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HomeMy WebLinkAboutMINUTES - 03042003 - C51 Contra TO: BOARD OF SUPERVISORS ;� _ �• Costa FROM: William B. Walker, MD, Health Services Director Count DATE: February 20, 2003 `- I SUBJECT: Use of Antioch Unified School District Facility 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, MD, Public Health Director, to sign a hold harmless agreement indemnifying the Antioch Unified School District for the use of the multi-purpose room located at 4325 Spaulding Street, Antioch, on Monday, March 10, 2003. BACKGROUND: The facility will be used for a public educational presentation on a local health issue, specifically, Sierra-Crete base material used in East County road pavement. FISCAL IMPACT: (done. CONTINUED ON ATTACHMENT: ®YES —NO SIGNATURE: ��RECOMMENDATION OF COUNTY ADMINISTRATOR I~^ RECOMMENDATION OF BOARD COMMITTEE 4- PPROVE OTHER c' SIGNATURE ' ACTION OF 7-- � APPROVE AS RECOMMENDED X OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE y� , 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: DISTRICT III SEAT VACANT ATTESTED MARCH 4. 2003 JOHN SWEETEN,CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR CONTACT: Michael Kent,313-6587 CC: William B.Walker,MD,HSD Director,20 Allen,Mtz Wendel Brunner,MD,Public Health Director,at 597 Center Avenue,#200,Mtz BY � � `� ,DEPUTY i� NOTE:"Lesee's interest In any teased premises may be ANTIOCH UNIFIED SCHOOL DISTRICT MAINTENANCE DEPARTMENT subject to prop*ty taxation as possessory interest and lessW shalt be responsible for payment of such taxes," 510 G«Street Antioch,California 10512 APPLICATION AND PERMIT FOR USE OF SCHOOL PROPERTY Request is hereby made for the use of the following school property at k U, 6�r'' School. (Check Facilities Needed) (Check Equipment No-aided) O � Multi-purpose Room �olding Chairs-Number 0 Classroom No, rabies„? 0 Library MrPublic Address System witl"pem " pr'r r�• � 'gNIA Z it C, 0 Music Room( ) 0 16 mm Projector with operator Q Auditorium 7Projection Screen CJ Faculty Dining Room only ❑Piano 0 Boys Gymnasium only 21peakers Stand ©Boys Shower and Looker Room 0 Stage Facilities 0 Girls Gymnasium only O Special effects stage lighting(including spot lights) 0 Girls Shower and Locker Room with operator. 0 Playfield 0 Bleachers 0 Football Field-Game use 0 other 0 Football Field-Other Use 0 Baseball Field 0 Tennis Courts 0 Track 0 Swimming Pool(Life Guard Required) 0 Kitchen-For use of kitchen facilities or equipment, arrangements must be made with the office of School Food Services. O Other ' Organization or Sponsor 64il fr*t, 5 •3 t.V1 �. Type of Organization:- Educational ❑ School Connected ❑ Recreational ❑ Youth Chars for Buildina,❑ Religious ❑ Political ❑ Private ❑ Other Description of activities to be conducted b, ' Is Meeting Open to Public? til e.s Attendance Expected 20 -676 Will paid entertainers,speakers,callers, etc., be used?. ,AJ-Q lI Will anything be offered for sale? Is an admission charge,donation,collection,dues or tuition fee required or solicited? _IV- Q Amount Proceeds to be used for 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 Antioch Unified School District governing the use of school premises or equipment.(SEE REVERSE.SIDE) I also agree to hold the Antioch Unified School District, Its Governing Board, the individual members thereof, and all District officers, agents, and employees free and harmless from any loss, damage, liability,cost, or expense that may arise during or be caused In any way by such use or occupancy of school property. NAME(Signature) NAME(Print) 4ddress Phone Street Number Date City APPLICATION APPROVED irincipal Guarantee Deposit Nrector of Maintenance Rental Fee ,USTOCNAN`S REPORT 'he above organization used the school facilities as listed above and followed the rules regarding their use with this exception: 'ate Custodian Reviewed by Principal )rm No.8506 Revised Bt96