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City Manager's Office - M -31 City Of Santa Ana 20 Civic Center Plaza Donation Request P.O. Box 1988 Santa Ana, CA 92702 a (714) 647.5200 Contactlinformation Fame: Nancy Mejia itle: Program Director fAddress: 1450 W 4th St �- - (city, State, zip: (Santa Ana Ca 92701 fPnone: x17145427792 r ~u r.., email: r_ nmejia @latinohealthaccess.org ��_ Fax 714 -542 -7792 Name: Latino Health Access Tax - Exempt Status: Is your organization a non -profit or public tax - exempt organization as defined under Section 501(c)(3) of the Internal Revenue Code? Select One: Yes ❑ No If No, you will only qualify for a credit for City - related costs for your request (i.e. permit fees, staff time, rental rates for facilities or equipment, etc.). Costs for City services vary and if If Yes, w 33- 0562943 approved, credit may or may not cover full cost of requested City services. ax ID #: Ddniitlon Reauest' City Services Credit -_, $ �_�� Date Needed: /'i 9 /ZOt3 Mayor /Councilmember: �� Amezcua �® Amount RequestedT�J�Y_�.. Direct Payment Amount Requested: �- Ig1, 500.00 Event Date: �On GDing Event Time: (Event Location: Community Center & Park Familias Corazones Verdes Address, City, State, Zip There are multiple benefits. One, it will create opportunities to awaken knowledge and talents of unemployed residents to Description of become entrepreneurs. It will also bring together the community's artistic knowledge so we can learn from each other (the cooperative model allows for more members tojoin). It will also promote the recycling, reuse, and transformation of Event /Purpose: materials for creative and economic development purposes, and create a collective system of equitable and sustainable production. The donation will support the formalization of the cooperative Maros Unidas Creando Arta. LHA has been supporting the - incubation of this micro - enterprise. The group consists of Santa Ana moms who were unemployed and were inspired to F,,,,,,tyenefit: collectively work to give life to new social, cultural, and economic opportunities in Santa Ana through the production of crafts andjewelry with recycled materials. The donation will support the group in taking that next step to get incorporated as an official business cooperative, to purchase materials needed for production, such as electric paper cutter, crafts glue, I� - jewelry supplies, and to pay fees associated with permits to sell teir products at various events and venues. - IAppl l cant Signature: + (Date: I a • c• s Mail: City Manager's Office- M -31 Email: donationrequest @santa- ana.org ^ ^�� 20 Civic Center Plaza Fax: (714) 647 -6954 P.O. Box 1988 Santa Ana, CA 92702 T_— Donation Request #: i DR - Referenre 0 on all related APVS Council Meeting Date: Eligibility Met: 'I, YES I NO Approved Amount: --- - -� -_- City Manager Signature: _. _.. Date: Exhibit 0 Revised 11/16/2015 LUGP_J