Fillable Facility and Space Use Questionnaire (Charlotte County BCC)

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Facility and Space Use Questionnaire (Charlotte County BCC)

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The Facility and Space Use Questionnaire (Charlotte County BCC) form is 3 pages long and contains:

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  • 10 check-boxes
  • 83 other fields

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File type: PDF

U.S.A. forms for Charlotte County BCC

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Facility and Space Use Questionnaire
To ensure the appropriate provisions are in place to provide you with the best service possible, please answer the
following questions. In some cases, fees may apply.
I. CONTACT INFORMATION
Please provide the information for the person presenting the event and signing the questionnaire below:
Group/Organization (if applicable):
Tax Exempt Organization Yes No If yes, please attach a copy of your tax exemption certificate.
Name of Individual Responsible:
Phone: Alternate Phone:
Address:
Email:
Today’s Date:
II. EVENT INFORMATION
Event Name: Type of Event:
Date(s) of Proposed Event:
Hours of Proposed Event: am pm to am pm Expected Attendance:
When deciding your requested time, please include your set-up/breakdown time along with the time of the event from
start to finish. Charlotte County Facilities does not provide room setup or breakdown services.
Intended Users (public, committee, staff, etc.)
General Description of Activity or Event (display, presentation, food, workshop, temporary work space, etc.)
_
III. FACILITY REQUESTED: If possible, please include a schematic drawing of preferred setup/layout.
Charlotte County Historical Courthouse
226 Taylor Street, Punta Gorda, FL
Maximum Capacity
Second Floor Courtroom
79
Exterior Grounds
Other – describe:
Other County Location, Facility, Address, Location
The Historic Courthouse is not a location available for general use and rental, as some of our Community Service Parks
locations are. The building was set up to contain an auxiliary courtroom space to be used as necessary by the Justice
Center. Any activity in the building and premises must be in keeping with both the historical nature of the building and
the gravitas of judicial proceedings. Additionally, any event allowed here must be for public benefit and cannot be for
commercial gain.
Please circle or write-in the appropriate answer below related to activity on County Property:
1. Will you or any company or individual hired by you require
a. Lighting YES NO
b. Electricity YES NO
c. Water YES NO
2. Describe any special considerations or requests_
3.
Will you be charging admission or soliciting donations related to your event?
YES
4.
Will you or any company or individual hired by you:
a.
Sell food or beverages
YES
b.
Provide live music or large scale entertainment
YES
c.
Provide or erect mechanical or inflatable structures during the event
YES
d.
Erect tents, canopies, or other temporary structures during the event
YES
e.
Require street or public property closings, or additional traffic control
YES
f.
Require additional safety and security personnel
YES
(Fire, law enforcement, or private security officers)
g.
Require emergency medical personnel onsite
YES
h.
Consume alcoholic beverages at your event
YES
i.
Sell alcoholic beverages at your event
YES
j.
Will you have animals or livestock (other than service animals)
YES
Please read and initial each of the following acknowledging understanding.
A certificate of liability insurance with the following limits may be required;
o Commercial General Liability Insurance $1,000,000 per occurrence
o Certificate Holder should read: Charlotte County Board of County Commissioners
o Certificate Holder listed as Additional Insured
**Additional insurance may be required for, but not limited to, the use of the following: bounce house, climbing
wall, presence of animals (e.g. petting zoo), and consumption of alcohol. Proof of liability coverage must be
furnished at least 14 days prior to the reservation date or all payments are forfeited.**
The client is responsible for putting trash inside the trash cans, taking any decorations down, and any
equipment brought in must be taken out.
Requests to cancel a reservation inside of 14 days will result in the forfeiture of rental fees paid.
If applicable fees are required, 25% of the total rental will secure a rental booking date for a facility with the
remaining balance due 14 days prior to rental date.
If deemed necessary, I will meet with Facilities personnel at least 14 days prior to my event.
I understand no refunds will be issued due to inclement weather or failure on the part of the renter to use the
space on the date reserved.
SIGNATURE
The information contained in this questionnaire will be used to approve or deny your request. I have read,
understood, and completed the Questionnaire in its entirety. I hereby agree and understand that it is my
responsibility to ensure compliance with all policies, rules, regulations, and guidelines of Charlotte County
Facilities and other relevant procedures and laws. I understand that any violations may result in immediate
cancellation of reservation. I understand that this information may be revised or expanded upon at a later date.
Signature: Date:
Facilities Use Only:
Insurance Required: Yes No (Commercial General Liability Insurance $1,000,000 per occurrence; Certificate Holder should read
Charlotte
County Board of County Commissioners; Certificate Holder listed as Additional Insured)
Fee Required: Yes No Amount:
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Facility and Space Use Questionnaire (Charlotte County BCC)

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Completed 17 July 2020

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