Statement of Information. The undersigned, as a duly authorized representative for , states that to the best of his/her knowledge the District property, for use o f which this application is hereby made will not be used for the commission of an y crime or any act which is prohibited by law. This agreement must be signed by persons authorized to sig n on behalf of the organization and bind the organization to the terms of this agreement. The Permittee, by its duly authorized officer, also hereby accepts and agrees to abide by the preceding terms and conditions. The District reserves the right to cancel or revoke this permit at any time based on no n-compliance with the terms and conditions stated herein or referenced by attachment or addendum. The District will be entitled to rec over all legal fees, costs and other expenses incident to securing performance or incurred as a consequence of nonperformance. For purposes of this agreement, the following persons are the authorized representatives for the District and the, entity respectively: The undersigned certifies that (s) he is authorized to sign this Agreement on behalf of the Permittee and that the Permittee acknowledges and accepts the terms and conditions herein and attached hereto. DISTRICT PERMITTEE Xxxxxxx Xxxxxxx Name: Long Beach Community College District Organization: 0000 X. Xxxxxx Street Address: Xxxx Xxxxx, XX 00000 City: CA Zip: Ph: 000.000.0000 Fax: 000.000.0000 Ph: Fax: Director, District Facilities Date Permittee Date
Statement of Information. (Pursuant to Education Code section 38136) The undersigned, as duly authorized representative for Applicant, states that, to the best of his or her knowledge, the Facilities for use of which application is hereby made will not be used for the commission of any crime or any act which is prohibited by law.
Statement of Information. The undersigned, as a duly authorized representative of the User, states that to the best of his/her knowledge the School Facility, use of which is being applied for, will not be used for the commission of any crime or any act which is prohibited by law. By my signature below, I acknowledge that I am authorized to sign on behalf of the User and bind the User to the terms of this Agreement. I understand and agree to all terms, conditions and Rules in this Agreement.
Statement of Information. The remittance and the R-115 form shall be accompanied by a statement containing the following information:
Statement of Information. The undersigned, as a duly authorized representative for [organization], states that to the best of his/her knowledge the District property, for use of which an application has been made, will not be used for the commission of any crime or any act which is prohibited by law. This Agreement must be signed by persons authorized to sign on behalf of the organization and bind the organization to the terms of this Agreement. The Licensee, by its duly authorized officer, also hereby accepts and agrees to abide by the preceding terms and conditions. The District reserves the right to cancel or revoke the permit granted under this Agreement at any time based on non-compliance with the terms and conditions stated herein or referenced by attachment or addendum. CONSULTANT shall indemnify, defend and hold harmless the DISTRICT, its officers, agents, and employees of and from any and all liabilities, claims, debts, damages, demands, suits, actions, and causes of actions of whatsoever kind including without limitation costs and fees of litigation, nature or sort which may be incurred by reason of CONSULTANT'S performance under this Agreement. CONSULTANT shall assume full responsibility for payments of federal, state, and local taxes or contributions imposed or required under social security, workers' compensation or income tax laws, or any disability or unemployment laws, or retirement contribution of any sort whatsoever concerning CONSULTANT or any employee and shall further indemnify, pay for the defense of, and hold harmless DISTRICT of and from any such payment or liability arising out of or in any manner connected with CONSULTANT'S performance under this Agreement. The provisions of this Section shall survive the expiration or sooner termination of this Agreement with respect For purposes of this Agreement, the following persons are the authorized representatives for the District and the Licensee respectively. THE UNDERSIGNED CERTIFIES THAT (S)HE IS AUTHORIZED TO SIGN THIS AGREEMENT FOR THE LICENSEE AND THAT THE LICENSEE ACKNOWLEDGES AND ACCEPTS THE TERMS AND CONDITIONS AND ATTACHED HERETO.
Statement of Information. The undersigned Applicant, or duly authorized representative of Applicant on behalf of Applicant, states that the District property for use of which Applicant’s Application is hereby made and any other District property will not be used for the commission of any crime or any act which is prohibited by law. The undersigned further declares that Applicant upholds the state and federal constitutions, and agrees that Applicant will abide by, and Applicant’s use of school facilities or grounds shall conform with, all District Board Policies, Administrative Regulations, and all other applicable District or school rules, regulations, and requirements, as well as all applicable federal, state, and local laws, rules, regulations, requirements, and ordinances.
Statement of Information. Education Code § 38136 provides that no governing board of a school district shall grant the use of any school property to any person or organization for any use in violation of § 38135 prohibiting any use, by any individual, society, group, or organization for the commission of any act intended to further any program or movement the purpose of which is to accomplish the overthrow of the government of the United States or of the state by force, violence, or other unlawful means. For the purpose of determining whether or not any individual, society, group, or organization applying for the use of the school property intends to violate § 38135, the governing board shall require the making and delivery to the governing board, by the applicant of a written statement of information in the following form:
Statement of Information. The undersigned states that, to the best of his or her knowledge, the school property for use of which application is hereby made will not be used for the commission of any act intended to further any program or movement the purpose of which is to accomplish the overthrow of the government of the United States by force, violence or other unlawful means; That , the organization on whose behalf he or she is making application for use of school property, does not, to the best of his or her knowledge, advocate the overthrow of the government of the United States or of the State of California by force, violence, or other unlawful means, and that, to the best of his or her knowledge, it is not a Communist action organization or Communist front organization required by law to be registered with the Attorney General of the United States. This statement is made under the penalties of perjury. As the undersigned, I have read the above STATEMENT OF INFORMATION and understand, as the individual and/or a duly authorized representative of my organization, that failure to comply with any of the above items will be grounds for the revocation of the facilities use permit. I understand further that as the individual and/or duly authorized representative of my organization that I/we are responsible for the implementation of the above requirements included in this Statement of Information. Organization Name (Print) Title Signature West Contra Costa Unified School District – Verification and Action Compliance of Statement of Expectations Non-compliance of Statement of Expectations Name Title Date West Contra Costa Unified School District 0000 Xxxxxxx Xxxxxx, Xxxxxxxx, XX 00000. (000) 000-0000 APPENDIX C Hold Harmless Agreement The following Hold Harmless Agreement shall be completed prior to use of facilities: To: WEST CONTRA COSTA UNIFIED SCHOOL DISTRICT In connection with the granted use of your facilities and premises at for
Statement of Information. The undersigned, as a duly authorized representative for [organization], states that to the best of his/her knowledge the District property, for use of which an application has been made, will not be used for the commission of any crime or any act which is prohibited by law. This Agreement must be signed by persons authorized to sign on behalf of the organization and bind the organization to the terms of this Agreement. The Licensee, by its duly authorized officer, also hereby accepts and agrees to abide by the preceding terms and conditions. The District reserves the right to cancel or revoke the permit granted under this Agreement at any time based on non-compliance with the terms and conditions stated herein or referenced by attachment or addendum. For purposes of this Agreement, the following persons are the authorized representatives for the District and the Licensee respectively. THE UNDERSIGNED CERTIFIES THAT (S)HE IS AUTHORIZED TO SIGN THIS AGREEMENT FOR THE LICENSEE AND THAT THE LICENSEE ACKNOWLEDGES AND ACCEPTS THE TERMS AND CONDITIONS AND ATTACHED HERETO.
Statement of Information. The undersigned, as a duly authorized representative of the User, states that to the best of his/her knowledge Taos Integrated School of the Arts, use of which is being applied for, will not be used for the commission of any crime or any act which is prohibited by law. By my signature below, I acknowledge that I am authorized to sign on behalf of the User and bind the User to the terms of this Agreement. I understand and agree to all terms, conditions and Rules in this Agreement.
