County Administrator Contra
Costa
County
Board ofSupervisors
County Administration Building
1025 Escobar Street. 4tn Fbor
Martinez. Caltfbmia 94553-1229
(925) 65&2075
John M. GIoIa
la Distdd
Candace Andersen
2'u District
Diane Burgls
3d District
Monica Nino
County Administrator
3:
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Karen Mitchoff
4e' Disti'td
FedenID. Glover
5n DistHct
November 30, 2022
City of San Pablo City Council
1000 Gateway Avenue
San Pablo, CA 94806
To Whom it May Concem,
On behalf of the Contra Costa Board of Supervisors, we wouldlike to request a waiver of fees for using Maple Hallon January 24, 2023, 6om 7:00am to 4:00pm. On this day the Board of Supervisors willbe holding a public muting in the City CouncilChambers and our board willbe using the Maple Room for the closed session pai't of their meeting and also for re6eshments.
Chief Assistant Clerk of the Board
CIW-SAN PABLO
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Rental Agreement #
Facility RentaIApplication
ONLY SAN PABLO INCORPORATED RESIDENTS ARE ELIGIBLE FOR RESIDEliIT RATES Date Requested:January 24. 2023 Day of Week:!yglgay
SetUptime: 7.
Event time:
Clean-Ub time: : am/pm- : am/pm
TotaiHours:.9. re @/Ao#rs mil 6e confer ivey
Name of Applicant: .!ami Merritt
N,m. of CKg«U«bon:contra Costa County
Address:1025 Escobar Street, lst Floor
Phone:925-655-2005
.Type of Event:.11:?ld of Supervisorsmeeting
Security Hours: .anVpm - .!mW«
TotaIHours of security:
.Phone Number:.9?1.655-2005
State Non-Profit ID#:
.city:Martinez
EmaHja mi. mo rritt@cob .cccou nty . u s
Designated Person in Charge on the Day of Event: :jamIMomtt .zip:g!!!g
Phone:925-723 .2773
Kitchen (2) L-.Fwn Lounge (4'D
ParkMulti-Purpose(80) L-.IActivityRoom2(41)
ParkSeniorCenter(50) LIActivityRoom3(41)RoomAorB(48) I ICommercialKitchen(2) Write the number of participants for each age group; the attendance numbers should be as accurate as possible.
TotaIAttendance: zo Children(agesl-12) Teens(13-20) Adults(21-35) Adults(35+) Willalcoholic beverages be served?E]VES+/l?INO For Said?EJvts+/lgINO B IJ" YES" see section VlofRelttalPolicy
Photo I.D Required:
Type:Number:
(96)
(187)
(139)
(]05)
Recreation
CM Staff Signature Date Received: Approved C] Denied C] By
OFFICEUSEONLY
Application Fee(Non-Refundable)
Insunnu Fn(WillorganizetionAipp icant provide their own Insuiancc? ...}!<=>J AlcohoIFee
StaRFces ($20/pasonhour)
Security Guards
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taffSipnahire: ])ateReceRred: Annroved [] Denied [] By:
Rental Agreement #
AGREEMENT AND ACCEPTANCE OF APPLICATIONS
In signing this application, I certify that I have received the Public Facility Rental Policies. I have read and understood the facility ruin and instructions, and I(or organization represented) willabide by any conditions set forth therein. I agree to hold the City of San Pablo, the individual members thereof. and all of its officers, agents and employees, b'ee and hamdess eom any loss, damage, cost of expense that may arise during or caused in any way by such use or occupancy of recreational facilities.
I accept hU responsibility for them tluoughout the period specified in the Facility RentaIApplication. I further understand that as the applicant lassume fUlresponsibility for any penalty fees assessed by the City of San Pablo for any violations of these rules and regulations goveming the use of the above requested facility. I am also aware that by signing this contract, rake fullresponsibility for the behavior exhibited by my guests during my rental. lunderstand that I(or organization represented) am responsible for any damages or fms sustained to the buildings, fumiture or equipment through occupancy. Responsibility includes but is not limited to third party Hoes issued as a result of not following facility rentalpolicies. Any lost equipment or damages sustained must be compensated within seven days of event date.
Name of Appncani(please print): Jaml Morrltt
November 28, 2022Date:
'-.'-m".-'-,-. o'.pp-:"'-.,:ContrKCosta County
[] Chok.here if renting out Map]e Ha]]and wi]]need ADA ramp for stage access. A minimum of ] week willbe needed to make this request.
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SanPablo
2014
COVID-19CHECKLIST
Effective Date October 12, 2022
Rental Name CITYaSAN PABLO
Permit #
The City remains committed to the health and safety of its employees and the San Pablo community throughout this COVID-19 pandemic.
To prevent mass Infection by COVID-19, please obey the following checklist items for rentals of any City of San Pablo facility. A facility rentalmay be refused if the renter is unable to adhere to the following regulations established by the State of California, Contra Costa County and the City ofSan Pablo.
The City of San Pablo willnotify you one month prior to your facility reservation/date with any new COVID regulations that may affect your rental. You may cancelyour rentalwithin one week of notification and receive a fullrefund if the current COVID regulations drastically affect your rentaln
If new regulations are enacted less than one month prior to your rentalwe willwork closely with to help develop a plan to meet the new regulations or consider a refund.
The City willfollow State and County regulations and City policies and willenforce whichever is stricter.
Please PRINT the emailaddress below you receive notifications at Q) c-b. c.ccouN+' . US
Per the City of San Pablo CORONOAVIRUS COVID-19 UPDATE and MODIFIED OPERATIONS PLAN V23 issued October 12, 2022 as a renter of a City facility you are responsible for:
Allowing City staff to ventilate the room periodically by opening windows and/or doors.
Allmembers of the public aged 2 years and older are encouraged to wear face masks when in the rented room but not required.
Members of the public are required to wear masks in allcommon indoor areas such as facility hallways, lobbies, restrooms and other indoor areas designated for City employees
Allcontact tracing if an attendee subsequently tests positive for COVID-19 or shows symptoms, including notifying the City.
OVER
Creating Community Through People, Parks & Programs
The mission of the City of San Pablo Community Services Department is to work passionately and collaboratively, to provide and promote quality services that create a safe and healthy community.
Remaining vigilant for symptoms of COVID amongst your attendees during your event. If City Staff notice anyone at your event displaying the following symptoms they willbe asked to leave: Fever or chills, cough, shortness of breath or difficulty breathing, fatigue, Muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea.
Not letting anyone from your event enter a City facility who has tested positive for COVID-19 unless at least 24 hours have passed since a fever of 100.4 degrees fahrenheit or higher has resolved without the use of fever-reducing medications; and COVID-19 symptoms have improved; and atleast 5 days have passed since COVID-19 symptoms first appeared or the date of specimen collection of the positive COVID-19 test, whichever is later.
The following is recommended but NOT required
e Try to avoid offering self-serve food or drink, such as buffets, salad bars, and drink stations.
B Discourage people from sharing items that are difficult to clean, sanitize, or disinfect.
Ihave read and understand the COVID-19 Checklist rules and regulations as they apply to my rentalstated above:
Print Name
Signature Date