Park Use Permit Form - City Of Benson
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1Park Use Permit
This Permit application, along with all other required permits must be received
COMPLETED AT LEAST SEVEN DAYS PRIOR to the event date.
1
RESERVATION NAME
Date of RECEIPT __________________
Name ____________________________________ Organization _____________________________
(if applicable)
Address _______________________________ City _______________, AZ
Zip_______________
Phone (520) ___________________
Is this event open to the public?
Yes
No
If yes, you may be required to provide the City of Benson with a copy of your health permit and a certificate of insurance.
2
RAMADA NUMBER
Ramada Number (check one)
# 1
# 2
# 3
# 4
Tin Ramada
Pool Ramada
Apache Park
Reservation Date ____________________________ Start Time ________ Finish Time ________
Number of people in your party ________________
Weekend Ramada Reservations MUST be completed no later than 4:00 pm Thursday, of that weekend.
3
PROOF OF INSURANCE FOR EQUIPMENT
Other Equipment ________________________?
Will you use a:
Jumping Castle
Train
If no, initial here __________. If yes, list the company and number providing the equipment below .
Company Name __________________________________Company phone number _____________
The equipment provider must be a company that is approved by the City of Benson.
4
Special Requests
Electric
Horseshoe Pits
Lights (Leagues, Tournaments and Special Events Only)
Volleyball Nets
Special requests MUST be made seven business days prior to event date.
If any unforeseen circumstances occur and/or permittee fails to meet the requirements the City has set fourth, the City of Benson shall have
the right to control, cancel or stop the event in progress. The sponsor or responsible party agrees to indemnify and hold harmless the City
of Benson, its officers, employees, and agents from and against all loss, costs, expenses, including attorney's fees, claims, suits and
judgments, whatsoever in conjunction with injury to or death of any person or persons or loss or damage to property resulting from any
and all operations performed by the sponsor, its officers, employees, and agents under any of the terms of this permit. The City of Benson
Parks and Recreation Department is not responsible for notifying sponsor or responsible party of other events or usage of
facilities in the park after issuance of permit.
IMPORTANT, PLEASE NOTE:
Please have this reservation form on hand while at the park.
Electricty is only avaliable at Ramada # 1.
.
Glass bottles and containers are prohibited in all City of Benson Parks
A Certificate of insurance naming the City of Benson as additionally insured for date of event showing general
liability insurance with combined single limit of $1,000,000 per occurrence for bodily injury and property
damage, is required for some events and for use of some types of equipment.
I accept and understand all conditions with my signature below
Signature, Renter
Authorized Signer, City Official
Date
Date
May 11, 2010
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