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City of Puyallup Pioneer Park Pavilion 330 S. Meridian Puyallup, WA 98371 Office: (253) 841-5518 Fax: (253) 864-4160 PIONEER PARK PAVILION RENTAL AGREEMENT Name or Group Person in Charge Address City Zip Home Phone Work Phone E-mail Address Alternate Contact Phone Check if: One Time Only Weekly Circle: Sun Mon Tue Wed Thur Fri Sat Starting Date Ending Date Set-up am/pm Event From am/pm To am/pm Clean up Until am/pm Total Number of Hours Per Use Tables Required # (50 max) Chairs Required # (400 max) Purpose of Use Number of People Expected: Adult Youth Admission Fee to be Charged Yes No $ per (Person/Couple) Will Items be Available for Sale? Yes No Describe Will Alcoholic Beverages be Available for Consumption (whether sold or not)? Yes No Does Applicant/Organization Carry Comprehensive Liability Insurance? Yes No Amount $ Insurance Co. Name Policy The Pioneer Park Pavilion is a Non-Smoking Facility. The undersigned hereby applies to the City of Puyallup for use of the above facility and certifies the information is correct and furthermore agrees to abide by all ordinances, policies, and rules and regulations, which may apply. The applicant shall indemnify and hold harmless the City of Puyallup, its elected and appointed officials, its employees and agents from and against any and all claims, demands, suits, actions, payments and judgments as a result of injury or death of any person or property damage to any property sustained by applicant or any other persons which arise from or in any manner grow out of any act or omission on or about said facility by applicant, its agents, guests, or employees, in the execution of this rental agreement including any and all expenses, legal or otherwise, incurred by the city or its representatives in the defense of any suit or claim. Such indemnity shall not include claims arising as a result of the sole negligence of the City of Puyallup, its elected and appointed officials, its employees and agents. Signed Date OFFICE USE ONLY Date Application Received By Deposit Amount Receipt # Date Balance Received By Balance Amount Receipt # Date Damage Deposit Rec’d By Deposit Amount Receipt # Date Linen Rental Rec’d By Linen Rental $ Receipt # Approved By Date ROUTING: WHITE - Office Copy YELLOW - Pavilion Supervisor PINK - Customer Copy