PUBLIC ROOM RESERVATION 2023 FOR TEMPE COMMUNITY CENTER FEB. 1, MARCH 1, AND APRIL 6, 2023 - VACCINE EVENTS.PDF

Community Services Department 
Westside Multi-Generational Facility  
 
 
 
 
ROOM RESERVATION REQUEST 2023 
 
 
 
RESPONSIBLE PARTY INFORMATION (Must be present at meeting/event)  
 
 
First Name 
Last Name 
Birthdate 
Cell/Home Phone 
 
 
 
 
 
Mailing Address 
City 
St 
Zip 
 
 
 
 
Email Address 
Alternate Phone 
 
 
 
 
 
 
 
ALTERNATE CONTACT PERSON   
 
First Name 
Last Name 
Birthdate 
Cell/Home Phone 
 
 
 
 
 
Email Address 
 
 
ORGANIZATION INFORMATION 
 
Organization Name: 
 
Mailing Address (If different from Responsible Party) 
City 
St 
Zip 
 
 
 
 
Brief Description of Organization 
 
 
MEETING INFORMATION 
 
Description of Meeting/Event: 
 
Number of Attendees: 
 
# of Tables Needed: 
# of Chairs Needed: 
Will your meeting/event include 
any of the following: 
Food/Drink          Arts/Crafts          Amplified Music/DJ        
Any special accommodations 
 
 
 
 
 
 
This is an application only. Nothing is finalized until all payments and required documents are received and a 
permit is sent to you from the Community Services Department. By signing below I attest that I am at least 18 
years of age, and have read, understand and agree to comply with all of the attached room reservation policies 
and procedures. 
 
 
FOR OFFICE USE ONLY 
DATE RECEIVED: 
 
PERMIT #: 
 
City Dept. 
Resident 
Non-
Resident 
Not for Profit 
Commercial/For Profit 
DATE OF EVENT: 
Signature of Responsible Party 
Date 
715 W. 5th St., Tempe AZ  85281 
Phone: 480-858-2466   Fax: 480-858-2431 
www.tempe.gov/westside 
Angelica
Penuelas
4041 N. Central Ave. 
Phoenix
85012
AZ
angelica.penuelas@maricopa.gov
Jhoana 
Molina
10/14/75
602 772-0509
jhoana.molina@maricopa.gov
4041 N. Central Ave. 
Phoenix
AZ
85012
Vaccine event 
30
accessibility for wheel chairs
80-100
10  tables 
12/1/76
Maricopa County 
Feb. 1st, March 1st and April 6th, 2023    4:00-7:00pm
602 206-0682

ROOM INFORMATION 
            
 
HOURS AVAILABLE 
 
ORGANIZATION NAME  
 
 
 
 
Cahill (80) 
 
 
 
Mon-Fri   8:00am-8:45pm 
Lindon Park (30) 
 
 
 
Sat  
10M-4:45pm 
 
RESPONSIBLE PARTY  
 
 
 
Los Vecinos (20)  
 
 
Sun 
CLOSED  
 
 
 
 
 
 
 
Sunset//Riverside (25-50) 
 
 
 
 
 
 
# OF PEOPLE ATTENDING   
 
 
 
  
 
 
 
 
DATES REQUESTED (PLEASE CIRCLE) 
Please include set-up and take-down time when requesting dates & times 
**Blacked out dates indicate facility closed 
Greyed out dates indicate non-standard facility hours or special event 
JANUARY 2023 
  
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SET-UP HOURS:   
 
     
 
MEETING/EVENT HOURS:   
 
 
APRIL 2023 
  
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MAY 2023 
  
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AUGUST 2023 
  
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NOVEMBER 2023 
  
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MARCH 2023 
  
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DECEMBER 2023 
  
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SET-UP HOURS:   
 
     
 
MEETING/EVENT HOURS:   
 
 
 
Maricopa County
80-100
4:00-7:00pm
3:00-4:00pm
3:00 -4:00pm
4:00-7:00pm
3:00 -4:00pm
4:00-7:00pm

CITY OF TEMPE FACILITY USE POLICIES 
 
Policies for Tempe Facilities Tempe City Code, Chapter 23, Article lll, Division, 2 Sections 23-56 & 23-57. Please read these policies 
carefully and make certain that all members of your group are familiar with them. 
 
