Code 903.4
Exhibit A
Application and Agreement for Use of Decorah Community School District Bus
Name of Organization:
Address of Organization:
Telephone of Organization:
Representative/Contact Person:
Email of Contact Person:
Telephone of Contact Person
The above-named organization requests to use a bus of the Decorah Community School District as follows:
Bus:
Date:
Time: From a.m./p.m. to a.m./p.m.
Destination:
For the following event/activity (be specific):
Anticipated No. of Participants:
The adult sponsors are:
Rental Fee: $
Driver's Charges: $
All charges are payable in advance if requested. Make checks payable to the Decorah Community School District.
Payment is required in advance: Yes _____ No _____
Check if a certificate of liability coverage is required of the organization.
I/We agree to be bound by the following conditions:
1. Availability of the bus is contingent upon the activity in no way interfering with the District's educational and activity program. I/We understand that the District reserves the right without penalty (but with refund of the charges) to cancel any agreement to allow my/our use of the bus(s).
2. The use of the bus will not conflict with any laws or the policies, rules or regulations of the District.
3. I/We will exercise care in the use of the bus and agree to compensate the District for any damage done to the bus or property of the District. (The individual representative(s) agrees to reimburse the District in the event the organization fails to make reimbursement.)
4. The activity will be constantly supervised by an adequate number of adult sponsors.
5. No alcoholic beverages or controlled substances, substance paraphernalia, or look-alike substance will be made available, used or consumed in the bus.
6. No smoking or use of tobacco products will be allowed in the bus.
7. The activity is not for a commercial profit‑making venture or for personal financial gain.
8. The bus will be used only within the State of Iowa.
9. I/We agree to provide an insurance certificate naming the District as an additional insured with the appropriate limits, if requested, in advance of the use of the bus.
10. The representative and the organization agree to indemnify, save and hold harmless the District, its agents, employees, and officials from any and all claims or damages, including attorney fees and expenses, that may arise by reason of the organization’s use of the bus.
Approved:
Representative Superintendent
Title:
Date: Date:
Copies to: Organization Representative
Superintendent
Manager of Transportation
896377
