HomeMy WebLinkAboutMINUTES - 08091994 - 1.67 TO: BOARD OF SUPERVISORS Contra
FROM: MARK FINUCANE HEALTH SERVICES DIRECTOR `A` t�► `'
Costa
y.....I�
August 9, 1994 ;;: County
DATE: r>.�.1 iiiiA��
USE OF DELTA COMMUNITY SERVICE'- CENTER FOR IMMUNIZATION
SUBJECT: ASSISTANCE PROGRAM-PUBLIC HEALTH DIVISION
SPECIFIC REOUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
I. RECOMMENDATION:
1
Authorize the Director of County Health Services Department or
his designee to hold harmless and indemnify Delta Community
Service Center, Brentwood, California in for use of
their premises by the Public Health Division Immunization
Assistance Program for administering flu shots and pneumonia
vaccines to the public.
II. FINANCIAL IMPACT:
None
III. REASON FOR RECOMMENDATION:
The Public Health Division of the County Health Services
Department 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 y APPROVED AS RECOMMENDED 4OTHER
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A TRUE
UNANIMOUS(ABSENT AND CORRECT COPY OF AN ACTION TAKEN
AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN.
Contact: Wendel Brunner, M.D. C,
CC: ATTESTED
Public Health Administration PHIL SATCHEL CLERK OF THE BOARD OF
Inununization Assistance Proqram SUPERVISORS ND COUNTY ADMINISTRATOR
M382 (10/88)
BY DEPUTY
For Office Use Only
Rooms and Equipment Requested
Multi-purpose room Extra Tables
Kitchen Piano
Conference Extra Chairs
PA System
Commeats :
Supervisor of Event Staff :
Tenant
RESERVATIONS ARE NOT COMPLETE UNTIL THE FOLLOWING HAVE BEEN COMPLETED
Administrative Assistant Supervisor Janitor
On Calendar Supervisor assigned Clean up
Copy to user Copy of application Copy of
Ledger card Special arrangement. application
Billing Key issued (if needed)
Date of event Report in log
Special Forms
Tour USER
Payment Rec'd Application form signed Insurance
Other
Deposit Special Form
'
Board Approval of Alcohol Rental fee
Arrangements made
PEES AND DEPOSITS
Classification of user NP C P
Multi-purpose room @
Kitchen @
Conference room @
Set-up @
Clean-up
Other
Administrative fee @
TOTAL FEE j
Date paid
Recd by
Cleaning Deposit
Food only $7s $
Food + Alcohol $150
Date Paid
Recd by
Amount Refunded $. Date
Incident report reviewed by Deposit returned by
For Office Use Onlv
Delta Community Service Center
730 Third Street
Brentwood—_..CA-9 4513
Applical for Facpil�tyTlse
634-8275
NAME OF
APPLICANT Contra Costa County Public Health DATE 7-19-94
ADDRESS 597 Center Ave. 200A PHONE(H) (W) 510-313-6767
Martinez AM AM
DATE OF (S) OF USE 10-4-94 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 —.i—MULTI-PURPOSE ROOM 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) X Commercial (C) Private (P)
MULTI-PURPOSE ROOM $30/HR. $50/HR. $50/HR.
Includes Kitchen) (Includes. Kitchen) (includes Kitchen)
4hrs.max/5hrs.min
CLEAN UP $50 flat fee $5.0 flat fee $50 flat' fee
CONFERENCE 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.
KITCHEN $15/HR. $15/HR. $15 HR.
DEPOSIT
FOOD ONLY $75 $75 $75
FOOD & ALCOHOL $150 $150 $150
Set-up, event, and clean-up must be scheduled for consecutive hours.
DESCRXPTXQN OF' AC7'XVXWXJTS TO499, CONDUCTED'
;' F., ,lLjj. Va_cci_ -be , admjjri�cpix
. Pd
to senior citizens and/or the"public
WILL BE MEETING/EVENT BE OPEN 'TO' THE PUBLIC?�PS ATTENDANCE 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 speciaY'.event `.form,' ' ssued and approved by the Brentwood Police
Dept. , must accompany this .appl.ication. , (Allow two weeks for processing. ).
WILL THERE BE DECORATIONS? no.' EXPLAIN
WILL ANYTHING BE OFFERED. FOR 'SALE?, no WILL ADMISSION CHAR GE, ''DONATION,
..
COLLECTION, DUES; OR OTHER FEES".BE REQUI2ED, OR SOLICITED? yes
PROCEEDS TO BE USED FOR "sup' lies`
I hereby certify that I'ishall be. responsible on behalf of my -`
organization for damage sustainedor.;'.Cos.tsincurred`by' the Delta Community
Service Center, because,of the :.oCc.upancy of sa.id.'`premises by myself or my:
1 organization. I have ,readjall„'the, Rules &''Regulations .of the Delta'
Community Service Center .and `agree°�to;' rby:.,them. (ATTACHED)
abide
I also agree to hold the Delta : Community Service :Center and its'"Board
and the City of Brentwood, `theindividual' members thereof agents, and
employees free and harmless 'from ;any damage,': liability, cost or expense'
that may arise during orbe 'Caused in any ,way by such use 'or occupancy of
the Community Service Center,
DATE APPLICANTS SIGNATURE
DATE DCSC STAFF SIGNATURE
CENTER SUPERVISOR DATE. USER FEES DUE
SUPERVISOR TELE# TOTAL OF USE FEE
ARRIVAL TIME DATE OF EVENT
Rev.
a:FUSEl 1/94