CITY OF TROUTDALE
SAM COX AND ANNEX BUILDING
1106 E. Columbia River Hwy.
Troutdale, OR 97060
RENTAL APPLICATION FORM
RENTAL DATE: ___________________
RENTAL TIME: ___________________
CLEANUP TIME: __________________
RENTAL LOCATION:
□ Sam Cox Building (holds 170 people)
□ Annex (holds 82 people)
□ Troutdale Resident/Non-Profit Organization □ Non-Resident
NO ALCOHOLIC BEVERAGES ARE ALLOWED
IN THE BUILDINGS OR ON THE PARK GROUNDS!
Application Date: _________________________ Number of People: _____________________
Applicant: ____________________________________________________________________
Address: _____________________________________________________________________
Phone No.: ______________________________ Fax No.: _____________________________
Group: ________________________________ Activity: ______________________________
• Will you require a set up time? ________
If yes, what day and time do you need it? __________________________
• Are you planning to have amplified sound outside the building? ________
If yes, a separate “Special Use Permit” is required; this permit is free.
The permittee, on behalf of itself, its agents, and any heirs, assigns, or successors, in exchange for the right to use a City building, park and/or
equipment, agrees to: Indemnify, defend and hold harmless the City of Troutdale and its elected or appointed officials, employees, agents and
assigns from any and all claims which may arise as a result of granting this permit, including but not limited to the acts of persons that the
permittee invites or allows to use the City building or City property; promptly notify the City of Troutdale of any claim or action, which the City
shall have the right to investigate, compromise and defend; assume all risks associated with the use of the City’s real or personal property; protect
the City’s real and personal property from any damage; return the City’s real and personal property in the same condition it was in prior to
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