City of Marco Island
Parks & Recreation Department
1361 Andalusia Terrace,
Marco Island, FL 34145
Phone: 239-642-0575
Name of Organization
Today's Date
Mailing Address
Contact Person
Day Phone Evening Phone
E-mail
Proposed Activity
**This is only a request form, NOT a confirmation.
You will be notified once your request is approved.
Request Dates of Use
Requested Time
Estimated Attendance Other Services
Mackle Park Facilities Athletic Fields and Parks
Mackle Park Mackle Park (lower)
Basketball court
Sand Volleyball court
Winterberry Softball Field
Winterberry Baseball Field
Winterberry Field
TBE Baseball Field
Vets' Community Park
Special Notes (number of tables or
chairs, seating configuration, lights,
lining, set-ups, scoreboards, bleachers)
Bald Eagle Room
Burrowing Owl Room
Picnic Hut
Is your request for a community group?
Yes No
Is your request for family or personal use?
Is you request associated with a business?
Does the activity involve athletics?
Is the activity open to the public?
Will there be any sort of admission charged?
Do you anticipate more than 30 people including participants and spectators to be at your event?
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
Insurance Requirements
Insurance is required for all organizations using Department facilities for all
events where attendance is estimated to be thirty (30) or more people, with
the exception of regular business meetings and bocce courts.
FACILITY REQUEST FORM
Lake side Pavilion
Parking Lots
Winterberry Field
Mackle Park (upper)
Veterans' Community Park
Other
Bocce Courts-
Number of Courts Requested
Note: No Reservations for Bocce on weekends
**Time frame for facility request must include set-up and tear-down time**
Gator Room
Lake side Dock
Print Form
Insurance Requirements
If your organization is required to provide Insurance, your organization must provide proof of insurance prior to using the facility requested in
the form of an
insurance certificate with the following:
a)The Name(s) of your organization,team,sponsor,etc. listed on the policy.
b)Liability Coverage with the City of Marco Island listed as additional insured in the amount outlined above.
c)Dates of policy must be consistent with dates requested
.
I understand the above requirements may apply. ______________________________________________________
Signature and title
Users shall have insurance coverage with a minimum of $300,000 per occurrence combined single limits for bodily injury and property damage
liability, including premises and operations. The City of Marco Island shall be named as an “additional insured” (not certificate holder). If the
Director believes a proposed use has an above average risk, such as a special event, liability insurance in the amounts of $500,000 or
$1,000,000 may be required.
If the user is subject to Florida Worker's Compensation Law, coverage shall be provided as required by law. The coverage shall be statutory
limits in compliance with applicable stage and federal law. The policy must include Employers' Liability with a minimum limit of $100,000 per
occurrence.
Athletic Leagues - Users shall have insurance coverage with a minimum of $1,000,000 per occurrence combined single limits for bodily injury
and property damage liability, including premises and operations. The City of Marco Island shall be named as an “additional insured” (not
certificate holder). If the user is subject to Florida Worker's Compensation Law, coverage shall be provided as required by law. The coverage
shall be statutory limits in compliance with applicable stage and federal law. The policy must include Employers' Liability with a minimum limit of
$100,000 per occurrence.
Police/Security Requirements
The City may require security staff for some events. If your organization is required to provide law enforcement for your event, your organization
must provide a copy of the contract with the City of Marco Island Police Dept. listing the dates and time coverage will be provided.
Fees:
If your organization must pay a fee, it must be paid at the time the reservation is confirmed and the permit issued. Once a facility has been
scheduled, refunds will be made only when requested in writing one week prior to the date of use. Groups not paying fees who fail to cancel
within 48 hours prior to the scheduled use of the facility may be charged a $30 penalty fee. If your organization's fee exceeds $200, fifty percent
of the fee is due upon reservation confirmation and the balance is due by the end of your scheduled dates of use.
Rules & Restrictions
1. The activity shall be restricted to that area for which permission is granted.
2. The activity shall not extend beyond the hours approved in the request.
3. The organization using the building shall be responsible for moving its equipment into and out of the building within the time reserved.
4. City staff must have free access to all rooms at all times.
5. Possession of permit is required while using the facility. Failure to supply permit when requested by City staff may result in expulsion from
the area.
6. Facility must be left clean and in adequate condition as determined by Director or Park Staff, or deposit will be partially or fully forfeited.
7. All City Ordinances and Park Rules and Regulations must be adhered to at all times while using the facilities.
8. The following are prohibited at Parks and Recreation facilities and outdoor areas : fires in undesignated areas, animals in undesignated
areas, alcoholic beverages or intoxicants, drugs of any kind, solicitors, sign advertisements (unless otherwise permitted) and any act or
behavior that may be displeasing to the public's enjoyment.
9. The group or individual(s) to whom a permit is issued shall be liable for any loss, damage, negligence, or injury sustained by other person(s)
in their party.
10. The Director or his designee has the authority to revoke any valid permit for violation of rules or ordinances, or City need, or any other valid
causes.
In consideration of the use of a City-owned/operated facility, the organization or person shall pay $ ____________. The organization or person
agrees to abide by the rules and regulations of the City of Marco Island and if, in the opinion of its officers, the organization or person, his
agents, employees or members violate said rules or fail to comply with said rules, the City will have the right to terminate the agreement without
liability or obligation of any nature whatsoever and the City will not refund monies to the organization. Further, the organization or person agrees
to save and hold harmless the City from any and all liabilities and claims arising out of or caused by any acts of the organization or person, its
agents, servants, employees, members and suppliers. The City of Marco Island will be responsible for all routine maintenance, cleaning and
care of aforementioned
premises leased. The organization or person shall be responsible for the repair of any damage to the aforementioned
premises leased caused by any intentional or negligent act or mission of its employees, agents or invitees. The organization or
person shall not
be responsible
for any damages caused by ordinary wear and tear. Contact person listed assumes responsibilities and must be present during
use. The Signature below attests to the understanding and agreement of all of the elements of this form.
Signature and title ___________________________________________________________ Date__________________________
Print name _________________________________________________________________
Agreement