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AGENDA ITEMS ON FILE FOR CONSIDERATION R E C E I V E D
� AT THE SPECIAL MEETING OF I CIN OF LYNWOOU I
THE LYNWOOD CITY COUNCIL Crrv c�[ai<s oF�icE
• TO BE HELD ON OCTOBER 14, '1999
9:30 A.M. OCi �: 19Sy
BATEMAN HALL � �
7i8i9iniff�lPi1�2�si4i5
RICARDO SANCHEZ �n��L�, � �1
MAYOR
LOUIS BYRD ARMANDO REA
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MAYOR PRO-TEM COUNCILMEMBER
ARTURO REYES PAUL H. RICHARDS, II
COUNCILMEMBER COUNCILMEMBER
CITY MANAGER CITY ATTORNEY
' RALPH W. DAVIS, III SHAN THEVER & ASSOCIATES
CITY CLERK CITY TREASURER
ANDREA L. HOOPER IRIS PYGATT
OPENING CEREMONIES ;
1. CALL TO ORDER
2. ROLL CALL OF COUNCIL MEMBERS '
Louis Byrd '
Armando Rea �
Arturo Reyes '
PdUI RICh2rd5 i
Ricardo Sanchez '
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3. CERTIFICATION OF AGENDA POSTING BY CITY CLERK I
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PUBLIC ORAL COMMUNICATIONS '
(Regarding Agenda Items Only) �
PUBLIC ORAL COMMUNICATIONS j
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IF AN ITEM IS NOT ON THE AGENDA, THERE SHOULD BE NO SUBSTANTIVE
DISCUSSION OF THE ISSUE BY THE COUNCIL, BUT IT IS ALL RIGHT FOR
COUNCIL TO REFER THE MATTER TO THE STAFF OR SCHEDULE �
SUBSTANTIVE DISCUSSION FOR A FUTURE MEETING.
(The Ralph M. Brown Act, Government Code Section 54950-54962, Part
III, Paragraph 5J �
•'�'°' CONSENT CALENDAR � ;
. NONE �
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DISCUSSIO ITEMS
4. LAW ENFORCEMENT SERVICES
Comments:
Sheriff Baca will be available to speak to the City Council on
issues relating to law enforcement.
Recommendation:
Staff respectfully recommends for the City Councif to receive
and file a presentation from Sheriff Baca.
5. FISCAL YEARS 1999-2004 MUNICIPAL LAW ENFORCEMENT SERVICES
AGREEMENT
Comments:
The current five•year Law Enforcement Services Agreement
between the City and the Los Angeles County terminated on
June 30, 1999. Pursuant to Section 8 of the current agreement,
the agreement may be renewable for another five years.
Recommendation:
Staff recommends for the City Council to authorize the Mayor
to execute the City County Municipal Law Enforcement Services
Agreement with the Los Angeles County.
6. SPECIAL PERMIT - ST. FRANCIS MEDICAL CENTER
Comments: �
St. Francis Medical Center plans to have a Drive-Up Flu
Vaccination Program for the community on Saturday, October '
23, 1999 from 9a.m. - 3p.m. and expects to serve around 2,000 �
people in Lynwood and its surrounding areas. St. Francis '
Medical Center would like to request for a special permit to
hold this event at the Caesar Chavez Lane. �
Recommendation: '
It is recommended that the City Council 1) review and approve ,
the special permit and 2) instruct city staff to work with the
staff from St. Francis Medical Center to ensure all maintenance �
and precautionary measures.
CLOSED SESSION
7. CLOSED SESSION ITEMS
A. With respect to every item of business to be discussed fn ;
closed session pursuant to Section 54957: '
PUBLIC EMPLOYMENT a ;
Title: Director of Recreation and Community Services �
ADJOURNMENT �
MOTION TO ADJOURN TO A REGULAR MEETING TO BE HELD ON OCTOBER
19, 1999 AT 6:00 P.M. IN COUNCIL CHAMBER ROOM, CITY HALL, CITY OF �
LYNWOOD, CALIFORNIA. '
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DATE: October 14, 1999
TO: THE HONORABLE MAYOR AND MEMBERS OF THE CITY COUNCIL
FROM: RALPH W. DAVIS III, CITY MANAGER
SUBJECT: FISCAL YEARS 1999-2004 MUNICIPAL LAW ENFORCEMENT
SERVICES AGREEMENT
PURPOSE:
To have the City Council adopt a resolution to renew a five-year law enforcement
contract with the Los Angeles County.
