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OFFICE OF <br />ASSESSOR-COUNTY CLERK- <br />RECORDER & ELECTIONS <br />COUNTY OF SAN MATEO <br />MARK CHURCH <br />CHIEF ELECTIONS OFFICER & <br />ASSESSOR-COUNTY CLERK-RECORDER <br />40 Tower Road, San Mateo, CA 94402 <br />P (650) 312-5222 F (650) 312-5348 email registrar@smcacre.gov web www.smcacre.gov <br />Facility Use Agreement and Information Form <br />Statewide General Election: Tuesday, November 3, 2026 <br />Thank you for agreeing to host a Vote Center in your facility from October 31 to November 3, <br />2026, Election Day. Please complete in full and sign before returning to our Vote Center Unit. <br />Facility Name for publication in all official Election documents (include room name, if applicable): <br />Facility Address for publication in all official Election documents: <br />Is this the address for the public entrance to the Vote Center? Yes No <br />If No, please clarify: <br />Primary Contact Name Primary Phone <br />Email Secondary Phone <br />Secondary Contact Name* Primary Phone* <br />Email* Secondary Phone* <br />Facility Contact Name Primary Phone <br />Email Secondary Phone <br />IT Contact Name Primary Phone <br />Email Secondary Phone <br />Emergency (24/7) Contact Name Primary Phone <br />Email Secondary Phone <br />Set Up/Recovery Days Contact Name* Primary Phone* <br />Email* <br />*Optional <br />ATTY/AGR.2026.200/San Mateo County Elections Office (Downtown Library_4-Day Vote Center Use Agreement N)(REV: 07-10-26 VR) (Page 1 of 8)