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Home My WebLink AboutCOM 0117.000 2014-2016Karen Eoff Council Member District 8 — North Kona January 29, 2015 HAWAII COUNTY COUNCIL County of Hawai `i West Hawai `i Civic Center, Bldg. A 74 -5044 Ane Keohokalole Hwy. Kailua -Kona, Hawai'i 96740 TO: Dru Mamo Kanuha, Council Chair and Members of the Hawaii County Council FROM: Karen Eoff Council Member, District 8� Iw RE: Contingency Relief Funds (District 8) Phone: (808) 323 -4280 Fax: (808) 329 -4786 Email: keoff @hawaiicounty.gov _a Contingency Relief funds from Council District 8 will be appropriated to the Department of Research and Development to provide a grant to West Hawaii Community Health Center, Inc., to purchase equipment, supplies, and furnishings for the Kealakehe Center. Attached is a resolution authorizing the transfer of $15,000 from the Clerk- Council Services — Contingency Relief account to the following account and project: FUNDING AMOUNT: FROM: $15,000 Clerk- Council SVC Contingency Relief 010.101.5101.91 KE /wpb Att. KRcs- Zg - k5) TO: Dept. of Research and Development HI Cty. Resource Center 010.161.5162.98 115 Misc. Contract Services (West HI Comm. Health Center, Inc.) Serving the Interests of the People of Our Island Hawai `i County Is an Equal Opportunity Provider And Employer Comm. No. Ref. To: Ref. Date JAN 2 9 7/9/08 COUNTY OF HAWAII CONTINGENCY RELIEF FUNDS REQUEST TO: Research and Development DATE: Department FROM: Karen Eoff, District 8 PHONE/FAX: Council Member A. REQUEST (ATTACH BACKUP INFORMATION, IF AVAILABLE) 1. AMOUNT: $15, 000 January 13, 2015 323 -4279 2. To ACCOUNT # (Le., 010.500.5503.02): 010.161.5162.98.115 3. To ACCOUNT NAME (Le., P &R Admin. OCE): HI Cry. Resource Center, Misc. Contract Svs. 4. PURPOSE(S) OF TRANSFER: To purchase equipment, supplies and furnishings, for the newest facility: West Hawai `i Community Health Center — Kealakehe 5. IF THE MONEY IS DESIGNATED FOR A NONPROFIT ORGANIZATION, NAME OF ORGANIZATION: West Hawai `i Community Health Center, Inc. 6. IS IT A 501(c)(3)? ® YES ❑ No *If YES, IRS determination letter must be attached to this form 7. COUNTY - RELATED PROGRAM(S) OR ACTIVITY(IES) TO BE FUNDED: R &D Integrated Resource Center 8. DEPARTMENTAL GOALS AND OBJECTIVES TO BE ADDRESSED: Support Hawai `i Island healthcare industry through partnerships. 9. FUNDING TO BENEFIT THE PUBLIC -AT -LARGE (AS OPPOSED TO PRIVATE BENEFIT)? EYES ❑ NO 10. IS THE PROGRAM OR ACTIVITY FUNDED ESTABLISHED BY CHARTER, ORDINANCE, OR DIRECTION OF THE MAYOR? ❑ YES ® NO B. DEPARTMENT'S RECOMMENDATION: IN ® APPROVE ❑ DENY ❑ DEFER: RATIONALE: These funds will assist in providing much needed access to healthcare services in West Hawai `i. DATE: 0112612015 Department Head C. MAYOR'S ACTION PPROVED ❑ DENIED ❑ DEFERRED: COMMENTS: DATE: JAN 2 9 2015 Mayor Exhibit A -1— Standardized Proposal Information DEPARTMENT OF RESEARCH AND DEVELOPMENT COUNCIL CONTINGENCY FUNDS Proposal Reference Number: (For Department Use) Name of Organization: West Hawai'i Community Health Center, Inc. Project Title: WHCHC at Kealakehe, Equipment, Supplies & Furnishings Mailing Address: 75 -5751 Kuakini Highway, Suite 203, Kailua -Kona, Hawaii 96740 Physical Address: 75 -5751 Kuakini Highway, Suite 203, Kailua -Kona, Hawaii 96740 Telephone: 331 -6472 Fax: 327 -1939 Organization E -Mail Address: lavery @westhawaiichc.org Federal Tax ID #: 200495394 General Excise Tax #: Lauren Avery, Director of Development Contact Name: and Marketing Title: Telephone: 331 -6472 Contact E -Mail Address: Amount Requested: Program Area (Please select just one). If different from above lavery @westhawaiichc.org $ 15,000.00 ❑ Agriculture ® Community Building ❑ Film Fax: If different from above ❑ Business Development ❑ Energy ❑ Tourism Project Summary: (brief description of the project including goals, objectives & outcomes ): The West Hawai'i Community Health Center, Inc., a 501(c)(3) nonprofit organization, that is completing construction of their newest facility at Kealakehe, named: West