HomeMy WebLinkAboutMINUTES - 08172004 - C89 BOARD OF SUPERVISORS ..........
Contra
FROM- William B. Walker, M.D.
Costa
DATE: July 26, 2004 N
------ County
SUBJECT: USE OF CITY OF BRENTWOOD COMMUNITY C"^Ida
CENTER, FOR PUBLIC HEALTH DIVISION-
IMMUNIZATION ASSISTANCE PROGRAM
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 hold harmless and indemnify the City of Brentwood, Parks and Recreation
for use of their community center on October 12, 2004, by the Public Health Division,
Immunization Assistance Program.
REASON FOR RECOMMENDATION:
The Public Health Division of the County Health Services Department will administer flu
vaccines to senior citizens and/or the public at the Community Center, 730 Third St.,
Brentwood, CA.
FINANCIAL IMPACT:
none
G04FINW66"ATTACHMENT: YES SIGNATURE:
---------—------------------------------------------------------------ ____/--------------------
—,---RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE(S):
----------------- ` - --- f _ '------___ --------- --____–––___-_ —–-–--–-–----–--–-–------------
ACTION OF BOiRON_ APPROVE AS RECOMMENDED O*HLsR
VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE
AND CORRECT COPY OF AN ACTION TAKEN
UNANIMOUS(ABSENT AND ENTERED ON THE MINUTES OF THE
BOARD OF SUPERVISORS ON THE DATE
AYES: NOES: SHOWN.
ABSENT: ABSTAIN:
ATTESTED
CONTACT: Angela Pepsin JOHN SMIETE
313-6767 CLERK OF THE ARD OF SUPERVISORS AND
COUNTY ADMINISTRATOR
CC: Health Services Administration
BY -,DEPUTY
Sent By: City,o` Brentwood; 925 516 5445; Jul-23-04 5:15PM; Page 2/2
Mental Contract 1 Permit
?"`; printed:22�tu1-d4, 04.15 FSM
f„ User,minchs
&r
Contract#: 1733 User: minglis
Data: 22-Jul-04 Status: Firm
City of Brentwood Parks&Recreation Department hereby grants City of Brentwood (hereinafter called the"Licensee")represented
by Mac Kaiser, permission to use the Facilities as outlined,subject to the Terms and Conditions of this Agreement contained herein
and attached hereto all of which form part of this Agreement.
I)Purpose of use Special Events
2004 Flu Shots
ii)Conditions of Use Request per Contra Costa Public Health Dept„Angela Petsin phone#313,6767
iii}date and Times of use #of Bookings 1 Starting: Tue 12 Oct 04 08:00 AM Expected 0
Ending: Tue 12 Oct 04 11:00 AM
Facility Day Stan Date Start Time End Date End Time Fee Extra Fee Tax Total
Brentwood Community Center- Tue 12-Oct-04 0$00 AM 12-Oct-04 11:00 AM $0.00 S000 $0.00 $0.00
Multi-Purpose Room
iv)Additional Fees
vj Payment Method
Mental F*es Extra Foos Tax Rental Total Damage Deposit Total Applied Balance Current
$0.00 $0.00 $000 $0.00 $000 $000 $0.00 So.00
Balance of rental due and payable immediately
vi)Other Information
Prompt Answer
Alcohol Use No
Special Equipment
Waiver of Liability 1,the undersigned. represent the legal internist of the individuals mentioned above and myself in consideration of the Facility
Rental as stated above we agree to indemnity and hold the City of Brentwood harmless and release the City and its'employees from any and all
liability for any injury which may be suffered by the above framed individuals arising out of or in any way connected with participation in the Rental.
We understand on behalf of myself and those individuals that participartion in certain activities can cause severe injury or death and assume the risk.
Unless otherwise indicated,we hereby grant pttrmission to they City to take photos And uat:onr narnes while parlicir7atirg in activities and use them for
Department publicity purposes.
If requested I agree to furnish the City,prior to Organization's occupancy of said facilities,a copy of Certificate of Insurance(not lass that
$1,000,000)of liability for death or bodily injury or loss sustained by more than one person in any one occurrence, i also agree to name the City of
Brentwood as additional insured.
I further agree to abide by and to enforce the rules,regulations and policies of the City of Brentwood governing the use of Park/Facility premiwex or
equipment.
X: X. r
Mac Kaiser � J Name. Z lej&�
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r
City of Brentwood
730 Third Street Title:
Brentwood CA 94513
Home () BLIsinP-313 (925)515-5444
Fax: (925)516-5445
City of Brentwood P�arrks�& Recreation
Department
nate: Date. � /° �'� -�7
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