Common use of Statement of Information Clause in Contracts

Statement of Information. The undersigned states that, to the best of his or her knowledge, the school property for use of which application is hereby made will not be used for the commission of any act intended to further any program or movement the purpose of which is to accomplish the overthrow of the government of the United States by force, violence or other unlawful means; That , the organization on whose behalf he or she is making application for use of school property, does not, to the best of his or her knowledge, advocate the overthrow of the government of the United States or of the State of California by force, violence, or other unlawful means, and that, to the best of his or her knowledge, it is not a Communist action organization or Communist front organization required by law to be registered with the Attorney General of the United States. This statement is made under the penalties of perjury. As the undersigned, I have read the above STATEMENT OF INFORMATION and understand, as the individual and/or a duly authorized representative of my organization, that failure to comply with any of the above items will be grounds for the revocation of the facilities use permit. I understand further that as the individual and/or duly authorized representative of my organization that I/we are responsible for the implementation of the above requirements included in this Statement of Information. Organization Name (Print) Title Signature Name Title Date ▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇. (▇▇▇) ▇▇▇-▇▇▇▇ The following Hold Harmless Agreement shall be completed prior to use of facilities: To: WEST CONTRA COSTA UNIFIED SCHOOL DISTRICT In connection with the granted use of your facilities and premises at for