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140 <br />City of Santa Ana <br />Donation <br />City Manager's Office» M-31 <br />20 Civic Center Plaza <br />A.U. Box 1988 <br />Santa Ana, CA 82702 <br />(714) 847.5200 <br />Name: Jose J. Rea Title: I MPNA Treasurer <br />;Address: 516 E. OccidentaL St,. ...... _-... _.... <br />city, state, zip: Santa Ana, CA 92707 Phone: 714-957-6697 <br />Email: madisonparkna@gmail.com Fax; <br />Name: Madison Park Neighborhood Association (MPNA) <br />Tax•Exempt Status: Is your organization a non-profit or public tax-exempt organization as <br />Select One: <br />defined under Section 501(c)(3) of the Internal Revenue Code? Yes ❑ Naa <br />If No, you will only qualify for a credit for City -related costs for your request (i.e. permit fees, <br />'staff time, rental rates for facilities or equipment, etc.). Costs for City services vary and if if Yes, 180-0201690 <br />approved, credit may or may not cover fog cost of requested Cityservices. Tax ID 8: <br />City Services Credit <br />Amount Requested: <br />Direct Payment Amount $ <br />;Requested: <br />''.Event Loontion: <br />Address, City, State, Yip <br />,Date Needed: 16/30/18 <br />$500 Event Data <br />Benevides <br />Time: 7am- fpm <br />Madison Park 1528 S Standard Ave, Santa Ana, CA 92707 <br />This year residents will complete a 5k walk along me bike trail from Edinger to <br />�iDescriptionof Chestnut Ave. Two police officers are needed at intersections that lack stop signs <br />fEvent I Purpose: ; to ensure the safety of the participants. <br />MPNA'invites `sponsors and community resources, which provide services to our <br />Community Benefit: cammunity to empower residents to make healthier life choices. We anticipate an <br />;attendaan_ce/of approximately 1,500, which consist of adults and children. <br />,Applicant Signature:I _. _.L� A ... 'L -'r..-._ ...._Date: . _. 4s/�✓/c�i. _. <br />I <br />Mali: City Manager's Office -M-31 'Email: donationrequest@santa-ano.org <br />20 Civic Center Plaza Fax: (714) 847.9584 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Donation Request 5 DR� <br />Council Meeting Da4e:.. 1111 <br />Eligibility Met: YES I NU v ' '-' �" Approved Amount; 1(i <br />City Manager Signature: ( i gate; <br />Revised 0110512017 <br />EXHIBIT 16 <br />