Parks Research Permit Application FormOrganization / Individual Contact Information Name Organization Name Mailing Address Phone Number(s) Email Address Full name of research project General description of activities Number of participants Provide a separate document with more detailed project methodology. Maximum 10 files.32 MB limit.Allowed types: jpg jpeg png pdf doc docx.On site researcher contact Name Phone Number(s) Email On site assistant contact Name Phone Number(s) Email Locations and dates for research project ProjectPark(s) research is to be conductedDate(s) or rangeStart / End time research date time research date time research date time Impact(s) in park (e.g., tags, traps, other) Project Summaryshort description we can use to explain to park users as necessary with data collection method, why the research will be beneficial and ultimate goal of findings Attach additional documents as required. Maximum 10 files.32 MB limit.Allowed types: jpg jpeg png pdf doc docx.Terms and ConditionsInsurance:All applications must include proof of commercial general liability insurance coverage in the minimum amount of $5,000,000, inclusive per occurrence, for bodily injury and property damage. The insurance shall also provide:that the Regional District of Nanaimo is named as an additional insured;that the Regional District is protected notwithstanding any act, neglect or misrepresentation of the named insured;that it is primary and non-contributing with respect to any policies carried by the Regional District of Nanaimo and that nay Regional District of Nanaimo policy of insurance is excess coverage; and that all rights of subrogation or recourse against the Regional District of Nanaimo are waived.The Regional District’s Manager of Parks Services may, in the Manager of Parks Services’ sole discretion, require the applicant to provide further liability insurance from time to time. I have read, understand and agree to the insurance requirements (Initials Required) Indemnity Agreement:If the special Event or program permit is granted to you by the Regional District of Nanaimo, you and your organization must indemnify and save harmless the Regional District of Nanaimo, its officers, employees and agents from any claim, lawsuit, liability, debt, demand, loss or judgment ( including all legal costs, on a solicitor and own client basis, and interest) whatsoever and howsoever arising either directly or indirectly as a result of, or in any way related to, the granting of the permit or the use of the Regional District of Nanaimo property or facilities. I have read, understand and agree to the indemnity agreement requirements (Initials Required) Signature info***A temporary sign may be requested that explains the event and its disruptions to the public using the park*** Research must follow the Regional District of Nanaimo Park Use Regulations Bylaw 1801, as amended from time to time.I hereby certify that all information provided in this application is true and correct. Signature Date Note: the person signing this application should be the person referred to in provided insurance and is responsible for ensuring that all conditions are met.If you have any questions, please contact Parks Services at 250-248-4744. Please allow up to six weeks for application approval.Information collected on this form is done so under the general authority of the Freedom of Information and Protection of Privacy Act (FOIPPA) and is protected in accordance with FOIPPA. Information provided will only be used to process the application form. Questions regarding the collection of your personal information may be referred to the Legislative Services Department at foi@rdn.bc.ca CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
