catering_application_form by xiaopangnv


									               CITY OF BELLEVUE
               Parks & Community Services Department                                          CATERING
               Required when caterer remains onsite to prepare and/or serve at a City of Bellevue facility.
                         Please complete each section below and submit with Catering Fee.

         Section I – Caterer Information
         Registered legal name of Caterer:
         “d.b.a.” name of Caterer:
         Contact Name:
         Mailing Address:
         Kitchen Address (if different):
         Telephone: (      )    -                              Fax: (    )     -
         The above entity operates under (if appropriate, insert “applied for”):
                  Washington State Business License #:
                  City of Bellevue Business License # (required):
                  Federal Tax ID #:
                  King County Food Service Establishment Permit #:
         Do you have an “I” liquor license?:            Yes, Copy attached                 No             Applied For

         Section II – Event Information
         Date of Event:                                      Time of Service:                    to
         Client/Renter Name:                                                          Rental #
         Please indicate at which facility you are catering:
                ellevue Youth Theatre                                   Mercer Slough Environmental Educ Center
               Crossroads Community Center                                North Bellevue Community Center
               Highland Community Center                                  Northwest Arts Center
               Lake Hills Clubhouse                                       South Bellevue Community Center
               Lewis Creek Visitor Center                                Winters House
         Will you be serving alcohol?              Yes          No

         Section III – Insurance Requirements
         With this completed form, please provide a Certificate of Insurance indicating the following coverage:
              General Liability $1,000,000
              Liquor Liability, if alcohol served by caterer
              Automobile Liability, if vehicles will be driven onto city property other than designated parking lot.
              City of Bellevue named as “Additional Insured”

       During the use of the Parks and Community Services facility, the applicant agrees to not exclude anyone from
       participation in, deny the benefits of, or otherwise subject anyone to unlawful discrimination or harassment.

       The undersigned hereby makes application to City of Bellevue Parks Department for use of Parks & Community
       Services facilities described above and certifies that the information given in the application is correct. The
       undersigned further states that he/she has the authority to make this application for the applicant and agrees that
       the applicant will observe the rules/regulations and policies/procedures for the Parks & Community Services
       Department in which the facilities are requested. The applicant agrees to exercise the utmost care in the use of
       Parks premises and property and to save the City of Bellevue harmless from all liability resulting from the use of
       said facilities. The applicant further agrees to reimburse the City for any damage arising from the applicant’s use of
       said facilities.

       Signature of Representative authorized to sign for Caterer                                          Date

       Printed Name
C:\Docstoc\Working\pdf\85be6633-1a35-4cee-a8b5-858bf2caaa20.doc 10/23/2009

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