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Sequim WA 98382 360-683-4908 See SMC 3.68 Rates (City of Sequim)

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Facility Rental Application
See SMC 3.68 Rates and Fees for Current Fees and Deposits, Including Nonprofit and In-City Discounts
(all fees except Cleaning Fee waived for Clallam County government agencies)
Events May Require a Special Event or Temporary Activity Permit in Addition to this Application
Ballfields at Carrie Blake Park
144 N. Blake Avenue
☐East ballfields
☐West ballfields
Guy Cole Event Center
144 N. Blake Avenue
☐Main Hall
☐Kitchen
If you select the Guy Cole Event Center,
please download or obtain from City staff
the Guidelines for Use for that facility. The
cleanup checklist included in the
Guidelines must be completed, signed,
and returned to the City after your Event
in order to process any refund you may be
entitled to.
Centennial Place
104 E. Washington Street
☐ Contact City regarding
availability and requirements
Band Shell at Water Reuse
Demonstration Site
506 N. Blake Avenue
☐James Center for Performing
Arts
Civic Center
152 W. Cedar Street
☐Civic Center Chambers
☐Civic Center Plaza
☐Burkett Community Room
☐With audiovisual needs
Applicant Information (Please print legibly if not using fillable form)
Applicant Name(s): _________________________________________________
(Only persons listed above will have authority to receive keys or access codes without a written permission slip from you [Applicant])
Organization/Entity/Agency (if any): ____________________________________________________
Email Address: ____________________________________________________________________
Mailing Address: ___________________________________________________________________
City/State/ZIP: ____________________________________________________________________
Phone No.: _______________________________________________________________________
Event Details (Leave no blanks)
Date(s) of Event: __________________________________________________________________
Description of Event: _______________________________________________________________
Will Event be open to the public? _____________________________________________________
Will admission/entrance fee be charged? _______________________________________________
Total rental hours (including setup, dismantling and cleanup): _______________________________
Time setup begins: ___________________ Time Event begins: ___________________________
Time Event ends: ____________________ Time cleanup ends: ___________________________
Expected number of attendees/participants: _____________________________________________
Estimated number of attendees/participants traveling over 50 miles: __________________________
152 West Cedar Street
Sequim WA 98382
360-683-4908
The following aspects of your Event may require special permits, licenses, or insurance in addition to
this Application. It is the City’s expectation that Applicant will acquire and timely submit all requested
documentation before the specified deadlines. For more information, please refer to the City’s
“Facility Rental Procedures and Rules” located on our website (www.sequimwa.gov) or available on
request from City staff.
Will items be offered for sale by a for-profit entity? (business license may be required) __________________
Will Event involve athletic participation? (enhanced insurance is required if attendees will register for or pay an entrance
fee to participate in an athletic activity, including but not limited to biking, running, walking, or engaging in any sport) __________
_______________________________________________________________________________
Will Event involve alcohol? __________________________________________________________
If yes: Will alcohol be: ☐ served at no charge (banquet license required; must be displayed during Event)
OR
☐ available for purchase (special occasion permit required; must be displayed during Event)
Will Event involve food? ____________________________________________________________
If yes:
☐ Is the Event being professionally catered? (caterer must be licensed/permitted)
☐ Is food being prepared or served on-site by Applicant or non-professional group? (temporary
food service permit required)
☐ Is the rented facility’s kitchen to be used for cooking? (permit, licenses, and enhanced insurance may be
required)
Applicant has obtained or will obtain prior to Event all required permits, licenses and
enhanced insurance coverage checked above. This provision specifically includes all licenses
and permits that may be required by other agencies. Initial ________
GUIDELINES FOR FACILITY USE AND CLEANUP CHECKLIST
The City has prepared “Guidelines for Use” for certain facilities. The Guidelines include special instructions you
will need to know about access to and use of the facility. Some Guidelines include checklists to fill out at the
conclusion of your Event which must be returned to the City before a refund of your deposit can be processed.
DECORATIONS AND EQUIPMENT
In the box below, please list all decorations and equipment you plan to have at your Event. Refer to the
“Facility Rental Procedures and Rules” to make sure your plans comply with City policy. Some common
decorations such as glitter or candles are prohibited or strictly regulated. Applications will be rejected if this
section is not completely filled out.
LIABILITY INSURANCE
Liability insurance is required for all rentals of City facilities unless the City agrees to waive the requirement.
No waivers are available if alcohol, site-cooked food, or athletic participation is involved in the Event.
