1 Floor, 66 Orsmond Street, Hindmarsh, PO Box 42, Hindmarsh SA 5007 Phone/Fax: 08 8346 7339 Email: enquiries@theballroom.net.au W: www.theballroom.net.

au ABN: 72827729498

ST

KOZAK BAR CLUBROOM

VENUE HIRE BOOKING FORM

Event Booking Date Day: ______ Date: _________of__________________ 20_________

Client Details Name:________________________________________________________________________________ (Mr/Mrs/Ms) (First Name) (Last Name) Name of Organisation (if applicable):_______________________________________________________ Phone: ______________________Home ___________________Work ____________________ Mobile Address:______________________________________________________________________________ ________________________________________________________________P/C _________________ Email:________________________________________________________________________________ Ukrainian Member Number: _______________________________ Expiry Date: ___________________

Event Hire Details Function Description: __________________________________________________________________ No. of guests attending: _____________

Venue Opening time for Set-Up:__________am / pm

(The Hirer cannot access the premises earlier than 10.00am on the day of the function) Event Commencement Time*: ________ am / pm Departure time*: __________am / pm

*To include set-up and clean-up times: Note: the departure time must not exceed 1pm
Caterer Details
Caterer being Hire: Yes No *Name of Caterer:______________________________________________

Are barbecues or smoke machine being used? Yes No Location of barbecue/machine: ________________

Venue Inventory Below is a list of all furnishings and equipment included in the hire fee. It is the responsibility of the Client to arrange for the hire of any additional items required.
Hall Kitchen

Approx 85 padded chairs (black) 30 Square Tables 80cm x 80cm Air conditioning Carpet and Vinyl Floor 5 Tall bar Tables with 12 Bar Chairs

1 Electric Oven/Gas top Stove 1 Commercial Dishwasher 1 Microwave oven 1 Domestic fridge 1 Electric Urn
No

Products Available for Hire * Sound Equipment Hire: Yes

Capacity of Venue
Theatre style: 180 Cocktail style: 250 Formal sit down with dance floor: 100 Formal sit down without dance floor 150

Parking
Off street and Street parking available. (Off street parking limited during Soccer Events held at the Hindmarsh Soccer Stadium)

Liquor Licence (Clients responsibility)

Required: Yes No

*Please note: Liquor & Gambling Commission require a minimum of 14 working days notice and may be applied for by completing an application via their web site, in person or, by requesting an application by fax. Details as follows: Office of the Liquor & Gambling Commissioner , 9th Floor, East Wing, 50 Grenfell St, Adelaide SA 5000 Phone: (08) 8226 8410 Fax: (08) 8226 8512 Email: olgc@agd.sa.gov.au Web Site: www.olgc.sa.gov.au Please note; you will require approval from the Association of Ukrainians in S.A. Inc / Kozak Bar Clubroom to support your application when submitted. *Liquor Licence not required for serviced bar hire only.

Pricing 2011 (place a tick next to the applicable hire) Kozak Bar Room Venue Hire Only---------------------------------------------------------*
Kozak Bar Venue Hire: $650.00 (includes the use of Kozak Room, kitchen & Foyer area only plus a Care Taker
for the duration of the function.)

New Years Eve Kozak bar Venue Hire: $850.00 (includes the use of Kozak Room, kitchen & Foyer area only
plus a Care Taker Guard for the duration of the function).

Kozak Room & Serviced Bar Hire - (Additional hours available @ $55p.h.)
*BYO NOT PERMITTED*

Kozak Clubroom & Serviced Bar Package (5 hour): $750.00 minimum of 30 to 50 Guests
(Includes one bar person, use of the Clubroom, kitchen & Foyer plus a Security Guard for the duration of the function)

Kozak Serviced Bar Package (5 hours): $900.00 51 plus Guests (Includes two bar persons, Clubroom,
kitchen & Foyer area plus a Security Guard for the duration of the function).

New Years Eve Kozak Serviced Bar Package (6 hours): $950.00 minimum of 30 to 50 Guests

(Includes one bar person, Kozak Clubroom, kitchen & Foyer plus, a Security Guard for the duration of the function).
New Years Eve Kozak Serviced Bar Package (6 hours): $1,050.00 51 plus Guests (Includes 1 Bar
Person, Kozak Clubroom, Kitchen & Foyer plus, a Security Guard for the duration of the function).

