23-127.00 East Valley School District G.,iVA
e Board of Directors: Theresa Noack, District 1;Laura Gates, District 2;Justin Voelker, District 3;
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Jonathan Horsley, District 4;Mike Bly, District 5 Superintendent:Brian Talbott
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3830 N. Sullivan Rd., Bldg. 1, Spokane Valley, WA 99216 Phone:509.924.1830 Fax:509.927.9500
FACILITY USE INSTRUCTIONS
East Valley School District is a supporter of youth and community programs and has a long history of
sharing district facilities and campuses with our community. At this time, we feel it appropriate and
plausible to reopen our facilities as an extension of opportunities for our young people. We have
appreciated your cooperation and patience throughout the pandemic as the safety of our
students, staff, and community remains a focal point.
Athletic Organizations/Coaches
Teams that have East Valley students have first priority.
All coaches (paid and volunteer) must complete Sudden Cardiac Awareness training. Below is a link to
a free online course through the National Federation of State High School Associations(NFHS). Please
print a copy of the certificate and submit it with your application as proof of meeting this training
requirement. https://nfhslearn.com/courses/61032
Organizations involving any athletic activity are required to have each student/parent read and sign
the following forms:
Student/Parent Concussion Information Sheet
Student/Parent Sudden Cardiac Awareness Sheet
Student/Parent Information Acknowledgment
Please have your organization's representative sign the Statement of Compliance stating that you
have completed all the necessary requirements above and are eligible to rent our facilities.
Lastly, please review and sign the Facility Use Reminder form. It is a reminder to all gym patrons the
rules and expectations to be followed in order for us to provide a clean and safe environment for
everyone.
Fee Assessment and Payment
Fees will be charged at an hourly rate based on the classification, to be determined by the
Superintendent. Payment is due upon receipt of the invoice for normal scheduled events and must be
paid in advance of the event.
Facility users on a recurring monthly schedule must pay the first month's invoice within the first ten
days of use and then will be billed monthly. Payment is due upon receipt of the invoice and before
continued use.
Payments can be made by credit card at 509-924-1830 or by check: East Valley School District#361 at
3830 N. Sullivan Rd., Bldg. 1, Spokane, WA 99206. *All invoices will be sent by email.
East Valley School District does not discriminate in any programs or activities on the basis of sex,race,creed,religion,color,national origin,age,veteran or military status,sexual
orientation,gender expression or identity,disability,or the use of a trained dog guide or service animal and provides equal access to the Boy Scouts and other designated youth
groups.The following employees have been designated to handle questions and complaints of alleged discrimination;Title IX Compliance Coordinator:Brian Talbott,Phone:(509)
924-1830,talbottb@evsd.org;ADA/Civil Rights Compliance Coordinator:Jane Stencel,Phone:(509)924-1830,stencelj@evsd.org;Section 504 Coordinator:Heather Awbery,
Phone:(509)924-1830,awberyh@evsd.org,3830 N.Sullivan Rd,Bldg 1,Spokane Valley,WA 99216.
Cancellation/Changes by the User
In the event a group wishes to cancel or make changes to the agreement for the use of a facility, it
must notify the school district at least two working days in advance. Failure to do so will result in
charges and/or cancellation of the Facility Use Agreement. In addition,the district must approve date
or time changes at least two working days in advance. Failure to do so will result in charges for the
time scheduled or actual hours used, whichever is greater.
Proof of Insurance Requirements
A certificate of liability insurance shall be required for all activities that are not directly sponsored by
the district.The user shall provide a certificate of insurance, satisfactory to the district, prior to use of
the facility.This insurance shall be primary and written for a minimum of$1,000,000 Combined Single
Limit, per occurrence.The insurance certificate shall list the East Valley School District, its officers,
directors and employees as an additional named insured and shall provide for notification to the
district in the event of cancellation or termination, or material change in the policy, with not less than
ten (10) days notice. For youth groups this policy must also include covering any injury or damage
with at least$50,000 due to bodily injury or death of one person and at least $100,000 due to bodily
injury or death of two or more persons.
Checklist
."Facility Use Application
V Proof of Insurance
Important Reminders-Signed Form
❑ Compliancc Statcmcnt for HB 1824
❑ COVID Disdosule dIid ReIe sc Fuiiir
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`e Board of Directors: Theresa Noack, District 1;Laura Gates, District 2;Justin Voelker, District 3;
.7. ID 11f Jonathan Horsley, District 4;Mike Bly, District 5 Superintendent:Brian Talbott
1.'
