3835 Holdrege Street | Lincoln, NE 68583-0742 | 402.472.2126 nebraska.edu/p2p

Eugene T. Mahoney State Park Deborah H. at ngpc.mahoney.functions@neb raska.gov

Anthony Taylor

UNMC

COPH

Pam Ehmke

(brief description and/ or event name)

6/12/26 COPH Annual Retreat - funded from NU Foundation Funds

$1,297 6/12/2026

N/A

UNMC Under $50K

N/A

INTERNAL USE ONLY

CW41787

28500 W. Park Highway Ashland, NE 68003 Phone: 402-944-2901 / Fax: 402-944-7604

Email: ngpc.mahoney.functions@nebraska.gov

Confirmation Event Date: Arrival Date _______________ Departure Date _______________ Your ___deposit___ payment amount of $_________ is due by_________. This amount includes the reservation fee [$8.50 plus tax, if applicable, per room]. Please sign and return this page with your advance deposit in the amount shown above. If the above amount is not paid by the due date, your reservation will be cancelled.

YOUR CREDIT CARD/PAYMENT AMOUNT OF $______________ has been processed.

*Tax Exempt Form 13 is enclosed. Please complete and return this to the Group Functions Department.

Please initial each line item.

-up/tear-down, trash bins, trash removal, use of beverage coolers, access to restrooms, and access to the Republican Room (storage).

The rental period for the Open Air Pavilion is from . Any event that goes past 8:00pm needs park approval.

The rental of the Open Air Pavilion include the indoor playground portion of the Activity Center or Venture Climb. Additional admission is required for entry during regular business hours and children must be supervised by an adult.

Restrooms are available inside the Activity Center during regular business hours.

Access to restrooms beyond regular business hours does require a second day rental of the Open Air Pavilion and rental of the Activity Center.

Although parking at the Pavilion/Activity Center is generally adequate, we suggest using buses if applicable. We have two open-air trams available and a trolley for rental for hourly fees and they must be requested in advance. They will make continuous tours of the park, stopping at designated spots for loading and unloading guests.

There is no access to a sink or kitchen equipment. Access to water is limited. It is the responsibility of the renter to communicate this with their caterer/food coordinator.

Should you find it necessary to cancel, a refund of your deposit (less the reservation fee and cancellation fee) can be made if you notify the Group Functions Department (in writing) 30 days or more in advance. Should you find it necessary to cancel this event closer to your event date (inside 30 days); your deposit/payment will be forfeited.

Ice is available for purchase at the Open Air Pavilion. Prepayment is required. Any unused ice in non-refundable.

Balloons, confetti, glitter, sequins, silly string, poppers, candles, open flames, sparklers, fireworks, fake flowers, drones, etc., Any additional decorations need prior approval before being placed. Chafing dishes used by catering companies are permitted.

1,297.00 June 12, 2026 June 12, 2026

+ Bur Oak Shelter

March 27, 2026

Please initial each line item.

*Tax Exempt Form 13 is enclosed. Please complete and return this to the Group Functions Department.

Placement and removal of all decorations (including linens) are the responsibility of the representative.

Failure to remove decorations from the facility or surrounding outdoors .

If damages, excessive trash, or failure to keep the venue space as it was when the representative took possession of the space, the park will assess the situation and .

Group Functions Department will contact you up to 10 days prior to discuss room set-up. Any set-up changes, AV equipment or equipment request inside 5 days may result in .

Any changes to set-up configuration the start of your event is the responsibility of the representative.

A valid is required by state law for all vehicles entering the Park. Permits are available at the park entry kiosk, the administration office, or at the Peter Kiewit Lodge. Please inform the members of your group of this fee.

Alcohol is allowed within the Open Air Pavilion. Nebraska State Parks prohibit alcohol consumption in parking lots, roadways, on trams and trolleys, or any building open to the public as required by State Law. Persons reserving the facilities are responsible for the conduct and deportment of their guests. Service to minors or those guests who are visibly intoxicated will be refused. Please see

When hiring a bar service, it is the responsibility of the representative to ensure the bar service has all required to be submitted a minimum of 30 days prior to the event.

No kegs allowed. Individual beverages must be either in cans or non-glass bottles. Serving bottles, such as wine, champagne, or hard alcohol, are permitted.

The park has two trams and one trolley available for rental. If your group is interested in these services, please let us know at least prior to your event in order to staff drivers and reserve the vehicles.

will be required for any additional add-on such as bounce houses and inflatables, food trucks, cookers/smokers, live bands, etc.

Please as an acceptance of the enclosed confirmation and the above-stated policies and with any payment due, to the Group Functions Department.

Thank you.

PRINT NAME: _________________________________

Signature __________________________________________________ Date ___________________________

FOR PARK USE ONLY:

EVENT ID #___________________________________

GROUP NAME: ______________________________

DATE OF EVENT: ______________________________

625186308

June 12, 2026 COPH Staff Picnic

Pam Ehmke

02/19/26 | 13:56 CST

02/20/26 | 19:11 CST

Certificate Of Completion Envelope Id: 763C5D3D-07CC-4B9D-B537-60ECA937F9D1 Status: Completed

Subject: CW41787 - COVER SHEET.docx

Source Envelope:

Document Pages: 3 Signatures: 2 Envelope Originator:

Certificate Pages: 5 Initials: 0 Anthony Taylor

AutoNav: Enabled

EnvelopeId Stamping: Disabled

Time Zone: (UTC-08:00) Pacific Time (US & Canada)

1400 R Street

LINCOLN, NE 68588

ataylor68@nebraska.edu

IP Address: 35.223.106.21

Record Tracking Status: Original

2/13/2026 11:35:07 AM

Holder: Anthony Taylor ataylor68@nebraska.edu

Location: DocuSign

Signer Events Signature Timestamp Pam Ehmke pehmke@unmc.edu

Assistant Dean of Finance

College of Public Health

Security Level: Email, Account Authentication (None)

Signature Adoption: Pre-selected Style

Using IP Address: 192.94.102.1

Sent: 2/19/2026 1:12:37 PM

Resent: 2/19/2026 1:13:36 PM

Viewed: 2/19/2026 1:56:26 PM

Signed: 2/19/2026 1:56:40 PM

Electronic Record and Signature Disclosure:

Accepted: 2/19/2026 1:56:26 PM ID: a6ac3120-56cb-4d41-be34-779f9bcfe6b6

Michael Hrncirik mhrncirik@unmc.edu

Assistant Vice Chancellor for Business F

University of Nebraska Medical Center

Security Level: Email, Account Authentication (None)

Signature Adoption: Pre-selected Style

Using IP Address: 75.163.90.168

Signed using mobile

Sent: 2/19/2026 1:56:41 PM

Viewed: 2/20/2026 7:10:12 PM

Signed: 2/20/2026 7:11:37 PM

Electronic Record and Signature Disclosure:

Accepted: 2/20/2026 7:10:12 PM ID: 1f4274de-59a0-4eac-8735-843d7963f3ed

In Person Signer Events Signature Timestamp

Editor Delivery Events Status Timestamp

Agent Delivery Events Status Timestamp

Intermediary Delivery Events Status Timestamp

Certified Delivery Events Status Timestamp

Carbon Copy Events Status Timestamp Pam Ehmke pehmke@unmc.edu

Assistant Dean of Finance

College of Public Health

Security Level: Email, Account Authentication (None)

Sent: 2/13/2026 11:54:08 AM

Viewed: 2/15/2026 4:31:20 PM

Electronic Record and Signature Disclosure:

Accepted: 2/20/2026 1:10:53 PM ID: 9bf84ffe-5055-4d9d-8a0b-15dea65c8ec9

Carbon Copy Events Status Timestamp Deborah H ngpc.mahoney.functions@nebraska.gov

Office Technician

Security Level: Email, Account Authentication (None)

Sent: 2/13/2026 11:54:09 AM

Resent: 2/20/2026 7:11:38 PM

Viewed: 2/13/2026 12:02:13 PM

Electronic Record and Signature Disclosure:

Accepted: 2/13/2026 12:02:13 PM ID: 2a0fb4b9-c08a-4c18-a492-1dbb6b889e68

Pam Ehmke pehmke@unmc.edu

Assistant Dean of Finance

College of Public Health

Security Level: Email, Account Authentication (None)

Sent: 2/20/2026 7:11:38 PM

Electronic Record and Signature Disclosure:

Accepted: 2/20/2026 1:10:53 PM ID: 9bf84ffe-5055-4d9d-8a0b-15dea65c8ec9

Witness Events Signature Timestamp

Notary Events Signature Timestamp

Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 2/13/2026 11:54:08 AM

Envelope Updated Security Checked 2/19/2026 1:12:36 PM

Envelope Updated Security Checked 2/19/2026 1:12:36 PM

Envelope Updated Security Checked 2/19/2026 1:12:36 PM

Envelope Updated Security Checked 2/19/2026 1:12:36 PM

Envelope Updated Security Checked 2/19/2026 1:12:36 PM

Envelope Updated Security Checked 2/19/2026 1:12:36 PM

Certified Delivered Security Checked 2/20/2026 7:10:12 PM

Signing Complete Security Checked 2/20/2026 7:11:37 PM

Completed Security Checked 2/20/2026 7:11:38 PM

Payment Events Status Timestamps

Electronic Record and Signature Disclosure

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Electronic Record and Signature Disclosure created on: 5/16/2023 6:53:28 PM Parties agreed to: Pam Ehmke, Michael Hrncirik, Pam Ehmke, Deborah H, Pam Ehmke

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