Address
Last Name
First Name
Email Address
Phone Number
City, State, Zip Code
Name and Description of Event
Expected Attendance:
Address
Email Address
Phone Number
Organization Name
City, State, Zip Code
501(c)3 Non-Profit:
IRS Non-Profit Number:
Responsible Person Day of Event
If Yes, list Department Name & Contact:
List of AV Equipment Needed *
Cell #
No Yes
Applicant's
Signature: Date:
Terms of Agreement
On behalf of the organization and myself, I have read and understand the facility use agreement. I agree to inform persons participating in this proposed activity of the terms and conditions of this agreement, and agree to comply with the conditions set forth herein. I understand that I am responsible for the actions and behavior of my guests, and I assume responsibility for any damages or extra fees that might be incurred due to my guests’ actions or behavior. I further agree to hold harmless and indemnify the City of Palo Alto, its officials, officers, employees and agent for any liability, loss or damage due to personal injury, death or property damage caused by or resulting from activities permitted by this use agreement, excepting that which is caused solely by the negligence, recklessness or willful misconduct of the City, its officials, officers, employees or agent. I have also read and reviewed the conditions on the back of this form.
Council Chambers Use Request and Use Agreement
Questions?
Email [email protected]
Event Co-Sponsored by City of Palo Alto
Use Date
Start Time
EndTime
No Yes
*Users are encouraged to bring their own audio/visual equipment.
City-owned A/V equipment may not be used without prior
authorization and proper supervision. Users may be charged a fee if City staff is needed to operate the A/V system, including speakers, microphones, cameras, etc.
Required ConfirmedInsurance
OFFICE USE ONLY
Required ConfirmedSecurity
Approved DeniedApplication
Conditions:
The Council Chambers Use Policy, as may be amended, is incorporated hereinby reference and made part of this Facility Use Agreement as if fully set forthherein.
All capacity limits must be adhered to and are set by the Fire Marshal.
USEUse of Council Chambers is prioritized as follows:
• Priority 1: Public meetings of bodies on which the City Council sit, CouncilCommittees, Boards and Commissions, and use by City staff. • Priority 2: Meetings or Events organized by other government agencies. • Priority 3: City sponsored events and meetings of organizations sponsored bythe City in accordance with the City Co-Sponsorship Policy. Events must befree and open to the public. A refundable security deposit in an amountdetermined by the City Clerk is required.
City staff will be present to assist with facility use but will not perform event-related tasks. Events that occur outside of regular City Hall hours may requireadditional City staffing, at the event organizer’s cost. Security may be required, and the user must hire a licensed, insured securityfirm approved by the City and provide proof of the event security plan.
REQUESTSThe City Clerk will establish the dates and times in which requests will beaccepted.
All requests to use the Council Chambers must be submitted in writing to theCity Clerk’s Office at [email protected], including the City Co-Sponsorship application, and an IRS 501(c)(3) status letter, if applicable. TheCity Clerk will determine whether the applicant meets standards for co ‐sponsorship status and what benefit level is applicable. This decision made beappealed in accordance with the City Co-Sponsorship Policy. • Use times must account for both set-up and clean-up. • Requests may be submitted up to six (6) months in advance but no later than30 days prior to the event. • The City reserves the right to cancel requests on short notice where necessaryto accommodate emergency or special City meetings or other urgent Citybusiness. If the City cancels a request, City staff will attempt to helpreschedule.• Cancelations must be submitted in writing at least 10 days prior before theevent; cancelations with less than seven days’ notice will result in forfeiture ofthe security deposit.
In no event will the City be liable for any cancellation.
LIABILITY/INSURANCEGeneral liability insurance is required for events with 100 or more participants.Proof of coverage must be submitted 14 days before the event; failure to do sowill result in cancellation of the request and forfeiture of the deposit.
Insurance Requirements:1.Minimum coverage of $1,000,000 for bodily injury and property damage isrequired.2.Include “The City of Palo Alto, its Council members, officers, agents, and“employees” as additional insureds. 3.List the following as the Certificate Holder:oCity of Palo Alto250 Hamilton AvenuePalo Alto, CA 943014.Send the Certificate of Insurance to [email protected] or mail it to theOffice of the City Clerk at the address above.
The requirements above apply to security providers, and any other vendorhired by User.
Users of the City Council Chambers will be required to submit a signed FacilityUse Application with the City Clerk and be subject to its terms.
FEES
DepositA refundable security deposit of $250 is required for all Priority 2 and 3requests and is due at the time the request is made to the City Clerk. Anassessment of the facility will be conducted within 24 hours after the eventand the applicant will be informed of the condition. The security deposit willbe refunded after 14 days via check. Refunds of the security deposit may befully or partially withheld for any of the following reasons:· Damages to the facility · Missing or Damages to equipment· Additional Janitorial Services needed· Additional staff time needed Attendant FeeIt is at the discretion of the City Clerk to determine if requests for facilityuse will require City staff to be present during the event. An hourlyattendant fee and/or an overtime fee per staff member may be applied forevents that are after hours or during the holidays. This determination will bebased on the size, nature, and/or complexity of the event. The amount of thefee will be established by City Council resolution and is non-refundable.
Technology Support FeeIt is at the discretion of the City Clerk to determine if technology support isrequired to be approved for the usage of the Audio and Visual equipment.City staff will be present primarily to supervise the use of the equipment.The fee amount of the fee will be established by City Council resolution andis non-refundable.
Special accommodations needed for guests will be under the soleresponsibility of the user.
The following are not permitted in Council Chambers:• Consuming food and beverages (PAMC 2.04.140)• Open flames• Pets (excepting service animals)• Smoking and the use of electronic smoking devices inside and within 25feet of entrances (PAMC 9.14.020)• Any type of drug use The City Clerk may establish additional rules and regulations for the use ofthe Council Chambers, as may be needed.
ConductThe user is responsible for all accidents, injuries, damages, and repair costsduring their use of the Council Chambers. Access is limited to reserved timesand all participants must leave by the scheduled end time. The user must ensure all participants follow City rules, maintain safety, andprevent misconduct or damage. The user or authorized representative mustbe present during the event and will be the direct contact.
Facility use is limited to the Council Chambers, Community Meeting Room,and Flex Conference Room only. Use of Council Conference Room and MediaSpace is restricted. No one may block entrances, exits, or aisles or createsafety hazards.
Noise:Event noise must not exceed 15 dB above ambient levels when measured 25feet from the Council Chambers (PAMC 9.10.050). Noise must not disruptCity business. Loud noise must end by 11:00 p.m. on Friday and Saturdaysand by 9:00 p.m., Sunday through Thursday.
Decorations:Storage is not allowed before or after the event. Set-up begins at thedesignated start time and the space must be cleared by the end time. Onlypainter’s tape may be used for decorations; all other adhesives and fastenersare prohibited. Users must restore the facility to its original condition,remove all items and trash, and handle cleanup without City staffassistance. The City is not responsible for any items left behind and anycleanup costs or damages will be deducted from the deposit and/or billed tothe user.
Event Shutdown:The City reserves the right to terminate any event that becomes disorderly,disruptive, or otherwise violates the Municipal Code, this Policy, the rulesestablished by the City Clerk, or that poses an imminent threat to publichealth or safety