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7/9/08 COUNTY OF HAwAI`I CONTINGENCY RELIEF FUNDS REQUEST TO: Department of Liquor Control DATE: 1111119 Department FROM: Ashley L. Kierkiewicz PHONE/FAX: 961-85361 f 961-8912 Council Member A. REQUEST(ATTACH BACKUP INFORMATION,IF AVAILABLE) 1. AMOUNT: $2,500.00 2. To ACCOUNT#(i.e., 010.500.5503.02): 010.251.5251.39.115 r 3. To ACCOUNT NAME (i.e.,P&R Admin. OCE): LiquorControl-Public Programs, 11 fisc Contract Svcs 4. PURPOSE(S)OF TRANSFER: Providing food for Hawai`i Island residents-Keik-i Backpack program Pilot(Ho`oulu Na Keiki `o Hawai`i)with Kua O Ka La Public Charter School students through Bodacious Women of Pahoa 5. IF THE MONEY IS DESIGNATED FOR A NONPROFIT ORGANIZATION,NAME OF ORGANIZATION: 6. IS IT A 501(c)(3)? ®YES ❑ No *If YES,the IRS determination letter and the Nonprofit Conflict The Food Basket, Inc. Disclosure Form must be attached to this request form. 7. COUNTY-RELATED PROGRAM(S)OR ACTIVITY(IES)TO BE FUNDED: Funds to support the Keiki Backpack initiative pilot—feeding 110 public school students monthly during the 2019-20 school year 8. DEPARTMENTAL GOALS AND OBJECTIVES TO BE ADDRESSED: Drug&alcohol free initiative Providing Hawai`i Island residents in need with food donations (health, safety, and welfare). 9. FUNDING TO BENEFIT THE PUBLIC-AT-LARGE(AS OPPOSED TO PRIVATE BENEFIT)? ®YES ❑ NO 10. IS THE PROGRAM OR ACTIVITY FUNDED ESTABLISHED BY CHARTER,ORDINANCE,OR DIRECTION OF THE MAYOR? ❑YES ®NO B. DEPARTMENT'S RECOMMENDATION: ®APPROVE ❑DENY ❑DEFER: RATIONALE: The Department of Liquor Control supports drug-free and alcohol-free programs that P, promote health, safety and we fare of the community. .. 06 DATE: NOV Departmint He , 3 'C. MA R'S ACTION co APPROVED ❑DENIED ❑DEFERRED: FtCD I COMMENTS: DATE: Managing Director Mayor