Revision No. 20170501-1 County of Sonoma Agenda Item Summary Report Agenda Item Number: 16 (This Section for use by Clerk of the Board Only.) Clerk of the Board 575 Administration Drive Santa Rosa, CA 95403 To: Board Agenda Date: June 13, 2017 Vote Requirement: Majority Department or Agency Name(s): Board of Supervisors Staff Name and Phone Number: Supervisor Susan Gorin, 565-3752 Title: Fee Waiver Recommended Actions: Supervisorial District(s): First District Approve Fee Waiver for Sonoma Home Meals in the amount of $886.00 Executive Summary: Sonoma Home Meals dba Meals on Wheels Sonoma is requesting a fee waiver for Health Inspection fees for the Meals on Wheels Program in Sonoma Valley. Discussion: Prior Board Actions: This fee was waived in 2014, 2015, and 2016 Strategic Plan Alignment Goal 4: Civic Services and Engagement
Revision No. 20170501-1 Fiscal Summary Expenditures Funding Sources Budgeted Expenses FY 16-17 Adopted FY 17-18 Projected Additional Appropriation Requested 886.00 Total Expenditures 886.00 General Fund/WA GF State/Federal Fees/Other Use of Fund Balance Contingencies 886.00 Total Sources 886.00 FY 18-19 Projected Narrative Explanation of Fiscal Impacts: Staffing Impacts Position Title (Payroll Classification) Monthly Salary Range (A I Step) Additions (Number) Deletions (Number) Narrative Explanation of Staffing Impacts (If Required): Attachments: Fee waiver application and related exhibits. Related Items On File with the Clerk of the Board:
SUBMIT TO: COUNTY OF SONOMA Board of Supervisors MAY 0 1 2017 575 Administration Dr, Ste looa r BOARD OF SUPERVISORS Santa Rosa, CA 95403 FcGfilJJNiJt'iSl@ffv~~V Fee Waiver/Board Sponsorship Request Form 1. Contact information for individual requesting fee waiver/sponsorship: Name: Susan Weeks First Middle Last Mailing Address: P 0 Box 622 Sonoma CA 95476 Number, Street, Apt/Suite City State Zip Phone: ( 707) 935-9141 Email: Area Code, Number 2. Name of Community Based Organization, Non-Profit, or Government Agency for which fee waiver/sponsorship is requested: Name: Sonoma Home Meals dba Meals On Wheels Sonoma Mailing Address: P 0 Box 622 Sonoma CA 95476 Phone: ( 707 ) 935-9141 Email: Number, Street, Apt/Suite City State Zip Area Code, Number 3. Please indicate by check mark the supervisory district in which the organization or agency submitting this request is located, where the project/activity/event will be held, and the district office to whom you would like to submit this request: Susan David Shirlee James Efren Board Member and District Gorin Rabbitt Zane Gore Carrillo District 1 District 2 District 3 District 4 District 5 Entity or organization location (select all that apply) D D D D Project/activity/event location (select all that apply) D D D D District office to receive request (select only one) [{] D D D D [{] [{] 4. Type of Community Based Organization, Non-profit, or Government Agency for which the fee waiver/sponsorship is requested: Deity D Special District D Other Local Government D School l./i Non-profit or CBO Other (please specify): ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~- 5. Please provide a description of the project/activity/event for which a fee waiver/sponsorship is being requested on a separate sheet of paper. Please include the number of individuals who will participate or be served, etc. 6. Please indicate if this is a one-time or annual event: Done Time l./i Annual Sonoma County Fee Waiver Form Revised 8/17 /2012
7. Type and amount of fee waiver/sponsorship requested. Please list all County fees you are requesting be waived/sponsored in conjunction with this project/activity/event. Please attach a copy of an estimate or receipt from the County Department or Veteran's Building Operator documenting the amount of each fee you are requesting be waived/sponsored. Department Assessing Fee Type of Fee Amount of Fee Health Services (EH) Food Permit $886.00 8. If your Community Based Organization, Non-Profit, or Governmental Agency has received a fee waiver/sponsorship for a similar project/activity/event in the past, please list below: Date of Department Amount of Type of Fee Fee Waiver Assessing Fee Fee 3 I I 2016 Health Services (EH) Food Permit $914.32 3 I I 2015 Health Services (EH) Food Permit $914.32 3 I I 2014 Health Services (EH) Food Permit $914.32 3 I I 2013 Health Services (EH) Food Permit $914.32 9. Does the organization or agency for which the fee waiver/sponsorship is requested receive funding from any of the following sources? If so, please specify: D Property Tax D Sales Tax D Special Assessment D User Fees Other (please specify): 10. If you checked any of the boxes in number 9 above, please provide an explanation and supporting documentation regarding the inability of the organization or agency to pay the fees which you are requesting be waived/sponsored. Please attach to this form and submit with your request. 11. Will the organization or agency be charging an entry fee or be requesting a donation for the project/activity/event for which you are requesting a fee waiver/sponsorship? If so, please provide an explanation detailing why the fees to be waived/sponsored cannot be recovered through the entry fee. Please attach to this form and submit with your request. Jup?/4-< LU~ Authorized Signature Title Sonoma County Fee Waiver Form Revised 8/17 /2012
Meals- on- Wheels of Sonoma P. 0. Box622 Sonoma, Ca. 954 76 (Non-Profit Organization)
County of Sonoma Department of Health Services Environmental Health & Safety Section 625 5th Street Santa Rosa, CA 95404 707-565-6565 INVOICE Public Health l'-re\"tnl. r r omo1 t'. f'ru tc<l. TO: Sonoma Home Meals Inc Invoice ID Date Sonoma Home Meals Inc IN0101172 PO Box 622 I 3/2/2017 Sonoma, CA 95476 Facility ID IF ood District03 Dis:::J FA0007764 I I ATIN: RE: Sonoma Home Meals Inc Sonoma Home Meals Inc Program Program Record ID Identifier Element Description Amount PR0000567 Meals On Wheels 3R11 Food - Moderate Preparation ( < 2,000 sq ft) $ 886.00 Total Due for This Invoice: $ 886.00 Due Date: 4/1/2017 Pursuant to the Sonoma County Code, Chapter 14, and the Board of Super\iisors approved fee schedule, all programs will be assessed a late fee of 25% of the remaining invoice balance due if full payment is not received within 30 days of the due date. An additional late fee of 25% of the remaining invoice balance due if full payment is not received within 60 days of the due date. Please return this portion with your payment From : Meals On Wheels Invoice ID Date 275 E Spain St lfi IN0101172 j I 3/2/2017 J District Facility ID IF, omod D i st.ric t 03... I FA0007764 To: County of Sonoma Department of Health Services Total Due for This Invoice: $ 886.00 Environmental Health & Safety Section Due Date: 4/1 /2017 625 5th Street Santa Rosa, CA 95404 707-565-6565 5200.rpt 1.0.1.03.00