Signature of. Tenderer……………………………………….. Date……………………………… STAMP
Signature of. Tenderer……………………………………….. STAMP
Signature of. General Instructions
Signature of. SIGNED by in the presence of: Signature of witness Name of witness (block letters) Address of witness Occupation of witness ) ) ) ) ) ) ) ) ) ) ) ) ) ) Signature of
Signature of. Agent Witness to Agent‟s Signature Name...…............................................. Name................................…….......... Address…....................................….... Address.................................…........ …...............…....................................... ....……......................…..................... ...............................................…….….. ..................…….........…....................
Signature of. Applicant (Full name)
Signature of. Applicant (Full name) List of Documents to be submitted along with Declaration
Signature of. Applicant: Date: Date Received Time Received Staff Initial □ Approved □ Denied Supervisor’s Approval: 2nd Contact Person: Cell Phone: (ONLY day of event for decorating/setup purposes) Time: to Name: Organization: Address: City: Zip: Home Phone: Cell Phone: The following fee schedule applies to general use of the facility. The City of Rosemead, other Government, and Rosemead-recognized Community Service/Non-Profit Organizations are granted priority use and may be exempt from fees. AUDITORIUMS Location Room (Dining Cap.) Resident Non-Resident Total Rosemead Center Room 1 (140 meeting) $ 63/hr $ 115/hr $ Rosemead Center Room 2 (300 dining) $ 78/hr $ 146/hr $ Xxxxxx Center Banquet Room (150 dining) $ 89/hr $ 146/hr $ Rosemead/Xxxxxx Kitchen $ 37/hr $ 63/hr $ Xxxxxx Center FGT (100 meeting only no food) $ 63/hr $ 115/hr $ Security Deposit Banquet, FGT, Room 1&2 $ 300 $ 500 $ Staff Supervision $ 46.50/hr $ 46.50/hr $ MEETING ROOMS Location Room (Capacity) Resident Non-Resident Total Rosemead Center Room 3 (80) $ 37/hr $ 73/hr $ Rosemead Center Room 4 (40) $ 37/hr $ 73/hr $ Rosemead Center Room 5 (20 mtg.only no food) $ 37/hr $ 73/hr $ Xxxxxx Center Rooms 103 & 104 (100) $ 52/hr $ 115/hr $ Xxxxxx Center Rooms 103,104,108 or 109 (50) $ 37/hr $ 70/hr $ Xxxxxx Center Room 108 & 109 (100) $ 52/hr $ 115/hr $ Security Deposit $ 300 $ 500 $ Staff Supervision $ 46.50/hr $ 46.50/hr $ OTHER Class I: Res. / Non-Res Class II: Res. / Non-Res Total Special Event Insurance 1-100 = $100 / $125 1-100 = $140 / $160 101-500 = $130 / $000 000-000 = $235 / $260 501-1500 = $200 / $000 000-0000 = $280 / $300 2 Private Security Guards Events (ages 13-20) Staff Initials for Proof of Cert.: Required (This section to be filled out by staff) Deposit submitted $ on date Received by Rental fees paid $ on date Received by If Security Guard required, copy of contract received on date. If Event Insurance required, copy of certificate received on date in the amount of $ Deposit refund of $ approved on date by Applicant: Facility: Date of Use: Room(s) No: # of Tables # of Chairs Round Table and Chair Ratio 6 Foot Rectangular 6 ft. Table = 6 Chairs (Only @ Xxxxxx Center) 8 Foot Rectangular 8 ft. Table = 8 Chairs Eating Tables = 19 (Including a head table) If 19 tables are being used = No Dance Floor Head Tables Round Table = 8 Chairs Eating Tables Serving Tables Gift Tables Auditorium Seating Is space needed for dancing? Yes No (If yes, indicate below) Name of Applicant: Date of Event: Facility/Roo...
Signature of. Execution page
Signature of. Here . u.s. person ► Date ► Section references are to the Internal Revenue Code unless otherwise noted. Future developments. Information about developments affecting Form W-9 (such as leg1slat1on enacted after we release 1t) ,s at xxx.xxx.xxx/xx0. An 1nd1v1dual or entity {Form W-9 requester) who Is required to file an information return with the IRS must obtain your correct taxpayer 1dent1ficat1on number (TIN) which may be your social secunty number {SSN), 1nd1v1dual taxpayer 1dent1f1callon number {ITIN), adoption taxpayer 1dent1f1cat1on number (ATIN), or employer 1dent1f1cat1on number (EIN), to report on an 1nformat,on return the amount paid to you, or other amount reportable on an 1nformat1on return. Examples of 1nformat1on returns include, but are not limited to, the following: • Form 1099-INT (interest earned or paid) • Form 1099-DIV (d1v1dends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, pnzes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S {proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transaci,ons) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tu1t1on) • Form 1099-C (canceled debt) • Form 1099-A (acqu1Sttion or abandonment of secured property) Use Form W-9 only 1f you are a U.S. person (1nclud1ng a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subJect to backup withholding. See What 1s backup withholding? on page 2. By signing the filled-out form, you:
