000,000 each occurrence 1$2,000,000 general aggregate.
b) Year Bound SportWRecreation Leagues:Minimum limit of$5,000,000 each occurrence/$5,000,000
general aggregate
c) Use of Swirand g Pool Minimum limit of$6,000,000 each occurrence/$6,000,000 general aggregate.
Additional Insured Endorsement:This is a separate form attached to the certificate.The endorsement must name
Ukiah Unified School District,it's elected or appointed officials,employees,agents and volunteers as Additional
Insured(or Additional Covered Party)under the general liability policy.Forms CG 2026 or CG 2011 or equivalent
required.For purposes of the CG 2011 only,this Agreement shall be deemed to be a lease.Blanket Additional
Insured forms are acceptable when accompanied with an approved Facility Use Agreement.
Evidente of Primary Insurance(either by endorsement or the actual page(s)of the policy typically found in the
"Other Insurance"section of policy):Applicants insurance shall be primary insurance as respects to Ukiah Unified
School District,it's elected or appointed officials,employees,agents and volunteers,Any insurance or self-insurance
maintained by Ukiah Unified School District,its elected or appointed officials,employees,agents and volunteers
shall be excess and shall not contribute with it.
The individual signing below on behalf of Applicant warrants that he/she has read the foregoina temis and
conditions, that he/she is authorized to execute this document, and that this document constitutes a legally
binding obligation of the individual organization which he/she represents_
Date dune 5, 2023 Applicant Signature: P71
dO—
Applicant Address411 W. Clay St., Ukiah, CA Telephone 707)272-2257
For Office Use Only
®Approved 03enied By: Date:_ . L4.3
Site Administrator
Approved I]Denied By: - �_____ Date:
Business Office
Facility Available❑Yes ❑No
Estimated Fees:
Application Fee:$25.00(non-refundable);Deposit: (applies toward fees);Date Paid: , _,20
District Cost:❑ Fair Rental Value Free:[!] Labor Charge:❑Yes ❑No
School Employee Support Required for this Rental: ❑Yes ❑No
Insurance Certificate Checklist:
Limits Adequate❑ Page 2 of 2
Additional Insured Endorsement❑
Primary Wording Provided❑
UKIAH UNIFIED SCHOOL DISTRICT
APPLICATION AND AGREEMENT FOR USE OF FACILITIES
District/Certificate Holder: Applicant:City of Ukiah - Day Camp
Ukiah Unified School District Company/Organization: City of Ukiah
Address: 511 South Orchard
Avenue,Ukiah CA 95482 Non-profit or anization? es r a
Phone:(707)-472-5012 Requestor's Name:Cassandra Borgrla
Email: kristinakeene@uusd.net (Must be an officer or authorised
representative of com any /o aniiation
Address:
411 W. Clay St., Ukiah, CA
Phone:707-272-2257 Email: labor na Pn fukiah.con
Facilities Requested.
.School Site: Pamollta Middle School `
Facility/RootnReguested:. , a e eria�ktof a ov i;� �� ' "n,Tleid_,
Gazebo and an emergency use room in case needed
Please indicate exact date s and timc(s)re nested.
One-time Use Daily Use Weekly Use ✓Monthly Use
Month Date(s) Year Day of Week Time Expected %of District
(frotn/to) Attendance Students
June 12- Monday-Friday 11:30am- 100 100%
July 28,2023 6:30pm
Event/Program: After summer school Sanart(Day Camp Program)
If this request is by the City of Ukiah,no other information is needed;skip to the signature section and sign.
Will a donation,fee or charge be collected from participants? Yes No
If yes,how will the proceeds be used?
Is the use non-exclusive and open to the public? Yes No
I. indemnification:To the fullest extent permitted by law Applicant shall hold harmless,defend and indemnify
the District,its governing board,officers,agents and employees,from and against any liability,claim,
action,cost,damage or loss,including reasonable costs and attorneys'fees,for injury,including death,to
any person or damage to any property arising out of the activities of Applicant or its agents,officers,
employees,invitees or guests in or about the Facilities,whether or not there is concurrent passive or active
negligence on the part of District,but excluding liability due to the sole negligence or willful misconduct of
District.This obligation shall continue beyond the term of this Agreement as to any act or omission that
occurred daring or under this Agreement.This indemnification obligation is not limited in any way by any
limitation on the amount or type of damages or compensation payable to Applicant or its employees or
agents under workers'compensation acts,disability benefit acts,or other employee benefit acts.
