INTAKE FORM – Facility Use Agreement – PALISADES LUTHERAN CHURCH

Agreement TypeSelect what type of agreement output you need

RENTAL DETAILSFOR OFFICE USE ONLY

Rental Request by: First Name

Last Name

Email Address

Phone

Renter Title or Organization Title

Organization Status:

Liability Insurance/ Tax Exemption Status:Liability Insurance ConfirmedLiability Insurance PendingLiability Insurance Not On FileTax Exemption Status VerifiedTax Exemption Status PendingTax Exemption Status Not On FileOther:

12. Insurance: The Renter must provide proof of Commercial General Liability insurance with a minimum of $1,000,000 per occurrence and $2,000,000 general aggregate. Palisades Lutheran Church, 15905 Sunset Boulevard, Pacific Palisades, CA 90272 must be named as Additional Insured. Coverage must be primary and non-contributory with waiver of subrogation. The Certificate of Insurance (COI) must be emailed to hello@palisadeslutheran.org at least 7 days before the rental date and must include event details, Additional Insured endorsement, and 10-day cancellation notice. Workers' Compensation is required if employing staff. Automobile Liability ($1,000,000 CSL minimum) is required if vehicles are used for event operations. Alternatively, the COI may be uploaded directly to this agreement.

Verfication Document(s)

Insurance Expiration Date

Not the date received. The date the insurance expires.

Event Details/Notes/Comments

Initial Inspection Date:

Renter is welcome to attend but it is not required.

PAYMENT SCHEDULE

Number of Payments Due:

Payment Amount Due:

Payment Due Date:

Initial Payment Status:ReceivedDueOther

PAYMENT TOTAL:

Including Security Deposit

Include AddendumYes, add custom addendum terms to this agreement

Addendum Content

Save as Intake Form Draft

INTAKE FORM – Facility Use Agreement

Log in with your credentials

Forgot your details?