BACKGROUND:
In June 1994, the City Council approved a five-year law enforcement services
agreement with the Los Angeles County. The current agreement will expire on June
30, 1999. In order to have the Los Angeles County Sheriff's Department continue to
provide law enforcement services to the City, the City must notify the Board o(
Supervisors by resolution.
ANALYSIS:
Proposed Aqreement Terms
Pursuant to Paragraph 8 of the current Law Enforcement Services Agreement with the
Los Angeles County, the contract may be renewable for a period not to exceed five
years. The proposed agreement if approved would have the Los Angeles County
Sheriffs Department continue to provide general law enforcement services within the
City limits. ;
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The are no significant changes contained in the proposed Agreement as submitted by i
the County, other than the following minor stipulation: i
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. Late payment considered after 60 days of date of invoice instead of 30 days.
The City Attorney has reviewed the proposed Agreement and recommended for the �
Counry to add the following language to Paragraph 2 of the proposed Agreement as �
second to the last sentence to read as follows: i
'The Shen/f shall use rts best ef/orls to accommodate the City's reasonable ,
concems over the necessity and cost of the level o/ services provided by the i
Counfy and to accommodate the City's reasonable concerns over the impact on
the City o/ the manner o/ perlormance o/ services provided by the County." �
The inclusion of this language will provide the City a betler leverage in resolving !
disputes with the County in reference to level of services. '
On August 26, 1999, the Sheriff's Department forwarded a revised Agreement that i
included the proposed revised language to Paragraph 2. i
Increase in Contract Rates
The contract rates on the Sheriff services vary annually. The rates for FY 1999-2000
represent a 2% increase from last fiscal year. The liability rate remains at 6°k. �
RECOMMENDATION: !
Staff recommends for the City Council to authorize the Mayor to execute the City - �
County Municipal Law Enforcement Services Agreement with the Los Angeles County.
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RESOLUTION NO.
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF LYNWOOD,
CALIFORNIA AUTHORIZING THE MAYOR TO EXECUTE THE CITY-COUNTY
MUNICIPAL LAW ENFORCEMENT SERVICES AGREEMENT WITH THE LOS
ANGELES COUNTY
WHEREAS, it is the City's goal to promote the safety of the community, and a
feeling of security among the citizens, through deterrence/prevention of crime and
apprehension of offenders, and
WHEREAS, the City Council of the City of Lynwood engages the Los Angeles
County Sheriffs Department as its general law enforcement agency; and
WHEREAS, the contract for such services is renewable in five year increments
at the option of the Board of Supervisors with the consent of the City; and
NOW THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF
LYNWOOD AS FOLLOWS:
SECTION 1. That the Mayor is authorized to execute the agreement by
and between the City of Lynwood and County of Los Angeles entitled "City-
County Municipal Law Enforcement Services" for the provision of basic law
enforcement services to the City of Lynwood by the Los Angeles County.
SECTION 2. That this agreement shall be effective July 1, 1999 and
remain in effect until June 30, 2004. I
SECTION 3. That this Resolution takes effect immediately. I
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PASSED, APPROVED AND ADOPTED this day of , 1 ggg, i
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Ricardo Sanchez, MAYOR '
City of Lynwood �
ATTEST: j
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Andrea L. Hooper, City Clerk Ralph W. Davis III, City Manager �
APPROVED AS TO FORM: �
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Ciry Attomey �
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SHERi:992 �
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1 � CITY-COUNTY
MUNICIPAL LAW ENFORCEMENT SERVICES AGREEMENT
2
3
4 THIS AGREEMENT, dated for purposes of reference only,
5 , 199_, is made by and between the
6 COUNTY OF LOS ANGELES, hereinafter reEerred to as "County," and the
7 CITY OF , hereinafter referred to as "City".
8 RECITALS:
9 (a) The City ia desirous of contracting with the County for the
10 Y performance of the hereinafter described law enforcement functions
11 within ita boundaries by the County of Los Angeles through the Sheriff
12 thereof.
13 (b) The County of Los Angeles is agreeable to rendering auch
14 aervicea on the terms and conditions hereinafter set forth.
15 (c) Such contracts are authorized and provided for by the
16 provisions of Section 56-1/2 and 56-3/4 of the Charter of the County
17 of Los Angeles and Article 1, Chapter 1, Part 2, Division 1, Title 5 i
18 of the Government Code of the State of California. i
19 THEREFORE, THE PARTIES M(ITUALLY AGREE AS FOLLOWS: �
20 1. The County agrees, thro�gh the Sheriff of the County of Los '
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21 Angelea, to provide general law enforcement services within the �
22 corporate limita of City to the extent and in the manner hereinafter i
23 aet forth.
24 Except as otherwise hereinafter specifically set forth, such
25 aervicea ahall only encompass duties and functions of the type coming j
26 within the jurisdiction of and customarily rendered by the Sheriff of
27 the County of Los Angeles under the Charter of said County and
28 etatutes of the State of California, and under the municipal codee of
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1 the city for which the Sheriff's aervices are provided.
2 2. During the term of this agreement, the'Sheriff or his
3 designee shall serve as Chief of Police of the City and shall perform
4 the functions of the Chief of Police at the direction of tt�e City.
5 The rendition of the services performed by the Sheriff's Department,
6 the etandards of performance, the discipline of officers, and other
7 mattera incident to the performance of such servicea and the control
8 of peraonnel so employed shall zemain with the County. �n
9
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13 The Sheriff ehall use hie beet i
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14 effort� to acco�odate the City'e reaeonable concerae over the �
15 neceeeity aad coet�of the'level of eervlcee provided by the County an� ;
16 to acc�odate the City'e reaeonable concerne over the impact on the ,
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17 City of the manner of performance oi eervicee provided by the Couaty. 'I
18 The Sheriff, in an unresolved dispute, shall have final and conclusive '
19 determination ae between the partiea hereto. ;
20 3. General law enforcement services performed hereunder may '
21 include, if requested by the City, traffic enforcement, license I
22 inspection and enforcement, the supplying of crossing guards, crime �
23 preve�tion, community service officers, and law enforcement education i
24 programs. The City is not limited to the foregoing services, but may �
25 also request any other service in the field of public safety, law, or '
26 related fields within the legal power of the Sheriff to provide.
27 If the City deaires to receive general law enforcement services,
28 the City ahall notify the Board of Supervisors by resolution of the
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1 City Council indicating its desire and that the Sheriff is willing to
2 provide such services. Should the City desire to receive any service
3 from tlie Sheriff not specifically listed above, the City Council, by
4 resolution, must indicate that the SheriEf is willing to provide siicti
5 services.
6 4. For the purpose of performing said functions, County shall
7 furniah and supply all neceasary labor, supervision, equipment,
8 communication facilitiea, and aupplies necessary to maintain the
9 agreed level of service to be rendered hereunder. Notwithstanding the
10 foregoing, the City may provide additional resources for the County to
11 utilize in performance of the services.
12 Wtien and if both parties to this contract concur as to the
13 necessity of maintaining a law enforcement headquarters within said
14 City which would not normally be provided by the Sheriff, the City
15 shall furnish a[ ita own cost and expense all necessary office space,
16 furniture and �furnishings, office supplies, janitor service,
17 telephone, light, water and other utilities. It is expressly further �
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18 underetood that in event such local office is maintained in said City, I
19 such quarters may be used by the Sheriff of the County of Los Angeles �
20 in connection with the performance of his duties in territory outside �
21 of the City, provided, however, that the performance of such outside j
22 duties shall not be at any additional cost to the City.
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23 Notwithstanding the foregoing, i[ is mutually agreed that in all
24 inetances where special supplies, sta[ionery, notices, forms, and the
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25 like must be issued in the name of said City, the same shall be
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26 aupplied by the City at its own cost and expense.
27 5. All persons employed in the performance of such services and ;
28 functiona pursuant to this agreement for the City shall be County �
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1 employees, and no City employee as such shall be taken over by said
2 County, unless by epecific additional agreement in the form of a
3 merger contract which must be concurrently adopted by the City and
4 County. No person employed hereunder for law enforcement service in
5 the City shall have any City pension, civil service, or any status or
6 right.
7 For the purpose of performing services and functions, pureuant to
9 thie agreement and only for the purpose of giving official status to
9 the performance thereof, every Co�nty officer and/or employee engaged
10 in performing any such service and function shall be deemed to be an
11 officer or employee of the City while performing such service for the
12 City, which aervice is within the scope of this agreement and is a ,
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13 municipal function. �
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14 6. The contracting City shall not be called upon to assume any �
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15 liability for the direct payment of any Sheriff's Department salaries,
16 wagee, or other compensation to any County personnel performing I�
17 aervices hereunder for said City.