Hawai'i Community Health Center - Kealakehe. The request for funds is to purchase equipment, supplies and furnishings for its newest facilitv at Kealakehe. RD ED Contingency Funds Forms Word Proposal Reference Number: (For Department Use) Please answer the following questions: Yes No Is your organization registered as a nonprofit? ® ❑ Does your organization have a Board of Directors? ® ❑ Does your organization have a corporate seal? ❑ AUTHORIZED SIGNER(S) FOR AGREEMENT (organizational documents attached): Chief Executive Richard Taffe Officer December, 2014 Legal Name (type or print clearly) Title Date Term Ends Telephone (business) (residence) 326 -3878 Second Signer (if applicable): Legal Name (type or print clearly) Title Date Term Ends Telephone (business) (residence) NOTE: PLEASE SUBMIT THIS DOCUMENT COMPLETED AND SIGNED, WITH YOUR PROPOSAL RD ED Contingency Funds Forms Word Exhibit A -2— Project Budget Form DEPARTMENT OF RESEARCH AND DEVELOPMENT COUNCIL CONTINGENCY FUNDS Project Title: WHCHC at Kealakehe, Equipment, Supplies & Furnishings EXPENSES County Funding Requested Other Cash Sources In -Kind Contribution Value TOTAL EQUIPMENT and SUPPLIES: Pediatric diagnostic (thermoscan thermometers, BP cuff kit, other equipment for each of the 5 exam rooms 1,000 1,000 FURNISHINGS: Furniture for 2 Doctor'S Offices 8,000 8,000 Furniture for 1 Registered Nurse 3,500 3,500 Furniture for 1 Exam Room 2,500 21500 Administration — Maximum 10% of request TOTAL EXPENSES 15,000 15,000 Budget Narrative: (Summary of above listed expenses) RD ED Contingency Funds Forms Word WEST HA WAI `I COMMUNITY HEAL TH CENTER 75 -5751 Kuakini Hwy., Suite 203, Kailua -Kona, HI 96740 PHONE: (808) 326 -3878 / FAX.- (808) 3271939 EMAIL: lavery @westhawaiichc. org PROPOSED BUDGET for $15, 000 of CONTINGENCY RELIEF FUNDS FROM KAREN EOFF, COUNCIL DISTRICT 8, FOR THE WEST HA WAI `I COMMUNITY HEAL TH CENTER — KEALAKEHE January 14, 2015 For EQUIPMENT, SUPPLIES and FURNISHINGS as follows: EQUIPMENT and SUPPLIES: $1,000 Pediatric diagnostic (thermoscan thermometers, BP cuff kit, other equipment for each of the 5 exam rooms) FURNISHINGS: $14,000 Furniture for doctor offices — 2 @ $4, 000 Furniture for Registered nurse — I @ $3,500 Furniture for Exam Rooms — I @ $2,500 TOTAL: $15,000 Exhibit A- 3--- Proposal Submission Acknowledgement DEPARTMENT OF RESEARCH AND DEVELOPMENT COUNCIL CONTINGENCY FUNDS ACKNOWLEDGEMENT I, the undersigned, hereby certify that the information provided in this County of Hawaii, County Council Contingency Fund Request has been reviewed in its entirety and the affixed signature accepts responsibility on behalf of said organization to inform its members of the content herein. All terms and conditions shall be a part of any contract entered into as a result of this proposal. Richard Taaffe Name (please type or print clearly) Chief Executive Officer Title ignature Date PLEASE SUBMIT THIS DOCUMENT COMPLETED AND SIGNED, WITH YOUR PROPOSAL RD ED Contingency Funds Forms Word William P. Kenoi Mayor fOFCF vE 7015 AN 27 PM 3 *2D OFFICE CF THE MAYOR C NTfrq'jrV` N5 Y ._ ILL- V County of Hawai "' i DEPARTMENT OF RESEARCH AND DEVELOPMENT 25 Aupuni Street, Room 1301 • Hilo, Hawai' i 96720 -4252 (808) 961 -8366 • Fax (808) 935 -1205 E -mail: chresdev @co.hawaii.hi.us TRANSMITTAL LETTER Date: January 27, 2015 To: Office of the Mayor (via inter - office pouch) From: Dorthi "Dot' Botelho -Kaili Private Secretary dbotelhokaili(a)-co. hawaii. hi. us Re: COUNCIL MEMBER EOFF: Council Contingency Relief Funds Requests Attached hereto: Laverne R. Omori Director Donn S. Mende Deputy Director 1. One (1) original, completed and executed CONTINGENCY RELIEF FUNDS REQUEST packet from COUNCIL MEMBER EOFF Re: West Hawaii Community Health Center. J Urgent ❑ Per Request ❑ Please Comment ❑ Please Reply Please note: Aloha, If at all possible, please RUSH process. Upon approval, please send to Leg. Auditors as Council has tight deadline to make a specific agenda. Mahalo nui! Hawaii County is an Equal Opportunity Provider and Employer