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OUR FOUNDER
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LEADERSHIP
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MEET THE STAFF
SCHOLARSHIPS
2023-2024: ACADEMIC SCHOLARSHIP
2023-2024: TRADE SCHOOLS SCHOLARSHIP
EMPLOYMENT
EVENTS
CENTENNIAL CELEBRATION
CENTENNIAL VIDEO WALL
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CENTENNIAL WURD LIVE BROADCAST PHOTOS
HUMAN SERVICES CENTER
Maintenance Request Form
Request for Temporary Use of Space
TRUST NEWS & UPDATES
KENDERTON SULLIVAN PROJECT
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Request for Temporary Use of Space
REQUEST FOR TEMPORARY USE OF SUITE 229
This form must be completed in its entirety and returned to the Administrative Office of the Leon H. Sullivan Charitable Trust at 1415 North Broad Street – Suite 226, Philadelphia, PA 19122, at least thirty (30)-days prior to the requested date for use of the space.
REQUESTER’S INFORMATION:
Organization
*
Contact Name
*
Contact Name
First
First
Last
Last
Address
Address
Street
Street
Suite/Floor/Room
Suite/Floor/Room
City
City
State/Province
State/Province
Zip/Postal
Zip/Postal
Address
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burundi
Côte d'Ivoire
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
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Cuba
Curacao
Cyprus
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Iran
Iraq
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Isle of Man
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Jordan
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Virgin Islands, U.S.
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Phone
*
Email
*
EVENT INFORMATION:
Date
*
Type of Event
*
Expected Attendance
*
Request for use of:
*
Suite 229-A ($100 per hr.)
Suite 229-F ($50 per hr.)
Parking Lot
Concrete Walkway Adjacent to Front of Building
Front Lawn
Concrete Area Under Trees
Use of time:
Including set-up and clean-up
Start Time
*
12
1
2
3
4
5
6
7
8
9
10
11
:
00
30
AM
PM
End Time
*
12
1
2
3
4
5
6
7
8
9
10
11
:
00
30
AM
PM
Are you charging a fee for any aspect of your activity?
*
Yes
No
If yes, please explain (include the Fee):
FOOD
Do you intend to serve food
*
Yes
No
If Yes, type of food:
Do you intend to prepare food on the premises
Yes
No
Do you intend to have food catered
Yes
No
Name of Cater
Name of Cater
First
First
Last
Last
Phone
Email
Attach a copy of the caterer’s License and Food Handler’s Certification, if applicable.
Drop a file here or click to upload
Choose File
Maximum upload size: 33.55MB
It is the general practice of the Leon H. Sullivan Charitable Trust (“the Trust”) to permit temporary use of space at the Center for certain activities conducted/sponsored by tenants or other non-profit organizations, provided a written request is received at least thirty (30) days prior to the date of the proposed use. The requester agrees to comply with the following terms and conditions as are applicable.
REQUESTER SHALL:
Provide a certificate of insurance for general liability covering the date and time for use of space outside your lease, including set-up and clean-up time, naming the Leon H. Sullivan Charitable Trust (“the Trust”), as additional insured at least one (1) week prior to the date of the event.
Be responsible for obtaining licenses and permits required for the respective event.
Be responsible for any energy required to operate equipment/sound systems.
Be responsible for complete clean up and disposal of all trash. All trash must be bagged and removed to receptacles.
Be responsible for any damage to the Center’s property resulting from Requester’s temporary use of space.
Be responsible for damage including but not limited to that caused by equipment/vehicles on the premises.
See that all items/supplies/equipment brought onto the premises are removed within twenty-four (24) hours of the conclusion of the event. Items remaining on the premises after twenty-four (24) hours will be disposed of as abandoned property.
Be required to provide restroom accommodations for attendees.
Be responsible for the safety of all participants.
Be responsible for providing adequate security by a licensed bonded and insured security agency and provide proof that required security is contracted at least one (1) week before the date of the event.
Insure that all activity including clean-up is completed by 9:00 PM.
Defend, indemnify and hold harmless the Trust for any injury, claims or causes of action that arise from the event.
Pay for security coverage ($35.00 per hour) during access outside of normal business hours or temporary use of space.
Liability Insurance Certificate (if applicable)
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Maximum upload size: 33.55MB
The TRUST SHALL:
Make space available for time agreed upon in this request.
Not be responsible for loss, theft, injury or accident to any person on the premises as a result of this event.
Invoice the requesting tenant for security coverage for use of space outside of normal business hours or temporary use of space.
In requesting use of space outside normal business hours or temporary use of space at the Leon H. Sullivan Human Services Center, I hereby acknowledge that I have read, understand and accept the above terms as a condition of this request.
As representative of the requesting agency, I accept full and complete responsibility for the conduct and safety of its staff and participants as well as any and all damages that may result from or the consequences of the temporary use of the Center’s premises.
Signature:
*
Clear
Date:
*
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