City of East Palo Alto
OPEASTRATO
7 Cooley Landing Education Center Reservation Application 2100 Bay Road East Palo Alto, CA 94303 Ph:650-853-3100 Fx:650-853-3115
CORPORAL DES
Cooley Landing Education Center is available to rent for public and private events.
Please contact the Community Programs Manager at 650-853-3149 for more information.
SECTION 1 - APPLICANT INFORMATION
Application Date: October 4,2022 Organization Name: Jan Matro County Mosquito & Vector Control District
PRIMARY CONTACT-
First & Last Name (REQUIRED): Rachel Curtis- Robles
Home Number: 832-564-6440 (pernal. Cell Phone (REQUIRED: 650-313-3155 (workcen) E-Mail: [email protected]
Street Address (REQUIRED): 1351 Rollins Rd (District office) City (REQUIRED): Burlingame State (REQUIRED): CA_ Zip Code (REQUIRED): 94010 SECTION 2 - EVENT INFORMATION
Event Date: Oct 110- Oct 19, 2022 Estimated Attendance: 5D Name of Event: East Palo Alto Community Assessment for Public Health Emergency Event Description: Collaboration of public health agencies to survey people Response lingin East Palo Alto about vectars, climatechange, and health Is your event? Private Public Staffonly
Government
Is your organization a registered 501(c)3 with the state of California? _YES X NO Agency
(If YES, please provide proper documentation with this application) Public Event - Will there be a charge to attend? If so, please indicate amount: $ NA Venue Set Up Time: Oct lo noon-lepm Event Start Time: Oct 17 7:30am Event End Time: Oct 19 l0:30pm Venue Vacant Time: Oct 19 7:30pm EVENT COORDINATOR INFORMATION:
(This person must be present and available at the event at all time/hours requested) Event Coordinator Name: Kachel Curtis-Robles
Personal Cell Phone Number for On-Site Coordinator: 832-564-6440 # 650-343-3155/ mainwak *Note: Please attach an event agenda of activities and a copy of any event flyer or other promotional material that may be available.
Cooey landing will sewe as headguarters for ~ 20 staff REV.01/2020-LGA dung each day, as well as training it break location for 230 additional staff throughout each day of the event.
EAST PATO City of East Palo Alto
Cooley Landing Education Center Reservation Application 2100 Bay Road East Palo Alto, CA 94303|Ph:650-853-3100|Fx: 650-853-3115
SORPORATED
SECTION 3 - AMENITIES REQUEST
Check all that apply and specify the amount your event requires:
CHAIRS How many does your event require?
60 120 CHAIRS AVAILABLE
TABLES How many does your event require? All, please
4 - 8'FT RECTANGLE TABLES 4 rectangular tables
10 - 60' ROUND TABLES 10 round tables
AUDIO VISUAL What will your event require?
MICROPHONES, PROJECTOR SCREEN, & microphone
SPEAKERS projector screen
(FOR PRESENTATIONS AND BUSINESS speakers
OCCASIONS ONLY)
SECTION 4 - SPECIAL REQUIREMENTS
(Food, Alcohol, Amplified Sound, Staging, Parking, Security, Portable Restroom, Trash/Recycling) Large community events generally require review by multiple City Departments and may require additional permits and/or fees from agencies other than the City. To help expedite this process and to ensure that your event is properly reviewed, please indicate which of the following apply to your event:
1. Will food be sold or prepared on-site at the event? YES X NO If YES, please indicate the name and contact information for the caterer or provider of food:
Boxed lunches will be provided; no selling or preparation will occur on-site *Note: Events open to the public where food will be sold or prepared on site must apply for a health permit from the County Environmental Services Department and the Menlo Fire District.
2. Will alcohol be sold or be available at the event? ]YES LANO
3. Will the event require electricity? X YES
If YES, please indicate the purpose for the electricity:
X SOUND X LIGHTING FOOD PREPARATION • OTHER:_
4. If you are hosting an event that will have cars, floats, animals or other unusual attractions please indicate the type and number as well as the contact information for the supplier.
Please describe:_ NA
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City of East Palo Alto
EASTPATO
Cooley Landing Education Center Reservation Application O
2100 Bay Road East Palo Alto, CA 94303|Ph:650-853-3100|Fx:650-853-3115
NCORPORATED
5. If there will be amplified sound, please indicate the amperage and source of power.
Note amplified music is restricted to indoors: Only using in house equipment for presentations
6. Will there be a stage(s) at the event? •YES XI NO
Please indicate the number and size of each stage as well as the contact information for the vendor who will be responsible for providing the stage.
