HomeMy WebLinkAboutMINUTES - 09112001 - C.185 A'..
f..70: BOARD OF SUPERVISORS' ¢ L. CONTRA COSTA
COUNTY
FROM: William Walker, M.D.
Health Services Director
sTA cbU+`n
DATE: August 1, 2001
SUBJECT: Use of Maple Hall from City of San Pablo for a Health
Services sponsored event
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
Recommendation:
Authorize the Health Services Director or his designee, Wendel Brunner, M.D., to hold harmless and
indemnify the City of San Pablo, Community Services Department for the use of Maple Hall located at
13831 San Pablo Avenue in San Pablo.
Background:
The facility will be used on September 17, 2001 for the Family, Maternal & Child Health to conduct
"CPSP: Skill Building" for Comprehensive Perinatal Services Program providers.
Fiscal Impact:
Funding for rental is included in the State allocation for Maternal & Child Health Programs
CONTINUED ON ATTACHMENT: 0 YES ❑NO SIGNATURE
t,-' RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
---APPROVE OTHER
SIGNATURE (S):
ACTION OF BOARD ON APPROVED AS RECOMMENDED OTHER
VOTE OF SUPERVISORS
UNANIMOUS (ABSENTI HEREBY CERTIFY THAT THIS IS A TRUE AND
CORRECT COPY OF AN ACTION TAKEN AND
AYES: NOES: ENTERED ON THE MINUTES OF THE BOARD OF
ABSENT: ABSTAIN: SUPERVISORS ON THE DATE SHOWN.
ATTESTEDOD
CONTACT PERSON: Itika Greene(313-6259) PHIL BATCHEL .CLERK OF THE BOARO OF
SUPERVIS RS AND COUNTY ADMINISTRATOR
CC: Public Health Director
Health Services Director
FMCH
BY: - UTY
-'• SAN PABLO RENTAL APPLICATION
APPLICATIONS/BOOKING FEE/DEPOSITS ARE REQUIRED 45 WORKING DAYS PRIOR TO EVENT
1. ORGANIZATION: Health Services Deet. Public Health
2. APPLICANT NAME: Family Maternal & Child Health
APPLICANT ADDRESS: 597 Center Ave, Ste 365, Martinez, CA 94553
HOME TELEPHONE: n/a WORK TELEPHONE: 925-313-6254
PHOTO I.D. REQUIRED - TYPE: n/a NUMBER: n/a
3. DESIGNATED PERSON IN CHARGE OF ACTIVITY: Itika Greene
4. FACILITY: Maple Hall
5. TYPE OF EVENT: Trai naryfor neri�nrovi dors
TOTAL ATTENDANCE 40± ADULTS X TEENS CHILDREN
RENTAL HOURS- MUST BE CONSECUTIVE
DATE DAY OF WEEK
SET-UP ACTIVITY CLEAN-UP TOTAL HOURS
9:17-_01 Mo 4 30 o
NOTE: TIME CHANGES WILL NOT BE CONSIDERED LESS THAN 10 WORKING DAYS BEFORE EVENT.
6. WILL ANY MONEY BE RECEIVED AT/OR FOR THE ACTIVITY?
PLEASE EXPLAIN: No
7. HOW ARE THE PROCEEDS TO BE USED? n/a
8. WILL A COMMERCIAL CATERER BE USED? no NAME
9. SAN PABLO BUSINESS LICENSE REQUIRED FOR CATERERS: SP BUS. LICENSE NO.
10. CATERER'S ARE REQUIRED TO HAVE A CURRENT DEPARTMENT OF HEALTH PERMIT:NO.
11. WILL ALCOHOLIC BEVERAGES BE SERVED? No FOR SALE? No TYPE?
FIVE (5) HOUR MAXIMUM ALCOHOLIC BEVERAGE SERVICE. DOES APPLICANT AGREE?
IS LETTER TO CHIEF OF POLICE REQUESTING ALCOHOL SERVICE ATTACHED?
IS ABC ONE-DAY PERMIT ATTACHED?
12. DO YOU UNDERSTAND THE ATTACHED RATES AND REGULATIONS REGARDING USE OF ALCOHOL?
13. EQUIPMENT OR SERVICES REQUESTED: screen
IF SET-UP IS REQUESTED,A DIAGRAM AND WRITTEN DESCRIPTION IS DUE AT LEAST 10 WORKING
DAYS IN ADVANCE.
14. IS THE ACTIVITY OPEN TO THE GENERAL PUBLIC? No TYPE OF PUBLICITY
15. TYPE OF DECORATIONS: (NO NAILS, STAPLES, TAPE OR SURFACE MARRING ADHESIVES)
No
16. HAVE THE SECURITY GUARD REQUIREMENTS BEEN MET? YES 11 NO ❑ n/a
IS PAID CONTRACT ATTACHED? YES NO n/a
17. I, THE UNDERSIGNED, HAVE READ AND AGREE TO ABIDE BY THE RULES AND REGULATIONS AS
STATED ON THE ATTACHMENT TO THIS APPLICATION.
DATE 8 03 /2001 SIGNATURE OF APPLICANT
ROUTING REQUEST (Office Use)
DATE RECEIVED APPROVED DENIED BY
Rental Coordinator
INTER-OFFICE ROUTING DATE TO POLICE DEPARTMENT:
DATE RECEIVED APPROVED El DENIED ❑ BY
CHIEF OF POLICE
BOOKING FEE (non-refundable) $ (Return to Coordinator after review)
BASE RENTAL FEE $
ALCOHOL FEE $
ADDITIONAL PERSONNEL $
INSURANCE FEE .$
SECURITY DEPOSIT(S) $
OTHER $
TOTAL $
AMOUNT PAID DATE RECPT/NO.
AMOUNT DUE/BY RECPT/NO.
AMOUNT PAID DATE RECPT/NO
CLOSING RENTAL PAYMENT DATE RECPT/NO.
AMOUNT REFUNDED PAYMENT REQUESTED- DATE CHECK NO.
FILE ;original) POLICE DEPARTMENT(blue) OFFICE (pink) APPLICANT COPY(yellow)