Form NA-16011 Application and Permit for Use of Space in Presidential

OMB Control No. 3095-0024

Expires 12/31/2007

APPLICATION AND PERMIT FOR USE OF

SPACE IN PRESIDENTIAL LIBRARIES AND GROUNDS

CONDITIONS OF USE

LIBRARY PROVISIONS: The library director may assess additional charges to reimburse the Government for expenses incurred as a result of the use by groups of library facilities. Each library: (1) sets its own schedule for size of donation and its own timetable for reservations, payments, and refunds; (2) decides what times are available for outside events; and (3) determines the number of people allowed for various outside events. In addition to the conditions listed here, which apply to all Presidential libraries, each library may impose conditions that apply to only that library.

PROHIBITIONS: Use of the auditoriums and other public spaces will not be authorized for any profitmaking, commercial advertising and sales, partisan political, sectarian, or similar purpose. No admission fee will be charged except by the library, no indirect assessment fees will be made for admission, and no collections will be taken. Organizations are prohibited from representing, implying, or suggesting in their invitations, publicity, or otherwise that the library endorses, sponsors, or in any way approves of the organization. Smoking is prohibited in library buildings.

PRE-APPROVAL REQUIRED: The following must be approved in advance by the library: (1) media coverage; (2) speakers, performers, movies, or programs (other than those included in the library program); (3) decorations that are fastened to any part of the building by any means; and (4) the serving of alcoholic beverages. Sponsoring organizations and their designated contractors must review their plans with library staff; and the plans must conform to library rules and procedures and to pertinent fire, safety, and security regulations. Events which do not receive library approval will be cancelled or altered to meet library requirements.

LIMITATIONS: Access to the facility shall be limited to the specific areas designated in the permit including restrooms, auditorium and cafeteria. Nothing shall impede access to the library building. The following may only be done in designated areas: (1) food preparation; (2) food and drink consumption; and (3) parking.

RESPONSIBILITIES OF THE APPLICANT: (1) The sponsoring organization is responsible for the entire clean-up operation, including the removal of trash from the premises immediately following the event. Library dumpsters may not be used. (2) The sponsoring organization is responsible for any damage to the library by event participants, contractors, and caterers. The library must be returned to its original condition. (3) The sponsoring organization should not have anything delivered to the library unless a representative of the organization is at the library to accept the delivery. Library staff do not sign for or in any other way assume responsibility for property belonging to the applicant, the caterer, or any other individual or organization involved in the event. (4) Organizations using the library facilities, caterers, and other contractors hired by such organizations, must follow the instructions from library staff regarding schedules for delivery and set-up.

The library reserves the right to withdraw approval of any use of a library building up to 30 days before the date(s) of the event. If, in any way, the permittee or any of his or her representatives fails to comply with the above conditions, the program may be canceled and the sponsoring organization may be held responsible for any and all costs to the Presidential library.

All eleven of the National Archives Presidential Libraries and Museums are handicapped accessible. However, organizations requiring special access for the mobility impaired are encouraged to notify the libraries in advance of their events.

APPLICATION FOR PERMISSION

TO SERVE ALCOHOLIC BEVERAGES

The Permittee agrees to comply with all state and local laws and ordinances in effect in the location of the planned event governing the serving or use of alcoholic beverages. The Permittee further agrees not to serve or allow the serving of alcoholic beverages to anyone under the legal drinking age established in the location of the planned event, or to serve or allow the serving of alcoholic beverages to anyone intoxicated or displaying signs of intoxication.

The Permittee shall indemnify and save harmless the United States, its agents and employees against any and all loss, damage, claim, or liability whatsoever, due to personal injury or death, or damage to property of others directly or indirectly due to the negligence of the Permittee, or any other act or omission of the Permittee, including failure to comply with any terms, conditions, or obligations imposed on the Permittee by the Permit to use the space or by approval of this Application for Permission to Serve Alcoholic Beverages.

______________________________________________________ _______________________

Applicant Signature Date

The request of ________________________________ to serve alcohol at the____________________________

Name of Organization Name of Presidential Library

on _______________________ is approved.

Date of Event

The sponsoring organization must agree to indemnify the Government against all liability. The organization must also agree to have a Library staff member present during the event.

______________________________________________________ _______________________

Signature of Library Director Date

______________________________________________________ _______________________

Concurrence (if applicable) Date

PAPERWORK REDUCTION ACT PUBLIC BURDEN STATEMENT

You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Public reporting burden for this collection of information is estimated at 20 minutes per response. Send comments regarding the burden statement or any other aspect of the collection of information, including suggestions for reducing this burden to the National Archives and Records Administration (NHP), 8601 Adelphi Rd., Rm. 4400, College Park, MD 20740-6001. DO NOT SEND COMPLETED FORMS TO THIS ADDRESS.

OMB Control No. 3095-0024

Expires: 12/31/2007

APPLICATION AND PERMIT FOR USE OF

SPACE IN PRESIDENTIAL LIBRARIES AND GROUNDS

INSTRUCTIONS: Type or print in ink all items and sign. Also sign the "Application for Permission to Serve Alcoholic Beverages" form if you plan to serve alcohol. Please submit with this application a copy, sample, or description of any material or item proposed for distribution or display. Any special services for the disabled must be provided by the sponsor. (All Presidential Libraries are handicapped accessible.) See Paperwork Reduction Act burden statement on the reverse.
part i - application
1. Name of applicant:	Complete mailing address:
Telephone number:
2. Name of person/organization sponsoring, promoting, or conducting the proposed activity (if different from above):	Complete mailing address:
Telephone number:
3. Name(s) of person(s) who will have supervision of and/or responsibility for the proposed activity (if different from above):	Complete mailing address:
Telephone number:
4. Description of proposed activity:	5. Special services required for this event (audiovisual, catering, etc.):
6. Proposed area(s) to be used at the Library:
7. Proposed dates and hours during which activity is to be carried out: DATE(S):______________ TIME - From:___________ To:__________		8. Approximate number of attendees:
I agree to follow the Conditions of Use attached to this permit. I agree to indemnify and save harmless the United States, its agents, and its employees against any and all loss, damage, claim, or liability whatsoever, due to personal injury or death, or damage to property of others, directly or indirectly due to the negligence of the user of the privilege granted by this agreement, or any other act or omission of user, including failure to comply with the obligations of this agreement. Signature of Applicant___________________________________________ Date Signed_______________________
part ii - permit (To be completed by NARA only) Subject to the attached regulations (36 CFR Part 1280) and conditions, use of the ____________________________________ is permitted for the date, time, and activity described above. Signature/Title__________________________________________________ Date Signed_______________________

NATIONAL ARCHIVES AND RECORDS ADMINISTRATION NA Form 16011 (4/01)

Revised 4/01