18 Except as herein otherwise apecified, the City shall not be �
19 liable for compensation or indemnity to any County employee or agent �
20 of the County for injury or sickness arising out of his/her employment I
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21 as a contract employee of the City. i
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22 7. The parties hereto have executed an Assumption of Liability �
23 Agreement approved by the Board of Supervisors on December 27, 1977, ,�
24 and/or a Joint Indemnity Agreement approved by the Board of j
25 Supervisors on October 8, 1991, and/or a revised Joint Indemnity !
26 Agreement approved by the Board of Supervisors on August 9, 1993. �
27 Whichever of theae documents the City has signed later in time is '
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2B currently in effect and hereby made a part of and incorporated into
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1 thie agreement as if set out in full herein. In the event the Board
2 of Supervisors later approves a revised Joint Indemnity Agreement and
3 the City executes the revised agreement, the subsequent agreement
9 as of its effective date shall supersede the agreement previously in
5 effect between the parties hereto.
6 8. Unless sooner terminated as provided for herein, this
7 agreement ehall be effective July 1, 1999 and shall remain in effect
8 until June 30, 2004. At the option of the Board of Supervisors and
9 with the consent of the City Council, this agreement may be renewable
10 for aucceaeive periods of not to exceed five years each.
11 Notwithstanding the provisions of this paragraph hereinbefore set
12 forth, either party may terminate this agreement as of the first day
13 of July of any year upon notice in writing to the other party of not
14 less ttian sixty (60) days prior thereto.
15 Notwithstanding any provision herein to the contrary, the City may
16 terminate this agreement upon notice in writing to the County given
17 within sixty (60) days of receipt of written notice by the County of ,
18 any increase in the rate for any service to be performed hereunder, �
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19 and in auch an event this agreement shall terminate sixty (60) i
20 calendar days from the date of the City's notice to the County
21 aforementioned. �
22 9. General law enforcement services will be provided by County on
23 the basis of a law enforcement service unit, or multiple or fraction '
24 thereof. IC is hereby agreed that the minimum level basic law �
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25 enforcement service shall be mutually agreed to by both the City and �
26 the County as provided in Paragraph 2 herein. �
27 Notwithstanding any provision herein to the contrary, the City may �
28 requeat a reduction in the level of law enforcement service provided �
5
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1 by County to occur within sixty (60) days of receipt of written notice
2�by the County of any increase in the rate for any service to be
3 performed hereunder.
4 10. The City ahall pay for such service or services as are
5 required and requested and provided under the terms of this service
6 agreement at the rate establiahed by the Auditor-Controller.
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1 SHERIFF'S DEPARTMENT'S CONTRACT CITY LAW ENFORCEMENT RATES
FISCAL YEAR 1999-2000
2
3
- YEARLY LIABII.ITY•
4 SERVICE UNIT t�TE 3 6� TOTAL
S
6 D�puty 9hariff 9�rvic• Onit
7 One Deputy, No-Relief 5 139,142 S 8,348.52 5 147,490.52
One Deputy, 40 Hour 156,038 9,362.28 165,400.28
8 One Deputy, 56 Hour 218,453 13,307.18 231,560.18
One Depu[y, B4 Hour 327,680 19,660.80 347,340.80
9 1WO Deputy, 40 hour 312,076 �8,724.56 7J0,800.56
T�ro Deputy, 56 hour 436,906 26,214.36 463,120.�6
10
11 D�puty 9h�zlff 9�rvle• On1t IHOnus I)
12 One Deputy, No-Relief 148,391 8,901.46 157,294.46
One Deputy, 40 Houz 166,410 9,984.60 176,J94.60
13 One Deputy, 56 Hour 232,974 13,978.44 246,952.44 I
One Deputy, 84 Hour 349,461 20.967.66 370,428.66 I
14
15 B�rg�ent (Supplamentel) 119,483 N/A 119,483.00 I
16 �
9uppl�m�ntal 8upport 9�rvic• Onit• �
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17 '
Hatch Deputy 97,289 S,B7�.34 103,126.]4 .
18 Law Enforcemen[ Technician 51,047 3,062.82 54,109.82 ;
Custody Assistant 58,211 3,492.66 61,703.66 .