2. Insurance:Attach a Certificate of Insurance with Additional Insured Endorsements specified In the
Insurance Required of Applicant Section clearly evidencing all coverage,limits,and endorsements required.
Said certificates shall be submitted prior to the execution of this Agreement. This policy shall not be canceled or
materially changed without first giving thirty(30)days prior written notice to District.Upon District's written
request,certified copies of insurance policies shall be submitted within thirty(30)days of the District's request.
Applicant's indemnity and other obligations shall not be limited by the foregoing insurance requirements. If
applicant,for any reason,fails to maintain insurance coverage as required,the right to use the Facilities shall be
deemed revoked,
3. Fees:Applicant understands that direct costs/fair rental value fees will be assessed in accordance with the
District's policies and regulations. An application fee and %deposit on estimated use
fees are due upon submittal of this Application and Agreement for Use of Facilities.Applicant agrees
Page I of 2
to remit payment in full within thirty(30)days after District's issuance of an invoice.
4. Compliance with District Policies and RegUlations.Applicant shall comply with District policies and
regulations concerning including,but not limited to,the prohibitions against unlawful discrimination and use
of tobacco and alcohol on District property.Applicant shall inform its staff and event/program participants
that tobacco and alcohol use are prohibited and shall strictly enforce the policy.Applicant shall not make any
modifications or alterations to the facilities without the advanced,specific,written authorization of District.
5. ,Supervision: Applicant shall be responsible for providing adequate personnel to supervise all persons who enter
the Facilities during Applicant's authorized use periods.
6. Applicant is responsible to repair or replace anything damaged during their use.The District will inspect facility
after use to determine damages,if any.
Insurance Required of Applicant
As evidenced by Certificate of Liability Insurance,Additional Insured Endorsement and other Amendatory Endorsements:
Certificate Holder:
Ukiah Unified School District
511 South Orchard Avenue
Ukiah,CA 95482
Commercial General Liability or Personal Liablify on an occurrence form with a minimum limit of$1,000,000 each
occurrence/$2,000,000 general aggregate for all groups except:
a) Seasonal Sports/Recreation Leagues,Sober Grad Organizations,or Private Events with 500+
attendees:Minimum limit of$2,000,000 each occurrence/$2,000,000 general aggregate.
b) Year Round Sp orts/Recreation Leagues:Minimum Iimit of$5,000,000 each occurrence I S5,000,000
general aggregate
c) Use of Swimming Pool Minimum limit of$6,000,000 each occurrence/S6,000,000 general aggregate.
Additional Insured Endorsement:This is a separate form attached to the certificate,The endorsement mutt name
Ukiah Unified School District,it's elected or appointed officials,employees,agents and volunteers as Additional
Insured(or Additional Covered Party)under the general liability policy.Forms CO 2026 or CG 2011 or equivalent
required.For purposes of the CG 2011 only,this Agreement shall be deemed to be.a lease.Blanket Additional
Insured forms are acceptable when accompanied with an approved Facility Use Agreement.
Evidence of Primary Insurance(either by endorsement or the actual page(s)of the policy typically found in the
"Other Insurance"section of policy):Applicants insurance shall be primary insurance as respects to Ukiah Unified
School District,it's elected or appointed officials,employees,agents and volunteers.Any insurance or self-insurance
maintained by Ukiah Unified School District,its elected or appointed officials,employees,agents and volunteers
shall be excess and shall not contribute with it.
The individual sing below on behalf of Applicant warrants that he/she has read the foregoing terms and
conditions, that he/she is authorized to execute this document, and that this document constitutes a legally
binding obligation of the individuallar anization which helshe re rese ts.
Date:`)une 5, 2023 Applicant Signature:
ApplicantAddress411 W. Clay St., Ukiah, CA Telephone 7( 07 )272-2257
Fa ffiee Use Only
Approved Cknied By:
Site i rator
Approved Denied By: L f _Date: U )) L7
Business Office
Facility Availablc❑Yes ❑No
Estimated Fees:
Application Fee:$25.00(non-refundable);Deposit: (applies toward fees);Date Paid: ,20_
District Cost:❑ Fair Mental Value 0 Free:❑ Labor Charge:❑Yes ❑No
School Employee Support Required for this Rental: ❑Yes ❑No
Insurance Certificate Checklist:
Limits Adequate❑ Page 2 of 2
Additional Insured Endorsement❑
Primary Wording Provided 13
UKIAH UNIFIED SCHOOL DISTRICT
APPLICATION AND AGREEMENT FOR USE OF FACILITIES
District/Certificate Holder: Applicant:City of Ukiah - Day Camp i
Ukiah Unified School District Company/Organization: City of Ukiah lj
Address:511 South Orchard j
Avenue,Ukiah CA 95482 Non-profit orgsnization?OYes ✓(]No
Phone: (707)-472-5012 Requestor's Name:Cassandra Borgna
Email:kristinakecne@uusd.net (Must be an officer or authorized
representative of cwmpanylorgantzadon)
Address: 1
411 W. Clay St., Ukiah, CA
Phonec707 272-2257 Email:cbor na@city fukiah.c
Facilities Requested.
