HomeMy WebLinkAboutMINUTES - 09261995 - C54 TO: BOARD OF SUPERVISORS Contra
FROM: f
Costa
MARK FINUCANE HEALTH SERVICES DIRECTOR � ."
9.�.::....
County
,..r..l.
DATE: f flsT+cdi K �*
September 26, 1995
SUBJECT:
USE OF DELTA COMMUNITY SERVICE CENTER IN BRENTWOOD FOR
IMMUNIZATION ASSISTANCE PROGRAM-PUBLIC HEALTH DIVISION
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
1. RECOMMENDATION:
Authorize the Director of County Health Services Department or his designee,
Wendel Brunner, M.D., to hold harmless and indemnify Delta Community Service
Center, Brentwood, California-;as`.noted* for use of their premises by the Public
Health Division Immunization Assistance Program for administering flu 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.
*Per attached contract:.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE(S):
ACTION OF BOARD ON - September 26 1995 APPROVED AS RECOMMENDED. OTHER
VOTE OF SUPERVISORS
1 HEREBY CERTIFY THAT THIS IS A TRUE
X 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 Person,: Wendel Brunner, M.D. ATTESTED September 26, 1995
PHIL BATCHELOR,,CLERK OF THE BOARD OF
Health Services Administration SUPERVISORS AND COUNTY ADMINISTRATOR
Public Health Administration
Immunization Assistance Program
M382 (10/88) B DEPUTY
Delta Conununi ty Service Center
730 Third Street
Brentwood, CA 94513
`,'Application for Facility Use
634-8275
NAME OF
APPLICANT Contra Costa County Public Health DATE •7`1-95
ADDRESS 597 Center Ave . 200A PHONE(H) (W) 510-313-6767
Martinez AM AM
DATE OF (S) OF USE 10-10-95 HOURS OF EVENT PM 2:00 PM 3:00
AM �+ AM SET UP AND
TOTAL HOURS OF USE PM 1 :00 PM 3:30 (INCLUDES CLEAN UP. TIMI
(CHECK)
FACILITIES REQUESTED `MULTI-PURPOSE ROOM CONFERENCE ROOM KITCHEI
PARKING FACILITIES ADJACENT TO THE DELTA COMMUNITY SERVICE CENTER ARE FC
PUBLIC USE AND ARE NOT UNDER THE JURISDICTION OF THE CENTER. THEREFORE,
AVAILABILITY OF THESE LOTS CANNOT BE GUARANTEED.
CLASSIFICATION Non Profit (N) X Conunercial (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 $50 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.
D99CRI,PTION CJS' ACWXVXT.T919 TO Py CCIMUC21RD� d
to senior citizens and/or the public
WILL BE MEETING/EVENT BE OPEN TO THE PUBLIC?;,es 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 special events"form,``issued and approved by the Brentwood Polic(
Dept. , must accompanyt this .application. (Allow two weeks for processing.)
WILL THERE BE DECORATIONS? no EXPLAIN
WILL ANYTHING BE OFFERED FOR,`SALE? 4
no WILL ADMISSION CHARGE,;DONATION,
COLLECTION, DUES, OR OTHER FEES ,BE REQUI12ED •OR SOLICITED? yes
PROCEEDS TO BE USED FOR supplies '
I herebycertify that.`I;'shall `be-res-responsible on behalf of my*...! ::..
'.
Y po :.. •.
organization for damage sus tained':•'or''cos is�. incurred by the Delta Commiini ty
1 . Service Center because of'!the!`o.ccupancy)of said. 'premises by myself. or;.my
j organization. I have' read !all!� the Rules &' Regulations of the Delta:: . '..:';
,1 Community Service Center:'and;r.agree':':.�o, abideby them. (ATTACHED)
i also agree to hold the Delta ' Community Service Center and i ts',Board
and the city of Brentwood, ,'.the 'indivi dual members thereof agents,
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 Conmiuni ty ServiceCenter.
DATE _ APPLICANT'S SIGNATURE
DATE DCSC STAFF SIGNATURE
CENTER SUPERVISOR DATE USER FEES DUE
SUPERVISOR TELE(# TOTAL OF USE FEE
ARRIVAL TIME DATE OF EVENT
a :FUSE1
Rev, • 1%94