Loading...
2011-2012 RentalBLAIR COMMUNITY SCHOOLS CONTRACT FOR RENTAL OF SCHOOL FACILITIES Date: January 12, 2012 THIS AGREEMENT is entered into between School District No. 1 of Blair, Washington County, Nebraska, and Rodney Storm who represents that he /she is authorized to enter into this agreement by the City of Blair for use by Ryan McCabe and who agrees to be individually, jointly, and severally responsible for the terms of this agreement. For the sum of N/A payable on or before N/A School District No. 1 of Blair, Washington County, Nebraska, agrees to and hereby rents the following schools facilities Deerfield Primary gymnasium to the City of Blair /Ryan McCabe on the following dates and for the following purposes to the above named individual. Date & Time: 1/19, 1/24 1/31 2/7 2/14 (times to be worked out with BBC/Marty R.) Purpose: basketball practice *NOTE: PLEASE FURNISH A CERTIFICATE OF INSURANCE NAMING THE BLAIR COMMUNITY SCHOOLS AS AN ADDITIONAL INSURED. Subject to the rules and regulations established by the Board of Education of School District #1 of Blair governing the use of school facilities. It is hereby agreed that the organization or party contracting for the use of school facilities of School District No. 1 of Blair, assumes full responsibility for damage to property or injuries to persons or other liability that may arise in connection with said leasing on the dates specified in this contract and will hold harmless said School District from any and all liability because of said damage to property or injuries to persons. SCHOOL DISTRICT NO. 1 OF BLAIR, WASHINGTON COUNTY, NEBRASKA A ente (For the Board of Education of School District No. 1) *There is a NO TOBACCO Policy in all buildings of the school system* BLAIR COMMUNITY SCHOOLS CONTRACT FOR RENTAL OF SCHOOL FACILITIES Date: December 12, 2011 THIS AGREEMENT is entered into between School District No. 1 of Blair, Washington County, Nebraska, and Rodney Storm who represents that he /she is authorized to enter into this agreement by the City of Blair for use by the Blair Wrestling Club, whose primary representative is Eric Dolezal and Aaron McClain, and who agrees to be individually, jointly, and severally responsible for the terms of this agreement. For the sum of N/A payable on or before N/A School District No. 1 of Blair, Washington County, Nebraska, agrees to and hereby rents the following schools facilities Blair High School wrestling facilities to the City of Blair /Blair Wrestling Club on the following dates and for the following purposes to the above named individual. Date & Time: December 5, 2011— March 1, 2012 (5:30pm- 7:00pm) Purpose: Wrestling club for elementary students *NOTE: PLEASE FURNISH A CERTIFICATE OF INSURANCE NAMING THE BLAIR COMMUNITY SCHOOLS AS AN ADDITIONAL INSURED. Subject to the rules and regulations established by the Board of Education of School District #1 of Blair governing the use of school facilities. It is hereby agreed that the organization or party contracting for the use of school facilities of School District No. 1 of Blair, assumes full responsibility for damage to property or injuries to persons or other liability that may arise in connection with said leasing on the dates specified in this contract and will hold harmless said School District from any and all liability because of said damage to property or injuries to persons. SCHOOL DISTRICT NO. 1 OF BLAIR, WASHINGTON COUNTY, NEBRASKA (Renter (For the Board of Education of School District No. 1) *There is a NO TOBACCO Policy in all buildings of the school system* ° CD 0 O CD 0 A o ° � � � O O CD n � O � O d C m o o. �x x O �r �o mo �y d CA ce IrD a' N N O 0 7d � O r� O � � x 00 � O n CA C-' d o fD o o o