Facility Request Form  
This form can be obtained online or in person at the requested facility, 
and must be completed in full and submitted to that facility for 
consideration. The request form should be submitted at least two 
weeks prior to the requested date.  
 
All activities must be under competent, adult supervision (18 years or 
over), with the organization using the facility assuming full 
responsibility for any damage to the facility or equipment used. The 
use of facilities and special equipment shall be issued by the 
Community Services employee on duty through the responsible party 
ONLY.  
 
The total number of people admitted for any usage shall not exceed 
the capacity of the assigned room as determined by an official 
designated by the Community Services Department and/or the City 
Fire Marshall.  
 
Verification of Building Use  
Verification of reserved meeting space is contingent upon final 
approval by the Community Services Department. Nothing is finalized 
until you have received a Facility Use Permit that is signed by the 
Permittee and a designee of the Community Services Department. Do 
not advertise your meeting or event until you have received the final 
permit from the facility.  
 
Permittee must: 
• 
Return to the facility a signed copy of the Facility Use Permit. 
• 
Submit payment by the deadline set by the facility. 
• 
Be present throughout the time that the facility is in use. 
• 
Ensure that all activity is confined to the rented area.  
 
Prohibited Activities 
• 
Tobacco use and smoking inside the facility. 
• 
Bringing alcoholic beverages into the facility. 
• 
Attaching material of any kind to any part of the facility without 
written permission. 
• 
Any use that detracts from general public enjoyment or use of 
the facility, or interferes with facility maintenance. 
  
Reservation Changes/Cancellations  
Changes to, or cancellation of, reservations must be made within two 
(2) business days (Monday through Friday) of the reservation and 
may be made ONLY by the Permittee. Any requests made during the 
scheduled activity must be made by the Permittee.  
 
If the facility is not notified of a cancellation, the permit holder will 
forfeit all fees associated with the reservation.  
 
All permits are made on a calendar year basis. Permits may be 
reissued each year with approval.  
 
 
Staff Responsibilities  
The Community Services Department employee on duty shall exercise 
authority over the organization and its activities. If adult supervision is 
inadequate, it is the responsibility of the staff person to report it to the 
facility supervisor.  
 
Facility Set-up/Clean-up  
Set-up and clean-up of the contracted area will be the responsibility of 
the Permittee. The user shall be charged on an hourly basis to pay for 
clean-up if it is necessary for the City to provide additional clean-up 
services. A clean-up deposit may be required if deemed necessary. No 
furniture/equipment shall be moved into the facility without permission. 
Any property remaining at the facility after the event will be disposed of 
or recycled. The Permittee must ensure that all facilities and requested 
equipment are left in good order.  
 
• 
Requested time must include time for set-up and clean-up.  
• 
All attendees must vacate the facility by closing time unless 
permission is otherwise granted.  
 
Certificate of Insurance  
The City of Tempe may require a Certificate of Insurance. If required, the 
Certificate must state at least the following minimum liability coverage: 
A. Bodily Injury  
$1,000,000 
B. Property Damage  $   100,000 
 
Additionally, on the Certificate of Insurance the following must be stated:  
• 
The City of Tempe is named as an additional insured.  
• 
This insurance is primary to the City of Tempe’s self-insurance 
retention. 
 
Indemnification 
User shall release, indemnify, defend, and save harmless the City, and 
its officers, employees and agents from and against all claims, suits, 
actions, damages, or causes of action for any personal injury, loss of life 
of damage to property sustained by reason or as a result of the use of 
the Premises for which this facility use agreement is entered into and 
from and against any  orders, judgments or decrees which may be 
entered thereto, and from and against all costs, attorney’s fees, 
expenses, and liabilities incurred in or by reason of the defense for any 
such claim, suit or action and the investigation thereof. Nothing in this 
facility use agreement shall be deemed to affect the rights, privileges, 
and immunities of the City, its officers, employees and agents as are 
provided for by law. This provision shall survive the termination of this 
facility use agreement. 
 
