Form 16011 Form 16011 Application and Permit for Use of Space in Presidential

OMB Control No. 3095-0024
Expiration date: XX/XX/2023

APPLICATION AND PERMIT FOR USE OF SPACE IN PRESIDENTIAL LIBRARIES AND GROUNDS
CONDITIONS OF USE
SCOPE: This form is required for all requests for events held in Presidential library areas or spaces that are
considered NARA property.
LIBRARY PROVISIONS: The Library Director or Deputy Director may assess additional charges to reimburse
the Government for expenses incurred as a result of the use by groups of Libraries and Grounds. Each Library: (1)
sets its own schedule for fees to be charged and policies for reservations, payments, and refunds; (2) decides what
times are available for outside events; and (3) determines the number of people allowed for outside events. In
addition, each Library may impose conditions that apply to only that Library. A NARA staff member must be
present during the entirety of the event (from set-up to breakdown).
PROHIBITIONS: Use of the auditoriums and other public spaces will not be authorized for any profitmaking,
commercial advertising and sales, partisan political, sectarian, or similar purpose. No admission fee will be charged
except by the Library, no indirect assessment fees will be made for admission, and no on-site collections will be
taken. Organizations are prohibited from representing, implying, or suggesting in their invitations, publicity, or
otherwise that the Library endorses, sponsors, or in any way approves of the organization. Smoking (including ecigarettes) is prohibited inside all NARA facilities, including Library buildings; smoking outside is permitted only
in certain designated areas (notification of which will be provided by each Library). Open flames are prohibited at
all times on Library grounds (both inside and outside).
EVENT SECURITY: NARA is responsible for the security and safety of the occupants, facility, and ground at all
times. Event security guidelines follow:
1) Any events that may require additional security, based on an assessment by the Library Director, will be
provided by NARA and require reimbursement by the event holder. No other armed security personnel are
authorized to provide protection for any event, unless expressly approved by the Library Director;
examples include School Resource Officers, and private Protective Details or other similar type security.
2) NARA security personnel are authorized to screen for and deny access to individuals attending the event
in legal possession of any firearms or other weapons (as defined in 18 U.S.C. Section 930), except for
local, state or federal law enforcement on official duty responding to the library, or as required by
governing laws. Illegal possession of any firearms, other weapons or prohibited items may result in
confiscation of the items, detainment and release to local law enforcement.
3) Unless an individual meets the exceptions outlined in paragraphs 1 and 2 of this section, only NARA
security personnel are authorized to possess firearms at the facility.
4) A list of other prohibited items, including weapons, will be provided to the event holder upon application
to use Library space.
PRE-APPROVAL REQUIRED: The following must be approved in advance by the Library: (1) media coverage;
(2) speakers, performers, movies, or programs (other than those included in the Library program); (3) the
installation of decorations; and (4) the serving of alcoholic beverages. (See page 3.) Sponsoring organizations and
their designated contractors must review their plans with Library staff; the plans must conform to Library rules and
procedures and to pertinent fire, safety, and security regulations. Events which do not receive Library approval will
be canceled or altered to meet Library requirements.
LIMITATIONS: Access to the facility shall be limited to the specific areas designated in the permit, including
restrooms, auditorium, meeting rooms, and food service areas. Nothing shall impede access to the Library building.
The following may only be done in designated areas: (1) food preparation; (2) food and drink consumption; and (3)
parking.

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NA Form 16011 (05-20)

OMB Control No. 3095-0024
Expiration date: XX/XX/2023

RESPONSIBILITIES OF THE APPLICANT: The sponsoring organization is responsible for: 1) any damage to
the Library by event participants, contractors, and caterers, and 2) the entire clean-up operation, including the
removal of trash from the premises immediately following the event. The Library must be returned to its original
condition, and Library dumpsters may not be used. Organizations using the Library facilities, caterers, and other
contractors hired by such organizations, must follow the instructions from Library staff regarding schedules for
delivery and set-up. The sponsoring organization should not have anything delivered to the Library unless a
representative of the organization is at the Library to accept the delivery. Library staff do not sign for or in any
other way assume responsibility for property belonging to the applicant, the caterer, or any other individual or
organization involved in the event.
The Library reserves the right to withdraw approval of any use of a Library building up to 30 days before the
date(s) of the event. If, in any way, the permittee or any of his or her representatives fails to comply with the above
conditions, the program may be canceled and the sponsoring organization may be held responsible for any and all
costs to the Presidential Library.
ASSUMPTION OF RISK TO PERMITTEE PROPERTY: Permittee assumes the risk of any loss or damage to
its property or the property of any person or entity authorized by it to be on the Library premises. The Library, and
its officers, agents, and employees shall not be responsible or liable for any loss of, or damage to, property while on
the premises, regardless of how the loss or damage is sustained.
INDEMNIFICATION AND HOLD HARMLESS: Permittee agrees to conduct its activities upon the premises
so as not to endanger any person thereon; and further agrees to indemnify, defend, and hold harmless the Library
and the United States against any and all claims, costs or expenses, or loss, injury, or damage to any persons or
property, regardless of how the loss or damage is caused, arising out of the activities conducted by Permittee, its
contractors, subcontractors, agents, members, or guests, including but not limited to claims of employees of
Permittee, or Permittee’s contractors, subcontractors, or guests.
FORCE MAJEURE: Neither Party will have any liability to the other Party for any delay or failure to perform, in
whole or in part, or for any cancelation in connection with performance of any obligations hereunder, if such failure
or cancelation is due to any cause beyond its reasonable control, including, but not limited to, acts of God, war,
riots, civil disturbances, fires, floods, government shutdown, strikes, terrorist acts or credible threat of same, lockouts, labor disputes, failures in public supply of utilities or any other causes beyond the control of the Parties,
whether similar or dissimilar to the foregoing.
ASSIGNMENT OF INTERESTS; ENTIRETY: Neither Party may assign its rights nor delegate its duties.
These conditions of use constitute the entire understanding of the Parties with respect to the matters addressed
herein, and it supersedes and replaces any prior or contemporaneous documents, correspondence, conversations,
agreements, and other written or oral understandings. Additional agreements may govern food and beverage
vendors related to the Permittee’s event.
REVOCATION: NARA may revoke this Permit for Use at any time by giving written notice.
GOVERNING LAW AND CERTIFCATIONS: Each of the individuals signing this Permit for Use certifies that
he/she has legal authority to bind his/her Party to these Conditions of Use. These Conditions of Use will be
governed by and in accordance with the laws of the United States (without regard to conflicts of laws).
All National Archives Presidential Libraries and Museums are handicapped accessible. However, organizations
requiring special access for the mobility impaired are encouraged to notify the libraries in advance of their events.

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NA Form 16011 (05-20)

APPLICATION FOR PERMISSION TO SERVE ALCOHOLIC BEVERAGES

OMB Control No. 3095-0024
Expiration date: XX/XX/2023

The Permittee agrees to comply with all state and local laws and ordinances in effect in the location of the planned
event governing the serving or use of alcoholic beverages. The Permittee further agrees not to serve or allow the
serving of alcoholic beverages to anyone under the legal drinking age established in the location of the planned
event, or to serve or allow the serving of alcoholic beverages to anyone intoxicated or displaying signs of
intoxication.
The Permittee shall indemnify and save harmless the United States, its agents and employees against any and all
loss, damage, claim, or liability whatsoever, due to personal injury or death, or damage to property of others
directly or indirectly due to the negligence of the Permittee, or any other act or omission of the Permittee, including
failure to comply with any terms, conditions, or obligations imposed on the Permittee by the Permit to use the space
or by approval of this Application for Permission to Serve Alcoholic Beverages.

Applicant Signature and Date
Gerald R. Ford Museum
The request of ________________________________ to serve alcohol at the____________________________
Name of Organization

Name of Presidential Library

on _______________________ is approved.
Date of Event

____________________________________________________________________________________________
Signature of Library Director or Deputy Director and Date

Concurrence and Date (if applicable)

PRIVACY ACT STATEMENT
Collection of this information is authorized by 44 U.S.C. 2104 and 2112. Disclosure of the information is voluntary; however,
we will be unable to respond to your request if you do not furnish your name and address and the minimum required information
about your event. The information is used by NARA employees to document actions taken on requests, schedules events, and
provide status information concerning approved events.
PAPERWORK REDUCTION ACT PUBLIC BURDEN STATEMENT
You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the
form displays a valid OMB control number. Public reporting burden for this collection of information is estimated at 20 minutes
per response. Send comments regarding the burden statement or any other aspect of the collection of information, including
suggestions for reducing this burden to the National Archives and Records Administration (MP), 8601 Adelphi Rd., Rm. 4100,
College Park, MD 20740-6001. DO NOT SEND COMPLETED FORMS TO THIS ADDRESS.

