At the time of agreement a Certificate of Insurance must be furnished by applicant indicating Commercial General Liability insurance written on an occurrence basis with minimum limits of $1,000,000 each occurrence/$2,000,000 aggregatenaming RIT as an additional insured. Certificate must be received by the Center, no less than fourteen (14) days prior to rental date. The general liability coverage must include sexual molestation and abuse if the event participants are minors or vulnerable adults. This coverage should be noted on the certificate of insurance under comments. Certificate of insurance must be provided to RIT within 2 weeks of the anticipated event date.

Today’s Date______

Event Title ______

Activities include ______

(Please note – if this event is a non-athletic “community” event, and/or may require other campus support services, or use of other campus facilities, do not complete this form – contact the RIT Office of Govt. & Community Relations at 585-475-5012.)

Name of Applicant ______

Name of Organization ______

Street Address ______City______State ______Zip ______

Phone (W)______(C)______

E-mail______

If you are not sure of the date please indicate a desired time frame, (weekdays/weekends/week/month/time of day etc.)

Day/Date Setup start time Event Start time Event End Time Teardown end time

(or doors open at)

Detailed Description of Event:

Objective/Purpose______

______

______

Type of Activity

Meeting Lecture Conference Game Sports Practice Exhibit Concert Camp

Tournament (type of)______Other______

Type of Space needed(where appropriate, indicate number needed)

Student Life Center: Classroom(s) Courts (how many) Locker Rooms Other______

Clark Gym (has bleachers) Aux. Gym Clark Gym Stage Other______

Grass Field(s) Turf Field Other______

Critical Information

Is this event open to the public?(explain)______

Numbers expected ______/______

participants / spectators

Are you charging a fee?$______/______Age range of participants______

participants / spectators

Is event a fundraiser?______If yes,for whom?______

Food Service

Will food be served/sold? ______By whom?______

(pre-packaged or delivered by licensed vendor only)

Special Equipment Requests

PA SystemShotClock Bleachers Lined Field Track/FieldEquip. Tables(#)

Chairs(#)Tables (#)Other Sports Equip.______AV Equip. (items needed)______

Support Staff (indicate yes/no, and/or numbers needed)

Ticket taker(s) Scoreboard operator Shot clock operator Announcer

Security Custodial Other______

Parking Needs

Number of cars expected (est.) Buses Handicapped spaces Equip. Parking______

Where has this event been held in the past?______

______

References: (Please provide a personal reference or contact person where event has been held in the past).

1) Name______2) Name ______

Title ______Title ______

Phone______Phone______

1

12/14/17