Number of stages:_ NA Size(s):
Name of Suppliers): Supplier Phone/Address:
7. Will there be any shade/temporary tents) at the event? ]YES • NO #Possibly Number of Tent(s): 2-3 Size(s): 8x8 or 10x10
8. All vendors must be licensed and insured. Please provide contact information for all vendors paid or not associated with your event:
Vendor List:
Name of Supplier: Phone:
Address:
Name of Supplier: Phone:
Address:
Name of Supplier: Phone:
Address:
Name of Supplier: Phone:
Address:
9. Please outline your plan for the following "day of" activities related to your event include the name and contact information for the individual(s) responsible for each activity:
Security Management: SMC DEM, SMC Health, & SMOMUCD staff will be an-site any emergency issues will call for PD support
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City of East Palo Alto
EAST PATO
TYO Cooley Landing Education Center Reservation Application 2100 Bay Road East Palo Alto, CA 94303|Ph:650-853-3100|Fx:650-853-3115
ACORPORATEO
Parking/Traffic
Management:_ SmCHealth SMMUCD/SMeDEm Staff
Waste Management/Clean-Up: SMC Health ISMCMUCD/SMCDEMstaff SECTION 5 - ASSURANCES AND AUTHORIZATIONS
The event site will be inspected within 24 hours after the close of the event. Any clean up that is performed by the City will be charged at the current hourly rate accrued by the Maintenance Department and will be due and payable within 30 days from the event. Event organizers will not be allowed to schedule any future events if charges remain outstanding.
I certify that I am an authorized representative of the organization applying for this permit and that I have been granted the authority to execute this application for the following organization/events:
I declare, under penalty of perjury, that all the information provided above is true and correct to the best of my knowledge. I understand that, as required by EPA Municipal Code Section 12.08.080-090, I am / my organization is required to provide proof of insurance and a cleaning deposit determined by the scope of the event.
Reukel CoRch Oct 4,2022
Signature of Applicant Date of Application
CITY STAFF USE ONLY
Date Application Approved:_ _PERMIT#: ISSUED BY:_
Department Approvals
POLICE DEPARTMENT:
PUBLIC WORKS/MAINTENANCE:
COUNTY TRANSIT AGENCY:
CDD/CODE ENFORCEMENT OFFICER:
MIDPEN:
MENLO FIRE:
COUNTY HEALTH DEPARTMENT
OTHER:
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OFFICIAL PUBLIC
HEALTH SURVEY SAN MATEO
AN MATEO COUNT
MOSQUITO & VECTO
CONTROL DISTRICT COUNTY HEALTH
ENCUESTA OFICIAL
DE SALUD PÚBLICA
SURVEY IN YOUR NEIGHBORHOOD ENCUESTA EN SU VECINDARIO
October 17-19, 2022 OCTUBRE 17-19, 2022
San Mateo County Health and the Mosquito El Departamento de Salud del Condado de and Vector Control District will be conducting San Mateo y el Distrito de Control de Mosquitos a survey in your neighborhood October 17- y Vectores llevarán a cabo una encuesta en su 19, 2022. The survey includes questions about vecindario del 17 al 19 de octubre del 2022. La pest control, climate change, emergency encuesta incluirá preguntas sobre control de preparedness, and health-related issues. plagas, cambio climático, preparación para casos de emergencias y temas relacionados
We will randomly select 210 households in East
con la salud.
Palo Alto to participate in the survey. If we
visit your house, please consider answering Seleccionaremos al azar a 210 hogares de the survey questions. Your participation will East Palo Alto para participar en la encuesta. help us better understand what issues are most Si visitamos su casa, por favor participe important to people living in East Palo Alto. contestando las preguntas del cuestionario.
Su participación nos ayudará a comprender
We will NOTask you any personal information mejor los temas de mayor importancia para las like your name, date of birth, or immigration
personas que viven en East Palo Alto.
status. We will not ask for any ID.
NO solicitaremos ninguna información personal
If you are concerned about any unusual activity como su nombre, fecha de nacimiento, o in your neighborhood, you can contact the East
estatus migratorio. No le pediremos ninguna
Palo Alto Police Department's non-emergency identificación. line at 650-321-1112.
Si le inquieta alguna actividad inusual en su
vecindario, puede comunicarse a la línea
regular del Departamento de Policía de East
Palo Alto al 650-321-1112.
FOR MORE INFORMATION
PARA MAYORES INFORMES
www.smcmvcd.org/CASPER
Cooley Landing
Insurance Requirements
A Certificate of Liability Insurance and endorsements are required for all facility rentals. No reservations will be confirmed without proof of sufficient insurance. The City requires the following insurance for all facility rentals:
• The renter's name must be listed as the one "insured." • The policy must be in effect at the time of the event. • The certificate holder must be: City of East Palo Alto, 2415 University Avenue, Suite 200, East Palo Alto, CA 94303.
• The "description" should list the rental location, day, and event planned • The minimum amount of such insurance shall be no less than Two Million Dollars ($2,000,000) per occurrence and Four Million Dollars ($4,000,000), in aggregate or Four Million Dollars (4,000,000) combined single limit bodily injury and property damage for each occurrence. The renter shall provide the City with certificates of insurance and copies of additional insured and primary coverage endorsements evidencing the insurance coverage as a condition of renting the facility.
• The renter shall name the City of East Palo Alto, its Officers, Agents and Employees as additional insureds. The policy shall also contain a provision that the insurance afforded to the City, its Officers, Agents, and Employees shall be primary and non-contributory.
Please provide these requirements to your insurer or insurance broker. Your insurance broker should be able to assist you in getting the appropriate coverage. The certificate and endorsements must be submitted to the City no later than two weeks after your request is approved.
Agreement Signature: Rahul LaRM Date: Oct 4,2022
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