HomeMy WebLinkAboutMINUTES - 09151998 - C93 To: BOARD OF SUPERVISORS
FROM: William Walker,M.D., Health Services Director Contra
Costa
DATE: August 3, 1998 County
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
RECOMMENDATION;
Authorize the Director of County Health Services Department or his designee,
Wendel Brunner,M.D.,to held harmless and indemnify Delta Community Service Center,
Brentwood., California on October 27, 1998, for use of their premises by the Public Health Division,
Immunization Assistance Program for administering flu vaccines to the public.
FINANCIAL IMPACE
None
uE ' N E0_ rtE!MM END ,TION:
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
8 1 ONATU REM/-"i"/ -
�j� Z e2'
ACTION OF&OARS?ON � pr�+mh, r 1 5_, c�S APPROVED AS RECOMMENDED x- OTHER
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A TRUE
X UNANIMOUS {ABSENT z= ) 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:Dottle Langthorn,393-6767
CC: Health Services AdrninistratioATTESTED
Public Health Administration PHIL BATCHELOK,CLERK OF THE BOAR[}OF
Immunization Asst. Program SUERVISORS AND COTY DMINISTR,ATOR
BY ' -,DEPUTY
v
.. A L)C iLd l.1JWIIIUi l 1.Ly :,71_L'V.LCk,:
730 Third St:z:cc.0
Brentwood, Calif. 94513
Application for Facility Use. t.
51C}-631-5'Z'75
NAME OF APPLICANT ConjLd Costa rQunt�4 Piffil is Health DA`I'E„$_��e3$
NAME OF ORGANIZATION (if applicable)
ADDRESS 597 Center Ave. 200A CITY t ZIP 94553
PHONE(H) (W) 313-67 7 DATE(S) OF USE October 27, 1998
(Check)
F=ACILITIES REQUESTED: MULTI-PURPOSE ROOM X KITCHEN
AM AM AM AM
HOURS OF EVENT pI.1..,2,;.,�,..,._..PM ' DD TOTAL HOURS OF USE PM -1 __ __-PM _�•3
(INCLUDES SET-UP & CLEAN-UP
Set-up, event and clean-up must be scheduled for consecutive houcs.
PARKING FACILITIES ADJACENT TO THE DELTA COMMUNITY SERVICE CENTER AZE POR; k
PU31,IC USE AND ARC NOT UNDER THE JURISDICTION OF THE CENTER. Tf(EllcrORE,
AVAILABILITY C3I'' TH13SC LOTS CANNOT BE GUARANTLCD.
CLASSIFICATION Non-ProfitX Commercial Private #r
i
MULTI-PURPOSE ROOM .730/14R. x:50/HR. $SO/HR
(Includes Kitchen) (Includes Kitchen) (Includes Kitchen)
5 hrs.max.
KITCHEN (only) $15/HR. $15/HR, $15/HR.
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 .
DEPOSIT
FOOD ONLY $75 $75 $75
FOOD & ALCOHOL $150 : 150 $150
Type of Event: b1ic.
Yp
WILL MEETING/EVENT BE OPEN TO THE PUBLIC? yes ATTENDANCE EXPtCTED 250
WILL ADDITIONAL EQUIPMENT BE BROUGHT IN FOR THE EVENT? Nn ,
WHAT? DESCRIBE;
WILL ALCOHOLIC BEVERAGES BE SERVED? No WILL THERE BE DiECORATSONSN,
EXPLAIN
I hereby certify that I shall be .responsible on behalf of my
organization for datmage sustained or costs incurred by the Del-IL-0 Community
Service Center because of the occupancy of said premises by myself or my
ocVanization. I havr_readtill the Rules & Regulations o5 the Delta
Community 5c_rvicr Center, and ac gee to abide by thea. A`1TACHT-j.) .
I also agree to hold 'the Delta Community Service Center and its uoal:d
and the City of Brentwood, the individual members thereof agents, and
er"Ployces .Gree 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#f DATE USER FEE DUE
ARRIVAL TIME _ _ DATE RECD SPECIAL PERMIT(BPD)
Delta Community Services, Inc. requires that a center trained supervisor be on site for all
events held at the center. The center supervisor has the authorization to close down the event
if the rules & regulations are not abided by.