o�71 " ¢ o L O y d � CD M OW ' c o ° �� y b' CD n° eD t lt� �•� ��-� o �,� xr r�r CD M ° y CD A v' ''C: F'C A: O O QP4-a� -o CA n CD 'C y CD CD c rA ° c �'D CrQ '►�� CD '� C� "" A: Gq p CD CD �, CD ". CD CD O CD o o Q, �"'� x C� p '� CD C•� n "" �' o a n o a+ o co CD rr CD �� z° �•° CD �• �. ". ". CD o o y 0 � o � `° d o CD 0 rD '� S CD �-h �. c m �"• ".. v Cp i "t Z N rA n o �r �° �� .. CD CD CD �--- CD CD ow "• CD CD � CD CD o En d CA ce IrD a' N N O 0 7d � O r� O � � x 00 � O n CA C-' 01105/2011 12:06 4264996 For the sum of NA payable on or before � NNA School District No. 1 of Blair, Washington County, Nebraska, agrees to and hereby rents the following schools facilities Flair ]high School and Blair Addle School Wrestling Facilities to Blair Wrestling Club on the following dates and for the following purposes to the above named individual. Fate & Time: January 3 to March 30, 2011 Purpose; Wrestling Practice 'RNOTB: lPLJ t�St RN - CVIL�T `CA' l - OF INSSU R�NCE NAMING TI CBI L AW Q INYTY Sir,H0 s- As .. AN � �D.X'T1+�lNA L �N17 V'J,'/Lla Subject to the roles and regulations established by the Board of Education of School District #1 of Blair governing the use of school facilities. It is hereby agreed that the organization of party contracting for the use of school facilities of School District No. I of Blair, assumes full responsibility for damage to property or injuries to persons or oth6r liability that may arise in connection with said leasing on the dates specified in this contract and will hold harmless said School District from any and all liability because of said damage to property or injuries to persons. SCHOOL DISTRICT NO. 1 OF BLAIR, WASHINGTON COUNTY, NEBRASKA L-)4,-e- 4 (For the Board of Education of School District No. 1) PAGE 01 *Thero, is a NO TOB Policy in all buildings of the school systern* To Whom It May Concern: The Blair wrestling club would like to request to be included under the city's recreational insurance policy. We currently have 42 Kindergarten- Second grade wrestlers, 31 third - sixth grade wrestlers, and 4 coaches that are in charge of teaching the technique. We have contacted Dave Kaslon with Blair community schools and he has informed us that we would need a letter from the city stating that we have been added to the policy. If you have any questions please feel free to contact one of us. Thank you, Erich Warner 402 -416 -1710 Aaron McClain 533 -1031 RJ Ryan 505 -1044 MIUM auldli Grades K-6 Location K -2 will practice at Otte Middle School wrestling room from 6:00 -7:00 3 -6 will practice at the Blair High School wrestling room from 6:00 -7:00 Please bring the signed form below to the first practice, Thursday, January 6". If you have any questions you can contact Erich Warner at 402 - 416 -1710 or Aaron McClain at 533 -1031. Student Name: Home Phone Number: Parents Names: Grade: My child has my permission to participate in the Youth Wrestling program sponsored by the Blair Wrestling Club. I accept full responsibly for the participation of my child and agree not to hold the sponsors or their representatives in any way responsible for injury that may occur during my child's participation. I understand that my child may be removed from the program for noncompliance with the stated rules and /or directives from the program representatives. Signature of Parent or Guardian: Check One: $40.00 per child $50.00 per family Please make checks payable to BLAIR WRESTLING CLUB T -shirt Size (circle one) Youth -Sm Youth -Med Youth -Lrg Adult -Sm Adult -Med Adults wanting T- shirts: $15.00 fee Name: Adult -Lrg Other Size: JAN -20 -2011 17:04 FROM:THOMPSON AGENCY 4024254729 TO:4264195 P.1 ACORa CERTIFICATE OF LIABILITY INSURANCE 1/20/2011 PRODUCER