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3 Exhibit D <br /> THE WEYERHAEUSER ROOM - <br /> AT EVERETT STATION <br /> 3201 SMITH AVENUE,EVERETT,WASHINGTON 98201 <br /> ROOM CONDITION AND SECURITY DEPOSIT RECONCILIATION FORM <br /> Applicant <br /> Contact <br /> Address City State Zip <br /> Business Phone Residence Phone Fax <br /> E-Mail <br /> Credit Card Guarantee: MC, Visa # Expiration <br /> Name on Credit Card: <br /> Date Reserved Time In Time Out <br /> Number of Participants <br /> Did client follow Cleaning Procedures and leave room in good condition? Y N <br /> Comments: <br /> SECURITY DEPOSIT HELD: Major Credit Card $ 500.00 <br /> Deductions from Security Deposit IF ANY: <br /> Item: Comments: Rate: <br /> Extra Cleaning $30.00/hour <br /> Stained chair $10.00 each <br /> Stained carpet $30.00/hour <br /> Damaged walls/doors $40.00/hour <br /> Damaged/missing place settings,flatware <br /> and glassware $5.00 per item <br /> Damaged/missing coffee urns $150.00 each <br /> Damaged/missing A/V equipment. Billed <br /> separately. Varies <br /> OTHER Varies <br /> SECURITY DEPOSIT BALANCE DUE: <br /> Work order attached from Janitorial Services for excess work necessary to return room to rentable condition. <br /> Repair or replacement of some items may require a separate billing. <br /> Weyerhaeuser Room—Exhibit D <br /> 17 <br />