19 '
20 Hiecellmeoue 9ervic• Dn1te �
21 STAR Deputy (formerly SANE) B6,3B4 N/A B6,3B4.00 �
Croseing G�ard (hourly) 9.96 0.60 10.56 �
22 License DeCail (hourly) 57.28 7.44 60.72 ;
l
23
Co�unity 9ervice Officsr �
24
i
With Vehicle 30,226 1,813.56 32,0)9.56 I
25 WiChaut Vehicle 24,�75 1,486.50 26,261.50 �
�
26 '
Orowth D�puty 92,790 5,567.40 98,357.40 �
27
•This amount is in eatisfaction of the city's liability under the Assumption of
28 Liability Agreement. '
7 ;
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1 The foregoing rates shall be readjusted by the County nuditor-
2 6ontroller annually effective July 1 of each year to reflect the cost
3 of such service in accordance with the policies and procedures for the
4 determination of auch rate as adopted by the Board of Supervisors of
5 County.
6 11. The coat of other services requested pursuant to thie
7 agreement and not eet forth in Paragraph 10 ahall be determined by the
8 Auditor-Controller in accordance with the policies and procedures
9 establiahed by the Board of Supervisors of County.
10 12. The County, through the Sheriff of the County of Los
11 Angelea, ahall render to eaid City within ten days after the close of
12 each calendar month a summarized invoice which covers all services
13 performed during said month, and said City shall pay County therefor
14 within aixty (60) days after date of said invoice.
15 If such payment is not delivered to the County office which is
16 described on said invoice within sixty (60) days after the date of the
17 invoice, [he Coun[y is entitled to recover interest thereon. Said 'I
18 interest shall be at the rate of ten (10) percent per annum or any I
i
19 portion thereof calculated from the last day of the month in which the �
20 aervices were performed. I
21 13. Notwithatanding the provisions of Government Code Section �
22 907, if such payment is not delivered to the County office which ie �
23 deacribed on said invoice within sixty (60) days after the date of the ;
I
24 invoice, the County may satisfy such indebtedness, including interest
25 thereon, from any funds of the City on deposit with the County without �
26 giving further notice to City of County's intention to do so.
27 14. As part of its compliance with all applicable laws and !
28 regulations relating to employee hiring, the County agrees that the '
8 �
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1 County Civil Service Rules to which it is subject and which prohibit
2 discrimination on the basis of non-merit factors, shall for purposes
3 of this contract be read and understood to prohibit discrimination on
4 the basis of sexual orientation.
5 ///
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1 IN WITNESS WHEREOF, the City of , by resolution
2 duly adopted by its City Council, caused this agreement to be signed
3 by its Mayor and attested to by its Clerk, and the County of Los
4 Angelea, by order of its Board of Supervisors, has caused these
5 presenta to be aubscribed by the Chairman of said Board to be affixed
6 thereto and atteated by the Clerk of said Board, all on tlie day and
7 year first above written.
e CITY OF
9
By
10 Mayor
11 COUNTY OF LOS ANGELES
12
By
13 Chair, Board of Supervisors
ATTEST:
14
15
City Clerk
16
ATTEST:
17
JOANNE STURGES
18 Executive Officer/Clerk of
the Board of Supervisors
19
2o By
Deputy
21
APPROVED AS TO FORM:
22
LLOYD W. PELLMAN �
23 County Counsel
24
By '
25 Deputy !
26 '
27
28 I
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INTER-OFFICE A1[MORANDUM
Datc: Octobcr 12, 1999
To: Honorable hiayor anJ Council h1cmbcrs
From: Ralph \\'. Da� is I II, City Managcr
Subjcct: SP[CIAL PERD91"t'
13�CKGKOU�D
St. Francis �tcdical Centcr plans to ha�e a Dri��c-Up Flu Vaccination Program for thc
community on Saturday, Octobcr 23, 1999 from 9 am —3 pm. and cxpccts to scrvc around
2,000 pcoplc in Lymti'ood and its surrounding arcas.
At thc rcgular Octobcr 12 mccting of thc Lymvood Womcn's Commission, Ms. Ciilda
Acusta Gunzalcs. Dir�cwr fur Comnttmiry licallh Iniliativcs, prescntcJ thc Plu
Vaccination program and recci�cd full endurscmcnt of this program from thc
commissiuncrs.
St. Francis \ledical Center �+ould like ro request for u special permit to hold this
e�ent at the Caesar Cha�ez Lane. Nomially, the Medical Center holds iu special
c�•ents ��•ithin the premises of the hospital. Howevei, due to the construction work at the
facility, the �tedical Center's administrative staff suggested to hold the Flu Vaccination
Proeram at the Cesar Chavez Lane.
