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2. Palm Beach Gardens Facility Maintenance Request Form
4. Please be as specific as possible so that the request can be properly assigned and completed.
8. Facility User/Organization Name:*
10. Is the user/organization willing to contribute to the funding of this project?*

    1. Yes

    1. No
12. Which City facility?*
    -- Select One --Burns Road Community CenterGardens District ParkGardens Park Baseball ComplexJoseph R. Russo Athletic ComplexLake Catherine SportsplexLilac ParkMirasol ParkPGA National ParkPlant Drive Park
14. Describe the exact location. Please be specific.
16. If the request is for maintenance of a CURRENT feature of a City facility, please explain the issue in detail.
18. If the request is for a NEW feature or piece of equipment for a facility, please describe the request in detail.
20. Please let us know if there is anything else that you would like to add in regards to the request.
24. Is the user/group requesting that City staff complete this project or would the user/organization be hiring a 3rd party vendor?*

    1. City staff

    1. 3rd Party
25. Please check the box to confirm that you understand and agree to the statements below.*

    1. City must approve of all work being completed. Files such as work scope or quotes may be attached below.
    2. City must have detailed work schedules of when vendor will be on site.
    3. Vendor must list City as additionally insured.
27. If a 3rd party vendor, please list the vendor.
28. If a 3rd party vendor, will the work require access to a City building?

    1. Yes

    1. No
30. If a 3rd party vendor, list the anticipated start date and completion date for the work to be comleted.
    If a 3rd party vendor, list the anticipated start date and completion date for the work to be comleted. Start Date

    —

    If a 3rd party vendor, list the anticipated start date and completion date for the work to be comleted. End Date
31. If City staff is being requested to complete this request, please select the appropriate priority level.*

    1. Low
    2. Medium

    1. High
35. Please list the user/organization point of contact.*
37. Please list the phone number for the point of contact.*
38. Please list the email address for the point of contact.*
44. Upload a file, if necessary.
46. Upload another file, if necessary.
Leave This Blank:


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

    This field is not part of the form submission.

50. Submit

* indicates a required field