FACILITY USE APPLICATION
Name of Renter (responsible party): __________________________________________________________ Organization (if applicable): ___________________________________________________________________
Primary Contact Person __________________________________ E-mail: ____________________________ Address ________________________________________City __________________ State ______ Zip_______ Phone: Day ____________________ Cell _________________________Evening _________________________
Secondary Contact Person ___________________________ E-mail: _________________________ _______ Address _______________________________________ City __________________ State ______ Zip_______ _ Phone: Day ____________________ Cell _________________________Evening _________________________
Space(s) requested: Main level and porches ______ Foundation Room / Lower Level______ Garden Pavilion ______ Full Property ______ Other ____________________________________________
Date for facility use ______________________________
Number of hours for facility use _______ (Minimum rental is 4 hours, includes time for set-up and clean-up) Additional hours charge is: $50 per hour, per area, or $100 per hour for the Full Property.
Arrival Time _________ Departure Time ________
Event Start Time________ Event End Time________
What type of function will be held? ______________________________________________________________ Approximately how many people will be attending the function? _______ Will alcohol be served at the function? Yes*____ No ____ * If alcohol is served, an additional $200 deposit is required.
How did you hear about the Lake Mansion? ________________________________________________________
Special Requests or Accommodations:________________________________________________________________
Renter’s Signature Date
Renter’s print name Title (if applicable)
For more information or to arrange visits or tours please contact VSA arts ~ ph. 775-826-6100 ~ email: info@vsanevada.org ~
As a user of the Lake Mansion building and/or grounds on ________________________________, I/we assume responsibility for any injury that may occur before (set-up), during or after (clean-up) the event by one of our guests, staff, volunteers or the public. We are responsible for any damage to the building, equipment or grounds that may occur before (set-up), during or after (clean-up) the event.
I have received a copy of the Lake Mansion Facility Use Rules, understand them, and agree to abide by, and also insure that my guests and vendors abide by them during my event. (Additional copies of these rules are available on request.)
I understand that a cleaning and security deposit of $300 is to be paid no less than thirty (30) days prior to my event date. If alcohol is to be served, an additional deposit of $200 will be required. This will be refunded within two weeks following the event, less the amount of any damages to the property or cleaning fees required. I understand that my date is not guaranteed until VSA has received this deposit.
I understand that once the reservation is made, an additional charge of $25 per visit will be deducted from the deposit for any additional visit(s) to the mansion for the event.
Not less than thirty (30) days prior to my event, I must furnish VSA arts of Nevada with proof of insurance in the amount of one million ($1,000,000) dollars and assume all liability in conjunction with this event. A certificate of insurance to include “Lake Mansion named as additional insured on (date and time of event)” is to be provided for facility rental. Failure to provide proof of insurance may result in the cancellation of my event reservation.
I understand that groups who exceed the number of hours paid, for any reason whatsoever, will be charged an overtime fee of $100 per hour to be payable to VSA arts Nevada directly to the Site Coordinator via check, or credit card. Overtime is rounded to the quarter hour and charged accordingly.
I agree to take responsibility for any and all additional rental items during my event. If any items I rent are lost, damaged or destroyed, I agree to pay for their replacement at full replacement value, such value to be determined at time of replacement. I further understand that any Deposit owed to me will be withheld pending determination of replacement costs. I understand that I will be charged for the items requested regardless of whether I use them or not.
I understand that my full rental fee of $______ is to be paid no less than thirty (30) days prior to my event date. Failure to pay this amount, or failure of the payment to be honored by my bank, may result in cancellation of my event reservation.
In the event that I cancel my event within thirty (30) days of my event date, I understand that my entire cleaning and security deposit will be considered non-refundable and will be kept by VSA.
Total Rental Fee:______________________ Date Due: _______________
_______Payment(s) will be made by credit card. A credit card information form is attached.
_______Payment(s) will be made by cash or check.
___________________________________________ ___________________________ Name of Organization, if applicable. (Please Print) Event Date
Lake Mansion Representative Signature Date
-------------------------------------------FOR LAKE MANSION USE ONLY--------------------------------------- Date of facility tour ____________________ by __________________________ Total Rental Fee:______________________ Date Due: _______________ Date Fees Rec’d:______________________ Rec’d by:________________ Date Insurance Certificate rec’d: __________________ Rec’d by: _________________ Amount of deposit returned ______________ Date deposit returned ______ by ____________________ 4/08