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City of Santa Ana <br />b1 Donation Request <br />City Manager's Office - h1.11 <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />(714) 647-5200 <br />1' r ' l.. t <br />- n r ,f• <br />Name: Karen Ruan Tltto: Executive Director <br />Address: 1605 E. 17th Street <br />'City, state, zip: Santa Ana, CA 92705 Phone: 714-480-1925 <br />Email: kruan@pyocbf.org Fax: 714480-1933 <br />a r: r r ,., <br />Name: 'Orange County Bar Foundation <br />Tax-Exompt Status: Is your organization a non-pro61 or public lax-exempl organiza0on as <br />defined under Section 501(c)(3) of the Internal Revenue Code? Select Ono: Yes ❑ No <br />NNo, you tvill only qualtly fora credit forCtfy-related costs for yourrequesf (i.e. permit lees. If Yos, <br />stafftime. rental rates forlecAVes or equipment etc.).Costs for City services vary andel 23-7068923 <br />approved, credit may or may not cover lull cost of requested City services. Tax ID 0: <br />City Services <br />Amountunt Requested: <br />.g Date Needed: 11/01/2018 MayorlCouncilmembeC VILLEGAS <br />Req <br />Direct Payment Amount 51 000 Event Data: 11/07/2018 Event Time: S:OO pm - 8:00 Pm <br />Requested: t <br />!Event Location: 1605 E. 17th Street, Santa Ana, CA 92705 <br />Address. City. Slate. Zip <br />Health Education Movie Night for Santa Ana youth and families. Featuring a HIV awareness film <br />Description of <br />Event /Purpose: and providing drug and alcohol prevention information and free HIV testing to celebrate World <br />AIDS Awareness Month - goal is to promote health education and HIV awareness <br />Community Benefit:Increased number of Santa Ana youth and family members that know their HIV <br />status. I creased access to healthcare services and promotion of drug free living. <br />Applicant slgnawre: — -- q �- Date:- - "09/05/2018 <br />Mail: City Manager's Office -M-a1 Email: donadonrequest@santa-ana.org <br />20 Civic Center Plaza Fax: (714) 647-6954 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Donation Reguesl :. OR - Council Mcctinr Date- October 16, 2018 <br />Eligibility fact YES I NO YES Approved Amount- 1,000 <br />City Manager Slgnaltlre Dale. <br />Revised 01/0512017 <br />EXHIBIT 5 <br />29A-24 <br />