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Facilities Use Event Notification Form

Today's Date:
School District:
Location of Event:
Organization Leasing Facility:
Event Description:
 For Profit:    Non-Profit: 
# of Attendees:
# of Rehearsals:
Date/Time of Event:
Event Charge:
If the organization is self-insured, please attach certificate of Insurance and fax with this form.
FAX form to Mrs. Miranda Green at (850) 638-6135 or email at greenm@paec.org
PAEC Risk Manager needs certificate to make sure insurance coverage is adequate.
* All Charges are Flat Charges per Event (see below)

** Multiple Dates above need to be submitted separately

*** More than one rehearsal per event must be reported to PAEC for pricing and approval

**** Music events other than recitals will need prior approval

***** Meetings/Athletic Games one time event is subject to attendance charges below
Flat Charges (Attendance)
1-50 attendees:$ 70.00
51-100 attendees:$105.00
101-150 attendees:$145.00
151-200 attendees:$200.00
201-500 attendees:$350.00
501+ attendees:submission to PAEC for pricing/approval
NOTES:
A $50 flat charge will be assessed for 3 or more rehearsals.

*Music events other than recitals will need prior approval

**Meetings: One time event subject to attendance charge
Seasonal or Annual (multiple events/same group/maximum 25 attendees), $23 per meeting subject to $70 minimum charge. Example: 4 meeting X $23 = $92

***Athletic Games: One time event is subject to attendance charge
Seasonal or Annual (multiple events/same group/maximum of 100 attendees), $29 per game; subject to $230 minimum charge; and 101-200 attendees, $41 per game & $317 minimum charge. Example: 8 games X $29 per game = $232.

District Representative:
Organization Representative:
APPROVED EVENTS:
Family or School Reunion
Funeral
Plays
Birthday Party
Dance Instruction
Dance Events (Under age 21 must have chaperones. Attendees not allowed to come and go.)
Twirlers Recital & 2 rehearsals (one charge+)
Piano Recital & 2 rehearsals (one charge+)
Beauty Pageant & 2 rehearsals (one charge+)
Wedding (including rehearsal) and/or Reception (One charge+)
Baby or Wedding Shower
*Music or Dance Recital & 2 Rehearsals (One Charge+) (Music events other than recitals will need prior approval)
*Gospel Concert or Meeting (Music events other than recitals will need prior approval)
**Meetings (Speaker OK. If entertainment, submit to company)
***Athletic Games (Soccer, Football, Baseball, Basketball, Tennis & Swimming)

SUBMIT EVENTS:
The following list of events (but not limited to this list) will be considered. Submit items to the company for approval and pricing.
  1. Any event NOT listed in the Approved Events list.
  2. Any event with 3rd party entertainment. 3rd party would be anyone other that the renter of the facility. The company will need to have a description of the entertainment and their General Liability insurance limits and name of insurance company.
  3. Any event with 201+ attendees.
  4. More than two rehearsals per event will need to be submitted to company for pricing consideration.

ADDITIONAL EXCLUSIONS:
It is agreed that this insurance does not apply to bodily injury to any person:
  1. While practicing for or performing in any concert.
  2. Live animal rides
  3. Mechanical riding devices
  4. School sponsored athletic teams or events
  5. While practicing for or performing in any show or theatrical event sponsored by the named insured.

CONTACT INFORMATION:
Panhandle Area Educational Consortium
753 West Blvd. Chipley, FL 32428-3508
Ph: (850) 638-6131 x 2247 Mrs. Miranda Green
Toll Free: (877) 873-7232
Fax: (850) 638-6135
Email: greenm@paec.org

Thank you for your request.

  


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