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�qu+ry <br /> AGENDA ITEM SUBMITTAL FORM <br /> For Clerk's Use On IN <br /> BOARD OF SUPERVISORS AGENDA NTNIBER <br /> CLERK OF THE BOARD <br /> 44 N.San Joaquin Street,Suite#627 <br /> Stockton. California 95202 <br /> SUBMIT ONE COPY OF THIS FORM WITH EACH BOARD AGENDA ITEM. <br /> At the time of submitting your agenda item documents,please provide ONE ORIGINAL& 7 COPIES <br /> OF THE BOARD LETTER AND ANY ACCOMPANYING DOCUMENTS(Resolutions. Board <br /> Orders. Contracts,etc.) for distribution atter Board Approval. <br /> If more than one original is required,you must prov%ide the appropriate number of originals to be <br /> executed by the Board of Supervisors. <br /> DATE: January 14,2014 DEPARTMENT: Human Services Agency <br /> CONTACT&PHONE#: Dean Fujimoto,(209)468-3805 <br /> AGENDA ITEM TITLE: CONTINUATION OF SPONSORSHIP OF THE ANNUAL <br /> SENIOR AWARENESS DAY AND EXEMPT EYED"T- <br /> RELATED FEES TOTALING $1,777 <br /> PROPOSED AGENDA PLACEMENT DATE: 1128;14 PROPOSED CALENDAR: H R HS Consent <br /> DISTRIBUTION: (MAILING ADDRESSES MUST BE PROVIDED IF NOT A COUNTY DEPARTMENT) <br /> TO: DOCUMENT #OF COPIES <br /> Clerk of the Board Board Order,Vicinity Map 1 Original <br /> Adult Services—Clerical Board Order I Oriainal <br /> Director,HSA Board Order 1 Copy <br /> Auditor-Controller Board Order 1 Copy <br /> Environmental Health Board Order I Copy <br /> Parks and Recreation Board Order 1 Copy <br /> Public Works Board Order 1 Copy <br /> Sheriff's Office Board Order I Copy <br /> Health Care Services Board Order 1 Copy <br /> Purchasing Board Order I Copy <br /> Risk Management Boar d Order I Copy <br /> Special instructions to the Clerk of the Board: <br /> AGENDA ITEMS MUST BE REVIEWED AND SIGNED OFF BY THE DEPARTMENT HEAD,COUNTY <br /> ADMINISTRATOR AND COUNTY COUNSEL. <br /> Depariment l lead Signature __ Date^._,._. ` 1 <br />