School Site: Frank leek Flemeni"Schwi
Facility/Room Requested:Cafeteria, entire outside campus(fields, blacktops and playgrounds)
classrooms 'I and 2 and an emergency use room in case needed
Pleas ate exact date s and time(s)re rented.
MIcne-time
Use
wily Use Weekly Use Fv]Monthly Use
Month Datc(s) Year Day of Week Time Expected %of District
(from/to) Attendance Students
June 12- Monday-Friday 11:30am- 325 100%
July 28,2023 6:30pm
Event/Program: ARorSummw30"setae(Day campP"ram)
If this request is by the City of Ukiah,no other information is needed;skip to the signature section and sign
Will a donation,fee or charge be collected from participants? Ycs No
If yes, how will the proceeds be used?
Is the use non-exclusive and open to the public?—Yes No
1. Indemnification:To the fullest extent permitted by law Applicant shall hold harmless,defend and indemnify
the District,its governing board,officers,agents and employees,from and against any liability,claim,
action,cost,damage or loss,including reasonable costs and attorneys' fees,for injury,including death,to
any person or damage to any property arising out of the activities of Applicant or its agents,officers,
employees,invitees or guests in or about the Facilities,whether or not there is concurrent passive or active
negligence on the part of District,but excluding liability due to the sole negligence or willful misconduct of
District.This obligation shall continue beyond the term of this Agreement as to any act or omission that
occurred during or under this Agreement.This indemnification obligation is not limited in any way by any
limitation on the amount or type of damages or compensation payable to Applicant or its employees or
agents under workers'compensation acts,disability benefit acts,or other employee benefit acts.
2. Insurance:Attach a Certificate of Insurance with Additional Insured Endorsements specified in the
Insurance Required of Applicant Section clearly evidencing all coverage,limits,and endorsements required.
Said certificates shall be submitted prior to the execution of this Agreement This policy shall not be canceled or
materially changed without first giving thirty(30)days prior written notice to District.Upon District's written
request,certified copies of insurance policies shall be submitted within thirty(30)days of the District's request,
Applicant's indemnity and other obligations shall not be limited by the foregoing insurance requirements. if
applicant,for any reason,fails to maintain insurance coverage as required,the right to use the Facilities shall be
deemed revoked,
3. Fees:Applicant understands that direct costs!fair rental value fees will be assessed in accordance with the
District's policies and regulations. An application fee and %deposit on estimated use
fees are due upon submittal of this Application and Agreement for Use of Facilities.Applicant agrees
Page 1 of 2
to remit payment in full within thirty(30)days after District's issuance of an invoice,
4. Compliance with District PoligigF and Regulations:Applicant shall comply with District policies and
regulations concerning including,but not limited to,the prohibitions against unlawful discrimination and use
of tobacco and alcohol on District property.Applicant shall inform its staff and event/program participants
that tobacco and alcohol use are prohibited and shall strictly enforce the policy.Applicant shall not make any
modifications or alterations to the facilities without the advanced,specific,written authorization of District.
5. Supervision: Applicant shall be responsible for providing adequate personnel to supervise all persons who enter
the Facilities during Applicant's authorized use periods.
6. Applicant is responsible to repair or replace anything damaged during their use,The District will inspect facility
after use to determine damages,if any,
Insurance Re4uired of Applicant
As evidenced by Certificate of Liability Insurance,Additional Insured Endorsement and other Amendatory Endorsements:
Cyrtiflcate
Ukiah Unified School District
511 South Orchard Avenue
Ukiah,CA 95482
Commercial r PersonaLLIshility on an occurrence farm with a minimum limit of$1,000,000 each
occurrence/$2,000,000 general aggregate for all groups except:
a) Seasonal Sports/Recraation Leagues,Sober Grad Organizations,or Private Events with 500+
attendees:Minimum limit of$2,000,000 each occurrence 1$2,000,000 general aggregate.
b) Year Round Sports/Recreation Leagues:Minimum limit of$5,000,000 each occurrence/$5.000,000
general aggregate
c) Use of Swimming Pool Minimum limit of$6,000,000 each occurrence/$6,000,000 general aggregate.
