Community Credit Union Business Innovation Centre ( CCUBIC ) 5 Ratchford Street, Amherst N.S. (902)

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1 Community Credit Union Business Innovation Centre ( CCUBIC ) 5 Ratchford Street, Amherst N.S. (902) breanne.murphy@cbdc.ca APPLICATION FOR FACILITY USE AGREEMENT Please note that this form should be completed and submitted to the Business Innovation Center a minimum of 2 weeks prior to your booking date whenever possible. CLIENT INFORMATION Name of Event: Organization: Contact: Phone: Street Address: City/Province: Postal Code: Are you applying for a community rate? Yes No Please indicate which room you are requesting: Conference Room Boardroom BOOKING DATE/S SET-UP REQUIRMENTS (Please indicate on attached the seating configuration you require for this even). Date: Time: EVENT DATE/S (attach separate sheet if necessary) Date Event Start Time Tear Down Time Number of People

2 2 TECHNICAL INFORMATION 1. The rental group is required to provide qualified people to operate all facility equipment. Technical Support is available. (see rental rates) 2. Any equipment brought into the venue must be CSA/UL approved. SOUND 1. Will you be using our house and sound system? YES NO 2. Do you require Microphones or direct inputs? YES NO How many 3. Will you have any extra sound equipment? YES NO 4. Please provide a list of any equipment you will be bringing: CATERING 1. Do you require beverage services? YES NO How Many 2. Do you require catering service? YES NO How Many 3. Please provide what kind of beverages and/or catering services you require: Outside food and beverages are not permitted on the Premises. If food and beverages are required for the event, the user shall request from the booking agent the list of approved catering service providers and use one of the approved catering service providers for the provision of all food and beverages at the event. The user shall be responsible for all costs associated with the catering services. LIGHTING AND SPECIAL EFFECTS 1. Will you be using the LCD projector or Smart Board? YES NO 2. Will you be using the Stage Lighting? Conference Room YES NO 3. Notes: All Audio, Visual and Lighting equipment must be maintained properly while in your position. Any repair costs related to damaged equipment will be charged to your account. FRONT OF HOUSE INFORMATION Please not that merchandise or information table are only permitted by the front lobby with special permission from Management. Two Tables (2.5 x 6 ) are available. How many requested for the lobby?

3 3 TEAR-DOWN REQUIRMENT INSURANCE All sets, props, instruments etc. must be removed from the building at the end of your rental period. All Renters are required to carry Commercial General Liability insurance in the amount of two-million dollars ($2,000,000.00), covering the Tenant s production and activities, and shall include a Tenant Legal Liability clause in an amount no less than five-hundred thousand dollars ($500,000.00) and shall include a Products & Completed Operations endorsement. The Renter s insurance must name the Community Credit Union Business Innovation Center as an additional insured. The Community Credit Union Business Innovation Centre does not Provide Liability coverage. Please fill in the Following: Name of Insurer: Name of Broker: Policy Number: Expiry Date: Copy of Certificate: Attached On File COSTS Based on the information provided and the dates scheduled for this event, the costs related to this booking will total $ plus HST. Please see schedule of fees attached. All payments shall be made payable to the Community Credit Union Business Innovation Centre. We will need contact information for the person who will be the key contact for the facility during your rental period. Who will be responsible for ensuring all sets, props, equipment, costumes, lobby displays, etc. have been removed and that the Green Room and Dressing rooms are tidy. You will be provided a FOB and key for building and equipment access which must be returned at the end of your booking period. If not returned, a charge of $100 will be levied on your account.

4 4 APPLICANT/RENTER Name: Position: Number: ALTERNATE CONTACT Name: Position: Number: The Community Credit Union Business Innovation Center reserves the right to deny any application or to shut down any effect onsite that is deemed unsafe or where proper permits cannot be produced. Print name: Signature: Date:

5 5 CCUBIC Rates Conference Room Commercial Daily 4 Hours Hourly Catering Audio/Visual Bar Service Up to 40 People $ 250 $ 150 $ 100 $ 75 $ 30 $ 50 (Pouring Fee) Up to 40 People $ 400 $ 240 $ 160 $ 125 $ 30 $ 50 (Pouring Fee) Community Daily 4 Hours Hourly Catering Audio/Visual Bar Service Up to 40 People $ 150 $ 90 $ 60 $ 45 $ 30 $ 50 (Pouring Fee) Up to 40 People $ 240 $ 144 $ 96 $ 75 $ 30 $ 50 (Pouring Fee) Theatre/Admission Event Daily Set up Day Rates $ 400 $ 250 Board Room Board Room Daily 4 Hours Hourly Catering Sound & Lights Bar Service Commercial $ 125 $ 75 $ 25 $ 25 N/A N/A Community $ 75 $ 45 $ 15 $ 15 N/A N/A

6 6 MEETING or BANQUET #1 MEETING or BANQUET #2 HORSESHOE ROUND TABLE THEATRE CLASSROOM Stage PANEL BOARD CHOOSE YOUR OPTION Meeting or Banquet 1 Meeting or Banquet 2 Horseshoe Round Table Theatre Classroom Panel Board

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