HOWARD D THO"SON AGENCY, INC. 1712 WASHINGTON STREET BLAIR, NE 68008 402 --426 -4707 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, INSURERS AFFORDING COVERAGE NAIC# INSURED City o f Blair 218 S 16th Street ' Blair, NE 68008 INSURERA: EMC Insurance Companies INSR LTR INSURER e TYPE OF INSURANCE INSURER G: POLICY EFFECTIVE DAT MlDDlW INSURER D- LIMITS INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR LTR DI L NSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DAT MlDDlW POLICY EXPIRATION DATE MMlDD LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1 O0O 0 00 DAMAGE 10 KEN I ED PREMISES Ea accurenae $ 100, X COMMERCIAL GENERAL. LIABILITY MED EXP (Any ona person) $ 5, CLAIMSMADE Fx-] OCCUR PERSONAL& ADV INJURY $ 1 000 000 A, X OD71456 11 -0110 11 -01-11 GENERAL AGGREGATE $ 2 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY 0 PRO- kOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 ,00 0, 0 0 0 X ANYAUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS A HIRED A U TO S OE71456 11- -01 -10 11 -01 -11 BODILYINJURY $ (Peraccident) NON- OWNEDAUTOS PROPERTY DAMAGE $ (Peraccident) AUTO ONLY -EA ACCIDENT $ GARA4EL1A131LITY ANYAUTO OTHERTHAN EA ACC $ AUTOONLY' AGG $ EACH OCCURRENCE $ 4, 000,000 EXCESSiUMBRfrLLALiABILITY $ 4 000 0 00 X OCCUR � CLAIMSMApE AGGREGATE , pJ71456 11 -01 -10 11 -01 -11 $ $ A, X DEDUCTIBLE RETENTION $ _ X TORYLIMITS ER- WORKERS COMPENSATION-AND EMPLOYERS! LIABILITY O H 714 5 6 1 11-01 -10 11 -0 1 - 11 E.L. EACH ACCIDENT $ 5 0 0 0 O 0 ANY PROPRIETOR/PARTNWAXECUTIVE E.L. DISEASE - EA EMPLOYE $ 5 00100 0 A OFFICERMEM6ER EXCLUDED? Ifyes, describeunder E-1- DISEASE - POLICY LIMIT $ 5 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS t LOCATIONS /VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION S HOULD ANY OF THE ABOVE DESCRIBE POLICIES BE CANCELLED BEFORE THE EXPIRATION School District No. 1 of Washington DATE THEREOF THE ISSUING INSURER WILL ENDEAVOR TO MA1 DAYS WRITTEN County NOTICE TO THE CERTIFICATE }COLDER NAMED TO THE LEFT BUT FAILURE TO DO SO SHALL 1 40 South 16th Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Blair NE 68 ocoacccnrreTivGS ACpRD25(2001108) ©ACO110CbRPORATION 1988 LAIR COMMUNITY SCHOOLS CONTRACT FOR RENTAL OF SCHOOL FACILITIES ME THIS AGREEMENT is entered into between School District No. 1 of Blair, Washington County, Nebraska, and Rodney Storm who represents that he /she is authorized to enter into this agreement for the City of Blair for use by the Blair Basketball Club, whose primary representative is Dave Warrick, and who agrees to be individually, jointly, and severally responsible for the terms of this agreement. For the sum of N/A payable on or before N/A School District No. 1 of Blair, Washington County, Nebraska, agrees to and hereby rents the following schools facilities Otte Middle School gymnasium to the City of Blair/Blair Basketball Club on the following dates and for the following purposes to the above named individual. ate & Time: Octo 2011 - February 2012 (SATU RDAYS) times t.b.a. NvAlarty Rogers Purpose: Hosting of basketball games for the Twin River Basketball League SCHOOLS THE BLAIR COMMUNITY SCHOOL DISTRICT NO. 1 OF BLAIR, WASHINGTON COUNTY, NEBRASKA (For the Board of Education %J School District No. 1) *There is a NO TOBACCO Policy in all buildings of the school system* AUG -23 -2011 15:55 FROM:THOMPSON AGENCY 4024254729 TO:4024264195 P.1 � 1 CERT IFICATE I II I 8/23 ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT 13ETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER HOWARD D. THOMPSON AGENCY, INC y 1712 WAS HINGTON STREET BLAIR ICE • 68008 ITMT NAME: PIIRQE 402 -426 -4707 Arc No 402- 426 -4729 M No em ADD RES S : ' .. . INSURER(S) AFFORDING COVERAGE NAiC INSURER A: EMC Insurance Co anie IN TYPE OF INSURANCE W8R gWyp POLICY NUMBER MMIOD MMIODNYYY LIMITS L7R ' INSURED City of Bla 218 S 16th Street Blair, NE 68008 INSURER B . INSURER 0: 106, 000 5 INSURER 0: INSURER E: 1 INSURER F . 