Additional Insured Endorsement:This is a separate form attached to the certificate.The endorsement must name
Ukiah Unified School District,it's elected or appointed officials,employees,agents and volunteers as Additional
Insured(or Additional Covered Party)under the general liability policy.Forms CG 2026 or CG 2011 or equivalent
required,For purposes of the CG 2011 only,this Agreement shall be deemed to be a lease.Blanket Additional
Insured forms arc acceptable when accompanied with an approved Facility Use Agreement.
Evidence of Primary Insurance(either by endorsement or the actual page(s)of the policy typically found in the
"Other Insurance"section of policy):Applicants insurance shall be primary insurance as respects to Ukiah Unified
School District,it's elected or appointed officials,employees,agents and volunteers.Any insurance or self-insurance
maintained by Ukiah Unified School District,its elected or appointed officials,employees,agents and volunteers
shall be excess and shall not contribute with it.
The individual signing below on behalf of Applicant warrants that he/she has read the foregoing, terms and
conditions, that he/she is authorized to execute this document.and that this document constitutes a legally
binding obligation of the individuta]lorganization which
he/ a resents
Date.June 5, 2023 Applicant Signature:�+ .
Applicant Address411 W. Clay St,, Ukiah,CA Telephone 707 1272-2257
For Office Use ly
A:�]Approvcd/�enied By;
ite nip
Approved Ejenied By; Date: ►6y L3
Business Office
Facility Available Yes []No
Estimated Fees:
Application Fee:$25.00(non-refundable);Deposit:__ (applies toward fees);Date Paid:_„_ 20_
District Cost:❑_ Fair Rental Value❑ Free:❑ Labor Charge:[]Yes ❑No
School Employee Support Required for this Rental: ❑Yes []No
Insurance Certificate Checklist:
Limits Adequate❑ Page 2 of 2
Additional Insured Endorsement❑
Primary Wording Provided❑
UKIAH UNIFIED SCHOOL DISTRICT
APPLICATION AND AGREEMENT FOR USE OF FACILITIES
District/Certificate Holder: A licant:City of Ukiah - Day Camp
Ukiah Unified School District Company/Organization: City of Ukiah
Address: 511 South Orchard
Avenue,Ukiah CA 95482 Non-12roflt or antzation. es r o
Phone: (707)-472-5012 Requestor's Name:Cassandra BOrgna
Email:kristinakeene@uusd.net (Must be an officer or authorized
representative of com an /or anization
Address:
411 W. Clay St., Ukiah, CA
Phone:707-272-2257 Email: cbor na d fukiah.con
Facilities Requested.
School Site: Grace Hudsm Elementary School
Facility/Room Requested: ym, Cafeteria, blacktop, Playground, Field an any rooms
designated for emergency use in case needed
Please indicate exact date Maily
time(s)re uested.
One-time Use Use Weekly Use ✓Monthly Use
Month Date(s) Year Day of Week Time Expected %of District
(from/to) Attendance Students
June 12- Monday-Friday 11:30am- 500 100%
July 28,2023 6:30pm
Event/Program: After Sumrnar Sd,od salad(Day Camp Program)
If this request is by the City of Ukiah,no other information is needed;skip to the signature section and sign.
Will a donation,fee or charge be collected from participants? Yes No
If yes,how will the proceeds be used?
Is the use non-exclusive and open to the public?_Yes No
l. Indemnification:To the fullest extent permitted by law Applicant shall hold harmless,defend and indemnify
the District,its governing board,officers,agents and employees,from and against any liability,claim,
action,cost,damage or lass,including reasonable costs and attorneys'fees,for injury,including death,to
any person or damage to any property arising out of the activities of Applicant or its agents,officers,
employees,invitees or guests in or about the Facilities,whether or not there is concurrent passive or active
negligence on the part of District,but excluding liability due to the sole negligence or willful misconduct of
District.This obligation shall continue beyond the term of this Agreement as to any act or omission that
occurred during or under this Agreement.This indemnification obligation is not limited in any way by any
limitation on the amount or type of damages or compensation payable to Applicant or its employees or
agents under workers'compensation acts,disability benefit acts,or other employee benefit acts.
