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McCullough Rodeo Arena Reservation Request Form A Certificate of Liability Insurance naming the Town of Pahrump as Certificate Holder or as Additionally Insured is MANDATORY. Please submit a copy ofyour liability insurance with this form, if you are going to be using the Bucking Shoots, this MUST be on your iusurance policy BY SICNING THIS FORM, I AGREE TO THE FOLLOWING: J will behave responsibly in accordance with all the Pahrump McCullough Rodeo Arena rules as posted. Each group is responsible for leaving the Pahrump McCullough Rodeo Arena in the order in which it was found, picking up trash aDd taking all items that were brought in, back out. J will maintain my general liability insurance policy throughout the entire dwation ofthe approved reservation and will have rough stock added to my policy, ifapplicable. -I understand that I am using the Pahrump McCullough Rodeo Arena at my own risk and do not hold the Town ofPahrump responsible for any damages and or injuries. f u( 3o?Zo Signature Date For Ofice Use Only: Reviewed by Pahrump Arena Advisory Committee: Committee Comments: This event has been APPROVED / DEMED by Pahrump Arena Advisory Cortmittee ---PAGE BREAK--- 'I 11, I t' ' ' . .ffr: ' . ---PAGE BREAK--- McCullough Rodeo Arenr Ilcated inside Petrack Park l50N Hwy 160 Pahrump, NV 89060 Town of Pahrump 2100 E Walt Williams Dr #100 Pahrump, NV 89048 Phone:. 7'7 5-727 -5107 xl TownOffi ce@pahrumpnv. org McCullough Rodeo Arena Reservation Request Form l-l € Organization Name: Address: 21 50 n E ed, Phone: l'ls - 490'taCi Contact Phone: 7OZ7f< 7 Projected Attendees: _ So z b to (N Contact IAorrtl Best Email: Event Description: I .a Event Dates: Q*t+-K-fi-E Event Times: Please select the options below that will apply to your upcoming evant: gcA g?n-- FEES FOR USE: FEE YES Arena Reservation Fee (Non-ref undable) Non-profit user fee (Arena Fee PLus 10% ofgate fees) For profit user fee (Arena Fee PLus 2016 ofgate fees) Horse Stalls - Per ho6e/per day (Non+efundable) changes to f acility (Non-ref undablel Details: DEFosm: YES TEE DESCEIPTIO 5250 oeposits:Oeanint(Refundable) S2m Livestock Pens (Refundable) S25 Racetracl{deaning-refundable) _ $5m Timers (Refundable) 5100 Announcing Equipment{Refundable} _ Ss@min Rough stock (Refundable) _ P5o Timed event lRefundable) _ Slsm Damages (Refundable) conession stard lnon-Foodl YES FEE D€9CflPIION Cleaning Deposit (Ref undable) 5m Damage Deposit (Refundable) concession Stand (food) fEE 52@ Cleaning Deposit 5200 Damage Deposit 515 x TBD Concession Stand ( on-Foodl YEs TEE 510x Non-pmfit us€rfee {perday) S2ox For profit userfee (perday) concession Stand (Foodl YES TEE OC$flPnO SA SseenCleaning(Non-r€fundable) Non-profit userfee (Fee PLus1016 of netprofit) For profituserfee (Fee PLUS 209( ofnetprofit) TOTAT IE TOTAL