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To OF WAPPINGER
P.O. BOX 324 - 20 MIDDLEBUSH ROAD
WAPPINGERS FALLS. NY 12590
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TowJclerk C h f..)s (}o/~',uJ
OffIce: 845.297.5771 N Fax: 845.297.4558
www.townofwapplnger.us
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Agreement For The Use Of The Town Hall Facilities For Meetings
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Name of Organization or Group
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Name of person representing the Organization or Group
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Address Phone No.
This will confirm the arrangements beln. requested for your groups' use of the Wappinger Town Hall
Facilities, as noted below:
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Senior Citizens Room
Large Meeting Room
Other: Specify:
The group Is not expected to exceed \.:<. 0
Date(s): .~ /Lfr ,4~/h;' ,,.- h~
persons
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Time: '1~, 6C - I 1. .) () 1'11-
It should be understood that groups using the Buildings' Facilities for evening m.etlngs must select
dates when Town Meetings are normally scheduled (I.e., Justice Court, Planning IBoard, 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 wlll 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.
Terms of this agreement must be strictly adhered to by the contracting grou~ as any disregard or
abuse of the rules for use of the facilities will result In termInation of use by ~e offending group, and
they will not be granted reinstatement.
TOW045,TC-nw (4-03 Rev)] of3
Town f Wappinger Town Clerk
Agreement for the use of the Town \I Facilities for Meetings
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I have read and understand the rules and regulations for the use of the Facllltles In the Town of
Wappinger Town Hall, and will comply with these requirements.
Signed: r<~ ~IV~
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For:
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(Name of Group or Organization)
Dated:
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Approved:
Date:
(L(1t~
.. ~\cjfown Clerk
TOW045,TC.THF (4-03 Rev) 2 of3
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Town of Wappinger Town Clerk
Agreement for the use of the Town Hall Facilities for Meetings
1. Using Group assumes responsibility for any damage to furnishings, equipment, or
property .
2. Food, beverages, and paper products, If used, will be provided by using group.
3. Group using Senior Citizen Room shall not use the TV, Kitchen, or Kitchen equipment
and/or Senior Citizen provisions.
4. No food or beverages are to be furnished and/or 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 apPllcable.~
6. Groups using Senior Citizen Room will close and loc' windows and doors and turn off
lights at end of each session.
7. Strict adherence to "NO SMOKING" regulations must be observed.
I i
TOW04S.TC-THF (4-03 Rev) 3 of3
Town of Wappinger
Request for main meeting room.
All times from 9:00 AM - 12:00 PM
Monday
Thursday
Thursday
Monday
Thursday
Monday
Thursday
Monday
Thursday
Thursday
Monday
Thursday
Monday
Thursday
Monday
Thursday
Thurs
Monday
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02/11/10 Jj
02/18/10 J'
02/22/10 I
02/25/10~
03/08/10
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03/15/10 ..;
03/18/1011"-
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03/29/10/ '
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. " Hvld Harmless Agreement & Thank You Letters
Page 1 of 1
Hold Harmless Agreement'" Thank You Letters
lakeisha.l.alston@census.gov [lakeisha.l.alston@census.gov]
Sent: Monday, December 14, 2009 10:45 AM
To: borcc.amrs.list@census.gov; borcc.reglonal.technlcians.list@census.gov
Cc: Kim Wong; borcc.area.managers.list@census.gov
AMRs,
We are providing the following information for you to use if a property manager/owner asks you to sign
a release of liability contract or a "hold harmless" agreement when securing their space for
testing/training. The information below may be implemented into your Thank-You Donor of Space
Letter as well.
"The Government is self-insured and does not maintain general liability insurance. Census agrees
to promptly consider and adjudicate any and all
claims which may arise out of use of subject donator's premises resulting from the actions of
Census or duly authorized representatives or
contractors of Census and to pay for any damage or injury as required by Federal law. Such
adjudication will be made pursuant to the Federal
Tort Claims Act, 28 V.S.C. 2671 et. seq. or such other legal authority as may be pertinent. "
"Census also agrees to consider and adjudicate any claims for damage or injury sustained by Census
personnel in the performance of their official
duties. Such adjudication will be made pursuant to the Federal Employees Compensation Act, 5 V.S.C.
8101 et. seq. or
other such legal authority as may be pertinent."
If you have any questions, please contact Kim Wong or Lakeisha Alston, at 617-223-3690
LaKeisha L. Alston
Recruiter
U.S. Census Bureau
Phone: 617-223-3690
Fax: 617-223-3675
Email: lakeisha.l.alston@census.gov