HomeMy WebLinkAboutReso - CC - 089-1977California State Peparintent of Education S>a'P.SP—CENTRE7-
State Agency for u:plus Property '
72 I'�'apitol. Mail, Sacramento, CA 95814 STATE OF CALIFORNIA !;:i:i'ti '� .:1. 1977
SAE-P Form No. 201 (10 77) . APPLICATION FOR ELIGIBILITY
FEDERAL SURPLUS PERSONAL PROPERTY PROGRAM
Before preparing this application, please read carefully the definitions given under Part B. Fill out all applicable sections.
Part A.
Legal name of organization CITY OF BURL INGAME Telephone342-3867
Address Snl Primrnga Road City Burlingame County Ran Macao ZIP94010
1. Application is being made as a (please check one) (a) Public agency :E or (b) Private, nonprofit and tax-exempt educational or public
health organization ❑. Please provide evidence that the organization is a public agency or enclose a copy 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 qualifications of the faculty or staff; (b) If a public health
institution or organization, include a description of the health services offered, qualifications 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 local-7�7.
❑ Conservation
❑ Economic development
❑ Education
Grade level
(Preschool, university)
Enrollment
No. of school sites
❑ Parks and recreation
❑ Public health
X3 Public safety & Civil Defense
❑ Two or more of above
❑ Other (specify) Incorporated City
NONPROFIT INSTITUTION OR ORGANIZATION:
❑ Education
Grade level
(Preschool, university)
Enrollment
No. of school sites
❑ School for the mentally or physically handicapped
❑ Educational radio or television station
❑ Museum
❑ Library
❑ Medical institution
❑ Hospital
❑ 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? Yes . If only a specified group of people is served, please indicate who
comprises this group.
5. Checklist of attachments submitted with this application:
.❑ Evidence that applicant's program is a public agency or exempt from paying taxes under Section 501 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 Form No. 202, "Resolution," properly signed, designating representatives authorized to bind the applicant to the terms and
conditions governing the transfer of federal surplus personal property
❑ SASP Form No. 203, nondiscrimination compliance assurance
❑ Statement concerning applicant's needs, resources, and ability to utilize the property
❑ Other statements or documentation required, as specified in the instructions, for certain categories of applicants.
Date: 4 ortnher 1977 Signed, n ,&4 Title: city Manager
Application approved:
Comments or additional information: _
FOR STATE AGENCY USE
Application
77 Signed:
Director
Part B.
DEFINITIONS
Accredited: Approval by a recognized accrediting board or
association on a regional, state, or national level, such as state board
of education or health; the American Hospital Association; a
regional or national accrediting association for universities, colleges,
or secondary schools; or another recognized accrediting association.
Approved. Recognition and approval by the State Department of
Education, State Department of Health, or other appropriate
authority. With respect to an educational institution, approval must
relate to academic or instructional standards. An educational
institution may be considered as approved if its credits are accepted
by accredited or state -approved institutions or if it meets the
academic or instructional standards prescribed for public schools in
the state.
Child care center: A public or nonprofit facility where day care
services such as educational, social, health, and nutritional services
we provided to children through age 14 and which is approved or
.licensed by the state or other appropriate authority.
Clinic: An approved public or nonprofit facility organized and
operated for the primary purpose of providing outpatient public
health services including customary related services such as labora-
tories and treatment rooms.
College: An approved or accredited public or nonprofit histitu-
tion of higher learning offering organized study courses and credits
leading to a baccalaureate or higher degree.
Conservation: A program or programs carried out or promoted,by
a public agency for public purposes involving,directly or indirectly,
the protection, maintenance, development, and restoration of the
natural resources of a given political area. These resources include
but are not limited to the air, land, forests, water, rivers, streams,
lakes and ponds, minerals, and animals, fish, and other wildlife.
Economic development: A program or programs carried out or
promoted by a public agency for public purposes which involve,
directly or indirectly, efforts to improve the opportunities of a given
political area for the successful establishment or expansion of
industrial, commercial, or agricultural plants or facilities and which
otherwise assist in the creation of long term employment opportun-
ities in the area or primarily benefit the unemployed or those with
law incomes.
Educational institution: An otherwise eligible public or nonprofit
institution, facility, entity, or organization conducting educational
programs, including research for any,such programs, such as a child
care center, school, college, university, school for the mentally or
physically handicapped, educational radio or television station,
museum, or library.
Educational radio stations: A radio station licensed by the
Federal Communications Commission and operated exclusively for
noncommercial educational purposes and which is public or
nonprofit and tax exempt under Section 501 of the Internal
Revenue Code of 1954. -
Educational television station: A television station licensed by the
Federal Communications Commission and operated exclusively for
noncommercial educational purposes and which is public or
nonprofit and tax exempt under Section 501 of the Internal
Revenue Code of 1954.
Health center: An approved public or nonprofit facility utilized
by a health unit for the provision of public health services, including
related facilities such as diagnostic and laboratory facilities and
clinics.
Hospital: An approved or accredited public or nonprofit institu-
tion providing public health services primarily for inpatient medical
or surgical care of the sick and injured, including related facilities
such as laboratories, outpatient departments, training facilities, and
staff offices.
Library: A public or nonprofit facility providing library services
free to all residents of a community, district, state, or region.
Medical institution: An otherwise eligible public or nonprofit
institution, facility, entity, or organization the primary function of
which is the furnishing of health and medical services to the public
at large or promoting public health through the conduct of research
for any such purposes, experiments, training, or: demonstrations
related to the cause, prevention, and methods of diagnosis and
treatment of diseases and injuries. The term includes but is not
limited to hospitals, climes, alcoholic and drug abuse treatment
centers, public health or treatment centers, research and health
centers, geriatric center laboratories, medical schools, dental
schools, nursing schools, and similar institutions. The term does not
include institutions primarily engaged in domiciliary care although a
separate medical facility within such a domiciliary institution may
qualify as a "medical institution."
Museum: A public or nonprofit facility which is attended by the
public free or at a nominal charge and which provides museum
services including the preservation and exhibition of artistic,
cultural, historical, or scientific objects.
Nonprofit institution: An educational or public health institution
or organization, no part of the net earnings of which inures or may
lawfully inure to the benefit of any private shareholder or individual
and which has been held to be tax exempt under the provisions of
Section 501 of the Internal Revenue Code of 1954.
Park and recreation: A -program or programs carried out or
promoted by a public agency for public purposes which involve
directly or indirectly the acquisition, development, improvement,
maintenance, and protection of park and recreational facilities for
the residents of a given political area. These facilities include but me
not limited to parks, playgrounds and athletic fields, swimming
pools, golf courses, nature facilities, and nature trails.
Public agency: Any state; any political subdivision thereof,
including any unit of local government or economic development
district; any department, agency, instrumentality thereof, including
instrumentalities created by compact or other agreement behvicen a
state and another state, a political subdividison, a multijurisdictional
substate district established by or pursuant to state law, or any
Indian tribe, band, group, pueblo, or community located on a state
reservation.
Public health: A program or programs to promote, maintain, and
conserve the public's health -by providing health services to
individuals and by the conduct of research, investigations, examina-
tion, training, and demonstrations. Public health services cozy
include but are not limited to immunization, maternal and child
health programs, sanitary engineering, sewage treatment and
disposal, sanitation inspection and supervision, water purification
and distribution, air pollution cgntrol, garbage and trash disposal,
the control and elimination of disease -carrying animals and insects,
and the control of communicable diseases.
Public safety: A program or programs carried out or promoted by
a public agency for public purposes involving, directly or indirectly,
the protection, safety, and law enforcement activities and the
criminal justice system of a given political area. Public safety
programs may include but me not limited to those carried out by
public police departments, sheriffs' offices, the courts, penal and
correctional institutions including juvenile facilities, state and civil
defense organizatious, and fire departments and rescue squads
including volunteer fire departments and rescue squads supported in
whole or in part with public funds.
School (except schools for the mentally or physically handi-
capped): A public or nonprofit, approved or accredited organiza-
tional entity devoted primarily to approved academic, vocational, or
professional study and instruction, which operates primarily for
educational purposes on a full-time basis for a minimum school year
and employs a full-time staff of qualified instructors.