2 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER. THIS IS 'f0 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CERTIFICATE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, IN TYPE OF INSURANCE W8R gWyp POLICY NUMBER MMIOD MMIODNYYY LIMITS L7R ' 1 00O 000 GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ 106, 000 5 CLA-MADE OCCUR MED EXP (Any one person) S IMS 0X71456 11- 1 - 1,0 -1 -11 PERSONAL &ADVINJURY $ 1 A Y GENERAL AGGREGATE s 2 PRODUCTS - COMP AGG s-2,000,000 GEN L AGGREGATE LIMIT APPLIES PER. $ X POLICY d EC�T LOC $ y/ 00(), 000 AUTOMOBILE LIABILITY Es accident BODILY INJURY (Per person) S 11 -1- 1011 -1 - 11 X ANYAUTO 0 X71456 ccident) BODILY INJURY (Per a 'S ALL OWNED SCHEDULED AUTOS NON O $ Per accident HIRED AUTOS AUTOS S UMBRELLA LIA9 EACH OCCURRENCE s X X . OCCUR O 11 -1- 1011 -1-11 s 4,000 4,000, 000 AGGREGATE A EXCESS LIAB CLAIMS -MADE S DED RETENTION $ C STATU- OTH- X T RY LIMIT ER WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN 0X71456 �.�- � �-�, —� ®11 E.L. EACH ACCIDENT S 54 / 000 ANY PROPRIETORiPARTNERIEXECUrIVE ® NIA A OFFICERlMEMBER EXCLUDED? E L. DISEASE - EA EMPLOYE S 500 / 400 (Mandatory in NH) If yos, describe under E.L• DISEASE - POLICY LIMIT $ 50 00 0 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES (Attach ACORD 107, Additional Remarks Schedule, if more apace is required) CANCELLATION BLAIR COMMUNITY SCHOOLS CONTRACT FOR RENTAL OF SCHOOL FACILITIES Im THIS AGREEMENT is entered into between School District No. I of Blair, Washington County, Nebraska, and Rodney Storm who represents that he/she is authorized to enter into this agreement by the City of Blair for use by the Blair Basketball Club, whose primary representative is Dave Warrick, and who agrees to be individually, jointly, and severally responsible for the terms of this agreement. For the sum of $480.00 payable on or before $480.00 School District No. I of Blair, Washington County, Nebraska, agrees to and hereby rents the following schools facilities Otte & BHS School gymnasiums/concession stands to the City of Blair/Blair Basketball Club on the following dates and for the following purposes to the above named individual. Date & Time: Saturday, December 17,2011 (BHS 7am-8pm, OMS 10am-7pm) Purpose: Twin River Valley Youth Girls League Tournament THE BLAIR COMMUNITY SCHOOLS AS AN ADDITIONAL INSURED. Subject to the rules and regulations established b the Board of Education of School District #1 of Blair g overning the use of school facilities. It is hereby agreed that the or or part contracting for the use of school facilities of School District No. 1 of Blair, assumes full responsibility for dama to property or injuries to persons or other liabilit that ma arise in connection with said leasing on the dates specified in this contract and will hold harmless said School District from any and all liabilit because of said damage to property or injuries to persons. SCHOOL DISTRICT NO. I OF BLAIR, WASHINGTON COUNTY, NEBRASKA z (Rente (For the Board of Education of School District No. 1) *There is a NO TOBACCO Policy in all buildings of the school system* B AIR COMMUNITY SCHOOLS CONTRACT FOR RENTAL OF SCHOOL FACILITIES Date: October 17, 2011 THIS AGREEMENT is entered into between School District No. 1 of Blair, Washington County, Nebraska, and Rodney Storm who represents that he /she is authorized to enter into this agreement by the City of Blair for use by the Blair Alumni Volleyball, whose primary representative' is