HomeMy WebLinkAboutMINUTES - 09241996 - C71 TO: BOARD OF SUPERVISORS
t
FROM: William Walker, M.D., Health Services Director Contra
DATE: September 12, 1996 Costa
County
SUBJECT:
USE OF DELTA COMMUNITY SERVICE CENTER IN BRENTWOOD FOR
IMMUNIZATION ASSISTANCE PROGRAM-PUBLIC HEALTH DIVISION
SPECIFIC REQUESTIS)OR RECOMMENDATIONIS) da BACKGROUND AND JUSTIFICATION
I. 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 indefinitely 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.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE(S):
ACTION OF BOARD ON September 24, 1996 APPROVED AS RECOMMENDED X OTHER
VOTE OF SUPERVISORS
I 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.
CC: Health Servicesp,dminis anonATTESTED September 24, 1996
Public Health Administration PHIL BAT , CLERK OF THE RD OF
Inmmization Assistance Program SUPE IS ND COUNTY MINI TRAT
TY
Delta Community Service Center 71
730 Third Street
Brentwood, Calif . 94513
Application for Facility Use
510-634-8275
NAME OF
APPLICANT Contra Costa County Public Health —DATE-7-1-96
Name of Organization (if applicable)
ADDRESS 597 Center Ave. 200A, Martinez PHONE (H) (W) 510-313-6767
AM AM
DATE (S) OF USE 10-22-9h HOURS OF EVENT PM q.:.3 .PM UI:_
AM AM
TOTAL HOURS OF USE PM 8:30 PM 11 :00 (INCLUDES SET-UP & CLEAN-UP)
Set-up, event and clean-up must be scheduled for consecutive hours .
(Check)
FACILITIES REQUESTED: MULTI-PURPOSE X 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-Profitx Commercial Private
MULTI-PURPOSE ROOM $30 HR. $50 HR. $50 HR .
(Includes Kitchen) (Includes Kitchen) (Includes Kitchen)
5 hrs .max.
CLEAN UP $50 FLAT FEE $50 FLAT FEE $50 FLAT FEE
One (1) hour minimum charge for non-profits . Four (4) hour minimum charge
for private and commerical events .
KITCHEN (only) $15/HR. $15 HR. $15 HR.
DEPOSIT
FOOD ONLY $75 $75 $75
FOOD & ALCOHOL $150 $150 $150
Type of Event :_Flu vaccine to be administered to senior citizen and/or thiapublic.
WILL MEETING/EVENT BE OPEN TO THE PUBLIC?_ATTENDANCE EXPECTED 250
WILL ADDITIONAL EQUIPMENT BE BROUGHT IN FOR THE EVENT? no
WHAT? DESCRIBE:
WILL ALCOHOLIC BEVERAGES BE SERVED? no WILL THERE BE DECORATIONS_
EXPLAIN
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 the Delta
Community 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 APPLICANT'S SIGNATURE
DATE DCSC STAFF SIGNATURE
CENTER SUPERVISOR TOTAL OF USE FEE
SUPERVISOR TELE# DATE USER FEE DUE
ARRIVAL TIME DATE RECD SPECIAL PERMIT(BPD)
a:FUSEI Rev. 3/95