HomeMy WebLinkAbout87-114California State Department of Gexzeral Services
Surplus Property
140 Commerce Circle
Sacraraeztto; CA 95815
SP Form No. 202 (287}
RESOLUTION Np. 8T-ll4
"BE IT RESOLVED by the Governing Board, OR by the Chief Administrative Officer of those organizations which do not
have a governing board, and hereby ordered that the official(s) andfor employee{s) whose name(s), title(s), and signature(s)
are listed below shall be and is (are) hereby authorized as our representative{s) to acquire federal surplus property from the
California State Agency for Surplus Property under the Terms and Conditions listed on the reverse.side of this form."
NAME TITLE SIGNATURE
{Print or type.)
A
B
OR
Thoina.s B. Struthers
Patricia Dur,~,a~,
Purchasing Office / _
_ -, _ ~
PASSED AND ADOPTED this 4th day of Augusi- ,,,,,,, , _,_„ , 19_ -_87 -- , by the Governing Board of
Superv.i.sors of the County_of_Butte_
_ _ _-
by the following vote: Ayes: 4 ;Noes: 0 ;Absent: ~. ~~
I, . _MARTIf~_J. NICh[0L5 ,Clerk of the Coverning.Boardof
S~perv sots , County of Butte da hereby certify that the foregoing is a full, true, and
correct copy of a resolution adopted by the Board at a - _ Re ~~ i 1 & r' meeting thereof held at its regulm~ place of
meeting at the date and by the vote above stated, which resolution is on file in the offrce of the Board.
COUNTY OF BU111TE
Name of organization
u t enter Drive
Maai!'n~ address
OrovilZe, California 90965
City County ~ZIi' code
MARTI~1 J . ~fICHOI.S, Chief Adrfli nistra-
tive Officer d Clerk of the Board
(Signed) By
deputy Clerk
C. AUTHORIZED this day of
19 , by:
Name of chief administrative officer Title
Name of organization
Mailing address
(Signed)
City County Zip code
NOTE: IF YOU HAVE A GOVERNING BOARD, SECTIONS "A" AND "B"' SHOULD BE COMPLETED.
IF YOU D~ NOT HAVE A GOVERNING BOARD, SECTIONS "A" AND "C" SHOULD BE COMPLETED.
I ~L~
California Department of General Servi~
State Agency for Surplus Property New
140`Commerce Circle
Sacramento, CA 95815 STATE OF CALIFORNIA Renewal Y~
OSP Farm No. 201 (7/84) APPLICATION FOR ELIGIBILFTY
FEDERAL SURPLUS PERSONAL PROPERTY PROGRAM
Before preparing this application, please read carefully the definitions given under Part B. Fill out aII appliczble sections.
Part A.
Legal name of organizatio Gt3'tt~;r.` 'Q`~ Dt.,Lf,~~ .Telephone ~~~~~ ~~~ ~726~.
Addre ~ ~ Gt~~=t~~7 'h ity `'~ Coun#y t' iP
1. Application is being made as a (please check one) {a} Public agency~ar (b) Private, nonprofit and tax-exempt educational or
public health organization ^. Please provide evidence that the organization is a public agency or enclose a cogy of the letter or
certificate from the United States Internal Revenue Service evidencing tax-exemption under Section 501 of the Internal Revenue
Code of 1954.
2. Check type of agency or organization and attach a supplement to this application describing the program operations and activities.
.For private, nonprofit organizations, the following additional information is required: (a} For educational institutions, include a
description of the curriculum, the number of days in the school year, and the number and qualification of the faculty or staff;
(b) if a public health institution or organization, include a description of the health services offered, qualificatons of staff and,
if applicable, the number of beds, number of resident physicians, and number of registered nurses on the staff.
PUBLIC AGENCIES: Check either state ^ or iocal$I~
^ Conservation
^ Economic development
^ Education
NONPROFIT INSTITUTION OR ORGANIZATION:
^ Education
Grade level
[Preschool, uruveraity)
Grade le~~~ _ Enrallmen±
(Preschool, university) No. of school sites- - --
Enrollment ^ School for the mentally or physically handicapped
No. of school sites ^ Educational radio or television station
^ Parks and recreation ^ Museum
^ Public health ^ Library
^ Public safety ^ Medical institution
~C~I'wo or more of above ^ Hospital
lather (specify) =~~'• G t' " 'S ~~ ^ Health center
^ Clinic
^ Other {specify}
3. Check if the applicant program is approved ^; accredited ^; or licensed ^. Enclose evidence of such approval, accreditation, or
licensing. If the applicant lacks evidence of formal approval, accreditation, or licensing, check here ^ and refer to the enclosed
instructions.
4. Are the applicant's services available to the public at large? ~~-'~ . ff only a specified group of people is served, please indicate
who comprises this group.
5. Checklist of attachements submitted with this application: ~~.1 ~.te?~ ~u~rr~~t:~~ o~ ~~.,~,~+.
^ Evidence that applicant's program is a public agency or exempt from paying taxes under Section 50I of the IRS Code of 1954.
^ Description of program operations and activities.
^ Evidence of approval, accreditation, or licensing or information submitted in lieu thereof.
^ SASP 1~orm No. 202., "Resolution," properly signed, designating representatives authorized to bind the applicant to the terms
and conditions governing the transfer of federal suplus persona! property.
^ SASP Form No. 263, nondiscrimination compliance assurance.
^ Statement concerning applicant's needs, resources, and ability to utilize the property.
^ Other statements ar documentation required, as specified in the~nstruction, for certain categories of applicants.
r~rp- -f~A~' .~ /~l'g7 S;vr,ed~%~zG 1~lx~.t..~~ Title: ~ii~C~r~v.~.Yl'° C)~"~'~.C~~
FOR STATE AGENCY USE
Application approved: pplication disapproved:
Comments or additional information:
Date; Signed:
Director