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29ATs58
<br />w City Manager's Office - M-31
<br />City of Santa Ana
<br />aQr 20 Civic Center Plaza
<br />Donation Request P.O. Box 1988
<br />Santa Ana, CA 92702
<br />-- (714) 647.5200
<br />r • a
<br />_
<br />,Name: Frank BeiaranO tie: O'vecmatroum and Pwm7y Eneapmmem
<br />Address:
<br />11902 W. Chestnut Ave.
<br />City, State, zip:
<br />—
<br />Santa Ana, CA, 92703
<br />IPhon�—
<br />714-834-9400
<br />Ema1r I:
<br />frank@kidvvorkSOC.org
<br />Fax:
<br />714-834-9494
<br />Name: KidWorks Community Development Corp.
<br />Tax-Exempt Status: Is your organization a non-profit or public tax-exempt organization as Select One
<br />dellned under Section 501(c)(3) of the Internal Revenue Code? Z Yes ❑ No
<br />If No, you will only quality for a credit for City-related costs foryourrequest p.e. permit fees,f Ye7 s,
<br />ISIaOtime, rental rates lorlac8ilies or equipment etc.).Costs for City services valy andif LL [74-3081569
<br />pproved, credit mayormaynot coverlull cost of requested Cityservices. j ax lD#:
<br />ICItYSemicr- es Credit —pates Needed,
<br />Requested:
<br />ayorlCouncllmember. Sarmiento
<br />Amount
<br />Direct Payment Amount �I �—
<br />5500 Fvont Date: May 12, 2018 Time: 1O:OOAM-2:OOPM
<br />Requested: Invent
<br />Event Location:
<br />1850 W. WI illits St. Santa Ana, CA 92703
<br />Address, CW,, State, ZFp
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<br />Event I Purpose:
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<br />Applicant Signatu ate: O 1G. 45J8
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<br />Mail: City Manager's Office-M-31
<br />Email: donationmquest@santaana.org
<br />20 Civic Center Plaza
<br />Fax: (714) 647.6954
<br />P.O. Box 1988
<br />Santa Ana, CA 92702
<br />Donation Request DR —
<br />Reference dun all related DPVs
<br />Council Meeting Date:
<br />j
<br />Eligibility Met:YES / NO
<br />Approved Amount:
<br />� City Manager Signature: I
<br />Date:
<br />Revised 01/0512017
<br />29ATs58
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