School for the mentally handicapped: A facility or institution
operated primarily to provide specialized instruction to students of
limited mental capacity. It must be public or nonprofit and must
operate on a full-time basis for the equivalent of a minimum school
year prescribed• for public school instruction of the mentally
handicapped, have a staff of qualifed instructors, and demonstrate
that the facility meets state and local health and safety standards.
School for the physically handicapped: A school organized
primarily to provide specialized instruction to students whose
physical handicaps necessitate individual or group instruction. The
schools must be public or nonprofit and operate on a full-time basis
for the equivalent of a minimum school year prescribed for public
school instruction for the physically handicapped, have a staff of
qualified instructors, and demonstrate that the facility meets state
and local health and safety standards.
Tax -supported organization: One which receives a major portion
of its financial support from moneys derived from slate or local
government revenues.
University: A public or nonprofit, approved or accredited
institution of higher education empowered to confer degrees in
special departments or colleges.
41
F77-2 DE 10786 7-77 7,500
California State Department of Education
State Agency for Surplus Property
721 Capitol Mall, Sacramento, CA 95814
SASP Form No. 202 (10-77)
RESOLUTION
City of buriingame No. 39-77
SEASP—CENTRAL
111;u i 2 51977
"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) and/or 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
(Print or type.)
TITLE
CHARLES SCHWALM CITY MANAGER
0 _ FRF.D FRT(TKR FIRE CHIEF
RALPH KIRKUP DIRECTOR, P17R WORKS
BERNARD J. BURKE EMERGENCY SERVICES
SIGNATURE
�GNATUR��
llth October 77 City Council
PASSED AND ADOPTED this day of 19 by the Geyeriiiiig BeaFd of
of the City of -,Burlingame, California
by the following vote: Ayes: 5 ; Noes: 0 ;Absent: 0 City Council
4 Evelyn H. hill Clerk of the f4of
Burlingame, California if$, igrdjyprtify that the foregoing is a full, true, and
correct copy of a resolution adopted by the! a NN meeting thereof held at its regular place of
meeting at the date and by the vote above stated, which resolution is on file in the office of the ems. Council.
CITY OF BURLINGAME
Name of organization
501 Primrose Road
Matting address
a,,, i an n [Signed] Evelyn U. Hill
anfunP Smn MatAc>—CA 9 1 �rkLr�c_ ✓ Lc L�
City County ZIP code
OR
AUTHORIZED this day of
19 ,by:
Name of chief administrative officer Title
Name of organization
Mailing address
City County ZIP code
TERMS AND CONDITIONS
(A) THE DONEE CERTIFIES THAT:
(1) It is a public agency; or a nonprofit educational or public health institution or organization, exempt from taxation under Section 501
of the Internal Revenue Code of 1954; within the meaning of Section 2030) of the Federal Property and Administrative Services Act of 1949,
as amended, and the regulations of the Administrator of General Services.
(2) If a public agency, the property is, needed and will be used by the recipient for carrying out or promoting for the residents of a given
political area one or more public purposes, or, if a nonprofit tax-exempt institution or organization, the property is needed for and will be used
by the recipient for educational or public health purposes, and including research for such purpose. The property is not being acquired for any
other use or purpose, or for sale or other distribution; or for permanent use outside the state, except with prior approval of the state agency.
(3) Funds are available to pay all costs and charges incident to donation.
(4) This transaction shall be subject to the nondiscrimination regulations governing the donation of surplus personal property issued
under Title VI of the Civil Rights Act of 1964, Title VI, Section 606, of the Federal Property and Administrative Services Act of 1949, as
amended, and Section 504 of the Rehabilitation Act of 1973, as amended.
(B) THE DONEE AGREES TO THE FOLLOWING FEDERAL CONDITIONS:
(1) All items of property shall be placed in use for the purpose(s) for which acquired within one year of receipt and shall be continued in
use for such purpose(s) for one year from the date the property was placed in use. In the event the property is not so placed in us., or
continued in use, the donee shall immediately notify the state agency and, at the donee's expense, return such property to the state agency, or
otherwise make the property available for transfer or other disposal by the state agency, provided the property is still usable as determined by
the state agency.
(2) Such special handling or use limitations as are imposed by General Services Administration (GSA) on any item(s) of property listed
hereon.
(3) In the event the property is not so used or handled as required by (B)(1) and (2), title and right to the possession of such property
shall at the option of GSA revert to the United States of America and upon demand the donee shall release such property to such person as
GSA or its designee shall direct.
(C) THE DONEE AGREES TO THE FOLLOWING CONDITIONS IMPOSED BY THE STATE AGENCY., APPLICABLE TO ITEMS WITH A
UNIT ACQUISITION COST OF $3,000 OR MORE AND PASSENGER MOTOR VEHICLES, REGARDLESS OF ACQUISITION COST,
EXCEPT VESSELS 50 FEET OR MORE IN LENGTH AND AIRCRAFT:
(1) The property shall be used only for the purpose(s) for which acquired and for no other purpose(s).
(2) There shall be a period of restriction which will expire after such property has been used for the purpose(s) for which acquired for a
Period of 18 months from the date the property is placed in use, except for such items of major equipment, listed hereon, on which the state
agency designates a further period of restriction.
(3) In the event the property is not so used as required by (C)(1) and (2) and federal restrictions (13)(1) and (2) have expired then title
and right to the possession of such property shall at the option of the state agency revert to the State of California and the donee shall release
such property to such person as the state agency shall dissect.
(D) THE DONEE AGREES TO THE FOLLOWING TERMS, RESERVATIONS, AND RESTRICTIONS:
(1) From the date it receives the property listed hereon and through the period(s) of time the conditions imposed by (B) and (C) above
remain in effect, the donee shall not sell, trade, lease, lend, bail, cannibalize, encumber, or otherwise dispose of such property, or remove it
permanently, for use outside the state, without the prior approval of GSA under (B). or the state agency under (C). The proceeds from any sale,
trade, lease, loan, bailment, encumbrance, or other disposal of the property, when such action is authorized by GSA or by the state agency,
shall be remitted promptly by the donee to GSA or the state agency, as the case may be.
(2) In the event any of the property listed hereon is sold, traded, leased, loaned, bailed, cannibalized, encumbered, or otherwise disposed
of by the donee from the date it receives the property through the period(s) of time the conditions imposed by (B) and (C) remain in effect,
without the prior approval of GSA or the state agency, the donee, at the option of GSA or the state agency, shall pav to GSA or the state
agency, as the case may be, the proceeds of the disposal or the fair market value or the fair rental value of the property at the time of such
disposal, as determined by GSA or the state agency.
(3) If at any time, from the date it receives the property through the period(s) of time the conditions imposed by (B) and (C) remain in
effect, any of the property listed hereon is no longer suitable, usable, or further needed by the donee for the purpose(s) for which acquired, the
donee shall promptly notify the state agency, and shall, as directed by the state agency, return the property to the state agency, release the
property to another donee or another state agency or a department or agency of the United States, sell, or otherwise dispose of the property.
The proceeds from any sale shall be remitted promptly by the donee to the state agency.
(4) The donee shall make reports to the state agency on the use, condition, and location of the property listed hereon, and on other
pertinent matters as may be required from time to time by the state agency.
(5) At the option of the state agency, the donee may abrogate the conditions set forth in (C) and the terms, reservations, and restrictions
pertinent thereto in (D) by payment of an amount as determined by the state agency.
(E) THE DONEE AGREES TO THE FOLLOWING CONDITIONS, APPLICABLE TO ALL ITEMS OF PROPERTY LISTED HEREON:
(1) The property acquired by the donee is on an "as is," "where is" basis, without warranty of any kind.
(2) Where a donee curies insurance against damages'to or loss of property due to fire or other hazards and where loss of or damage to
donated property with unexpired terms, conditions, reservations, or restrictions occurs, the state agency will be entitled to reimbursement from
the donee out of the insurance proceeds, of an amount equal to the unamurtized portion of the fair value of the damaged or destroyed donated
items.
(F) TERMS AND CONDITIONS APPLICABLE TO THE DONATION OF AIRCRAFT AND VESSELS (50 FEET OR MORE IN LENGTH)
HAVING AN ACQUISITION COST OF $3,000Olt MORE, It EGARD LESS OF TIIE PURPOSE FOR Will CII ACQUI R1;D:
The donation shall be subject to the terms, conditions, reservations, and restrictions set forth in the Conditional Transfer Document
executed by the authorized donee representative.
F76-233 DE10780 7-77 7,500