NATIONAL ARCHIVES AND RECORDS ADMINISTRATION

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NA Form 16011 (05-20)

OMB Control No. 3095-0024
Expiration date: XX/XX/2023

APPLICATION AND PERMIT FOR USE OF SPACE IN PRESIDENTIAL LIBRARIES AND GROUNDS
INSTRUCTIONS: Type or print in ink all items and sign. Also sign the "Application for Permission to Serve Alcoholic Beverages" form if you plan to
serve alcohol. Please submit with this application a copy, sample, or description of any material or item proposed for distribution or display. Any special
services for the disabled must be provided by the sponsor. (All Presidential Libraries are handicapped accessible.) See Privacy Act Statement and
Paperwork Reduction Act Public Burden Statement on the reverse.
PART I – APPLICATION

1. Name of applicant:
Complete mailing address:

Complete billing address; check here if same as mailing address

Personal and/or Business contact number(s):
Email address:
2. Name of person/organization sponsoring, promoting, or conducting the proposed activity (if different from Name of applicant):

Organization’s website:
Personal and/or Business contact number(s):
Email address:
3. Name(s) of person(s) who will have supervision of and/or responsibility for the proposed activity (if different from Name of
applicant):
Personal and/or Business contact number(s):
Email address:
4. Description of proposed activity and proposed media coverage (if applicable):

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NA Form 16011 (05-20)

OMB Control No. 3095-0024
Expiration date: XX/XX/2023

5. Special services required for this event (audiovisual, catering, accommodations, etc.):

Note: The Library reserves the right to require up to a 50% deposit of the facility fees in order to hold the date for your event.
Note: If a caterer is used, the caterer must contact the facility no later than 24 hours before the event to finalize set-up needs.

Will there be a catered meal?

Yes

No

Is the caterer on the Library’s approved list?

Yes

No

Do you require an accommodation for this event? Please check the following box(es) as appropriate:
Captioning or CART services

Materials in alternative format

Sign Language interpreter

Nursing/Lactation

Assistive Listening Device

Other (please identify)
Note: Accommodation requests cannot be guaranteed without five (5) business days’ notice.

6. Proposed area(s) to be used at the Library:

7. Proposed dates and hours of the event:

Setup

DATE(S):_________________________________________

From:__________ To:_________

Actual Event From:__________ To:_________
Breakdown

From:__________ To:_________

8. Approximate number of attendees:
I agree to follow the Conditions of Use attached to this permit and certify that I have the legal authority to bind any entity I may represent. I agree to
indemnify and save harmless the United States, its agents, and its employees against any and all loss, damage, claim, or liability whatsoever, due to
personal injury or death, or damage to property of others, directly or indirectly due to the negligence of the user of the privilege granted by this
agreement, or any other act or omission of user, including failure to comply with the obligations of this agreement.

Signature of Applicant and Date Signed _____________________________________________________________________________
PART II – PERMIT
(To be completed by NARA only)

Gerald R. Ford Museum
Subject to the attached regulations (36 CFR Part 1280) and conditions, use of the ____________________________________
is permitted for the date,
time, and activity described above.
Signature/Title and Date Signed _______________________________________________________________________________________________
PRIVACY ACT STATEMENT
Collection of this information is authorized by 44 U.S.C. 2104 and 2112. Disclosure of the information is voluntary; however, we will be unable to respond to your request
if you do not furnish your name and address and the minimum required information about your event. The information is used by NARA employees to document actions
taken on requests, schedules events, and provide status information concerning approved events.
PAPERWORK REDUCTION ACT PUBLIC BURDEN STATEMENT
You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number.
Public reporting burden for this collection of information is estimated at 20 minutes per response. Send comments regarding the burden statement or any other aspect of
the collection of information, including suggestions for reducing this burden to the National Archives and Records Administration (MP), 8601 Adelphi Rd., Rm. 4100,
College Park, MD 20740-6001. DO NOT SEND COMPLETED FORMS TO THIS ADDRESS.
NATIONAL ARCHIVES AND RECORDS ADMINISTRATION

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NA Form 16011 (05-20)

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