2. Insurance: Attach a Certificate of Insurance with Additional Insured Endorsements specified in the
Insurance Required of Applicant Section clearly evidencing all coverage,limits,and endorsements required.
Said certificates shall be submitted prior to the execution of this Agreement. This policy shall not be canceled or
materially changed without first giving thirty(30)days prior written notice to District.Upon District's written
request,certified copies of insurance policies shall be submitted within thirty(30)days of the District's request.
Applicant's indemnity and other obligations shall not be limited by the foregoing insurance requirements. If
applicant,for any reason,fails to maintain insurance coverage as required,the right to use the Facilities shall be
deemed revoked.
3. Fees: Applicant understands that direct costs I fair rental value fees will be assessed in accordance with the
District's policies and regulations. An application fee and % deposit on estimated use
lees are due upon submittal of this Application and Agreement for Use of Facilities.Applicant agrees
Page 1 of 2
to remit payment in full within thirty(30)days after District's issuance of an invoice.
4. Compliance with District Policies and Regulations:Applicant shall comply with District policies and
regulations concerning including,but not limited to,the prohibitions against unlawful discrimination and use
of tobacco and alcohol on District property.Applicant shall inform its staff and event/program participants
that tobacco and alcohol use are prohibited and shall strictly enforce the policy.Applicant shall not make any
modifications or alterations to the facilities without the advanced,specific,written authorization of District.
5. Supervision: Applicant shall be responsible for providing adequate personnel to supervise all persons who enter
the Facilities during Applicant's authorized use periods.
6. Applicant is responsible to repair or replace anything damaged during their use.The District will inspect facility
after use to determine damages,if any.
Insurance Reauired of Apalicant
As evidenced by Certificate of Liability Insurance,Additional Insured Endorsement and other Amendatory Endorsements:
Certificate Holder:
Ukiah Unified School District
511 South Orchard Avenue
Ukiah,CA 95482
Commercial neral Liability r Personal Liability on an occurrence form with a minimum limit of$1,000,000 each
occurrence 1$2,000,000 general aggregate for all groups except:
a) Seasonal Sports/Recreation Leagues,Sober Grad Organizations,or Private Events with 500+
attendees:Minimum limit of$2,000,000 each occurrence/$2,000,000 general aggregate.
b) Year Round Sports/Recreation Leagues:Minimum limit of$5,000,000 each occurrence/S5,000,000
general aggregate
c) Use of Swimming Pool Minimum limit of$6,000,000 each occurrence/$6,000,000 general aggregate.
Additional Insured Endorsement:This is a separate form attached to the certificate.The endorsement must name
Ukiah Unified School District,it's elected or appointed officials,employees,agents and volunteers as Additional
Insured(or Additional Covered Party)under the general liability policy.Forms CG 2026 or CG 2011 or equivalent
required.For purposes of the CG 2011 only,this Agreement shall be deemed to be a lease.Blanket Additional
Insured forms are acceptable when accompanied with an approved Facility Use Agreement.
Evidence of Primary Insurance(either by endorsement or the actual page(s)of the policy typically found in the
"Other Insurance"section of policy):Applicants insurance shall be primary insurance as respects to Ukiah Unified
School District,it's elected or appointed officials,employees,agents and volunteers.Any insurance or self-insurance
maintained by Ukiah Unified School District,its elected or appointed officials,employees,agents and volunteers
shall be excess and shall not contribute with it.
The individual signing below on behalf of Applicant warrants, t foregoin telMs an
conditions, that he/she is authorized to execute this document. and that this document constitutes a legally
binding obligation of the individual/organization which he/she represents.
Date:June 5, 2023 Applicant Signature:
Applicant Address411 W. Clay St., Ukiah, CA Tele ne( 07 )272"2257
or f tee Use Only
Approved/�enied By: �4 Date:
Sit Administrator
Approved Dcnicd 13y:� Date:
Business Office
Facility Available❑Yes ❑No
Estimated Fees:
Application Fee:$25.00(non-refundable);Deposit: (applies toward fees);Date Paid: , 20_
District Cost:❑ Fair Rental Value Frew:❑ Labor Charge:[]Yes ❑No
School Employee Support Required for this Rental: ❑Yes ❑No
Insurance Certificate Checklist:
Limits Adequate❑ Page 2 of 2
Additional Insured Endorsement❑
Primary Wording Provided❑