Bria Lally, and who agrees to be individually, jointly, and severally responsible for the terms of this agreement. For the sum of N/A payable on or before /A School District No. I of Blair, Washington County, Nebraska, agrees to and hereby rents the following schools facilities Blair High School practice gymnasium to the City of lair lair Alumni Volleyball on the following dates and for the following purposes to the above named individual. Date & Time: Saturday, November 19 (7:30am- 5:00pm Purpose: Annual Alumni Volleyball Tournament THE BLAIR COMMUNITY SCHOOLS AS AN ADDITIONAI EUSURED. SCHOOL DISTRICT NO. I OF BLAIR, WASHINGTON COUNTY, NEBRASKA (For the Board of Education of School District No. 1) *There is a NO TOBACCO Policy in all buildings of the school system* Bren - From: Koch, Kerry [kerry.koch @blairschools.org] Sent: Tuesday, October 18, 2011 8:28 AM To: Brenda Wheeler Subject: Re: Another contract Dave is required to pay for use of the facilities this year (in certain circumstances). He is paying a charge to have custodians present in the building. This is something that the school system has put into place regarding the use of school facilities on the weekends. Dave Warrick is the person responsible for paying- we know that, and we also know that the City of Blair only covers Dave on the insurance aspect. Dave works very well with us- so the payment factor is not a concern for us. As far as the alumni tournament - fees were waived but otherwise for certain situations it is policy now. Kerry Koch Administrative Assistant to the Superintendent Blair Community Schools PO Box 288 Blair, NE 68008 Phone: (402) 427 -2713 Fax: (402) 426 -3110 From: Brenda Wheeler < brwheelerCci.blair.ne.us > Date: Tue, 18 Oct 2011 08:21:51 -0500 To: Kerry Koch < kerry.kochCblairschools.org > Subject: RE: Another contract Hi Kerry, Rod is not willing to sign the contract for Twin River Valley Youth Girls League because it shows a $480.00 charge. We have never sponsored a program with a charge. Why is this one different? Could you shed some light on this issue. Rod will reconsider signing the contract after this additional information is received. Brenda Wheeler, City Clerk (402) 426 -6694 brwheelerCci.blair.ne.us City of Blair, 218 S. 16th Street, Blair, NE 68008 P Please consider the environment before printing this e-mail. - - - -- Original Message---- - From: Koch, Kerry fmailto :kerry.kochCblairschools.org1 Sent: Monday, October 17, 2011 3:36 PM To: Brenda Wheeler Subject: Another contract Here is another one! Thanks Brenda! Kerry Koch Administrative Assistant to the Superintendent Blair Community Schools PO Box 288 Blair, NE 68008 Phone: (402) 427 -2713 Fax: (402) 426 -3110 BLAIR COMMUNITY SCHOOLS CONTRACT FOR RENTAL OF SCHOOL FACILITI Date: September 21, 2011 THIS AGREEMENT is entered into between School District No. 1 of Blair, Washington County, Nebraska, and Rodney Storm who represents that he /she is authorized to enter into this agreement by the City of Blair for use by the Blair Basketball Club, whose primary representative is Dave Warrick, and who agrees to be individually, jointly, and severally responsible for the terms of this agreement. For the sum of N/A payable on or before N/A School District No. 1 of Blair, Washington County, Nebraska, agrees to and hereby rents the following schools facilities Blair High School and Otte Middle School gymnasiums and concession stands to the City of Blair/Blair Basketball Club on the following dates and for the following purposes to the above named individual. Date & Time: Sat., Feb. 18 (7:00am- 10:00pm); Sun. Feb. 19 (8:00am- 7:00pm Purpose: Blair Youth Boys Bball Tournament Fundraiser *NOTE: PLEASE FURNISH A CERTIFICATE