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�`- City Manager's Office- M -31 <br />;. City of Santa Ana <br />20 Civic Center Plaza <br />�,. %s1 Donation Request P.O. Box 1986 <br />''_' <br />Santa Ana, CA 92702 <br />(714) 647.5200 <br />Contact <br />Na,,. iAna Urzua -� Title: Campaign Coordinator <br />Address: 11505 E 17th St, Suite 111 <br />Clty, state, zip: (Santa Ana Ca. 92707 Phone: 714 - 335 -1528 �l <br />Emall: i ana.Urzua @sa- bhc.org Fax: <br />Organization <br />Name: (Santa Ana Building Healthy Communities c/o Charitable Ventures of Orange County j <br />Tax - Exempt Status: Is your organization anon - profit qr public tax - exempt organization as (Select One: Z <br />defined under Section 501(c)(3) of the Internal Revenue Code? Yes No <br />If No, you will only qualify fora credit for City- related costs for your request (i.e. permit fees, I4 Yes, — <br />staff time, rental rates for facilities or equipment, etc,). Costs for City services vary and if <br />approved, credit may or may not cover full cost of requested City services. Tax ID #: I <br />20- 8756660 <br />Donation R- . <br />Services Credit <br />Citount Requested: <br />m <br />h-� <br />[Date Needed: 6/1/16 rtinez <br />e e 1 Mayor /Councilmembar: (Ma Lt <br />Direct Payment Amount <br />Readeated: <br />Event Date: 6/29/16 Event Time: <br />$1,000 _.. _�--- ___.,....__ 5pm <br />-- <br />Event Lgoatlon: <br />Address, City, State, Zip <br />First Congregational Church; 2555 Santiago St, Santa Ana, Ca. 92706 <br />In line with the Wellness Resolution approved by the City in June of 2015, community members will be <br />(Description of <br />hosting a summer training open to the public to learn technical skills in growing food, and connect to food <br />(Event / Purpose: <br />I _ <br />justice concepts and principles, towards the creation of a community run microfarm in Santa Ana. <br />Participants will learn to grow culturally relevant, health promoting foods in season, be <br />�ommunity Benefit: knowledgeable of food justice concepts such as the impact of the modern food system on <br />envivirotnnmemrent health, the crucial role of planning inr food and more. <br />daaccess, <br />/—rand <br />Applicant Signature: �YJ1" I Date: 5/5/16 <br />Return completed form <br />�— <br />7 Mall: City Manager's Office -M -31 <br />20 Civic Center Plaza <br />Email: donationrequest @santa - ana.org <br />Fax: (714) 647.6954 <br />P.O. Box 1988 <br />Santa Ana, CA 92762 <br />Donation <br />Request #: i DR Council Meeting Date. —T— —' <br />Eligibility Met: YES l NO Approved Amount: <br />City Manager Signature: Data: <br />Revised 11/1612015 <br />�� T� <br />