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PROPOSER APPLICATION <br />Agency Legal Name <br />Orange County Asian and Pacific Islander Community Alliance, Inc. <br />Agency DBA <br />I <br />Program Name <br />Youth Employment Program <br />Agency Address <br />12900 Garden Grove Blvd., Suite 214A <br />Contact Person & Title <br />Jason Lacsamana, Director of Youth Initiatives and Special Projects <br />Email <br />ilacsamana @ocagica.org <br />Telephone # <br />714- 636 -9095 <br />Fax # <br />714 -636 -8828 <br />Federal ID Number <br />91- 2047245 <br />AGENCY STATUS <br />Public Non-Pr:o::fit= <br />OC Health Care <br />Corporation <br />I <br />I Private Non -Profit <br />x <br />Years in Operation? <br />16 <br />Private for Profit <br />I <br />I Government <br />Foundation of <br />Other <br />I <br />PRIMARY FUNDING SOURCES <br />Funding Source <br />OC Health Care <br />US DHHS <br />OC Workforce <br />OC Health Care <br />College Access <br />Saturday <br />Agency <br />Office of <br />Investment <br />Agency <br />Foundation of <br />9am -6 <br />pm <br />MHSA FSP <br />Minority <br />Board <br />MHSA PEI <br />California <br />Health <br />Amount <br />$1,000.000 <br />$880,245 <br />$434,151 <br />$426,208 <br />$170,000 <br />HOURS OF OPERATION AND DAYS <br />Days <br />Monday <br />Tuesday <br />Wednesday <br />Thursday <br />Friday <br />Saturday <br />Sunday <br />Hours <br />9am -6pm <br />9am -6 <br />pm <br />9am -6pm <br />9am -6 <br />pm <br />9am -6 <br />pm <br />TARGET POPULATION <br />Older Youth 8 Younger Youth 1 7 Out -of- School 7 In- School 8 <br /># of Youth to be Served in 2013/2014 1 15 1 Total WIA Funds Requested 1 $101,340.00 <br />In compliance with the RFP noted above, and subject to the conditions thereof, the undersigned offers to furnish <br />the services stipulated and certifies he has read, understands, and agrees to all terms, conditions, and <br />requirements of this RFP and is authorized to contract on behalf of the agency named above. <br />Director, Strategic <br />Signature Title Partnerships <br />EXHIBIT A <br />WOMIC <br />Date 5/10/13 <br />