APPLICATION FOR USE OF MADISON COUNTY GROUNDS
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- Marylou Byrd
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1 APPLICATION FOR USE OF MADISON COUNTY GROUNDS After you have completed this form, please return it to the Clerk to the Board of Supervisors by fax , or delivery to Madison County Board of Supervisors, 112 N. John Wayne Dr. / PO Box 152, Winterset, IA Name of Event: Purpose of Event: Date(s) of Use: Time of Use (start finish): Group Requesting Use: Has this group used County grounds for other events? Yes No If so, please list functions and dates: Specific area of County grounds requested for use: Explain if you are requesting water or electricity service: Number of Participants Expected: Is the event open to the general public? Yes No Name of Person Responsible: Address of Person Responsible: Telephone Numbers: Address: A Certificate of Liability Insurance is required in the amount of a minimum of one million dollars at the time of this event. Does this group have liability insurance to cover this event? Yes No 1
2 RULES FOR USE OF MADISON COUNTY GROUNDS 1. Use of County grounds requires approval of the Madison County Board of Supervisors. 2. There shall be a pre-event meeting between County representatives and the party responsible for the event to inspect the grounds and determine the placement of any equipment. 3. County grounds shall not be used for any unlawful purpose. 4. Use of County grounds shall not interfere with local government operations or public access to County services. 5. Madison County Board of Supervisors may grant permission to Not-for-Profit businesses, organizations, and charitable organizations for use of County grounds. 6. Madison County Board of Supervisors may grant permission to For-Profit businesses, organizations, and charitable organizations for use of County grounds. 7. No vehicles, trailers, or animals except guide dogs are allowed on County grounds without explicit permission from the Buildings & Grounds Manager. 8. Camping is prohibited on the courthouse and courthouse grounds and in Monument Park. 9. Fires are prohibited on County grounds. 10. Nothing shall be placed or used on County grounds that could harm grass, trees, or other property. 11. Nothing shall be attached to County grounds without explicit permission from the Buildings & Grounds Manager. 12. County grounds shall be cleaned and returned to pre-event condition by the person or group responsible immediately after the designated event. 13. The Application for Use of Madison County Grounds shall be signed by the person or group responsible which shall acknowledge responsibility for the payment of any damages that might occur to County grounds during the designated event. 14. Any person or group using County grounds shall provide a Certificate of Liability Insurance indicating insurance of a minimum of one million dollars for the designated event. 15. Madison County Board of Supervisors, in the exercise of its discretion, may grant variances from these rules for cause shown on a case-by-case basis. 16. Madison County Board of Supervisors reserves the right to refuse use of County grounds for any event that may compromise security of the County or safety of County employees and general public. 17. Violation of any of these Rules for Use of Madison County Grounds may be cause for the County to deny the person s or group s future use of County grounds. 2
3 I have read the Rules for Use of Madison County Grounds, and I agree that the County Grounds will be left in a clean and neat condition after use for my event. I understand that I am, or my Group is, liable for all damages, expenses, and loss caused by any person who attends or participates in this scheduled event. By signing this application, I agree to defend and hold harmless the County regarding any damage that may occur as a result of this scheduled event. Signature of Person Responsible Date Recommendation by Maintenance Department: APPROVE DENY Signature of Denny Peterson, Building & Grounds Manager Final Approval by Board of Supervisors: APPROVE DENY Signature of Chairman, Madison County Board of Supervisors Madison County accepts donations for use of County grounds for organized activities to help offset expenses incurred for your event such as over-time, re-seeding worn lawn areas, any use of utilities, etc.,. Please make the check payable to Madison County Treasurer and submit to the Clerk to the Board of Supervisors (located in the Auditor s office). 3
4 CHECKLIST FOR APPLICANT I have attached the required Certificate of Liability Insurance. I have read the Rules for Use of Madison County Grounds I have signed and dated the Application for Use of Madison County Grounds Principles & Guidelines used by Madison County Board of Supervisors to approve Application for Use of Madison County Grounds Is event family oriented? Does it provide humanitarian service? Does it encourage high ethical standards? Does it build goodwill? Does it support education? Does it strengthen our local economy? Will it be beneficial to persons involved? 4
5 ***FOR COUNTY USE ONLY*** Applicant: Date Application Received: Date Certificate of Liability Insurance Received: Date Approved by the Board of Supervisors: 5
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