UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA APPLICATION AND AGREEMENT TO USE COURT FACILITY Please review the Court's "Policy Regarding Public Requests to Use District Court Facilities," available on the Court's website at www.cacd.uscourts.gov/clerk-services/policy-regarding-public-requests-use-district-court-facilities, before completing this form. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Name of requesting agency/organization: Federal government agency State Court Bar association Name and title of person making request: Address: E-mail Address: Telephone: Request for District Court facilities located at: Facilities requested: Law school Other: Courtroom(s) Conference Room(s) Other: Date(s) & time(s) space is requested: Purpose of request: Court "Sponsor": Non-court employees submitting this form must also complete the following section. I am authorized to act on behalf of the organization listed above, and to enter into this agreement on its behalf. On behalf of the organization listed above, therefore, I hereby agree as follows: 1) To assume full responsibility for the payment of any overtime utility and custodial expenses. 2) To assume full responsibility for the payment of any overtime building security guard expenses. 3) To assume full responsibility for any damage to the building facilities, court equipment, or furniture that may occur during the use of court facilities requested above. 4) To indemnify and save harmless the United States, its agents and employees, in both their personal and official capacities, against any and all loss, damage, claim, or liability whatsoever, due to personal injury or death, or damage to property of the Federal Government or others, directly or indirectly, due to the use of court facilities requested above, or any act or omission of the organization in connection with that use. 5) That, if a fee will be charged to participants attending this program, the fee will be based upon the estimated cost of the program only, and will not include any component representing proceeds in excess of estimated costs. 6) That I understand all reservations are subject to cancellation or substitution if the judicial business or security needs of the Court so require. DATED: SIGNATURE NAME TITLE G-58 (4/17) APPLICATION AND AGREEMENT TO USE COURT FACILITY American LegalNet, Inc. www.FormsWorkFlow.com