Precinct 1539 and 1540 Caroyln Sims CenterThe City of Boynton Beach
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PRECINCT NUMBER(S): 1539 and 1540
POLLING LOCATION AGREEMENT FORM
CITY OF BOYNTON BEACH CITY CLERK'S OFFICE
TO: CAROLYN SIMS CENTER
225 NW 12TH AVENUE
BOYNTON BEACH, FL 33435
This agreement, dated this _ day of
Beach, FL, and the owner of the Polling Place located at:
FROM: CITY OF BOYNTON BEACH
CITY CLERK'S OFFICE
100 E. OCEAN AVENUE
BOYNTON BEACH, FL 33435
2023, by and between the City of Boynton
Carolyn Sims Center
NAME OF POLLING LOCATION (Include name and/or room number)
225 NW 12th Avenue, Boynton Beach, FL 33435
(POLLING LOCATION STREET ADDRESS, CITY AND ZIP CODE)
THE OWNER AGREES TO
• Provide the Polling Place for holding the following elections:
GENERAL ELECTION ------------------------------------------------------TUESDAY, MARCH 14, 2023
RUN-OFF ELECTION (if necessary) -------------------------------------TUESDAY, MARCH 28, 2023
• To provide the following items from 6:00 a.m. until all closing procedures required by the Florida Statutes to
be performed by the Election Board are completed:
Yes No "ECE,•�r�
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CHAIRS FOR ELECTION WORKERS IA ❑
TABLES FOR ELECTION WORKERS IN ❑ JAN 3 0 2023
RESTROOM FACILITIES AVAILABLE IX ❑ 101N OF ao
CrrY C�y
• To provide access to the Polling Place on election day by one of the following means: ERiQQ F�� A.
A Owner will open Polling Place NO LATER THAN 5:30 a.m. on Election Day
Owner will provide the Precinct Clerk with a key to the premises prior to Election Day.
THE CITY OF BOYNTON BEACH, THROUGH THE CITY CLERK, AGREES:
• To pay the owner $ for the use of the above described location for each Election, if
it is used.
I AGREE TO THE ABOVE CONDITIONS AND WILL MAKE MY FACILITY AVAILABLE TO THE CITY OF BOYNTON
I EACH Q THE DATES INDICATED ABOVE.
L Kacy Young Recreation & Parks Director 561 742-6236
71 5W U PRINT NAME TITLE TELEPHONE NO.
100 E. Ocean Avenue Boynton Beach, FL 33435
MAILING ADDRESS (INCLUDE CITY, STATE AND ZIP CODE)
ADDITIONAL INFORMATION
DATE SIGNED
To provide access to the premises for delivery and pickup of voting equipment before and after each
Election, please provide the days/hours facility is open for equipment delivery/pickup:
Monday -Friday; 10am-7pm
Name of contact person and telephone number at Polling Place: Frank Ireland, 561 742-6641
• Name of contact person and telephone number before and after regular business hours, in case of
emergency. Frank Ireland, 561742-6641 or Mary DeGraffenreidl, 661742-6642 or Franky Lazo, 561 564-6821
• Make checks payable
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(003).doc