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City Hall Council Chambers Application

2. APPLICANT/USER GROUP CONTACT INFORMATION

3. *APPLICANT MUST BE AT LEAST 21 YEARS OLD.

5. First Name*

6. Last Name*

8. Billing Address*

10. Address2

12. City

13. State

14. Zip

16. Phone Number*

17. Email*

19. 501(c)(3) Non-Profit ID

20. Facility Usage Detail:
    *PLEASE NOTE: REQUEST DOES NOT GUARANTEE RESERVATION APPROVAL! ALL REQUESTS MUST BE SUBMITTED NO LESS THAN 2 WEEKS PRIOR TO START DATE. FAILURE TO DO SO MAY RESULT IN REJECTION OF APPLICATION REVIEW OR APPROVAL! *USE OF THE CHAMBERS/ FACILITY DOES NOT GUARANTEE USE OF CITY OWNED EQUIPMENT! DAMAGES OR LOSS/ THEFT OF EQUIPEMENT MAY RESULT IN ADDITIONAL FINES AND/OR FUTURE BAN ON USE OF CITY OWNED SPACE/ FACILITIES! ALL APPLICANTS REQUESTING USE OF EQUIPMENT MUST HAVE APPROVAL IN WRITING FROM AN APPROPRIATE CITY STAFF MEMBER, AND GO THROUGH NECESSARY TRAINING!

    *PLEASE NOTE: REQUEST DOES NOT GUARANTEE RESERVATION APPROVAL! ALL REQUESTS MUST BE SUBMITTED NO LESS THAN 2 WEEKS PRIOR TO START DATE. FAILURE TO DO SO MAY RESULT IN REJECTION OF APPLICATION REVIEW OR APPROVAL! *USE OF THE CHAMBERS/ FACILITY DOES NOT GUARANTEE USE OF CITY OWNED EQUIPMENT! DAMAGES OR LOSS/ THEFT OF EQUIPEMENT MAY RESULT IN ADDITIONAL FINES AND/OR FUTURE BAN ON USE OF CITY OWNED SPACE/ FACILITIES! ALL APPLICANTS REQUESTING USE OF EQUIPMENT MUST HAVE APPROVAL IN WRITING FROM AN APPROPRIATE CITY STAFF MEMBER, AND GO THROUGH NECESSARY TRAINING!

22. Set Up Date/Time*
    Set Up Date/Time

    Set Up Date/Time

23. Tear Down Date/Time*
    Tear Down Date/Time

    Tear Down Date/Time

24. Main Usage Date/Time
    Main Usage Date/Time

    Main Usage Date/Time

26. Will this be open to the public?*

    1. Yes
    2. No

    *May require additional permitting.

27. Number of People*

    *Maximum Occupancy: 139

28. Will signs, banners, ads be displayed?*

    1. Yes
    2. No

    *May require additional permitting

30. Please detail usage purpose.*

32. *PLEASE NOTE!
    CITY HALL IS A MUNICIPAL BUILDING, AND GROUPS UTILIZING THE CHAMBERS DURING REGULAR BUSINESS HOURS (8:00 AM—5:00 PM, MONDAY THROUGH FRIDAY, EX. HOLIDAYS) ARE EXPECTED TO MAINTAIN A LOW-NOISE LEVEL AT ALL TIMES, PROPERLY CLEAN ONCE THE EVENT IS OVER, AND RETURN ALL KEYS/ PASSES/ RENTED EQUIPMENT PROMPTLY AND IN GOOD WORKING CONDITION! FAILURE TO DO SO MAY RESULT IN FUTURE BAN ON UTILIZING CITY OWNED SPACE/ FACILITIES!

    CITY HALL IS A MUNICIPAL BUILDING, AND GROUPS UTILIZING THE CHAMBERS DURING REGULAR BUSINESS HOURS (8:00 AM—5:00 PM, MONDAY THROUGH FRIDAY, EX. HOLIDAYS) ARE EXPECTED TO MAINTAIN A LOW-NOISE LEVEL AT ALL TIMES, PROPERLY CLEAN ONCE THE EVENT IS OVER, AND RETURN ALL KEYS/ PASSES/ RENTED EQUIPMENT PROMPTLY AND IN GOOD WORKING CONDITION! FAILURE TO DO SO MAY RESULT IN FUTURE BAN ON UTILIZING CITY OWNED SPACE/ FACILITIES!

