HomeMy WebLinkAboutCOM 0566.000 2016-2018 •.rarfoldury pun JaplaoJd(f71unmoddo pvnbq uv s1 (luno)1,Inn1"H
---11f217770-G4Da 4961,1
'Ol 'dab
�C•-I -11g1 'Sn>
1W
ig:Og
(«punct pa.insuiun„
—JOTua3 powaw ici.F.Inuttuop fund)
saoln.IaS J.o14uoD •asm S I t
867915'191'O10 i6'tOIS'i0I'OiO
Jalua3 aomosa'l i 3 IH Jaliau Aoua2upuo3
000`5$ wauzdoianaG puu II0.1U0s321lo ldac DAS I?a 0D-3I'ai3
:ZNI 01AIV ONIQNIld :O,.L :YA1021d
:loafozd puE Tun000u ulnnojjoJ alfa Tun000v Jatja2l Aoua5uguo3—saoluaS
jtouno3-3pai0 alit uzozj 000`S$jo.Iajsuu..4 a4 2umiotp.nu uopnjosa1 pull asiaid pagan y
„•punj pamsutun„ ski
jioddns ialuaj polpaJ,s A4Iunu .To0 Fund ol.I.ue.z2 apinoid ivauzdofanaG puu Ijo.masa21
jo Tuaullludo paTeuzdo.Iddu aq IBM'b TopsIG fiounoD uzo.Iu spunj Jatfag ifoua2upuo0
(f,Toil.sm ftouno0) spund jana2i Aoua5upuo0 :,L3afafl.S
Topism f!OUnOD
JaquTJA fiouno0 '1H0 uaapg IW :JAIME
flouno3 Auno0 I umtH alp jo s.Iagumaw pug
L< .7113 llounoD `Japcapulod Z aliapA :OZ
c.) LtOZ `SZ.10g0100 :MINCE
- .. cy
Q
'jam c ZI,68-1.96(808) xed • 99Z8-I.96 (808)
OZL96 !,1eMeH.`oI!H • Z0171- al!nS `TaaJTs !undny gZ
/ puno3 cf;uno3 hinctivll-
1,!nettnH J0 djUYIOd
eajlwwoo Atlllgeuletsns .
• -'��H i°�';:•�• as iwwo uewefieue
�ffireu3?aajeM eirmnoufiy ;:��,M t%O ,.1,1+ �l. W
• pue aa. lwwoo fiuluueld :aie4O a°in . c - `, lejuewuonnu3 :a!ey3
-.moi:=- =
• ��..�+• t�
no6.Alunoo!!emey@eaego.ueep :llew3 louislp llounoo� as wa iouno
2668-696 (808) :xed ••.•.`Mi..::�.;,o� g W L
Z6LZ-996 (808) :euoyd "'�"1 eaeHLO uae i3
7/9/08
COUNTY OF HAWAI`I
CONTINGENCY RELIEF FUNDS REQUEST
TO: Research and Development DATE: October 12, 2017
Department
FROM: Eileen O'Hara PHONE/FAX: 965-2713
Council Member
A. REQUEST(ATTACH BACKUP INFORMATION,IF AVAILABLE)
1. AMOUNT: $5000 2. To ACCOUNT#(Le., 010.500.5503.02): 010.161.5162.98.115
3. To ACCOUNT NAME (i.e., P&R Admin. OCE): HI Cty Resource Center Misc. Contract Svs.
4. PURPOSE(S)OF TRANSFER: Financial assistance to Puna Community Medical Center for its
"Uninsured Fund"
5. IF THE MONEY IS DESIGNATED FOR A NONPROFIT ORGANIZATION,NAME OF ORGANIZATION:
6. Is ITA 501(C)(3)? E YES ❑ No
*If YES,the IRS determination letter and the Nonprofit Conflict
Puna Community Medical Center Disclosure Form must be attached to this request form.
7. COUNTY-RELATED PROGRAM(S)OR ACTIVITY(IES)TO BE FUNDED: Resource Center
8. DEPARTMENTAL GOALS AND OBJECTIVES To BE ADDRESSED: To idents social economic
community based needs and promote collaborations that identify solutions to support economic growth for the community
9. FUNDING TO BENEFIT THE PUBLIC-AT-LARGE(AS OPPOSED TO PRIVATE BENEFIT)? EYES El 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: This project aligns with the mission of this department wherein community needs are
identified and collaborations made for social economic growth for the community
oZ°- DATE: /0A9-7/7
Department Head
C. MAYOR'S ACTION
APPROVED ❑DENIED ❑DEFERRED:
COMMENTS:
/ r/1
DATE: •
Managing Director