Request City Services – Fire or EMS

Please complete and submit the following form to request either Fire or EMS services for your upcoming event. Please note this application must be completed and returned to the Fire Department 30 days prior to your event. A request for service does not guarantee availability or approval of services. In-kind service or marketing will be discounted in the final price.

City Services Application Form

This application must be completed and submitted to the Fire Department, with all supporting documentation 30 days prior to your event.

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Contact Details

Name of Organization

Phone Number of Organization

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Phone(Required)

Address(Required)

Street Address Address Line 2 City

Enter the Days/Times Needed for Requested Services

Fire/2 Personnel per truck

Price: $80.00

The price is per hour so please enter the quantity that will cover the hours of your event.

EMS/2 Personnel per truck

Price: $80.00

The price is per hour so please enter the quantity that will cover the hours of your event.

Fire/Ladder Truck

Price: $50.00

The price is per hour so please enter the quantity that will cover the hours of your event.

Total Due Before Event

A request for service does not guarantee availability or approval of services. In-kind Service or Marketing will be discounted in Final Price

Payment Details

Once your requests have been approved, you must make payment to Belen City Hall prior to your Event.

Acknowledgement of Policy and confirmation of Application and Signature(Required)

HOLD HARMLESS CLAUSE: The Organization or group herby agrees to indemnify and hold harmless the City of Belen, New Mexico, its agents, public officials, officers, employees, and authorized volunteers, from and against any and all legal actions, claims, damages, losses, or expenses arising out of the event or any activity associated with the organization or group’s conduct or operation of the event including but not limited to, claims for personal or bodily harm, disease or death, or injury to or destruction of property, including without limitation to attorney fees and court costs incurred or top be accrued in the defending any actions brought against them as a result of the organization or group’s use of public property or operation of the event. The parties acknowledge that the Event Sponsor or its agents are not an agent or employee of the City of Belen, and they have no authority to conduct, incur liabilities, obligate, nor commit City in any form, fashion, or manner. LIABILITY WAIVER: The organization or group agrees for itself and its employees, agents, or volunteers associated or to be associated with the permit being sought, to waive and relinquish all claims that may result in any manner against the City, its agents, public officials, officers, employees and authorized volunteers from said sponsored event or activity. MISCELLANEOUS This Application does not create, nor does either party to this Application intend to create any right, title, or interest in or for the benefit or any person other than the City or the Event Organizer or Group, and no person shall claim any right, title, or interest under this Application, or seek to enforce this Application as a third-party beneficiary of this Application or Otherwise. Each party shall be solely responsible for fiscal or other sanctions occasioned because of its own violation or alleged violation of requirements applicable to the performance of the Application. Each party shall be liable for its action subject to the immunities and limitation of the New Mexico Tort Claims Act. This application shall be constructed in accordance with the laws of the State of New Mexico. The parties Agree that proper venue shall be Belen New Mexico, Valencia County. Acknowledgement of Policy and confirmation of Application: By signing this application, the Primary Event Organizers acknowledges that they have received a Copy of the City Event Policy and agree, to abide by all parts of this policy, at all times. The Primary Event Organizer affirms that all information provided within this application is true and correct to the best of their knowledge

Date

City Services Application Form

Next Steps: Install a Payment Add-On

Contact Details

Event Details

Payment Details