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Renter’s Name: ____________________________________ Tribal Department: ____________________________________________
Tribal ID Number: __________________________________
Street Address: _________________________________________________________________________________________________
City: ______________________________________________ State: _________________________Zip: __________________________
Work Number: _____________________________________ Evening Number: _____________________________________________
Email Address: _________________________________________________________________________________________________
Event Name (example: birthday party): _________________________________________________________________________________
Date of Event: _____________________________________ Start Time: _____________________End Time: _____________________
Additional Dates: ___________________________________ Start Time: _____________________End Time: _____________________
Additional Dates: ___________________________________ Start Time: _____________________End Time: _____________________
FACILITY RENTAL REQUESTED (you may check more than one)
Kenny Moses Building – Kitchen (note: Kenny Moses Building is not available from November through March.)
Waterfront Beach Area
Tribal Gym (Greg Williams Court)
Uppy’s Kitchen (note: you will need to provide your own cooking supplies, i.e. pots, pans, and cooking utensils)
Fire Pit
Walk-In Refrigerator
Food Storage/Delivery Date:_________________________ Time: ____________________
Prep Date:_________________________ Time: ____________________
Cooking Date:_________________________ Time: ____________________
Approval Signature Required: ___________________________________________________Date: _________________________
Mission Highlands Community Building (note: not subject to daily fees but deposit still applies)
Early Learning Academy:
Gym Library
Hermosa Point Building:
Gray White
Equipment Requested (note: custodial staff to set up and take down tables and chairs is for tribal events only.)
Tables and Chairs for Approximate Number of People: ____________________________
Microphone – Big Screen (Tribal Gym only)
ID checked by (initials): _____________ FOR OFFICE USE ONLY
Denise Jones
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Facility Rental Terms
No overnight events. Renter assumes responsibility for all equipment borrowed during your rental agreement, including but not
limited to, condition and working order of walk-in refrigerator in Uppy’s Kitchen.
As per Tribal Government Facility & Equipment Policies (II General Rules #5): User must agree that costs may be withheld
from the damage and cleaning deposit, and any additional costs beyond the deposit amount may be deducted from the renter’s
per capita distributions until the total costs are satisfied.
Renter assumes responsibility of ensuring walk-in refrigerator is clean and no garbage or debris is left behind. A Tulalip Tribes
kitchen staff member will go over a detailed checklist prior to use of the kitchen.
Damage and Cleaning Deposit returned in full, or proportional after the following:
Maintenance Inspection
Community Services Kitchen Inspections (if acceptable)
CSR – Reimbursement Process
14 Business Day Process – Refund or Cancellation Deposit
(note: a $100 refundable deposit is required and it is the renter’s responsibility to pick up and return equipment)
Quantity of Tables: _________________________ and Chairs: __________________________
Pick Up Requested Date:___________________________Time: ______________________
Return Date:___________________________Time: ______________________
Pick up and Return Process: Equipment is picked up and returned to the Kenny Moses Building either when event is over
(ifMonday through Friday from 8:00 am to 12:00 noon) or the first business day after event date, no later than 12:00 noon
unless prearranged with custodial staff.
Note: Approximate cost to replace tables is $149 each and chairs $24.75 each.
This agreement may not be assigned or transferred, nor may the facilities be sublet or used by anyone other than the renter.
I have read and understand this agreement and the Tribes Building Use Policy, which by reference is a part of this agreement.
Iagree to be bound by them.
Applicant/Person Responsible Signature:
X_______________________________________________ Date:__________________________Tribal ID No. ___________________
CSR Coordinator: Reimbursement Request
Submitted for approval by:
________________________________________________________Date: _______________________
Approved by: ____________________________________________________________________Date: _______________________
TDS-19933 (06/16)
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