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Amezcua <br />0BoxCity Manager's Office — M-31 <br />City of Santa Ana 20 Civic Center Plaza <br />P.Donation Request Santa Ana, CA 92702 <br />1988 <br />(714) 647.5200 <br />Name: <br />Lea Roma <br />Address: <br />2390 E. Orangewood Avenue, Suite 300 <br />City, State, zip: <br />Anaheim, CA 92806 <br />Email: 'LRomo@BrightFutures4Kids.org <br />Name: Orange County Child Abuse Prevention Center <br />Director of Development <br />Phone: 714-955-6530 <br />'.Fax: 714-543.4398 <br />Tax -Exempt Status: Is your organization a non-profit or public tax-exempt organization as ;Select One: <br />Wined under Section 501(c)(3) of the Internal Revenue Code? <br />If No, you will only quality fora credit for City -related costs for your request (i.e. permit fees, :If Yes, <br />` <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 cast of requested City services. Tax ID #: <br />City Services Credit 'i$ !Date Needed: ; iMayor/Councilmember: <br />Amount Requested: <br />Direct Payment Amounts <br />Requested: $750 .Event Date:'13/18/17 IEvent Time: <br />Event Location: iSanta Ana Zoo - 1801 E. Chestnut Avenue, Santa Ana, CA 92701 <br />Address, City, State, Zip I <br />Q Yes ❑ No <br />33-0013237 <br />Amezcua <br />11 am to 4pm <br />Families Helping Families Camp heART event is to help provide a fun, safe and healthy <br />peon of I environment for art as a way of communicating that goes beyond words. It allows for emotional <br />I Purpose: communication and expression for approximately 135 children and their parents. <br />Community Benefit: <br />,Applicant Signature: ,^I <br />an who participate in the arts have increased self-esteem and resiliency, as well as <br />er connections to others. You can help us make a difference in the children and families we <br />to have the itemstskills they need to do well with their expression and connections. <br />Return completed form via: xx <br />Mail: City Manager's Office—M-31 I Email: donationrequest@santaana.org <br />20 Civic Center Plaza Fax: (714) 6476954 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Donation Request # OR - Council Meeting Date: <br />Eligibility Met: YES I NO Approved Amount: <br />City Manager Signature: Date: <br />EXHIBIT 1 <br />Revised 1 V1612015 <br />29C-3 <br />