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7!9/08 <br /> COUNTY OF AWAI`I <br /> CONTINGENCY RELIEF FUNDS REQUEST <br /> TO: Department of Liquor Control ATE: 1111012022 <br /> Department <br /> FROM: Ashley L. Kierkiewicz PHONE/FAX: 8536 <br /> Council Member <br /> A. REQUEST (ATTACH BACKUP INFORMATION,IF AVAILABLE) <br /> 1. AMOUNT: $2,500 2. TO ACCOUNT#(i.e., 010.500.5503.02): 010.251.5251.39.115 <br /> 3. TO ACCOUNT NAME (i.e., P&R Admin. OCE): Liquor Control- Publ Programs, Misc Contract <br /> 4. PURPOSE(S) OF TRANSFER: to support Kumukahi Health and Wellness in providing gift cards <br /> .for metals to individuals living with HIV <br /> 5. IF THE MONEY IS DESIGNATED FOR A NONPROFIT ORGANIZATION,NAME OF ORGANIZATION: <br /> 6. IS IT A 501(0)(3)? ®YES ❑ NO <br /> *If YES,the IRS determination letter and the Nonprofit Conflict <br /> Kumukahi Health and Wellness Disclosure Form must be attached to this request form. <br /> 7. COUNTY-RELATED PROGRAM(S)OR ACTIVITY(IES)TO BE FUNDED: Community engagement <br /> 8. DEPARTMENTAL GOALS AND OBJECTIVES TO BE ADDRESSED: to support public programs in a <br /> drug-and alcohol free environment <br /> 9. FUNDING TO BENEFIT THE PUBLIC-AT-LARGE(AS OPPOSED TO PRIVATE BENEFIT)? ®YES ❑ NO <br /> 10. IS THE PROGRAM OR ACTIVITY FUNDED ESTABLISHED BY CHARTER,ORDINANCE,OR DIRECTION <br /> OF THE MAYOR? ❑YES ®NO <br /> B. DEPARTMENT'S RECOMMENDATION: <br /> ®APPROVE ❑DENY ❑DEFER: <br /> RATIONALE: The Department of Liquor Control supports organizations that focus on the health and <br /> wellness of our community members through alcohol_free and drug free programs. <br /> DATE: V 2 2022 <br /> Department Head <br /> C. MAYOR'S ACTION <br /> APPROVED ❑DENIED ❑DEFERRED: <br /> COMMENTS: <br /> DATE: �) <br /> XovMayor <br />