CONTACT INFORMATION
Renters Name Tribal Department Tribal ID Number
Street Address City State Zip Code
Work Phone Cell Phone Email
PURPOSE OF REQUEST
Event Name/Descripon Addional 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:
condion 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 addional costs beyond the deposit amount may be deducted from the
renters per capita distribuons including, but limited to, replacement of items/equipment missing or broken, re-key
costs if key is not returned, unl the total costs of damage/replacement is sased.
SECURITY DEPOSIT (RETURNED IN FULL OR PARTIAL AFTER THE FOLLOWING)
• Kitchen Sta Inspecon (both pares are required to sign o on walk-through)
• CSR – Reimbursement could take up to 14 business days to process – including a refund or cancellaon.
OPENING/CLOSING BUILDING
Kitchen sta will do a walk-through with renter before/aer event. Sta will open/close building according to me renter
placed on rental request. Sta will only wait an addional 30 minutes. Any me aer that, renter will need to reschedule
event for another date.
AGREEMENT
This agreement may not be assigned or transferred, nor may the facilies 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 Renters 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
Uppys Kitchen
Clear Form
Print Form
Email Form
click to sign
signature
click to edit
FACILITY NOTICE
Uppys Kitchen & Tribal Gym is currently used for community gathering – there is a possibility of having to reschedule
events that have been scheduled months in advance, funeral gathering are at a moments noce. Upper Management will
give as much advanced noce as possible for renter to reschedule another tribal government building or another date.
SECURITY DEPOSIT REIMBURSEMENT FORM
(MUST HAVE BOTH PARTIES SIGNATURES)
DESCRIPTION PASS FAIL NOTES
Sink Area Wiped Down
Coee Machine Cleaned
Cook Top Wiped Down
Convenonal Oven Wiped
Deep Fryers Turned O
Warmers–Turned o, Emped, Wiped
Ice Machine Wiped Down
Floors–Mop Buckets–Cleaned
(Only Use Bleach Provided)
WALK-THROUGH
BEFORE
DATE
AFTER
DATE
Kitchen Sta Signature Kitchen Sta Signature
Renters Signature Renters Signature
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)
Uppys Kitchen