,,\ 3830 N. Sullivan Rd., Bldg. 1, Spokane Valley, WA 99216 Phone:509.924.1830 Fax:509.927.9500
Facility Use Application
Application for(School): F-A i N2 \ ,1c\c\\e SG'CZ\
Name of Organization: C l�1. C 3C- S. ,2, e U,, ,\\.e
First and Last Name: -�C)V\A kk iVV:Vrx , c �l 'cr
Email: Cl J \( . rim
Contact Phone Number: CSVC1 ) 1 3C) — 5.C.CCD
Purpose and Nature of Facilities Requested: 71ne C1' N I% \A V1 Oci a
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Normal Schedule:Sin le Date, Multiple Dates,Same Location:
Event Date(s): O[D/awa3
Setup Begin Time: : CO AMM please circle)
Start Time: S : 30 AM/a)lease circle)
End Time: Ti C0 AM/please circle)
Breakdown End Time: -7 = 00 AM i .lease circle)
Number of Total People Expected (Participants &Spectators): S1M.a. - c-3Nr k7`-�S
Recurring Use: Daily,Weekly, Month ,Same Location:
Name of Head Coach, Assist. Coa or Team/Group Leader:
Team/Group Name and Gra Level:
Total Number of Parti • ants in Group:
Day(s) of Week:/
HMo, y N/ Pc
uesday
Wednesday
Thursday
Friday
East Valley School District does not discriminate in any programs or activities on the basis of sex,race,creed,religion,color,national origin,age,veteran or military status,sexual
orientation,gender expression or identity,disability,or the use of a trained dog guide or service animal and provides equal access to the Boy Scouts and other designated youth
groups.The following employees have been designated to handle questions and complaints of alleged discrimination;Title IX Compliance Coordinator:Brian Talbott,Phone:(509)
924-1830,talbottb@evsd.org;ADA/Civil Rights Compliance Coordinator:Jane Stencel,Phone:(509)924-1830,stencelj@evsd.org;Section 504 Coordinator:Heather Awbery,
Phone:(509)924-1830,awberyh@evsd.org,3830 N.Sullivan Rd,Bldg 1,Spokane Valley,
Start Date:
End Date:
Hold Harmless Agreement
The undersigned hereby makes application for the use of school facilities described on the facility use
agreement to East Valley School District No. 361 and agrees and acknowledges that use of school
facilities is without representation or warranties by the school district, its employees and agents as to
the condition of the property.
The undersigned further states they have the authority to make this application for the applicant and
agrees that the applicant will observe all rules and regulations of the Board of Education and the
school in which the facilities are required.
The applicant agrees to exercise the utmost care in the use of the school premises and property and
further agrees to use only those facilities indicated under Facilities required listed.
The applicant further agrees to take full responsibility for any and all damage to the property and/or
injury to persons allowed or reasonably anticipated to be on the premises by the undersigned.
The applicant specifically waives any and all rights, remedies and causes of actions against East Valley
School District, its employees and agents and further agrees to hold the school district harmless from
any and all claims arising out the use of premises.
The applicant agrees to reimburse the school district for any and all judgment costs and expenses,
including attorney's fees, incurred by the school district in the defense of any such action.
Applicant has read and agrees to abide by the Policies & Procedures as approved by the Board of
Directors and assigning school.
I further agree to reimburse the school district for costs described in the final billing.
/"Z_ 6 23-- Z3
Sig ture Today's Date
2 WA
2 0 3 WCIA Insurance Coverage Summary Insurance Authority
Member: City of Spokane Valley
LIABILITY PROGRAM
Liability Joint Protection Program
Auto Liability, General Liability,Police Liability, Errors or Omissions Liability, Employment Practices
Liability, Employee Benefit Liability and Stop-Gap Liability. 100% occurrence form.
Layer: Limits:
Self-Insured Layer Limit $4M per Occurrence
Reinsured Layer—Governmental Entities Mutual (GEM) $6M per Occurrence
Reinsured Layer—Safety National $5M per Occurrence and per Member
Aggregate and $25M Pool Aggregate
Reinsured Layer—Allied World Assurance Company $5M per Occurrence and per Member
Aggregate and $25M Pool Aggregate
Total Limit: $20M per Occurrence, subject to
aggregates and sub-limits.
Deductible: All members are in the liability program, however if a deductible
is listed the member is subject to it.
