State Facility (check one):
If you are a non-State agency, you must have a sponsor for events in the Pavilion Auditorium. Please acquire sponsorship from a State agency/department or legislator for your group’s activities for this date and time and attached it to this form.
Persons Who Can Supply Supportive Information About Your Group:
(include names, titles, affiliation/relationship, and phone numbers)
I have read and agree to the conditions set forth below:
I request use of the described State facility based upon the information set forth above. I certify that I am an authorized representative of the person(s), firm, group, or organization applying for permission to use the facilities and am authorized to enter into agreements and understand that any mis-statement of the information provided herein shall be grounds to refuse or revoke the application.
INDEMNIFICATION: The applicant agrees to indemnify, defend and hold harmless the Department of Buildings & General Services and the State of Vermont, its agencies, departments, divisions, offices, officers, employees and agents from all claims, demands, suits, actions, proceedings, loss, cost, and damages of every kind and description, including attorney’s fees or other litigation expenses which may be asserted or made against or incurred by the Department of Buildings & General Services, the State of Vermont, or its officers, employees or agents on account of or loss of or damage to any property or for injuries to or death of any person caused by, arising out of, or contributed to, in whole or in part, by reasons of any alleged act, omission, mistake, negligence or other fault of Applicant, its guests, employees, agents, representatives, members or contractors and their employees, agents or representative or guests in connection with or incident to this permit, or arising out of Applicant’s use of the facility. The Applicant will provide certificates of insurance to show that the following minimum coverage's are in effect. It is the responsibility of the Applicant to maintain current certificates of insurance on file with the State through the term of this permit.
GENERAL LIABILITY & PROPERTY DAMAGE: The State may require the Applicant to carry and provide proof of general liability insurance having all major divisions of coverage including, but not limited to: premises --operations; products/completed operations; personal injury liability and contractual liability. The policy shall be on an occurrence form and limits shall not be less than: $1,000,000 per occurrence, $1,000,000 general aggregate, and $50,000 fire legal liability.
COMPLIANCE WITH RULES: By submitting this application and as condition of this permit, the Applicant agrees that the person(s), firm, group, or organization has read and will comply with all rules and regulations which are applicable to the facility which is subject to this permit.
LINK TO STATE FACILITIES RULES: http://bgs.vermont.gov/commissioner/facilities_rules.
CONDITION OF PROPERTY: The Applicant agrees to leave the premises in a condition equal to that at the time of possession. The authorized representative shall be responsible for assuring compliance with this paragraph. Failure to comply may result in civil action for damages under 29 V.S.A. Sec. 4 and may result in the denial of future requests for use of State property.