RETURN TO CSUN HOMEPAGE
University Licensing
UNIVERSITY LICENSING OFFICE
TEL NO: (818) 677-2744
FAX NO: (818) 677-3017
MAIL CODE: 8309
Campus Event Check-off List
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TO HOLD AN EVENT ON THE CALIFORNIA STATE UNIVERSITY, NORTHRIDGE CAMPUS, (RENT SPACE), PLEASE ANSWER THE QUESTIONS LISTED BELOW AND MAIL TO: UNIVERSITY LICENSING AT MAIL CODE 8309.
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I. WRITTEN REQUEST FOR EVENT SENT TO THE UNIVERSITY LICENSING OFFICE:
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 EVENT DATES: FROM TO
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 TIME OF EVENT: FROM AM PM TO AM PM
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 ESTIMATED NUMBER OF PEOPLE ATTENDING:
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 WILL FOOD BE SERVED? YES NO
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 EXACT LOCATIONS ON CAMPUS THAT YOU ARE REQUESTING:
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 NAME OF SPEAKERS/LECTURERS:
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 ELECTRICITY NEEDED / TYPE OF EQUIPMENT:
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 TYPE OF EQUIPMENT BRINGING ON CAMPUS:
(Licensing does not provide chairs, tables, tents, etc.)  
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 TYPE OF ACTIVITY:
(Describe in detail, use reverse if necessary)
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 TYPES OF MUSIC: BANDS DJ STEREO RADIO
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 NAME OF PERFORMING SINGING GROUP/BAND:
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II. UNIVERSITY LICENSING WILL RESERVE FACILITY SPACE REQUESTED.
PREARRANGED LOCATION? Yes No - ENTER LOCATION
III. UNIVERSITY LICENSING WILL CONTACT THE FOLLOWING DEPARTMENTS:
POLICE DEPARTMENT
PARKING OFFICE
PPM
CSUN EVENT COORDINATOR
IV. UNIVERSITY LICENSING WILL PROVIDE AN ESTIMATED COST OF THE EVENT.
V. UNIVERSITY LICENSING WILL DRAFT AND SEND THE AGREEMENT. (Requires Company Name, Address, Phone, and Signature)
VI. ORGANIZATION WILL RETURN 2 SIGNED AGREEMENTS, FULL PAYMENT, AND INSURANCE, 10 TO 15 DAYS PRIOR TO THE EVENT.
VII. ORGANIZATIONS MUST OBTAIN IMSURANCE FROM EITHER A PRIVATE CARRIER OR THE CSUN RISK OFFICE (818) 677-2079.
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 CERTIFICATE OF INSURANCE FOR $2 MILLION DOLLARS
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 TO INCLUDE: GENERAL LIMITABILITY, AUTO LIABILITY AND WORKER'S COMPENSATION.
 
1.
 GENERAL LIABILITY: $1,000,000 PER OCCURRENCE (BODILY & PROPERTY DAMAGES)
2.
 COMMERCIAL AUTO LIABILITY: $1,000,000 PER OCCURRENCE (BODILY & PROPERTY DAMAGES)
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 WORKER'S COMPENSATION: $1,000,000 PER OCCURRENCE (BODILY OR DISEASE)
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 SEPARATE ENDORSEMENT LETTER: THE UNIVERSITY CORPORATION AND THE UNIVERSITY IS TO BE NAMED AS AN ADDITIONAL INSURED.
~ FAX COPY TO (818) 677-3017 AND HAVE INSURANCE COMPANY MAIL THE ORIGINAL ~
IX. UNIVERSITY LICENSING WILL NOTIFY AND ARRANGE FOR POLICE OFFICERS, LIASON, AND CUSTODIAL, ETC.
X. EVENT SUBMITTED BY:
Signature: _________________________________________ Date: _______
Print Name: Email: Phone: