City Hall Facility Request Form

CONTACT INFORMATION

Primary Contact

This person is the person held primarily responsible for providing to the City all required event information including licenses, permits, and certificates by the established deadlines.

Phone

Email

Address

City

State

ZIP

Organization

ORGANIZATIONS AFFILIATION

City of Bellevue Program

Governmental Agency

Neighborhood/Community Association

Local Non-Profit

If Local Non-Profit please provide ID #

Is the City of Bellevue Co-Sponsoring the Event?

If yes, which City Department?

City Staff Contact

Co-sponsoring means City staff are collaborating on planning, are providing staff to assist with logistics, share responsibility for ensuring facility usage guidelines are met, and will attend the event.

If fee applies, invoice is to be sent to

Name

Company

Address

City

State

ZIP

SPACE & USE

ENTERTAINMENT / FOOD / BEVERAGES

Will there be entertainment?

Describe

Will there be amplified sound?

For what purpose?

How will the sound be amplified?

PA System

Stereo

Live Band

DJ

Other…

Will you serve food and/or beverages?

Describe

Food and beverages are not allowed in our facility unless you have advised us in advance. City Hall is not equipped with kitchen facilities.

Will event be catered?

If yes, complete a "Bellevue City Hall Catering Form".

Will sterno/flame be used?

If yes, fire extinguishers are required and we will have Fire Department review space setup for Fire Code compliance.

Request permission to serve wine/beer?

Will you be selling wine/beer?

The City of Bellevue reserves the right to deny permission to serve wine/beer at the Bellevue City Hall campus.

Will you be charging a fee to attend?

Selling concessions or providing giveaways?

Vendor Name(s)

Describe concessions/giveaways

The City of Bellevue reserves the right to deny the sale or distribution of items deemed to be hazardous, a nuisance, or not family friendly.

SPACE SETUP

For meeting rooms, is the standard space configuration suitable for your use?

Yes I will use the space "as is" and will ensure the space remains in its standard configuration.

No I would like to request a different configuration. Speak with us about available options;fees apply.

Do you need access to electricity?

What for?

What equipment are you bringing?

Are you renting equipment?

Rental company

For some items, a certificate of insurance is required from rental company naming City of Bellevue as an additional insured with $1 million General Liability Coverage.

Will you have deliveries made to City Hall?

What will be delivered?

On-site storage is not available. You must be available to receive your deliveries on-site unless you have made other arrangements with our staff.

AGREEMENTS

The applicant agrees that during the use of the City of Bellevue City Hall facility to not exclude anyone participation in, deny anyone the benefit of, or otherwise subject anyone to discrimination because of the person's race, color, national origin, age, sex, or disability.

The undersigned hereby makes an application to the City of Bellevue for use of the City Hall facility described above and certifies that the information given in the application materials is correct. The undersigned further states that he/she has the authority to make this application for the applicant and agrees that the applicant will observe the rules/regulations and policies/procedures of the City of Bellevue. The applicant agrees to exercise the utmost care in the use of the premises and property and to defend and hold the City of Bellevue harmless from all liability resulting from the use of said facilities. The applicant further agrees to reimburse the City of Bellevue for any damage arising from the applicant's use of said facilities. The applicant signing this agreement will be considered the responsible party in case of damage, theft, or disturbances during the usage period.

I understand that that Bellevue City Hall meeting and special event facilities may not be used to support or oppose a candidate for election or promote or oppose a ballot proposition and agree and affirm that my use will comply with this rule.

I have read, understand, and accept all procedures and regulations in the City of Bellevue's City Hall Meeting & Event Facilities Guidelines & Information document. I further certify that I am 21 years of age or older and I understand that failure to comply with the established facility use guidelines (and within the established timeframes), puts my meeting or event at risk for cancellation.

Primary Contact Signature

Sign above

Date