OF INSURANCE NAMING THE BLAIR COMMUNITY SCHOOLS AS AN ADDITIONAL INSURED. Subject to the rules and regulations established by the Board of Education of School District #1 of Blair governing the use of school facilities. It is hereby agreed that the organization or party contracting for the use of school facilities of School District No. 1 of Blair, assumes full responsibility for damage to property or injuries to persons or other liability that may arise in connection with said leasing on the dates specified in this contract and will hold harmless said School District from any and all liability because of said damage to property or injuries to persons. SCHOOL DISTRICT NO. 1 OF BLAIR, WASHINGTON COUNTY, NEBRASKA (Re er) (For the Board of Education of School District No. 1) *There is a NO TOBACCO Policy in all buildings of the school system* BLAIR COMMUNITY SCHOOLS CONTRACT FOR RENTAL OF SCHOOL FACILITIES Date: August 23, 2011 THIS AGREEMENT is entered into between School District No. 1 of Blair, Washington County, Nebraska, and Rodney Storm who represents that he /she is authorized to enter into this agreement by the City of Blair for use by the Blair Basketball Club, whose primary representative'is Dave Warrick, and who agrees to be individually, jointly, and severally responsible for the terms of this agreement. For the sum of N/A payable on or before N/A School District No. 1 of Blair, Washington County, Nebraska, agrees to and hereby rents the following schools facilities Deerfield, Arbor Park, Otte Middle School and Blair High School gymnasiums to the City of Blair/Blair Basketball Club on the following dates and for the following purposes to the above named individual. Date & Time: September 2010 -July 2011 (M, TU, TH, F, SA)- times t.b.d w /Marty Rogers Purpose: Basketball team practices *NOTE: PLEASE FURNISH CERTIFICATE OF INSURANCE NAMING THE BLAIR COMMUNITY SCHOOLS AS AN ADDITIONAL INSURED. Subject to the rules and regulations established by the Board of Education of School District #1 of Blair governing the use of school facilities. It is hereby agreed that the organization or party contracting for the use of school facilities of School District No. 1 of Blair, assumes full responsibility for damage to property or injuries to persons or other liability that may arise in connection with said leasing on the dates specified in this contract and will hold harmless said School District from any and all liability because of said damage to property or injuries to persons. SCHOOL DISTRICT NO. 1 OF BLAIR, WASHINGTON COUNTY, NEBRASKA (Renter) (For the Board of Education of School District No. 1) `There is a NO TOBACCO Policy in all buildings of the school system* AUG -23 -2011 15:55 FROM:THOMPSON AGENCY 4 024264729 TO:4024264195 P.1 a CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DDIYYYY) 8/23/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, Subject to the terms and conditions of the policy, certain pollcles may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER HOWARD D. THOMPSON AGENCY, INC 1712 WASHINGTON STREET T 7� �Yt+ BLAIR, NE . 68008 CONTACT NAME: PHONE 442 - 426 - 470? AIC,No 402- 426 -4729 AJC No Ext - ADDRESS': - INSURER(S) AFFORDING COVERAGE NAICS INSURER A: EMC Insurance Copmanies PROPER Per accident) INSURED City of Bla 218 S 16th Street Blair, NE 68008 INSURER B . $ INSURER C: 1.1- 1- 1011 11- 1- 1011-1 INSURER o EACH OCCURRENCE INSURER E A INSURER F . UMBRELLA LlA.B EXCESS LIAR COVERAGES GERTIFICATE NUNgdtK: "�'•" - THIS IS YO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN! IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR 'npE OF INSURANCE wsR WV POLICY NUMBER MMJ00 MM/DDM -YY LIMITS L7R GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIA131LITY PREMISES Ea occutTerce $ 10 CLAIMS -MADE I -- I OCCUR MED EXP (Any one person) S 5` 0 0 0 A Y 0X71456 11 - 1- 1011 -1 -11 PERSONAL &ADVINJURY S 1, 000,000 GENERAL AGGREGATE 5 2 ,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMPIOP AGG S 2,000 X POLICY me LOC $ S 1,000,000 A AUTOMOBILE LIABILITY X A OWN EDULED ALLL L OWNED SCHEDULED AUTOS NON AWNED HIRED AUTOS AUTOS 0 X71456 11- 1-1011 - 1 - 11 (Le accldeM BODILY INJURY (Per parson) S BODILY - INJURY (Per accident) 5 PROPER Per accident) $ $ 0X"11456 OX71456 1.1- 1- 1011 11- 1- 1011-1 -1-11 - 11 EACH OCCURRENCE S 4,000, A X UMBRELLA LlA.B EXCESS LIAR X. O CCUR O CLAIMS -MADE NIA AGGREGATE $ 4,000 WG STATU OTH X T RY LIMITS ER S DED RETENTION 5 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPMETMPARTNERIEXECLITIVE ❑ OFFICER!ldEM6ER EXCLUOED9 (Mandatory in NH) If yes, doscribe under DESCRIPTION OF OPERATIONS below A E.L. EACH ACCIDENT $ 500 ,00 0 E. L. DISEASE - EA EMPLOYE G 0 , o 0 5 5 E L. DISEASE - POLICY LIMIT 5001000 $ I DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 10'l, Additional Remarks Schedule, IS more spore Is required ;ERTiFICATE HOLDER.. CANCELLATION Blair Community Schools SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO BOX 28 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Blair, NE 68008 AUTt•i /��? R SENTA7NE a ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD25(2010105) The ACORD name and logo are registered marks of ACORD B AIR COMMUNITY SCHOOLS CONTRACT FOR RENTAL OF SCHOOL FACILITIES Date: October 17, 2011 THIS AGREEMENT is entered into between School District No. 1 of Blair, Washington County, Nebraska, and Rodney Storm who represents that he /she is authorized to enter into this agreement by the City of Blair for use by the Blair Alumni Volleyball, whose primary representative' is Bria Lally, and who agrees to be individually, jointly, and severally responsible for the terms of this agreement. For the sum of N/A payable on or before /A School District No. I of Blair, Washington County, Nebraska, agrees to and hereby rents the following schools facilities Blair High School practice gymnasium to the City of lair lair Alumni Volleyball on the following dates and for the following purposes to the above named individual. Date & Time: Saturday, November 19 (7:30am- 5:00pm Purpose: Annual Alumni Volleyball Tournament THE BLAIR COMMUNITY SCHOOLS AS AN ADDITIONAI EUSURED. SCHOOL DISTRICT NO. I OF BLAIR, WASHINGTON COUNTY, NEBRASKA (For the Board of Education of School District No. 1) *There is a NO TOBACCO Policy in all buildings of the school system* Bren - From: Koch, Kerry [kerry.koch @blairschools.org] Sent: Tuesday, October 18, 2011 8:28 AM To: Brenda Wheeler Subject: Re: Another contract Dave is required to pay for use of the facilities this year (in certain circumstances). He is paying a charge to have custodians present in the building. This is something that the school system has put into place regarding the use of school facilities on the weekends. Dave Warrick is the person responsible for paying- we know that, and we also know that the City of Blair only covers Dave on the insurance aspect. Dave works very well with us- so the payment factor is not a concern for us. As far as the alumni tournament - fees were waived but otherwise for certain situations it is policy now. Kerry Koch Administrative Assistant to the Superintendent Blair Community Schools PO Box 288 Blair, NE 68008 Phone: (402) 427 -2713 Fax: (402) 426 -3110 From: Brenda Wheeler < brwheelerCci.blair.ne.us > Date: Tue, 18 Oct 2011 08:21:51 -0500 To: Kerry Koch < kerry.kochCblairschools.org > Subject: RE: Another contract Hi Kerry, Rod is not willing to