HomeMy WebLinkAboutMINUTES - 09141993 - 1.153 TO ` hOARD OF SUPERVISORS n,�,}
FROM: MARK FINUCANE, HEALTH SERVICES DIRECTOR n�,.,ntraC
Costa
DATE: ,JULY 20, 1993 C'0
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SUBJECT: USE OF DELTA COMMUNITY SERVICE CENTER FOR IMMUNIZATION '�'�
ASSISTANCE PROGRAM-PUBLIC HEALTH DIVISION
SPECIFIC REQUEST(S) OR RECOMMENDATIONS) & BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
Authorize the Director of County Health Services Department or his designee to hold
harmless and indemnify Delta Community Service Center, Brentwood, California indefinitely
for use of their premises by the Public Health Division Immunization Assistance Program
for administering flu vaccine and pneumonia vaccine, to the public.
FINANCIAL IMPACT:
None
REASON FOR RECOMMENDATION:
The Public Health Department of County Health Services will administer vaccines to
senior citizens and/or the public at Delta Community Service Center, 730 Third Street,
Brentwood, California.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE S :
ACTION OF BOARD ON _.___.______ APPROVED AS RECOMMENDED lC _ OTHER
VOTE OF SUPERVISORS
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1 HEREBY CERTIFY THAT THIS IS A TRUE
K UNANIMOUS (ABSENT AND CORRECT COPY OF AN ACTION TARN
AYES:` NOES'.---- AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN.
Contact: Wendel Brunner, N.D. 313-6712
cc: Health Services Director ATTESTED _ _ EP Igg3
Public Health admin, 597 Center #200 PHIL BATCHELOR, CLERK OF THE BOARD OF
County Administrator SUPERVISORS AND COUNTY ADMINISTRATOR
M382/7-83 BY ,DEPUTY
Delta Community Service Center
730 Third Street
Brentwood, CA 94513
Application for Facility Use
634-8275
NAME OF
APPLICANT Contra Costa County Public Health Dept. -DATE 9-27-93
ADDRESS-- 597 Center Ave. 200A —PHONE(H) (w) -(510) 313-6767
AM AM
DATE OF (S) OF USE 9-30-93 HOURS OF EVENT PM 10:00 Pm 11:30
AM AM SET UP AND
TOTAL HOURS OF USE PM 9:00 Pm 12:00 (INCLUDES CLEAN UP TIME)
(CHECK)
FACILITIES REQUESTED j_MULTI-PURPOSE ROOK_ CONFERENCE ROOM KITCHEN
PARKING FACILITIES ADJACENT TO THE DELTA COMMUNITY SERVICE CENTER ARE FOR
PUBLIC USE AND ARE NOT UNDER THE JURISDICTION OF THE CENTER. THEREFORE,
AVAILABILITY OF THESE LOTS CANNOT BE GUARANTEED.
CLASSIFICATION_ Non Profit (N)_ Commercial (C) _ Private (P)
MULTI-PUBT-Q1U—&Q-QM $30/HR. $50/HR. $50/HR.
( Includes Kitchen) (Includes Kitchen) (Includes Kitchen)
4 hr. minimum
CLEAN UP . $50 flat fee $50 flat fee $50 flat fee
-ROOM $25/HR. $30/HR. $30/HR.
CLEAN UP $20 flat fee $20 flat fee $20 flat fee
*Kitchen "as available" included in Conference Room.
22-CHFIn $15/HR. $15/HR. $15/HR.
RET-=
FOOD ONLY $75 $75 $75
FOOD & ALCOHOL $150 $150 $150
Set-tip, event, and clean-up must be scheduled for consecutive hours .
DESCRIPTION, OF ACTIVITIES TO BE CONDUCTED flu shots to be given to senior citizens.
WILL BE MEETING/EVENT BE OPEN TO THE PUBLIC? yesATTENDANCE EXPECTED 300
WILL ADDITIONAL EQUIPMENT BE BROUGHT IN FOR THE EVENT no
TABLES -CHAIRS OTHER_HOW MANY
WILL ALCOHOLIC BEVERAGES BE SERVED? no
**If yes, a special event form, issued and approved by the Brentwood Police
Dept. , must accompany this application. (Allow two weeks for processing. )
WILL THERE BE DECORATIONS? -no EXPLAIN
WILL ANYTHING BE OFFERED FOR SALE? no WILL ADMISSION CHARGE, DONATION,
COLLECTION, DUES, OR OTHER FEES BE REQUIRED OR SOLICITED? y,q
PROCEEDS TO BE USED FOR '!.xX:ixxxxXXxxXxxxxx:kx supplies
I hereby certify that I shall be responsible on behalf of my
organization for damage sustained or costs incurred by the Delta Community
Service Center because of the occupancy of said premises by myself or my
organization. I have read all the Rules & Regulations of thea
C-Qmmunitv Service Center and agree to abide by them, (ATTACHED)
I also agree to hold the Delta Community Service Center and its Board
and the City of Brentwood, the individual members thereof agents, and
employees free and harmless from any damage, liability, cost or expense
that may arise during or be caused in any way by such use or occupancy of
the Community Service Center.
DATE SEP 14 1993 APPLICANT' S SIGNATURE_ Z"
DATE_ DCSC STAFF SIGNATURE
CENTER SUPERVISOR DATE USER FEES DUE'
SUPERVISOR TELE# - --TOTAL OF USE FEE
ARRIVAL TIME DATE OF EVENT
a : FUSE1 Rev. 5/93