Fillable Condition-of-Facility-Agreement-web City of Huntington Beach

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Condition-of-Facility-Agreement-web City of Huntington Beach

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Original – Custodian Copies – Office & Applicant
City of Huntington Beach
Community Services Department
2000 Main Street, Huntington Beach, CA 92648-2702
(714) 536-5486
Condition of Facility Agreement
Facility:_________________________________ Date of Use: __________________
Applicant’s Name: _______________________________ _____ ________________
Applicant (or his/her representative, excluding caterers) agrees to return the facility in
reasonable condition to be entitled to a full refund of deposit. If Applicant (or his/her
representative, excluding caterers) is not present at scheduled opening and closing
times, the decision by Community Services staff as to the condition of the facility and
fees due or deposits forfeited is final. Applicant is to explain any discrepancies in the
condition of the facility at closing time in writing on an attached page signed by them.
I understand that I am to arrive at the facility at ________ a.m./ p.m. and I am to
be out of the facility at ________ a.m./ p.m. The premises are to be completely
cleaned, including floors swept and wet mopped if needed (maintenance supplies
provided) and all set ups taken down before leaving.
I have read the above:
SIGNATURE OF APPLICANT
The checklist on the reverse side is to prevent negligence by either the Community
Services staff or the Applicant. It is a formal agreement of proper use and maintenance
of the facility. This form must be completed and the person(s) responsible for check-in
or check-out must be present for a security deposit refund.
________________________________ _______________________________
Name of Person Checking In Name of Person Checking Out
________________________________ _______________________________
Cell Phone Number Cell Phone Number
Original – Custodian Copies – Office & Applicant
Condition of Facility Report
PRIOR TO USE
AFTER USE
CLUBHOUSES
FACILITY IN GOOD CONDITION
□ Yes □ No □ Yes □ No
If not, explain (be specific):
FACILITY AND RESTROOMS
Floors
□ Clean □ Dirty □ Clean □ Dirty
Sinks/Counter
□ Clean □ Dirty □ Clean □ Dirty
If not clean, explain:
KITCHEN
Floors
□ Clean □ Dirty □ Clean □ Dirty
Sinks/Counter
□ Clean □ Dirty □ Clean □ Dirty
Ovens
□ Clean □ Dirty □ Clean □ Dirty
If not clean, explain:
Coffee Pot Present
□ Yes □ No □ Yes □ No
Fire Extinguisher Present
□ Yes □ No □ Yes □ No
LAKE PARK BBQ/PICNIC AREA
Grounds
□ Clean □ Dirty □ Clean □ Dirty
Sinks
□ Clean □ Dirty □ Clean □ Dirty
Grills
□ Clean □ Dirty □ Clean □ Dirty
Griddles
□ Clean □ Dirty □ Clean □ Dirty
Sinks/Counter Tops
□ Clean □ Dirty □ Clean □ Dirty
If not clean, explain:
Grills used by Applicant
(
PLEASE CIRCLE GRILL NUMBER
)
Grills
All decorations removed
□ Yes □ No
Trash put in receptacle
□ Yes □ No
Time Applicant
Arrived a.m./p.m.
Departed a.m./p.m.
Refund Due
□ Total □ Partial
Facility checked by: (Print Name)
Community Services Staff Signature
X
X
Applicant/ Representative Signature
X
X
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Completed 13 June 2020

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