Item N09
REQUEST FOR USE OF COUNTY PROPERTY
IN MONROE COUNTY, FLORIDA
Date:
Name of Contact and organization:
Address & Telephone number:Email:
Specific County property or meeting room requested:
Date(s) needed:Time:
Official Monroe County Government Use: YesNo
Number of participants:
Alcohol consumption/sales? YesNoUse of personal BBQgrill:YesNo
USE OF COUNTY PROPERTY ONLY
Clean up provisions, assurances, and state if any improvements are to be to facility:
_______________________________________________________________________________________
_______________________________________________________________________________________
Coordination with:Sheriff Dept:Yes No
Security:Yes No
Public Works: Yes No
Previous history of holding similar events:Yes No
USE OF MEETING ROOMS ONLY
Special Audio Visual Equipment needed: Yes No
Describe:
Public Address System: Yes No
Arrangement of Room:
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COUNTY USE ONLY
_________________________________________________
Scheduled Date:
_________________________________________________
Insurance /Hold Harmless Requirements:
__________________________________________________________
Approved: YesNoBy:
_______________________________________________________________________________
Fees:
____________________________________________________________________________
Remarks:
PW 10/12