It is rcquested that Caesar Cha��ez Lane be closed to normal traffic usc. As this is a
dri��c-up ilu vaccination program, �•chicics �ti-ill cntcr Gom Cacsar Chavcz Lanc at Martin
l.uthcr King E31��d. and esit at Birch Sirect. A conopy ���ill bc situatcJ at thc Cacsar
Chavcz dcdication monununt.
Walk-up �� ill be hcld at thc Natatorium parking lot• ',
Since flyers need to be distributed as soon as possible, the medical centcr staff rcquests
that the City Council revic��� anJ approve the special permit. ,
I
RFr0�1MENDATION !
It is recommended lhat the City Council I) review and approve thc special permit and 2)
inswct city staff to �t�ork ���ith thc staff from St. Francis Mcdical Ccntcr to cnsurc all !
maintcnance anJ precautionary measures. I
i
I
AC}ENllA �M ,
l. �' I
------ .___""__'----
�► !
. CITY OF LYNWOOD
APPLICATION FOR SPECIAL PERMIT 11330 BULLIS ROAD
, LYNWOOD, CA 90262
- 310�03-0220
�;;�;;��,�,�-,,;`-�;�;�'�;'�` •" PPUCANTtINF,ORMATiONh�' �„ *��+'�'"'�
Sf- � �a.z�r � taI (¢u.f=
NAME: Csi I�.L. J}tlyJJ_ �x7f1a Z CDL#: PHONE: �00 3- (03 Z�
ADDRESS: �(0�0 ���i�u�rr.� r�uy CIN: �,c%��///� ZIP: �(d L6 Z
OCCUPATION: , �Q.��y Ce7n /11cvn�-�'> N�+�-�-`�1 '7r�1' �.t7�J
NUMBER OF PERSONS EMPLOYED: SBE:
(Stata Board of Equal¢alion Numbor)
' �;�.�� as" ,.,`.-�� l ';;� Ys�."'n �'�EVENT�INFORMATION�'„��'b'�i+�` v .
- ,.
TYPE OF PERMIT RE�UESTED: l ��tQ QI' i e �7 �1 �M� • r e[� •
DA7E(S) OF EVENT: - l- iC�jLG
HOURS OF OPERATION: �/,p '�'��m P�1Q % �/� .3�Y+'�•
ADDRESS OF PROPOSED EVENT LOCATION: �5.�� C`l�zc�lZ Ln n-� 6F>�
SPECIFIC AREA DESIGNATED FOR EVENT:
IS STREET CIOSURE BEING REOUESTED: YE NO � (CIRCLE ONE)
(IF YES, BRIEFLY EXPLAIN REASON FOR EVENT � CLOSURE:) rp ,�uQ���'Q (�-ai7� -l� •�t c. i
� �I a /� /m G /_7 � ./1(� �AYI7 �ZL//1uZCt _ _- -__ _ — — �
, / �
IF INDOORS, APPROXIMATE TOTAL GROUND FLOOR AREA OF STRUCTURE: .tJ(�4 �
HAVE YOU MADE AN APPLICATION FOR THIS TYPE OF PERMIT BEFORE7 YES NO ;
IF YES, WHERE AND WHEN: !
IS THIS A FOR-PROFIT O�ON-PROFIT�EVEN�IRCLE ONE) '
IF THIS IS A NON-PROFIT EVENT OR A CERTAIN PORTION OF THE PROCEEDS BENEFIT A
NON-PROFIT AGENCY OR ORGANIZATION, PLEASE PROVIDE THE FOLLOWING:
NAME OF ORGANIZATION BEING BENEFITED: ri �lc.
STATE NON-PROFIT NUMBER: �
ADDRESS OF ORGANIZATION: PHON
IS A WAIVER OF FEES BEING RE�UESTED: YES NO
IF YES, EXPLAIN: '
I
�
i
I HEREBY CERTIFY THAT ALL STATEMENTS MADE IN THIS APPLICATION ARE TRUE AND
COMPLETE AND THAT ANY MISSTATEMENTS OF GATERIAL FACT WILL CAUSE A ;
FORFEITURE OF FEES AND DENIAL OF PERMI . —
/Q —/Z-`�/� i
N URE OF AP L AN DATE
SIGNATURE OF APPLICANT DATE �
ACCEPTANCE OF THIS APPLICATION FOR REVIEW DOES NOT IMPLY APPROVAL. TMIS '
i
PERMIT REQUIRES CI7Y COUNCIL APPROVAL YOU WILL BE NOTIFIED ACCORDINGLY. �
