Request for Temporary Use of Space

As a service, Suite 229 A and 229 F is available as a donation of free use, under the following conditions:

–          FREE for up to 8 hour a day by a small for-profit or non-profit.  The criteria for use would be:

o   Providing a human or social services-related or educational program.

o   Non-recurring; up to 3 days per month, but no more than 3 months a year

o   No political or illegal related programming

o   Must provide copy of 501C3 designation or business license.

o   Annual revenues not to exceed $100K (990 or tax return)

 

o   Fees applied for other uses and if hours of use are beyond those allocated.

REQUEST FOR TEMPORARY USE OF SUITE 229

This form must be completed in its entirety and returned to the Administrative Office of the Leon H. Sullivan Charitable Trust at 1415 North Broad Street – Suite 226, Philadelphia, PA 19122, at least thirty (30)-days prior to the requested date for use of the space.

REQUESTER’S INFORMATION:

Contact Name
Contact Name
First
Last
Address
Address
Street
Suite/Floor/Room
City
State/Province
Zip/Postal

EVENT INFORMATION:

Use of time:

Including set-up and clean-up
Start Time
End Time
Are you charging a fee for any aspect of your activity?

FOOD

Do you intend to serve food
Do you intend to prepare food on the premises
Do you intend to have food catered
Name of Caterer
Name of Caterer
First
Last

Maximum file size: 33.55MB

It is the general practice of the Leon H. Sullivan Charitable Trust (“the Trust”) to permit temporary use of space at the Center for certain activities conducted/sponsored by tenants or other non-profit organizations, provided a written request is received at least thirty (30) days prior to the date of the proposed use. The requester agrees to comply with the following terms and conditions as are applicable.

REQUESTER SHALL:

Maximum file size: 33.55MB

The TRUST SHALL:

In requesting use of space outside normal business hours or temporary use of space at the Leon H. Sullivan Human Services Center, I hereby acknowledge that I have read, understand and accept the above terms as a condition of this request.

As representative of the requesting agency, I accept full and complete responsibility for the conduct and safety of its staff and participants as well as any and all damages that may result from or the consequences of the temporary use of the Center’s premises.

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