34. Insurance Requirements
    *REQUIRED WHEN APPLICABLE; WHEN APPLICABLE, INSURANCE PROOF REQUIRED UPON APPLICATION SUBMISSION; APPLICATIONS SUBMITTED WITHOUT INSURANCE WILL NOT BE REVIEWED OR APPROVED

    *REQUIRED WHEN APPLICABLE; WHEN APPLICABLE, INSURANCE PROOF REQUIRED UPON APPLICATION SUBMISSION; APPLICATIONS SUBMITTED WITHOUT INSURANCE WILL NOT BE REVIEWED OR APPROVED

36. *INSURANCE IS REQUIRED OF ALL APPLICANTS HOSTING/ SUPERVISING SPORTING OR ATHLETIC EVENTS, SPORTING OR ATHLETIC WORKSHOPS, SPORTING OR ATHLETIC CLASSES, ETC. *INSURANCE IS REQUIRED OF ALL EVENTS UTILIZING INFLATABLES, AMUSEMENT RIDES, HIGH-RISK GAMES/ ACTIVITIES, ETC. *FOR INSURANCE LIMIT REQUIREMENTS, PLEASE CONTACT CITY HALL; INSUFFICIENT COVERAGE WILL RESULT IN REJECTION OF APPLICATION!

    *INSURANCE IS REQUIRED OF ALL APPLICANTS HOSTING/ SUPERVISING SPORTING OR ATHLETIC EVENTS, SPORTING OR ATHLETIC WORKSHOPS, SPORTING OR ATHLETIC CLASSES, ETC. *INSURANCE IS REQUIRED OF ALL EVENTS UTILIZING INFLATABLES, AMUSEMENT RIDES, HIGH-RISK GAMES/ ACTIVITIES, ETC. *FOR INSURANCE LIMIT REQUIREMENTS, PLEASE CONTACT CITY HALL; INSUFFICIENT COVERAGE WILL RESULT IN REJECTION OF APPLICATION!

38. Will insurance be necessary?*

    1. Yes
    2. No

    If Yes, please submit insurance proof at the time of the application submission.

40. Please upload your insurance proof if required.

42. Applicant Signature
    By signing below, application agrees to all terms and conditions. If upon arrival, applicant identifies a problem with the facility, it is the responsibility of the applicant to contact City Hall at (509) 755-6700 immediately to report the issue. The applicant assumes the entire responsibility and liability for losses, damages and claims arriving out of injury or damage to the applicants displays, equipment and other property brought upon the premises of the City and shall indemnify and hold harmless the City, agents and employees from any and all such loses, damages, and claims. Applicant is responsible for maintaining the cleanliness of the rented park space/ facility, and agrees to properly dispose of waste in proper receptacles. Applicant agrees to provide all required permits, certificates, etc. at the time of submission, and acknowledges that failure to do so will result in rejection of application request. By signing, applicant hereby makes application to the City of Liberty Lake for the use of City facilities/property and certifies the information given in this application and supporting material is correct. The applicant agrees to indemnify, defend, and save harmless the City or its officers, agents, employees, alleging damage or injury arising out of the subject matter of this agreement; provided, however, that such provision shall not apply to the extent that damage or injury results from the sole fault of the City or its officers, agents, or employees. Applicant acknowledges that cancellation of the requested event for any reason outside of inclement weather or unavoidable emergency will not result in a refund from the City. Applicant acknowledges that changes made to the reservation post approval and confirmation (if approved and confirmed) without written, formal approval from City staff may result in cancellation of event and rejection of refund requests. Above all, the applicant agrees to abide by all City ordinances and Park rules while utilizing City space/ facilities, and acknowledges that failure to do so may result in future revoking of privileges.

    By signing below, application agrees to all terms and conditions. If upon arrival, applicant identifies a problem with the facility, it is the responsibility of the applicant to contact City Hall at (509) 755-6700 immediately to report the issue. The applicant assumes the entire responsibility and liability for losses, damages and claims arriving out of injury or damage to the applicants displays, equipment and other property brought upon the premises of the City and shall indemnify and hold harmless the City, agents and employees from any and all such loses, damages, and claims. Applicant is responsible for maintaining the cleanliness of the rented park space/ facility, and agrees to properly dispose of waste in proper receptacles. Applicant agrees to provide all required permits, certificates, etc. at the time of submission, and acknowledges that failure to do so will result in rejection of application request. By signing, applicant hereby makes application to the City of Liberty Lake for the use of City facilities/property and certifies the information given in this application and supporting material is correct. The applicant agrees to indemnify, defend, and save harmless the City or its officers, agents, employees, alleging damage or injury arising out of the subject matter of this agreement; provided, however, that such provision shall not apply to the extent that damage or injury results from the sole fault of the City or its officers, agents, or employees. Applicant acknowledges that cancellation of the requested event for any reason outside of inclement weather or unavoidable emergency will not result in a refund from the City. Applicant acknowledges that changes made to the reservation post approval and confirmation (if approved and confirmed) without written, formal approval from City staff may result in cancellation of event and rejection of refund requests. Above all, the applicant agrees to abide by all City ordinances and Park rules while utilizing City space/ facilities, and acknowledges that failure to do so may result in future revoking of privileges.

44. Signature Date*
    Signature Date

    Signature Date

45. By checking Yes, I acknowledge this as an electronic signature. *

    1. I Agree
    2. I Disagree-Application is Void.

    Your application will not be accepted or acknowledged if you check No.

47. Staff Signature Date
    Staff Signature Date

    Staff Signature Date

48. Signature of Approving City Staff Member

Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field