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COUNTY OF HAWAI`I <br />CONTINGENCY RELIEF FUNDS REQUEST <br />7/9/08 <br />TO: Research and Development <br />Department <br />FROM: Matt Kaneali `i-Kleinfelder <br />Council Member <br />A. REQUEST (ATTACH BACKUP INFORMATION, IF AVAILABLE) <br />DATE: 1012212024 <br />PHONE/FAX: 961-8674 <br />1. AMOUNT: 10,000 2. To ACCOUNT # (Le., 010.500.5503.02): <br />3. To ACCOUNT NAME (i.e., PAR Admin. OCE): <br />010.161.5163.20.115 <br />Business Development, Misc. Contract Services <br />4. PURPOSE(S) OF TRANSFER: Puna community outreach program to provide constituents with HIV, <br />HepC, and STI testing as well as support with health insurance, case management services/support <br />5. IF THE MONEY IS DESIGNATED FOR A NONPROFIT ORGANIZATION, NAME OF ORGANIZATION: <br />6. IS IT A 501(c)(3)? EYES ❑ No <br />Hawaii Island HIV/AIDS Foundation, *If YES, the IRS determination letter and the Nonprofit Conflict <br />dba Kumukahi Health and Wellness Disclosure Form must he attached to this request form. <br />7. COUNTY -RELATED PROGRAM(S) OR ACTIVITY(IES) TO BE FUNDED: Providing community with <br />Health clinic services, testing and housing referral project. <br />8. DEPARTMENTAL GOALS AND OBJECTIVES TO BE ADDRESSED: <br />Economic Development, Social, Community, and Environmental Well-being <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 />■ ►, <br />B. DEPARTMENT'S RECOMMENDATION: <br />/1APPROVE DENY ■D <br />RATIONALE: This project aligns with the department's objective to support social, community, and <br />Department Head <br />C. MAYOR'S ACTION <br />Q/APPROVED ❑ DENIED ❑ DEFERRED: <br />COMMENTS: <br />DATE: <br />Mayor <br />