sign the contract for Twin River Valley Youth Girls League because it shows a $480.00 charge. We have never sponsored a program with a charge. Why is this one different? Could you shed some light on this issue. Rod will reconsider signing the contract after this additional information is received. Brenda Wheeler, City Clerk (402) 426 -6694 brwheelerCci.blair.ne.us City of Blair, 218 S. 16th Street, Blair, NE 68008 P Please consider the environment before printing this e-mail. - - - -- Original Message---- - From: Koch, Kerry fmailto :kerry.kochCblairschools.org1 Sent: Monday, October 17, 2011 3:36 PM To: Brenda Wheeler Subject: Another contract Here is another one! Thanks Brenda! Kerry Koch Administrative Assistant to the Superintendent Blair Community Schools PO Box 288 Blair, NE 68008 Phone: (402) 427 -2713 Fax: (402) 426 -3110 BLAIR COMMUNITY SCHOOLS CONTRACT FOR RENTAL OF SCHOOL FACILITIES Date: September 21, 2011 THIS AGREEMENT is entered into between School District No. 1 of Blair, Washington County, Nebraska, and Rodney Storm who represents that he /she is authorized to enter into this agreement by the City of Blair for use by the Blair Basketball Club, whose primary representative is Dave Warrick, and who agrees to be individually, jointly, and severally responsible for the terms of this agreement. For the sum of N/A payable on or before N/A School District No. 1 of Blair, Washington County, Nebraska, agrees to and hereby rents the following schools facilities Otte Middle School gymnasium to the City of Blair/Blair Basketball Club on the following dates and for the following purposes to the above named individual. Date & Time: October 2011 - February 2012 (times t.b.d. :2 -3 hours) 10/23 10130 11/6 11/13 1 1/20 9 11/27 12/4 12/11 12/18, 1/8 1/15 1/22 1/29 2/12 Purpose: Basketball open gym for boys /girls *NOTE: PLEASE FURNISH A CERTIFICATE OF INSURANCE NAMING THE BLAIR COMMUNITY SCHOOLS AS AN ADDITIONAL INSURED. Subject to the rules and regulations established by the Board of Education of School District #1 of Blair governing the use of school facilities. It is hereby agreed that the organization or party contracting for the use of school facilities of School District No. 1 of Blair, assumes full responsibility for damage to property or injuries to persons or other liability that may arise in connection with said leasing on the dates specified in this contract and will hold harmless said School District from any and all liability because of said damage to property or injuries to persons. SCHOOL DISTRICT NO. 1 OF BLAIR, WASHINGTON COUNTY, NEBRASKA (Rente (For the Board of Education of School District No. 1) *There is a NO TOBACCO Policy in all buildings of the school system* O O O O A d U O X � O n O O d � o eD ffDD C �"� Z O `C (D 0 CD G "t O fD o CL m �p 'S o y �•° C7o � CD y o CL ot O ►�' �' �' rA CD ol e� fD � ��.,r �O ems,, p� cr CD En CD CD e� O_ AD �'• O CD � M"'i � �' F..► UQ � �"� �• `C `C fD �_ ►� CD f�D f7 r�i� O ► f7 O c CD ��n _ �- O ZD `C ter O O fD C O p C C '�' „°� e tt "7 CD � AD O- CCDD p C AD CD CD o CD fD v� n ' S � f7 CD CD ZD �, v1 r Ia CD CD O W . CD �--� �, �• � Una "g v' • bd � CD �. �. o G� o C CD AD CD CD d CD fD K a, N O O � O r L/1 O n O n O C/) x O � o �o CD Q O Z n � � eD ffDD C �"� Z O `C (D 0 CD G "t O fD o CL m �p 'S o y �•° C7o � CD y o CL ot O ►�' �' �' rA CD ol e� fD � ��.,r �O ems,, p� cr CD En CD CD e� O_ AD �'• O CD � M"'i � �' F..► UQ � �"� �• `C `C fD �_ ►� CD f�D f7 r�i� O ► f7 O c CD ��n _ �- O ZD `C ter O O fD C O p C C '�' „°� e tt "7 CD � AD O- CCDD p C AD CD CD o CD fD v� n ' S � f7 CD CD ZD �, v1 r Ia CD CD O W . CD �--� �, �• � Una "g v' • bd � CD �. �. o G� o C CD AD CD CD d CD fD K a, N O O � O r L/1 O n O n O