Civic Center
Recurring Use Application
Fee $15 per day + $100 refundable deposit
Yes No
Yes
No
Yes
No
Organization Name
Complete Address
Complete Mailing Address
Contact Person Name
Complete Mailing Address
Phone
Email
Recurring Meeting / Event Title
Recurring Meeting / Event Time
and duration
Dates Requested for Calendar Year
Equipment / Facility Use:
Will the kitchen be used?
Will the table arrangement be
changed? Will the PA system be used?
Will the wi-fi system be used?
Yes No
What equipment, if any, will be brought into the Civic Center and for what purpose?
Official Use Only
Date Rec'd
File No.
Fee Paid
Policy Acknowledgement:
The deposit will not relieve the applicant from liability for the full amount of damage to the
Civic Center or damage to or loss of any equipment or supplies. The $100 deposit must be
maintained; if a portion or all of the deposit is used to recover costs associated with loss or
damage, the user must restore the deposit to the full amount of $100. The deposit will be
refunded after the Civic Center is no longer being used for the recurring-use event, if all the
rules have been complied with, and if there is no damage to the Civic Center or damage to
or loss of any equipment or supplies.
I have read and agree to the terms of the deposit refund policy.
The applicant or organization represented by the applicant will be liable to the City for all
damage to the Civic Center and all damage to or loss af any equipment or supplies resulting
f
rom the use of the Civic Center, and shall defend, indemnify, and hold the City of Dallas and
its officers, employees, and agents harmless from and against any and all claims, liabilities,
losses, demands, damages or actoins, of whatever form or nature, for property damage, bodily
injury or death, including attorney fees incurred in defense thereof, arising from or relating in
any way to the use of the Civic Center. The City Manager may require a Certificate of Liability
Insurance of not less than one million dollars naming the City of Dallas as additionally insured.
I have read and agree to the terms of the liability policy.
AGREEMENT: I certify that the information given in this application is correct. I further state that
I have the authority to make this application, and agree to observe all rules and regulations
f
or use of the Civic Center, as adopted in Resolution No. 3259, Exhibit A. I will be personally
responsible for the repair of damage to equipment or facilities and replacement of lost or
stolen equipment or supplies.
Applicant’s Signature
Date
Please return completed form to:
City Manager’s Office
187 SE Court Street
Dallas, OR 97338
503-831-3502
sam.kaufmann@dallasor.gov
Form
# 24
Last Revised: 01/11/2021
File Location: I:ALL/City Forms
click to sign
signature
click to edit
RULES FOR USE OF THE DALLAS CIVIC CENTER
In accordance with Dallas City Resolution 3259, Exhibit A
1. Application: A civic or nonprofit organization desiring to use the Civic Center must submit the
application and receive approval prior to use.
2. Hours: The Civic Center is available for use only during business hours on business days. An
exception to this provision to allow use on evenings or weekends may be allowed for good
reason, subject to any imposed special conditions, fees, or limitations.
3. Fees: The fees for single-use events must be paid in advance; the fees for recurring-use events
will be billed quarterly.
4. Deposits/Refunds: The refundable deposit is $100 and must be paid prior to use. The deposit for
single-use events will be refunded if these rules have been complied with and there is no
damage to the Civic Center or damage to or loss of any equipment or supplies. For recurring-
use events, the $100 deposit must be maintained; if a portion or all of the deposit is used to
recover costs associated with loss or damage, the user must restore the deposit to the full
amount of $100.
5. Kitchen Use: Use of the kitchen and dining facilities and equipment will require prior approval.
Please bring disposable paper plates, cups, and flatware, dishcloths and dishtowels.
6. Equipment Use: Prior approval and instruction is required for use of the projector and public
address system. Under no circumstances may any of the equipment, supplies, tables or chairs,
or any City property be removed from the facility.
7. Piano: The piano is on loan to the people of Dallas for their use and enjoyment. Please do not
allow abusive use or set items or beverages on the piano.
8. Signs/Notices: Signs or notices may be pinned or stapled to the outside bulletin boards on either
side of the Jefferson Street door. A small A-frame sign is allowed next to the sidewalk on
Jefferson Street.
9. Cleaning/Damages: The facility is public property and there are no janitorial services available.
Any staff time associated with cleaning and/or repair of damages will be charged against the
deposit.
Upon vacating:
a. Remove garbage, spills, and debris from the premises; garbage cans must be emptied
and trash placed in the dumpster outside of the building.
b. Tables, chairs, and equipment must be returned to the original location and/or
arrangement. Please note that tables need to be picked up to prevent scrapes and
scratches to the floor.
c. Remove all decorations, signs, notices, and handouts from the premises.
d. All kitchen items used must be washed and put away; counters and appliances left
clean.
e. Restrooms must be left clean and in order.
f. All private property removed from the premises.
10. Alcohol: No alcohol is permitted to be served or consumed in the Civic Center.
11. No Smoking: No person shall smoke or carry a lighted cigarette, cigar or pipe in the Civic
Center, and smoking within 10 feet of the external boundaries of the entrances and exits is
prohibited.
12. Fire Policy: Per Fire Marshall, maximum seating capacity is 133 persons. Open flames are
prohibited, except candles safely enclosed in a chimney-type candle holder. All
decorations shall be flame-proof or flame-retardant.
13. Liability: In all cases, the applicant shall be liable to the City of Dallas for any loss or damage
to the facilities, kitchen, restrooms, equipment, furnishings, and appliances resulting from
such use of this room and its related facilities. The applicant shall defend, indemnify and
hold the City of Dallas and its officers, employees and agents harmless from and against
any and all claims, liabilities, losses, demands, damages or actions, of whatever form or
nature, for property damage, bodily injury or death, including attorney fees incurred in
defense thereof, arising from or relating in any way to the use of the Civic Center. If
damage to or loss of any equipment or supplies is in excess of the $100 deposit, the person
or persons making the application is still liable for the full amount of repair or replacement.
The City of Dallas will have no liability for any loss of or damage to private property. The City
Manager may require an applicant to obtain and maintain during the term of use a policy
of general liability insurance in an amount of not less than $1 million, which shall name the
City of Dallas as an additional insured.
14. Cancellation: If you need to cancel your room reservation, 24 hours notice is required for
credit.