Bump In/Out: $50.00 p.h. (minimum 3 hours, depending on availability)

Bond: $300.00 (Refundable, Conditions apply refer to the Terms & Conditions attached) Accessories (place a tick next to the applicable hire)
Cordless Microphone Hire: $50.00 per day Sound Equipment Hire: $70.00 per day

Client Cost Clubroom Hire: Bar & Clubroom Hire: Bond: Sound Hire: Bump In/Out: Total Cost: $___________.00 $___________.00

Office Use Only

Value of Bond Refunded: $____________________ Cheque No:________________________________ Date Completed:____________________________ Receipt No:________________________________

$300.00
$___________.00 $___________.00 $____________.00

Payment Details 3

Bond Date Received: ______/_____/_____ Receipt No: _________________________ Bond Cheque Refunded to Name: _________________________________________________________ Address:__________________________________________________________________P/C_________ Type of Payment: ______________ (Cash - Cheque - Direct Debit)

Venue Hire Balance Balance $ Value: $_________________________ Date Balance Due: _______/_____/______

Type of Payment: ________________________________________________ (Cash, Cheque, Direct Debit) Receipt No: ______________________ Date Payment Received: _____/_____/_____

PAYMENT MAY BE MADE BY:

Cash, Cheque or Direct Debit (EFT) (All Cheques are made payable to: Kozak Bar Social Club)

Direct Debit Payment shall be paid to:

Account Name: Kozak Bar/Social Club BSB: 704 - 235 Account No: 0280 2008 Please notify us of all Direct Debit payments via email to:
enquiries@theballroom.net.au, marked to the attention of: Centre Manager

Full & final confirmation is given upon receipt of a $300.00 bond and a signed copy of the Kozak Bar Clubroom Venue Hire Booking Form.

The Kozak Bar Venue Hire Terms & Conditions

4

Activities Permitted

Family or Private function (weddings, engagement, christenings and birthday parties) Social, Recreation and Service Club meetings Art Cultural and craft displays and events Community group meetings Musical events of a non-intrusive manner Registered Political Meetings

Activities Not Permitted

Political Party rallies Activities likely to cause damage to the premises Activities likely to cause nuisance to neighbouring residents or commercial properties

Payment of Hire Charges

All prices are subject to variation and hire fees will be those current at the time the function is held. A bond will be required from the hirer of the venue prior to each function and may be varied depending on the type of function held by the hirer. This will be refunded within 14 working days if not required to cover excess cleaning or repair costs. A bond must be lodged in conjunction with the Venue Booking Application form to confirm a booking. If the deposit is not received within 10 business days of the initial booking being made, the reservation may be cancelled without further notice. The balance money must be paid at least 14 working days prior to the date of reservation. If your booking is made within 14 days of the required date, payment is required immediately.
Sub-Letting

Sub-letting of the halls or any part thereof is prohibited.

Cancellations

Cancellation of bookings must be given in writing not less than 4 (four) weeks prior to the function date, a deposit will only be refunded less 50% administration cost when there is another confirmed booking for the function room at the same time and on that date. Cancellations within 14 days of the hire incur 100% of the total cost of the hire. The Kozak Bar /Association of the Ukrainians in SA Inc. reserves the right to refuse an application for a booking or cancel a booking if it is deemed that the activity being undertaken does not adhere to the permitted activities.
Accessing Premises

The hirer cannot access the premises earlier than 10.00am on the day of the function to set up the hall. This allows time for inspection of the venue to occur and any emergency cleaning from the previous night.

Vacating Premises

The function must conclude by the time specified on the Venue Hire Booking Form and no later than Midnight in the case of an evening booking. One hour is allowed after this time for cleaning. Therefore the venue must be cleaned and vacated by no later than 1.00am in the case of an evening booking. Within one hour of the termination of the period of hire, or within such other time as may be approved by the Centre Manager, the hirer shall remove from the building all materials that are the property of the hirer. Materials not removed within the stipulated period may be disposed of at the discretion of The Kozak Bar Clubroom / Association of the Ukrainians in S.A. Inc.
Damages

Hirers will be required to pay for any property and equipment that is damaged, lost or stolen as a result of your hire and agrees to indemnify The Kozak Bar Clubroom / Association of the Ukrainians in S.A. Inc. against all proper costs, charges and expenses in respect thereof. Below is an example costs deductible from your Bond prior to refund, if damages exceed the bond value you will be liable for any extra costs incurred:
Item Penalty

Damage to the structure of the building Electrical equipment Damage to tables, chairs, doors, locks or equipment Extra Cleaning (additional cleaning that may include but is not limited to leftover rubbish or mess, stained carpets, broken glass, stove/oven/bar area/fridge not cleaned, counters not wiped.

