Form 16016 Form 16016 Limited Facility Report

OMB Control No. 3095-0073
Expiration date XX/XX/20XX

Limited Facility Report
Limited security exhibitions need a minimal amount of environmental control,
supervision, and art-handling experience. Requires a climate-controlled, limitedaccess display space with minimal temperature, humidity, and lighting controls.

National Archives
Traveling Exhibits Service

Name of Institution:
Mailing
Address:

Shipping
Address:

Contact Person:
Phone #:

Title:
ext.

Email:

Institutional Information
Does your organization hold 501(c)3 status?

Yes z No z

Gallery/Museum Open Hours: Mon __________ Tues ___________ Wed __________ Thurs ___________
(e.g. closed, 10am-5pm, 10am-7pm)
Fri ____________ Sat ____________ Sun __________
Do you open/close seasonally? Yes z No z If yes, please explain:
Does your facility meet accessibility criteria of the Americans with Disabilities Act? Yes z No z
What is your annual attendance? _________
Type of Institution:

z Museum:
z
z Art
z Natural History/Science
z History
z College/University
z Historic House/Site
z Children’s
z Other (Specify): _____________
NATES - Limited Facility Report

Cultural Institution:
z Archives
z Library
z Community/Civic Center
z Religious Facility

NATIONAL ARCHIVES AND RECORDS ADMINISTRATION

z Other:
z Fair Building
z Commercial/Retail

(Specify): _____________________
z Other
(Specify): ____________________

Please continue on next page

NA FORM 16016 (09-16)
Required by NARA 1612

OMB Control No. 3095-0073
Expiration date XX/XX/20XX

Facility Information
Is your building/facility locked and secure after viewing hours?

Yes z No z

Does your facility have fire systems and fire protection devices according to local ordinances?

Yes z No z

Does your facility have an electronic security control system?

Yes z No z

Is your temporary exhibition gallery/space limited-access (no exterior doors)?
If no, please explain:

Yes z No z

Is your temporary exhibition gallery/space locked after public hours?

Yes z No z

Can you provide exhibition supervision by volunteer, receptionist, or guard during public hours?

Yes z No z

Size of your temporary exhibition gallery/space? Square Feet _______ Linear Feet _______
On what floor of your building is your temporary exhibition gallery/space located? _________
Do you have a freight or passenger elevator that can handle crates up to 600lbs?

Yes z No

Do you have a climate-controlled, pest-free crate storage area?

Yes z No z

Environmental Information
Does your gallery have a temperature and humidity control system active at all times?

Yes z No z

Does your temporary exhibition gallery/space maintain a temperature between 68-72 degrees?

Yes z No z

Does your temporary exhibition gallery/space maintain relative humidity between 45-55%?

Yes z No z

Are all sources of sunlight in temporary exhibition gallery/space blocked by UV filters or shades?

Yes z No z

What type of lighting system do you use in the temporary exhibition gallery/space? Check all that apply.

z Artificial Light:
z Fluorescent Lighting
z Fluorescent Lighting with UV Filters
z Incandescent Lights, Stationary
z Incandescent Lights, Track
z Halogen Lights, Stationary
z Halogen Lights, Track

z Daylight Windows:
z Shades or Draperies
z UV Filters

z Skylights:
z Shades or Draperies
z UV Filters

Are you able to adjust the light levels in your temporary exhibition gallery/space?

Yes z No z

Do you allow eating and drinking in the temporary exhibition gallery/space or during packing/unpacking?

Yes z No z

Have you had any pest/insect problems in the building within the past 6 months?

Yes z No z

NATES - Limited Facility Report

NATIONAL ARCHIVES AND RECORDS ADMINISTRATION

Please continue on next page

NA FORM 16016 (09-16)
Required by NARA 1612

OMB Control No. 3095-0073
Expiration date XX/XX/20XX

Shipping and Handling Information
Who handles exhibition objects? Check all that apply.
z Trained Staff
z Volunteer Staff:
z Professional
z Trained
z Technical
z Untrained with trained supervision
z Clerical
z Other (specify): _______________________

Are you able to provide 3-4 people to assist in loading, unloading, installation and de-installation?

Yes z No z

Do you have staff or volunteers able to handle exhibit crates up to 600 lbs in weight?

Yes z No z

Do you have a raised loading dock?

Yes z No z

If no, please explain your loading area:
If yes, can your loading dock accomodate a 53’ tractor trailer?

Yes z No z

Contact person for shipping and installation issues:
Name:

Title:

Phone #:

Email:

ext.

Please attach a building floorplan and photographs of your temporary exhibition gallery/space.

Name

Title

Signature

Date (mm/dd/yyyy)

PAPERWORK REDUCTION ACT PUBLIC BURDEN STATEMENT: You are not required to provide the information requested on a form that is subject to the Paperwork Reducation Act unless the form displays a valid OMB control number.
Public burden reporting for this collection of information is estimated to be 60 minutes per response. Send comments regarding the burden estimate or any other aspect of the collection of information, including suggestions for reducing this burden, to

National Archives and Records Administration (MP), 8601 Adelphi Rd, College Park, MD 20740-6001. DO NOT SEND COMPLETED FORMS TO THIS ADDRESS.

Mail to:
---or---

National Archives Traveling Exhibits Service
400 W. Pershing Road
Kansas City, MO 64108

Email to:

NATES@nara.gov

Contact NATES at:

816.268.8088

PRINT

NATES - Limited Facility Report

NATIONAL ARCHIVES AND RECORDS ADMINISTRATION

National Archives
Traveling Exhibits Service
RESET

SAVE

Thank you!

NA FORM 16016 (09-16)
Required by NARA 1612