CITY OF SAN PABLO RECREATION DIVISION
2450 ROAD 20, SAN PABLO, CA 94806
PHONE: (510) 215-3080
FAX: (510) 215-3015CITY SAN PABLO
CiVo#Ncw DirKti('ns
PARK KIOSK AND CONCESSION STAND RENTAL APPLICATION
RumrilIFood Kiosk Davis'Park Concession Stand
'#l#l #2 (
1. Applicant's Name:
Designated/ Contact Person Name:
.Day Phone
EvePhone
(Please Print Clearly)
Day Phone:
Eve Phone
2. Address: 2'76 5 (:)o } 4 ll)r .c-~: $,1ol.,4..J .ZiPC.d.: qq'2bQ
3. Email Address: '5al,IQ p(;UblrOC,O tD
4 Requested RentalStart Date:..2/Za ,& Lease Duration:o I month trialo 3months(/) 6 monthso lyear 5 Request access to San Pablo Community Center (SPCC) commercialkitchen? ( )Yes (4No a. Requested Days of the week:.J
b. Rental Times a.m. /p.m. to a.m. /p.m
6. Description of good to be
'B
RENTAL AG REEMENT
My signature certifies that Ihave read and understood the rules and regulations as set forth by the City of San Pablo Recreation Division governing the use of the Public Facility and Field Rentals, that lwill take full responsibility for ensuring that the use of tjlis facility and areas by the organization/pity Irepiesent is in fulladheience and compliance with these rules and regulations, and that lwillhold the City of San Pablo hamlless from any damage, claim 6or damage for personal injury or death, damage or loss of property, claim 6or damage to or loss of properV hlcurred in the use of this facility. I will accept full responsibility for them tlnoughout the period specified in the Park Kiosk and Concession Stand Rental Application. I further understand that as the applicant I assume full responsibility for any penalty fees assessed by the City of San Pablo for any violations of these rules and regulations goveming the use of the above requested facility or field. I am fully aware that the Deposit is non-refundable Date
Date
For Office Use Only
Amount Paid
Amount Due
Amount Paid
Amount Due
Amount Paid
Application Fee(non-refundable)
Deposit
Rental Fee
Insurance Fee
Other
TOTAL
RECPTMO
RECPTMO
RECPT/NO
RECPTMO
RECPTOqO
Amount Refunded
Request sent to Finance Date.
Payment Request Date
Check NO
REV.08032021
Rental Agreement
CITY.SANPABLO
('ig' l$Nav I)ircctians
Sports Field Rental Application
ONLY SAN PABLO INCORPORATED RESIDENTS ARE ELIGIBLE FOR CI'lY RESIDENT RATES M' .,,]$avis Park Baseba]] Field (8:00 AM-8:00 PM)
7' Davis Park Multi-Use Field (8:00 AM-8:00PM)
[] RumrillPractice Field* (8:00 AM-12:00 AM)
[] Rumrill Fields 1 (8:00 AM-12:00 AM Depending on Day of Renta]) [] RumrilIField #2 (8:00 AM-12:00 AM Depending on Day ofRenta]) [] Rumrill Field #38 (8:00 AM-12:00 AM Depending on Day of Renta]) +Closes at 10 pm Sun Thur & ll pm Fri & Sat.
Date Requested:..Z:l22, Z02'Z '' 4.-...5h,n
.Day of Week: . of Activity
Time
C,Lz.tw'
pm
.Type
Starting Field Time:. .am/pm .!.Q Ending Field
Name of Applicant: l4Pzlr'e L. l4,/i/ ll.
Name of Organization: €)mn Ab£l0 Zl01il&o\
Phone Number: ::. \ib '?b-' '32qG.
State Non-Profit ID# c11"7' 'L2.
Designated Person in Charge on the Day of Event:.
.,Jo .i4n/) Zlr ' city:.7
Phone: Z.$;dci6 9if£i-. 5Z(7i)
Address: B ;.:, h««, "''4 .zip:.
Cellphone: (l:2f O$ $ft)u 5 2 'Yb .Email: €A !2 bloc bfczzVKdl)' Below please write ilt attendaltcejor each age gi'oup; attendance nuntbers need to be as accurate as possible.
Children(ages 1-12)...£2..2 (ages 13-20)..f.Q lts(ages21-35) i(' Adults(ages35+)...Lf
RENTAL AGREEMENT
My signature certifies I have read and understood the Sports Field RentalPolicy and RentaIAgreement as set forth by the City of San Pablo governing the use of Public Fields. I take fullresponsibility for ensuring the use of this facility and areas by the organization/party I represent is in full adherence and compliance with these rules and regulations. I understand lassume fullresponsibility for any penalty fees assessed by the City of San Pablo for any violations of these rules and regulations governing the use of the above requested field. I am aware my Deposit is non-refundable ifl cancelwithin 2-weeks of my reservation for any reason. I am also aware that by signing this contract, I take full responsibility for the behavior exhibited by my guests during my rental
APPLICANTSIGNATURE
OFFICEUSEONLY.
t:ee VJa\v'O '
Application Fee(Non-Refimdable)
Deposit
Hourly Fee
LightFee
Amount Total
1=I i$
By:Recreation Staff Signature: Date Received "PP'"'dX
Approved []
Denied
Denied []CM Staff Signature: Date Received: By