Proof of liability insurance coverage must be presented to the City for review by the Sequim City Attorney
within 10 business days of submission of this Application. Documentation must include a Certificate of Liability
and appropriate Endorsements naming “City of Sequim” as an Additional Insured, or covering the City through
a blanket additional insured endorsement. Please contact the City Attorney’s Office at 360.681.6611 for
questions and additional information.
Applicants may seek liability insurance coverage for their Event through the City’s risk pool, Washington Cities
Insurance Authority (WCIA). For details visit www.wciapool.org/insurances/tulip
or call 1-800-507-8414
(OneBeacon Customer Service). Applicant may use any insurance provider licensed to do business in the
State of Washington with a current A.M. Best rating of not less than A:VII.
General Liability policies must name or cover the City of Sequim as an additional insured using ISO form CG
20 11 or coverage at least as broad.
If alcohol is available or sold, Applicant must obtain liquor liability insurance coverage naming “City of Sequim”
as an additional insured with minimum coverage of $1,000,000/occurrence. (Host liquor liability coverage may
be substituted when alcohol is consumed but not sold at event.)
For athletic events the General Liability policy must include coverage for “participant liability” with limits of not
less than $1,000,000/occurrence and be endorsed to reflect that Applicant’s insurance coverage is primary as
respects the City of Sequim.
REFUNDS
Fees and deposits are determined by Sequim Municipal Code 3.68. The City has discretion on what portion of
an Applicant’s fees and deposits may be refunded to Applicant, based on the specific circumstances and the
City’s Facility Rental Procedures and Rules.
Refunds resulting from cancellation of an Event may be calculated as follows:
TIMING OF CANCELLATION PERCENTAGE OF REFUNDABLE FEES AND DEPOSITS
More than 60 calendar days prior to Event 100%
30 to 59 calendar days prior to Event 80%
8 to 29 calendar days prior to Event 50%
Fewer than 8 calendar days prior to Event 30%
The above formula may be used whether the cancellation is by the Applicant, or the result of the City’s removal
of the Event from the calendar due to Applicant’s failure to timely provide a complete Application.
Cleaning fees vary in amount depending on facility and use, and are nonrefundable to any Applicant (even
local government and nonprofit) except in the case of cancellation of the Event.
A rescheduling fee may be charged if Applicant asks to reschedule an Event more than one time.
Rescheduling fees may be assessed against any Applicant, including local government or nonprofit.
Disputes over fees, deposits and refunds may be appealed to the City Manager.
STATEMENT OF RESPONSIBILITY, RISK ASSUMPTION,
RELEASE AND INDEMNIFICATION
In addition to any required liability insurance policies and endorsements (which must be submitted
within 10 business days of this Application), the undersigned Applicant agrees as follows:
I am authorized to submit this Application and enter this Facility Rental Agreement on behalf of myself
or the above-referenced organization/entity/agency.
I have read, understand, and agree to the City of Sequim’s Facility Rental Procedures and Rules and
accept FULL LEGAL LIABILITY for the above-described Event, and will exercise due care in the use
of the rented facility. Initial _____
I am aware of and expressly assume all of the various risks of property damage, serious injury and/or
death associated with or arising out of the use of the rented facility. Initial _____
In consideration for approving this Application, and being fully aware of all of the risks, I hereby
RELEASE the City of Sequim and its officials, employees, volunteers and agents (“Released
Parties”), and AGREE TO WAIVE ANY RIGHT OF RECOVERY THAT I AND/OR THE ORGANI-
ZATION/ENTITY/AGENCY, AS APPLICABLE, MAY HAVE, including the right to bring a legal claim,
cause of action, or lawsuit for any property damage, bodily injury, death or other harmful conse-
quences in any way arising out of use of the facility. I understand that this release extends to all
claims of any kind and every nature, known, unknown, suspected or unsuspected, in any way arising
out of or related to use of the rented facility. Initial _____
I agree to defend, indemnify and hold harmless the Released Parties from and against any and all
claims, suits, actions, or liabilities for injury or death of any person, or for loss or damage to property,
which arises out of the use of the facility or from any activity, work or thing done, permitted, or
suffered by Applicant in or about the facility, except only such injury or damage as has been
occasioned by the sole negligence of the Released Parties. Initial _____
I have read the rules and regulations above, attached, and incorporated by reference and agree to be
jointly and severally bound to all of the terms and conditions set forth, on my own behalf and on
behalf of the Organization/ Entity/ Agency as applicable.
State of Washington on the date and at the place below.
APPLICANT SIGNATURE(S)
____________________________________
Date signed: __________________________
Place (city/state) signed:
_____________________________________
Application reviewed on (date): _____________
Insurance requirement waived? _____________
Amount paid with Application: $_____________
____________________________________
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Sequim WA 98382 360-683-4908 See SMC 3.68 Rates (City of Sequim)

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Completed 16 July 2020

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