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COUNTY OF HAWAII <br />CONTINGENCY RELIEF FUNDS REQUEST <br />TO: Liquor Control DATE: September 23, 2020 <br />Department <br />FROM: Ashley Kierkiewicz PHONE/FAX: (808) 961-8536 <br />Council Member <br />A. REQUEST (ATTACH BACKUP INFORMATION, IF AVAILABLE) <br />1. AMOUNT: $1,500 2. To ACCOUNT # (i.e., 010.500.5503.02): <br />010.251.5251.39.115 <br />7/9/08 <br />3. TO ACCOUNT NAME (i.e., P&R Admin. OCE): Liquor Control-Publ Programs; Misc Contract Svcs <br />4. PURPOSE(S) OF TRANSFER: Hawai `i Care Choices —.funding to create brochures to raise awareness <br />to Hawai `i Island Community regarding options at end of life. <br />5. IF THE MONEY IS DESIGNATED FOR A NONPROFIT ORGANIZATION, NAME OF ORGANIZATION: <br />6. IS IT A 501(c)(3)? xYES ❑ No <br />*If YES, the IRS determination letter and the Nonprofit Conflict <br />x Hospice of Hilo DBA Hawai `i Care Choices Disclosure Form must be attached to this request form. <br />1. COUNTY -RELATED PROGRAM(S) OR ACTIVITY(IES) TO BE FUNDED: Funding: Pohai Mdlama Care <br />Brochure to raise awareness and education of end of life choices <br />8. DEPARTMENTAL GOALS AND OBJECTIVES TO BE ADDRESSED: Provide Hawai `i Island residents <br />access to initiatives supporting `ohana with end of life needs <br />9. FUNDING TO BENEFIT THE PUBLIC -AT -LARGE (AS OPPOSED TO PRIVATE BENEFIT)? RYES ❑ NO <br />10. IS THE PROGRAM OR ACTIVITY FUNDED ESTABLISHED BY CHARTER; ORDINANCE, OR DIRECTION <br />r� T,:.. <br />THE MAYOR? ❑ YES X NO <br />B. DEPARTMENT'S ,RECOMMENDATION: <br />® �APPRQ:VE ❑ DENY ❑ DEFER: <br />RATIONALE::�..=The Department Of Liquor Control supports organizations that assist families to lead an <br />alcohol free, drug-free and healthier lifestyle during their time of need. <br />DATE: SEP 2 5 2020 <br />�j Department Head <br />C. MYOR'S ACTION <br />7 <br />APPROVED ❑ DENIED ❑ DEFERRED: <br />COMMENTS: <br />DATE: 9 19,9 la"Dao <br />Y KIM <br />