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Jarvis Hall Rental Application

Steps

1. Page 1 This section is complete This section is incomplete
2. Page 2 This section is complete This section is incomplete
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Page 1

Submit a completed application at least 30 days before your event and a $100.00 refundable deposit (for residents) or $300 deposit (for non-residents and businesses outside of town limits) made payable to the Town of Lauderdale-By-The-Sea:
Clerk’s Office, Attn: Katrina Adler, 4501 N. Ocean Drive, Lauderdale-By-The-Sea, Fl. 33308, Phone: (954) 640-4201, email: townclerk@lbts-fl.gov.
Rental fees were established by Resolution 2012-35 and revised by Resolution 2014-20.
Applicant Information
Name/Organization/Business
Representative
Street Address
City
State
Zip Code
Home Phone
Work Phone
Fax Number
Cell Phone
Email Address
Event Description
Type of Event
Date and Time of Event
Date and Time of Event Start Date
Date and Time of Event Start Time
—
Date and Time of Event End Date
Date and Time of Event End Time
Set Up Requirements
Description of the use of the facility. Please include whether you will require the use of the hall, portico, kitchen, electronic equipment, tables, chairs, etc.
*Setup fee may apply on weekend or after hour events.
Please include number of people attending event (maximum room capacity, Jarvis Hall: 260, 120 with tables)
Diagram of Setup*
Please upload a diagram of the room setup.
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Page 2

Please provide the following information:
Serving/Selling of alcoholic beverages (proof of insurance and state permit required). Serving alcoholic beverages will require specific approval and the applicant shall provide the Town with Insurance Certificates or Binders establishing proof of coverage for general liability insurance with a minimum coverage of one million dollars ($1,000,000) per occurrence.
Collection of donations or entrance fees.
Agendas, publications, and/or advertising to be distributed before, during, and after the event.
If the event is proposed to be sponsored/co-sponsored by the Town, include a Statement of Benefit to the Town for the proposed event, a projection of revenues from the event, if any, and distribution of those revenues.
All organizations using Jarvis Hall shall complete and return the attached indemnity and Hold Harmless Agreement (downloadable at the end of the form).
Type response below.
Optional File Upload
Names and Addresses of All Financial Sponsors of the Event
Financial Sponsor #1
Financial Sponsor #2
Financial Sponsor #3
Names/Addresses of All Charitable and/or Not-For-Profit Organization Receiving Any Portion of Proceeds from the Event
Charity or Not-For-Profit Recipient #1
Charity or Not-For-Profit Recipient #2
Charity or Not-For-Profit Recipient #3
All events occurring in Jarvis Hall shall be subject to video recording for broadcast or rebroadcast on the Town’s governmental access channel if the event is determined by the Town Commission to be of great public importance.
Town Hall lot parking shall be the responsibility of the applicants unless other arrangements are approved. The use of Jarvis Hall includes non-exclusive parking in the Town Hall parking lot. The applicant shall be responsible to ensure that all required permits are obtained prior to event/meeting.
Applicant shall be responsible for clean-up of the premises following the conclusion of the event.
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Page 3

Summary Checklist of Required Items
• Refundable security deposit of $100 for town residents, town civic associations, non-profit organizations located in Lauderdale-By-The-Sea, and town businesses.
• Refundable security deposit of $300 for non-residents, non-profit organizations located outside of Lauderdale-By-The-Sea, and businesses located outside of Lauderdale-By-The-Sea.
• Rental fee for non-residents is $200 for up to 3 hours, then $50 per additional hour.
• Rental fee for businesses located outside of Lauderdale-By-The-Sea is $300 for up to 3 hours, then $50 per additional hour.
• Detailed description of event attached.
• Copy of license issued by the Florida Division of Alcoholic Beverages & Tobacco if alcoholic beverages are to be served/sold.
• Insurance certificates or binders establishing minimum coverage of $1,000,000 per occurrence and proof of coverage of general liability insurance with the Town of Lauderdale-by-the-Sea as additional insured if alcoholic beverages are to be served/sold.
• Statement of Benefit if the applicant is seeking sponsorship/co-sponsorship from the Town.
• Notarized Indemnity and Hold Harmless Agreeme.
Application is considered incomplete if all required items are not submitted with the application.
Applicant Signature*
1. I authorize the below as my digital signature.
First Name
Last Name
Date
Please download, print, and notarize the Indemnity and Hold Harmless Agreement.
Click here to download, print, and notarize the Indemnity and Hold Harmless Agreement.
Please upload the notarized Indemnity and Hold Harmless Agreement.*

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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