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''p�=' City of Santa Ana City Manager's Office -M-31 �, Y 20 Civic Center Plaza Donation Request P.O. Box 1988 •L� Santa Ana, CA 92702 —' (714) 647-5200 Name: INatis House DBA Neutral Ground empt Status: Is your organization a non-profit or public tax-exempt organization as under Section 501(cX3) of the Internal Revenue Code? ou will only qualify for a credit for City -related costs for your request (i.e. permit fees, e, rental rates for facilities or equipment, etc.). Costs for City services vary and if d, credit may or may not cover full cost of requested City services. Select One: Z Yes ❑ No � If Yes, ax ID #: 145-4041042 Name: Nati Alvarado F,tie: Executive Director Address: 11920 E. 17th Suite 202 city, State, zip:' Santa Ana, Calif. 92705 Phone: 714_-267-_7.747 Email• pati@ngservices.org Fax: - --, Name: INatis House DBA Neutral Ground empt Status: Is your organization a non-profit or public tax-exempt organization as under Section 501(cX3) of the Internal Revenue Code? ou will only qualify for a credit for City -related costs for your request (i.e. permit fees, e, rental rates for facilities or equipment, etc.). Costs for City services vary and if d, credit may or may not cover full cost of requested City services. Select One: Z Yes ❑ No � If Yes, ax ID #: 145-4041042 Return completed form via: Mail: City Manager's Office -M-31 Email: donationrequest@santa-ana.org 20 Civic Center Plaza Fax: (714) 647.6954 P.O. Box 1988 Santa Ana, CA 92702 City Services Credit DR- Council Meeting Date: ount Requested: Date Needed: 6-23-2018 I r Ma ar/Councilmember: Solodo - Direct Payment Amount 1000.00 Event Date: F Event Time: City Manager Signature: Requested: Data. Event Location:1825 Civic Center Dr Santa Ana, Ca. 92706 Address, City, State, Zip provides mediation and intervention services to Santa Ana youth andDescription of Event/ Purpose: FNasHouse lies in need. The funds from this sponsorship will go towards on-going ram cost and services throuqh June 30, 2018. he community benefits from Natis House services and program by overcoming Community Benefit: life challenges, learning workforce skills, completing educational opportunities. Applicant Signature: .1YCCtGQ�.tQ1LQl�Q ,Date: 06-0$-201$ Return completed form via: Mail: City Manager's Office -M-31 Email: donationrequest@santa-ana.org 20 Civic Center Plaza Fax: (714) 647.6954 P.O. Box 1988 Santa Ana, CA 92702 Revised 01/05/2017 Donation Request#: Reference 0 on all related DPVs DR- Council Meeting Date: JUNE 19, 2018 Eligibility Met: YES / NO YES Approved Amount: $1,000 City Manager Signature: Data. Revised 01/05/2017