Permits are revocable if any rule is violated.  
 
I have read and understand Tempe City Code, Chapter 23, Article lll. 
Division, 2, Sections 23-56 & 23-57.  
 
 
 
 
 
  
Responsible Party  
 
 
Date  
                              
(Please return with your application) 
Angelica Penuelas
1/9/2023

City of Tempe Community Services 
Neighborhood Facility Reservation Fees 
 
During Business Hours 
Outside of  
Business Hours 
Facility 
 
Resident or 
Not-for-Profit Group 
(per hour) 
Non-Resident 
(per hour) 
Commercial 
Group 
(per hour) 
All Users 
(per hour) 
Conference Room 
$5 
$10 
$20 
$80 
Classroom 
$5 
$10 
$20 
$80 
Classroom (large) 
$10 
$20 
$40 
$100 
Multi-purpose Room 
$30 
$60 
$120 
$180 
Gymnasium  
$90 
$120 
$150 
$210 
 
 
 
 
 
 
 
 
 
 
 
Facilities 
Conference 
Room 
Classroom 
Classroom 
(large) 
Multi-purpose 
Room 
Gymnasium 
Gymnasium 
(half) 
Clark Recreation Center 
 
X 
X 
 
 
 
Edna Vihel Center 
 
 
 
X 
 
 
Escalante Center 
X 
X 
X 
X 
X 
X 
North Tempe Center 
X 
X 
X 
X 
X 
X 
Pyle Adult Center 
X 
X 
X 
X 
 
 
Tempe History Museum 
 
 
 
X 
 
 
Tempe Public Library 
 
 
X 
X 
 
 
Westside Center 
 
X 
X 
X 
X 
 
 
• 
A 2-hour minimum is required for all reservations outside of normal business hours. 
• 
Reservations outside of normal business hours should be submitted at least 30 days prior to the event date. 
• 
Non-athletic events in the gymnasium may require a gym floor cover at certain locations at an additional cost of $400 per event. 
• 
Additional staff and security may be required for certain facility use reservations. 
• 
A deposit may be required for certain facility uses. 
• 
Applicable surcharges may apply for additional reservation needs. 
• 
All reservations are subject to facility and staff availability. 
Definitions: 
Resident: A resident of Tempe (a business address does not qualify), reserving a facility for personal use. 
Not-for-profit Group: Any non-profit 501(c)(3) or other not-for-profit organization. 
Non-Resident: Any non-Tempe resident reserving a facility for personal use. 
Commercial: Any business or for-profit entity; anyone who charges for his/her services provided in the reserved facility. 
 
Neighborhood Facilities: 
Clark Recreation Center 
1730 S. Roosevelt St., Tempe 85281 
480-350-5287 
www.tempe.gov/recreation 
Edna Vihel Activities Center 
3340 S. Rural Rd., Tempe 85282 
480-350-5287 
www.tempe.gov/arts 
Escalante Community Center 
2150 E. Orange St., Tempe 85281 
480-350-5800 
www.tempe.gov/escalante 
North Tempe Multi-generational Center 
1555 N. Bridalwreath St., Tempe 85281 
480-858-6500 
www.tempe.gov/northtempe 
Pyle Adult Recreation Center 
655 E. Southern Ave., Tempe 85282 
480-350-5211 
www.tempe.gov/pyle 
Tempe History Museum 
809 E. Southern Ave., Tempe 85282 
480-350-5100 
www.tempe.gov/museum 
Tempe Public Library 
3500 S. Rural Rd., Tempe 85282 
480-350-5500 
www.tempe.gov/library 
Westside Multi-generational Center 
715 W. 5th St., Tempe 85281 
480-858-2466 
www.tempe.gov/westside