This member is currently listed in the following programs if a deductible is listed or the box is marked:
PROPERTY PROGRAM
Property Joint Protection Program
WCIA self-insures (pools)the first$1,000,000 of covered perils other than flood and earthquake. We
purchase and follow a Lloyd's of London policy with the limits provided below.
Limits: $400,000,000 per Occurrence
Sub-Limits: $162,500,000 Earthquake per Occurrence and Annual Pool Aggregate
$100,000,000 Flood per Occurrence and Annual Pool Aggregate, except $50,000,000 Flood
Sub-Limit within Flood Zones A and V.
Other sub-limits may apply.
Deductible: Earthquake: 2%of Values Involved Subject to $250,000 Minimum per Occurrence
Flood: $250,000 per Occurrence, except within Flood Zones A and V 3% of the total
building/facility values involved in the loss subject to a$500,000 minimum occurrence.
$25
All Other Perils: ,000 Deductible shown only .fprogram i member.
AUTO PHYSICAL DAMAGE PROGRAM
Auto Physical Damage Joint Protection Program
Limits: Actual Cash Value (ACV) for scheduled vehicles. Optional replacement cost coverage for
vehicles valued $50,000 or higher and scheduled with the current replacement value.
Deductible waived for glass repair and damage caused by fire or lightning.
S1,000
Deductible: Deductible shown only if program member.
EQUIPMENT BREAKDOWN(BOILER AND MACHINERY)PROGRAM
Insured by The Hartford Steam Boiler Inspection and Insurance Company
Limits: $100,000,000 Maximum Limit(Equipment Breakdown)
Sub-Limits: $10,000,000 Business Income, Service Interruption
$5,000,000 Demolition, Ordinance of Law
$1,000,000 Extra Expense
$500,000 Perishable Goods, Expediting Expenses, Hazardous Substances
$100,000 Off Premises Equipment Breakdown, Contingent Business Income,
Data Restoration
Deductible: $10,000 Combined All Coverage Except:
$25 per KW Turbine Generator Units with a $50,000 Minimum
*$25 per HP Motors, Pumps, and Deep Well Pump Units
*$2.50 per KVA Transformers
*$25 per HP A/C and Refrigeration Systems
*$25 per HP Internal Combustion Engines and Generators>=500 HP
*Subject to a$10,000 Minimum Deductible
CO Checked only if program member.
POLLUTION LIABILITY PROGRAM
Insured by Allied World Assurance Company
Coverage included with membership in WCIA
Policy Terms 02/01/22—02/01/24(One policy limit applies for both years)
Limits: $2,000,000 Per Condition Pollution Condition Limit of Liability
$10,000,000 Total Policy and Program Aggregate Limit of Liability for all Pollution
Conditions
Sub-Limit: $250,000 Maximum for"Catastrophe Management Costs"Arising out of all Pollution
Conditions
Deductibles: a) $100,000 Per Pollution Condition
b) 5 Days Per Pollution Condition for Business Interruption Loss
CRIME/FIDELITY PROGRAM
Insured by AIG—National Union Fire Insurance Company of Pittsburgh PA
Limits: $2,500,000: Employee Theft-per Loss Coverage, Forgery or Alteration, Inside Premises - Theft
of Money and Securities, Inside Premises -Robbery or Safe Burglary of Other
Property, Outside the Premises, Computer Fraud, Funds Transfer Fraud,Money Orders and
Counterfeit Money, Credit/Debit Card Forgery, and Faithful Performance of Duty as prescribed
by law. Blanket coverage for all employees unless excluded under the insurance policy.
Deductibles: $10,000 ® Checked only if program member.
$50,000 Impersonation Fraud Coverage Deductible with a $250,000 sub-limit.
INFORMATION SECURITY INSURANCE (CYBER INSURANCE)
Insured by AIG Specialty Insurance Company
Coverage included with membership in WCIA
Policy Terms 05/31/22—05/31/23
Limits: $5,000,000 Aggregate Pool Policy Limit and per Member$1,000,000 Limit
Sub-Limits: $1,000,000 Security and Privacy Liability Insurance per Member
$1,000,000 Regulatory Action per Member
$1,000,000 PCI-DSS Assessment or Fine per Member
$1,000,000 Privacy Event Services per Member/$5M Pool Limit
$1,000,000 Event Management Electronic Data per Member
$1,000,000 Event Management Event Response per Member
$1,000,000 Bricking
$100,000 per Member/$2.5M Pool Limit Cyber Extortion Including Bitcoin Ransom Coverage
Deductibles: $100,000 Security and Privacy Liability Insurance Including Regulatory Action
$100,000 PCI-DSS Assessment
$100,000 Event Management,E-Discovery None
$100,000 Cyber Extortion
Note:New Members coverage subject to carrier approval.
