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X:\common\file cabinet\CVIC Hall\Applications\CVICHALLAPP_2014(in Microsoft Word) Please return to: Town of Minden 1604 Esmeralda Ave. Suite 101 Minden, NV 89423 Phone: [PHONE REDACTED] Fax: [PHONE REDACTED] TOWN OF MINDEN CVIC HALL APPLICATION AND USE PERMIT This application and deposit must be on file in Town of Minden in order to guarantee facility rental. Name of Organization / Contact Person Date(s) of Rental Type of Activity to be First Time Rental? Yes No Home phone: Work phone: Email Address: Mailing Address: and Zip Code Physical Address: and Zip Code Requested opening time Requested closing time Total hours Anticipated number of People Is this event open to the public? Yes No If so, what is the starting time of the event? **If a public event with multiple days, please fill in the back page with starting times for each day.** Will the activity involve alcohol consumption? Yes___ No___ If yes, will alcohol be sold? Yes___ No___ If alcohol is to be sold, a permit must be obtained from the Sheriff's Office at [PHONE REDACTED]. Will the activity involve selling food? Yes___ No___ If food is to be sold, please contact the Health Department at [PHONE REDACTED] for permit requirements. ***The Hall must be cleaned and vacated by midnight. Town staff will come to lock up at midnight if not contacted prior to that time, and the renter will be billed for the cleaning efforts of Town staff. Initials CVIC HALL AMENITIES Mark all that will be needed for your event: Upstairs Meeting Room (Additional charge) Dumpsters Kitchen Audio-Visual Screen Stage Lights Microphones, If so, how many? Computer connection IPod Dock Connection MP3 CD Player Other Special Needs: Note: If you are using DVDs or computers, please bring them with you when you arrive. The person operating these must also be present. Our Facilities staff will be available to help you set up at that time. If the Facility staff have to return later, there will be a call back fee of $25. Thank you! APPLICANT CERTIFIES RECEIVING THE CVIC HALL POLICIES AND PROCEDURES AND AGREES TO ABIDE BY ALL PROVISIONS THEREOF. APPLICANT/RESPONSIBLE PARTY MUST HAVE A COPY OF THIS APPLICATION DURING THE CVIC RENTAL. Policy Received: Date: Signature EXPECTED FEES DUE ACTUAL FEES Calendar Amount of Insurance Required: Proof Rec’d: Security Required: Proof Rec’d: (attached) Dep. Amount: Check No. Date: QB Credit No. QB Sales No. QB Inv No. Name on Deposit Check / Credit Card: Address on Deposit Check/CC Billing Payment Rec’d: Check No. Date: Deposit Returned: QB Credit Refunded ---PAGE BREAK--- X:\common\file cabinet\CVIC Hall\Applications\CVICHALLAPP_2014(in Microsoft Word) ***This is for the public/web calendar*** Date of Event for the Public: Opening Time: Date of Event for the Public: Opening Time: Date of Event for the Public: Opening Time: Date of Event for the Public: Opening Time: Date of Event for the Public: Opening Time: Date of Event for the Public: Opening Time: ***For the Staffing Calendar*** Date of Opening for Opening Date of Opening for Opening Date of Opening for Opening Date of Opening for Opening Date of Opening for Opening Date of Opening for Opening Date of Opening for Opening