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Ctty of Santa Ana <br />Donation Request <br />City Manager's Office - M•d 1 <br />20 Civic Canter Plaza <br />P.O. Box l9aa <br />Same Ann, CA 92702 <br />(7t4l 647.5200 <br />r • • <br />Name: Karen Ruan 7100; Executive Director <br />Address: 1605 E. 17th Street <br />city, state, zip: Santa Ana, CA 92705 Phone: 714.480-1925 <br />emaR: kruan@pyocbf,org Pax: 714480-1933 <br />Nom: Orange County Bar Foundation <br />Tax -Exempt Status: Is your organization a non-morit or public lsx•axempl organization as Select ono: <br />de8�s d under Section 501(c)(0) of the Internal Reverm Cade? Yes ❑ Na <br />11 No. you ndll only es for <br />ci it erode for Gime ted costa for <br />your request <br />services <br />p.e. Very <br />and <br />tees. If Yes ,.5 M..r rs ra <br />staff time, reMarates JortasttlttesaegWpmartt.atO.j.Costs torCdy sarvkas vary and it L (U `! <br />approved,, credit may or may not cover full cost of requested City services. Tax ID e: <br />dilation Re frost <br />City Services Credit $ Cate Neaded: 1 1101 /201 8 MayorlCounclimembor: VILL.EGAS <br />Amount Requested: <br />Direct Payment Amount $ 1 000 Event Date: 11107/2018 event Timor 5:00 m - 8;00 m <br />Requested: r p <br />Event Localism 1605 E. 17th Street, Santa Ana, CA 92705 <br />Add(ess. Cay. State, Zip <br />Health Education Movie Night for Santa Ana youth and families. Featuring a HIV awareness film <br />Description of and providing drug and alcohol prevention information and free HIV testing to celebrate World <br />Event l Purpose: <br />AIDS Awareness Month - goal is to promote health education and HIV awareness <br />Mall: City Manager's Ofloo-1111-31 <br />20 Civic Center Plaza <br />PA, Box 1888 <br />Santa Ana, CA 82782 <br />O,m dual Fpi µ,esti a 11R <br />cq,lunii,y, Flet <br />:d] N1a0"I'l it signnRir:. <br />es to) YES <br />rTM <br />r a... <br />r <br />emall: donationroquest(Msenta-sne.org <br />Pax: (714)847.8854 <br />Cowl'; i MA, u„q Quo <br />.1puw�!x1 Arr,uPl' <br />EXHIBIT 5 <br />October 16, 2018 <br />1,000 <br />Revised 0110512017 <br />