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COUNTY OF HAWAI`I <br /> CONTINGENCY RELIEF FUNDS REQUEST <br /> TO: Office of the Prosecuting Attorney DATE: April 11, 2020 <br /> Department <br /> FROM: Karen Eoff, Council District 8 PHONE/FAX: 808/323-4279 <br /> Council Member <br /> A. REQUEST(ATTACH BACKUP INFORMATION,IF AVAILABLE) <br /> 1. AMOUNT: $10,000 2. To ACCOUNT#(i.e., 010.500.5503.02): 010.271.5271.02.115 <br /> 3. To ACCOUNT NAME (i.e., P&R Admin. Prosecuting Attorney OCE,Misc. Contract Services <br /> 4. PURPOSE(S)OF TRANSFER: For reimbursement of expenses to purchase PPE for the West Hawai`i <br /> Community Health Center, Inc., during the COVID-19 outbreak. <br /> 5. IF THE MONEY IS DESIGNATED FOR A NONPROFIT ORGANIZATION,NAME OF ORGANIZATION: <br /> West Hawai`i Community Health Center, Inc. 6. Is ITA 501(C)(3)? ®YEs El No <br /> *If YES,the IRS determination letter and the Nonprofit Conflict <br /> Disclosure Form must be attached to this request form. <br /> 7. COUNTY-RELATED PROGRAM(S)OR ACTIVITY(IES)TO BE FUNDED: COVID-19 Assistance <br /> 8. DEPARTMENTAL GOALS AND OBJECTIVES To BE ADDRESSED: To address emergency needs <br /> of the healthcare community by providing Personal Protection Equipment due to the COVID-19 crisis. <br /> 9. FUNDING TO BENEFIT THE PUBLIC-AT-LARGE(AS OPPOSED TO PRIVATE BENEFIT)? EYES ❑ 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 /> p�]APPROVE ❑DENY ❑DEFER: <br /> RATIONALE: <br /> } DATE: C-/ J <br /> e/j/0 <br /> Dep: ment Head <br /> C. MAYOR'S ACTION <br /> [APPROVED DENIED ❑DEFERRED: <br /> COMMENTS: <br /> p DATE: <br /> APR 1 5 2020 <br /> Managing D' "• fw. Mayor <br />