CONTACT INFORMATION
Renter’s Name Tribal Department Tribal ID Number
Street Address City State Zip Code
Work Phone Cell Phone Email
PURPOSE OF REQUEST
Event Name/Descripon Addional Space Requested
Fire Pit Walk-in Refrigerator
Food Storage Date Start Time
AM PM
Prep Date Start Time
AM PM
Cook Date Start Time
AM PM
End Time
AM PM
Number of Guests
Date Approval Signature Required
(Denise Jones)
Date Kitchen Walk-Through Signature
FACILITY RENTAL TERMS
Renter assumes responsibility for all equipment borrowed during your rental agreement, including but not limited to:
condion and working order of walk-in refrigerator in 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 addional costs beyond the deposit amount may be deducted from the
renter’s per capita distribuons including, but limited to, replacement of items/equipment missing or broken, re-key
costs if key is not returned, unl the total costs of damage/replacement is sased.
SECURITY DEPOSIT (RETURNED IN FULL OR PARTIAL AFTER THE FOLLOWING)
• Kitchen Sta Inspecon (both pares are required to sign o on walk-through)
• CSR – Reimbursement could take up to 14 business days to process – including a refund or cancellaon.
OPENING/CLOSING BUILDING
Kitchen sta will do a walk-through with renter before/aer event. Sta will open/close building according to me renter
placed on rental request. Sta will only wait an addional 30 minutes. Any me aer that, renter will need to reschedule
event for another date.
AGREEMENT
This agreement may not be assigned or transferred, nor may the facilies 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.
Date Renter’s Signature
Req #:
Vendor #:
TDS-23250
Tulalip Tribes
6406 Marine Drive
Tulalip, WA 98271
Tulalip Tribes
Fax Number
360-716-0606
Facility Rental Form
NOTE: You will need to provide your own cooking equipment
(i.e. pots, pans, cooking utensils, and pot holders)
This building requires: $300 refundable security deposit
Uppy’s Kitchen
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signature
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