Cost of repair Fee for report or replacement Cost of repair and replacement Cost of additional cleaning services

Advertising

No advertising is permitted on or in any part of the building and its surrounds without prior approval from the Manager of the Ballroom Function Centre / Kozak Bar Clubroom.
Liquor Permit

In accordance with the provisions of the Licensing Act 1997, a Limited Licence must be obtained for the supply of liquor at a function where either: The cost of liquor is to be recouped by imposing an admission/cover charge on those attending the function or Liquor is to be sold or consumed on the premises. It is the responsibility of the hirer to arrange for the relevant Limited Licence, a copy which must be lodged with the Liquor and Gambling Commissioner, 9th Floor, East Wing Zurich Building, 50 Grenfell Street, Adelaide. The hirer must take the licence to the function. Please note; that you will need approval from the Kozak Bar Clubroom / Association of the Ukrainians in S.A. Inc. to support your application when submitted.

Cleaning and Caretaker

A cleaning charge is included in the charge for the venue hire which covers basic floor and toilet cleaning only plus a caretaker for the duration of the function. The centre reserves the right to exclude or eject and all objectionable persons from the centres premises without liability. Prior to vacating the building, it is the Hirers responsibility to ensure: Rubbish is removed from the internal bins and is to be emptied into external wheelie bins. External wheelie bins are not to be left inside the venue. All tables, chairs, kitchen, bench and bar areas to be left clean. All tables and chairs to be replaced to original locations in the clubroom. Extra Cleaning fees will apply if the following is present: leftover rubbish or mess, stained carpets and hard floors, broken glass/dangerous goods, stove/oven/bar area/fridge not clean, counters not wiped and tables & chairs that require additional cleaning.
*Cleaning materials and equipment are not provided. Decorations

The hirer may not affix decorations to the walls, doors and ceiling or any other surface using adhesive tape, nails, screws, staples or the like that may damage the surfaces. Decorations must be removed before vacating the premises.
What you need to provide

Hirers are advised that it is their responsibility to arrange for the supply of crockery, cutlery, glasses, tea towels, napery and all consumable materials including the dish detergent. Hirers must also provide their own cleaning materials and equipment. Hirers are advised that it is their responsibility to arrange for the supply of power boards and extension cords, should these be required.
Noise

The volume of music must be controlled in the interests of the nearby residents and must cease no later than Midnight in the case of an evening booking. The volume of music played shall be no greater than that which would conform to the provisions of the Environmental Protection Act. Excessive noise will result in the loss of bond money.
Fire Extinguishers and Exits

Fire extinguishers are provided for use in emergency situation only and are regularly tested and tagged. If any fire extinguisher has been released or tags broken or removed, the hirer will be charged for the cost of refilling, retesting and tagging the units. Fire exits are to be used for emergencies only and not for a thoroughfare. The misuse may result in a security fee callout which will be charged to the hirer.
Smoking

Smoking is not permitted in the Ballroom Function Centre / Kozak Bar building. This is in accordance with the Ballroom / Kozak Bar Occupational Health and Safety Policy. Cigarette butts must not be left on the floor or on surrounding footpaths of the building. Failure to clean up may result in additional fees being charged.
Insurance

Whilst every possible care is taken, no liability is accepted whatsoever or howsoever with respect to loss, damage, injury or any other cause to any person or property and the hirer shall indemnify the Association of Ukrainians in SA Inc. from any claim made by any guest, invitee, licensee or contractor of the hirer. I acknowledge having read and understood the Conditions and Terms of Hire, for the property and associated facilities indicated above, and agree to abide by the conditions. I hereby certify that I am 18 years of age or older.
Print Name:____________________________________________ Signature:______________________________________________ Date:____________________________