2021 ROV Polling Place & Hold Harmless Agrmts - Sept 14 CA Gubernatorial Recall ElectionREBECCA SPENCER
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Please forward a copy of this contract to the contact person responsible for coordinating facility use
before and during the Election period. Provide the contact person’s phone number
( ) _______ - ________
Polling Place location for the: 6HSWHPEHU &DOLIRUQLD*XEHUQDWRULDO 5HFDOO (OHFWLRQ
I give my permission for the use of:
Please provide the name of the room or rooms you are authorizing use of: ________________________
Please check (X) the appropriate boxes that apply:
Check here if you can provide three 6’- 8’ tables and 10 chairs
Check here if you require for the Registrar to deliver tables and chairs to your facility
Facility use “Free”
Request $25.00 Compensation (Must provide W-9 enclosed)
Contact Name (print):________________________Title:_______________________Phone #:_____________________
Alternate Contact Name (print):____________________________Phone #:______________________________________
*Emergency contact:_____________________________________Phone #:_____________________________________
Mailing Address: _____________________________________________________________________________________
After Business Hours Phone: ________________________________Fax #:_____________________________________
E-mail Address:_____________________________________________________
For future requests how would you prefer to be contacted? Fax E-Mail Regular Mail
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*This is the person and phone number the Registrar of Voters will use in an emergency (Election Day access, etc.)
Facility use not authorized for this Election
Initial Here: _________
ID#
760 835 9768 for Jorge Vizcarra or (760) 567 - 6605 for Monika Radeva
X
X
X
Monika Radeva City Clerk
Cell: (760) 567 - 6605
(760) 777 - 7035
Nichole Romane, Deputy (760) 777 - 7092
Jorge Vizcarra, Building Access (760) 777 - 7082
78495 Calle Tampico, La Quinta, CA 92253
(760) 835 - 9768 Jorge V.
mradeva@laquintaca.gov & jvizcarra@laquintaca.gov
XX
July 25, 2021____________________________________________________
Study Session Room
N/A
REBECCA SPENCER
Registrar of Voters
ART TINOCO
Assistant Registrar of Voters
REGISTRAR OF VOTERS
COUNTY OF RIVERSIDE
July 16, 2021
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The County of Riverside Registrar of Voters thanks you for the use of your facility as a Polling
Place in past elections.
To prepare for the upcoming September 14, 2021, California Gubernatorial Recall Election,
the County of Riverside Registrar of Voters office is inquiring about the availability of your
facility. The County of Riverside would use your facility as a Polling Place from September 11
through September 13, 2021 (8:00 am – 5:00 pm) and Election Day, September 14, 2021
(6:30 am – 9:00 pm).
Please acknowledge that your facility is available by completing, signing, and dating the
attached “Polling Place Availability Request Agreement” form. You may return the completed
agreement by email to Rovpolls@rivco.org,by mail in the enclosed postage paid envelope, or
by fax to (951) 486-7320. When completing the form please indicate the specific room
space that will be available for the four (4) day voting period, it is very important that our office
provides the correct location to our voters.
We carefully review all facilities to determine which will be used as a Polling Place. A
confirmation letter will be mailed approximately 29 days before the scheduled election when a
facility is SELECTED. A letter will be sent approximately 15 days before the scheduled election
when a facility is NOT SELECTED,providing the reasons the facility may not have been
selected. Please call us at (951) 486-7341 or (877) 663-9906 (toll free) if you have not
received a letter 15 days prior to the election. Note: If your facility is SELECTED to serve as
a Polling Place, the Lead Election Officer for your site will contact you to make arrangements to
access the facility prior to the beginning of the voting period for setup (about ½ hour) and to
guarantee access to the facility.
Voting equipment will be delivered approximately five (5) days prior to the first day of voting
to the SELECTED Polling Places. Tables and chairs can be delivered upon request. The
Registrar of Voters office or our contracted carrier will call to schedule a time and date for
delivery of equipment. Please identify a secure area for voting equipment storage.Pick up of
the equipment will occur within one week after the election, you will receive a call from our
office, or that of our carrier.
Should you have questions or concerns regarding the use of your site as a Polling Place,
please contact our office at (951) 486-7341 or (877) 663-9906 (toll free).
Sincerely,
Election Officers and Polls Division
County of Riverside Registrar of Voters
POLLING PLACE AVAILABILITY REQUEST AGREEMENT
COMPLETE, SIGN, AND RETURN THIS FORM VIA FAX, EMAIL,
OR REGULAR MAIL TO THE REGISTRAR OF VOTERS OFFICE
E-Mail: Rovpolls@rivco.org Fax # (951) 486-7320 Mail: Use the self-addressed stamped
envelope provided.
Please forward a copy of this contract to the contact person responsible for coordinating facility use
before and during the Election period. Provide the contact person’s phone number
( ) _______ - ________
Polling Place location for the: September 14, 2021, California Gubernatorial Recall Election
I give my permission for the use of:
Please provide the name of the room or rooms you are authorizing use of: ________________________
Please check (X) the appropriate boxes that apply:
Check here if you can provide three 6’- 8’ tables and 10 chairs
Check here if you require for the Registrar to deliver tables and chairs to your facility
Facility use “Free”
Request $25.00 Compensation (Must provide W-9 enclosed)
Contact Name (print):________________________Title:_______________________Phone #:_____________________
Alternate Contact Name (print):____________________________Phone #:______________________________________
*Emergency contact:_____________________________________Phone #:_____________________________________
Mailing Address: _____________________________________________________________________________________
After Business Hours Phone: ________________________________Fax #:_____________________________________
E-mail Address:_____________________________________________________
For future requests how would you prefer to be contacted? Fax E-Mail Regular Mail
*I HAVE READ AND UNDERSTAND ALL THE TERMS OF THIS AGREEMENT, AND BY SIGNING THIS AGREEMENT VOLUNTARILY I AM
AGREEING TO ABIDE BY THESE TERMS.
Signature: _________________________________________________ Date:______________________________________________
Please contact us at (951) 486-7341 within 15 days prior to the election if you have not received a letter
informing you of a decision for your facility to serve as a polling place.
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*This is the person and phone number the Registrar of Voters will use in an emergency (Election Day access, etc.)
Facility use not authorized for this Election
Initial Here: _________
ID#
760 902 4451 for Luis Magallanez or (760) 567 - 6605 for Monika Radeva
X
Community Room
X
X
Luis Magallanez Community Resources
Coordinator
Cell: (760) 902 - 4451
(760) 777 - 7189
Christina Calderon, Manager (760) 777 - 7183
Luis Magallanez (760) 777 - 7189
La Quinta City Hall - 78495 Calle Tampico, La Quinta, CA 92253
(760) 9021 - 4451 N/A
X X
lmagallanez@laquintaca.gov & mradeva@laquintaca.gov
July 25, 2021
A
________________________________________________________________________
September 2, 2021
Monika Radeva, City Clerk
September 10, 2021
Monika Radeva, City Clerk