HomeMy WebLinkAboutMINUTES - 11081994 - 1.9 (2) �. 90
TO.
BOARD OF SUPERVISORS
FROM: Mark Finucane, Health Services Director =>r�. Contra
Costa
DATE: November 2, 1994 _ C011rity
T •'
SUBJECT. USE OF PITTSBURG CENTRAL JUNIOR HIGH SCHOOL CAFETERIA FOR EAST COUNTY
COMMUNITY FORUM -NOVEMBER 15, 1994
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSM71CAIION
RECOMMENDATION:
Authorize the Director of the County Health Services Department or his designee, Wendel Brunner, M.D.
to hold harmless and indemnify the Pittsburg Unified School District for use of the Central Junior High
School cafeteria for an East County Community Forum,Tuesday,November 15, 1994, 6:00 p.m.-8:00 p.m.
BACKGROUND:
The Contra Costa County Public and Environmental Health Advisory Board (PEHAB) will be holding
an East County Community Forum to discuss health care issues on Tuesday, November 15, 1994, 6:00 p.m.
- 8:00 p.m., at Pittsburg Central Junior High School cafeteria, 1201 Stoneman Ave., Pittsburg, California.
FISCAL IMPACT:
None.
CONTINUED ON ATTACHMENT: XX YES SIGNATURE
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE _OTHER
SIGNATURE (S): NOVpp
O
ACTION OF BOARD ON V APPROVED AS RECOMMENDED _� OTHER
VOTE OF SUPERVISORS
/ I HEREBY CERTIFY THAT THIS IS A TRUE
✓ 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, MD 313-6711 NOV
CC: Health Services Director ATTESTED
PHIL BATCHELOR, CLERK OF THE BOARD OF
SUPERVISORS AND COUNTY ADMINISTRATOR
BY ?CL DEPUTY
PITTSBURG UNIFIED SCHOOL DISTRICT
2000 Railroad Avenue
Pittsburg, CA 94565
APPLICATION AND AGREEMENT FOR USE OF SCHOOFACILTTIES
Request is hereby made for the use of the following school property:
a�kia-r�-."L�.�a LJ
Ceo+ral kl-r. ffi*ah ALAn�
(DESCRIBE SCHOOL sim,,��BUILDING,GROUN OR FACILITIE(S�l,R WHICH REQUEST IS MADE)
DATE �S)OF USE: C.J e �1,,1 �'p, ( !
HOURS OF USE: �. , 7 0 D M "" 7� 1 0 0 YY1
(Specify actual time you i6risli to be admitted to premises.)V
School personnel required for performance: CUSTODIAN TECHNICIAN OTHER
Will Cafeteria/Kitchen facilities be required? YES NO HOURS OF USE
DATE(S)OF REHEARSAL
HOURS OF USE
School personnel required for rehearsal: CUSTODIAN TECHNICIAN OTHER
Will Cafeteria/Kitchen facilities be required? YES NO HOURS OF USE
NAME OF ORGANIZ TION01 SPONSOR -
(, 0 Ad y 1S5 C)
cl
Type of Organization: t/ Public Agency(Governmental) � 4- ReGroup
Private Individual or Organization(Nos-Resident) Community Recreation
Civic Center: 1.School related group
2.Character Building or Welfare Organization
3.Private Individual or Organization(Resident)
t
Description of activities to be conducted V
I
Is an ADMISSION CHARGE,DONATION,COLLECTION,DUES OR TUITION FEE REQUIRED OR SOLICITED?
Specify type Amount Proceeds used for:
Open to the Public: t,,/YES NO Attendance Expected �QQ_ Off Street Parking? %m,r YES NO
r (R ui for large capacity crowds)
Indicate uip icnt needed:
I hereby certify that I shall be personally responsible,on behalf of my organization for any damage sustained by the school premises,furniture,or equipment
because of the occupancy of said premises by our organization. I agree to abide by and to enforce the rules,regulations and policies of the Pittsburg Unified
School District governing the use of school premises or equipment.
NO ALCOHOLIC BEVERAGES SHALL BE CONSUMED,SOLD,GIVEN AWAY OR DELIVERED TO ANY PERSON ON THE PROPERTY OF A
SCHOOL DISTRICT. I also agree to hold the Pittsburg Unified School District's Governing Board,the individual members thereof,and it's officers,agents and
employee,free and harmless from the cost or expanse of claim of all persons for bodily injury and/or property damage liability which may arise or be caused by
reason of such use or occupancy of school property and,if required by the District,to furnish it in advance of such use or occupancy with on acceptable
certificate of insurance evidencing coverage of the District as a PRIMARY INSURED for claims against the district for bodily injury and/or property damage
liability.
7 SIIGGNpATURE, / TITLE OF OFFICE HELD
ADDRESS / L.t_ 7GY �� I� �K 2`b O PHONE/p ) .TII,3"(✓v 7/ DATE
(Street,City,State&Zip)
Signature shall be that of an officer of the applicant group. If not,written authorization from applicant group dhall accompany this application approving
signature.
CHARGES ARE SUBJECT TO CHANGE-ESTIMATED ACTUAL COSTS PER APPROVED CONTRACT
(Additional billing may follow for variations to the approved contract atter the performance takes place.)
Payment of Rental Fee,in the form of cash or cashier's check,shall be made to the Diatrict Business Office no later than (Failure
to meet this requirement shall result in cancellation of this Agreement for Use of School Facilities without further notice.)
REQU
SECURITY:
Security for Grounds and Building: YES NO Number of Security Officers Required: Inside Oaa:rk
(Must check in with Custodian 112 hour before performance)
COMPREHENSIVE GENERAL LIABILITY INSURANCE CERTIFICATE:
Proof that the above requirements have been met shall be filed in the School District Business Office no later than (Failure
to meet this requirement shall result in cancellation of this Agreement for Use of School Facilities without further notice,)
APPLICATION APPROVED:
SIGNATURE OF SITE ADMINISTRATOR SIGNATURE OF BUSINESS MANAGER
DATE DATE
THE PITTSBURG UNIFIED SCHOOL DISTRICT RESERVES THE RIGHT TO CANCEL SAID CONTRACT AT ANY TIME