21
2010-01-19 JCM
Received by:
Chris Masterson 0
Christine Fulton 0
Sue Rose 8
9- t91)jLfL
Town of Wappinger
Agreement for the Use of the Town
Hall Facilities for Meetings
FOR INTERNAL USE ONLY
Date Received:
Serial #: )... \
,\ ~cation ~~O.OO ~ofLI
~~ed Recreation (date: ~ / a'>l, D)
Agreement for the Use of the Town Hall Facilities for Meetings
/A!;~ J. jJPvJ M.I1#Od !1,vA z> /1-s< /) L
Name of Organization or Group
-;h Il#/:t rlG/~ #~J
Name of person representing the Organization or Group
,~ p./ I "/J J.}vtl /) )U/f) ~ ;;!.O f1
Address
C',<M- ;f/) Fv{:,-t;J'.5l
Phone No.
This will confirm the arrangements being requested for your groups' use of the Wappinger Town Hall Facilities, as
noted below:
( )
~
Senior Citizens Room
Large Meeting Room
Other: Specify:
The group is no~ected to exceed ;;'0
Date(s): J~) /t!PrJ "5 . :J../) f)
. ,
Time:
":38 ~
00
-9r;
persons
It should be understood that groups using the Buildings' Facilities for evening meetings must select dates when
Town Meetings are normally scheduled (Le., Justice Court, Planning Board, etc.) Special requests will be
considered upon their own merit, and arrangements can be made for access to, and closing, the building at the close
of your meeting.
You and your Organization hereby agree to adhere to the rules set forth on the attached page by signature of an
authorized member of your Organization or group.
The Town of Wappinger reserves the right to suspend temporarily this agreement should the Town have need of the
facility for its own purposes. Advance notice will be given as soon as possible on such occasions.
The Town Clerk should be informed promptly of any schedule change or cancellation of your group activities.
Arrangements for access to specific area to be used should be made with the Town Clerk at the time this form is
submitted.
No application shall be considered approved until it has been submitted to the Town Clerk for review and
Clearance.
2010-01-19 JCM
Terms of the agreement must be strictly adhered to by the contracting group as any disregard or abuse of the rules
for use of the facilities will result in termination of use by the offending group, and they will not be granted
reinstatement.
I have read and understand the rules and regulations for the use of the Facilities in the Town of Wappinger Town
Hall, and will comply with these requirements.
Signed:
c1~ lief
tJ /L6tvtJo.o 111,1"vp/l tJpN~ 0 /l~:>6C/4//t)~
(Name of Group or Organization)
For:
Date:
c)
Date:
Approved:
Cf
2010-01-19 JCM
Rules For Use Of Town Hall Facilities For Group Meetine:s
1) Using Group assumes responsibility for any damage to furnishings, equipment, or property.
2) Food, beverages, and paper products, ifused, will be provided by using group.
3) Group using Senior Citizen Room shall not use the TV, Kitchen, or Kitchen equipment andlor
Senior Citizen provisions.
4) No food or beverages are to be furnished and lor served when using the Large Meeting Room.
5) Using group agrees to restore tables, chairs, etc. to places where found at beginning of session,
clean tables and discard rubbish, if applicable.
6) Groups using Senior Citizen Room will close and lock windows and doors and turn off lights at
end of each session.
7) Strict adherence to: "NO SMOKING" regulations must be observed.
JUN, 30, 2010 3:09PM
GERELLl lNSU~ANCt
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pRQOUCER (845) 265-2220 FAX: (645) 265-4754
Gerell~ In5uranoe Agency, Inc.
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Cold Spr.~.ng
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COVERAGES
THE POLICIES OF INS\JF\ANCE LISTED BEl.OW HAVe BEEN IsSUED TO TN!; INSUReo NAMEO ABOVE FOR TH~ J'OUCY PERIOO IN D1CAretl , NOTWIiHSTAN DING
ANY REQUIRfiMENT, TERM OR CONDITION OF ANY CONTAACT OR OTl-IER OOCUMENl" WITH RESP~CT TO WI..UCH THIS CERTIFICATE; MAY Bi,; ISSUED OR
MAY PERtAIN. TI1~ l~suRANCE AFFORDED BY THE POLICIES DEseRIBED HeREIN IS SUBJECT TO ALL THE TERM~L EXCI,.US1OOS AND CONOlTlONS Of'SUCH
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THIS CERTIFICA. TE IS IssUED AS A. MA TIER. OF INFORMATION
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CERTIFICATE ~mLOER
(845) 29a-147S At~n:
Town of Wappinger
20 Middlebush Read
Wappinger E'alls, NY
12590
. 1
CA",,'.LA 110N ~
stiOULD AN'( Of TilE ABOVE DESCfllElED POUCIES BE CANCELLED BEFORE THE EXPIRA nON
DATE l11EREOF. THE ISSUING INSURER Wa.L END5AVOR TO MAil EL DAYS WRrTTEN
NOl1Cf. TO tilE CERlIFICA TE' HOLDER NAMED TO THE LEFT, BuT FAILURE TO tlO SO SHALL.
IMPOSE NO OBI..lGAl1ON OR LIA'9ILITV OF ANY KIND UPON THE lN$UIlER, ITS AGENTS OR
REPRE.SEr-rl'ATIVES.
AUTHO~EDREPRESENTATWE
Gregg Gerelli/LRO
@ 1988-2009 ACORD CORPORATION. All rights reserved.
\ The ACORD name and logo are registered marks of ACORD
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ACOR.D 25 (2009101)
INS025 (200001)