This summary is for your reference only. Please refer to the Joint Protection Program or insurance policies for
specific terms, conditions, limits and exclusions.
Facility Use Fee Schedule
Effective November 7, 2022
Classification I II III IV
Extra Custodian-2hr min If Necessary If Necessary If Necessary If Necessary
School Day $3/hour $35/hour $35/hour $35/hour
Non-School Day $50/hour) $50/hour $50/hour $50/hour
Holiday our $70/hour $70/hour $70/hour
Gymnasium
School Day N/C $20/hour $40/hour $45/hour
Non-School Day ( N/C ' $50/hour $55/hour $60/hour
Holiday N/C $70/hour $75/hour $80/hour
Cafeteria/Commons/Library
School Day N/C_ $15/hour $35/hour $40/hour
Non-School Day C N/Cm) $45/hour $50/hour $55/hour
Holiday N/C $65/hour $70/hour $75/hour
Kitchen Plus One Staff $45/hour $75/hour $75/hour $75/hour
Classifications
I -School or Chartered Youth Groups, Scouts or other Government Agencies
II - Non-Profit Youth Groups: (Youth Club Sports,AAU, YMCA, YWCA, SYSA, Church Youth
Groups, etc.)
III - Non-Profit Community Groups: (Adult Community&Service Clubs, Adult Athletics,
Churches, etc.)
IV- Commercial or For-Profit Organizations: (Businesses & Organizations using facilities
for a profit)
V-40%rule. If more than 40%of your team are East Valley students, then the cost of the rental
facility is waived on normal school days when a custodian is already on duty. Use on weekends and
Holidays are an added fee.
5�V A � Board of Directors: Theresa Noack, District 1;Laura Gates, District 2;Justin Voelker, District 3;
Q'
w le I tf Jonathan Horsley,District 4;Mike Bly, District 5 Superintendent:Brian Talbott
♦fi .
3830 N. Sullivan Rd., Bldg. 1, Spokane Valley, WA 99216 Phone:509.924.1830 Fax:509.927.9500
Important Reminders for Coaches/Gym Patrons
1. Youth must be supervised at all times.The presence of non-participating siblings is discouraged. If
siblings must be in attendance, then they must stay in the gym under the coach's supervision at all
times. No venturing into the hallways or other rooms of the school.
2. No food or drink in the gym.
3. Use of the bleachers require prior authorization and so we can notify the custodian to assist you.
4. Do not use any tape or markers on the floors or walls.
5. Outdoor sports(football, baseball, softball, soccer, rugby, etc.) may use the gyms for conditioning
purposes only—NO EQUIPMENT IS ALLOWED, which includes soccer balls, baseballs, softballs, bats,
mitts, etc.
6. Please pace your group's arrival at the school with your assigned gym time. Do not intrude on the
group using the gym prior to your time. Likewise, please have your group off the court when your
assigned time is over.
7. Please carry your schedule confirmation with you to the gym each time you use your scheduled
gym time. If a conflict should arise with another team, please see the night custodian.
8. The priority of gym use is:
a. School and District events
b. Community Education
c. Supervised youth athletic/recreational groups
The safety of all gym users is the primary consideration, followed closely by concern that no
harm is done to the gym, surfaces,fixtures or equipment. Continued violation of any of the above
could result in gym use cancellation.
If you have any questions or concerns, please contact Tom Gresch at grescht@evsd.org:
After office hours, please see the custodian in charge at your assigned building.
I understandstan and agree to the rules listed above:
` i�� — z 3 --2
Applicant's Signature: Date:
East Valley School District does not discriminate in any programs or activities on the basis of sex,race,creed,religion,color,national origin,age,veteran or military status,sexual
orientation,gender expression or identity,disability,or the use of a trained dog guide or service animal and provides equal access to the Boy Scouts and other designated youth
groups.The following employees have been designated to handle questions and complaints of alleged discrimination;Title IX Compliance Coordinator:Brian Talbott,Phone:(509)
924-1830,talbottb@evsd.org;ADA/Civil Rights Compliance Coordinator:Jane Stencel,Phone:(509)924-1830,stencelj@evsd.org;Section 504 Coordinator:HeatherAwbery,
Phone:(509)924-1830,awberyh@evsd.org 3830 N.Sullivan Rd,Bldg 1,Spokane Valley,WA 99216.