Request for Use of City Facilities Form

Venue*

Building
Special Area

Building (location)*

Special Area*

Street Address City State ZIP Code

Event Name*

Event Date*

Hours of Use*

Responsible Contact*

Contact Address*

Street Address City State ZIP Code

Phone

Email

The undersigned understands that the undersigned is applying for use of property owned by the City of Attica, a Municipal Corporation, and that said property is never for "rent" in the sense that commercial buildings or areas are available.

The undersigned agrees to make the property or area available to police, fire, and emergency personnel as needed by such personnel.

The undersigned agrees to be responsible for any damage to the building or area incurred in the use and occupation of the building or area.

The undersigned agrees to provide liability insurance protecting and indemnifying the City of Attica from the use of the building or area by the undersigned.

The undersigned represents that information on the liability insurance company is as fallows:

Liability Insurance Name*

Insurance Agent*

Insurance Agent Phone*

Date*

Signature*

Utility Payments

City Forms

Contact Attica

Receive Attica News By Email