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"i City of Santa Ana <br />t Donation Request <br />(Name: Johnathan Hernandez <br />Address: 422 E Chestnut Ave. Unit A. <br />City State, zip I Santa Ana Ca 92701 <br />Email: SantanaUnldoS@gmall COm <br />Name: Santa Ana Unidos Boxing Club <br />City Manager's Office — M-31 <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />(714) 647.5200 <br />Executive Director and Founder <br />714.815.1099 <br />Status: Is your organization a non-proft or public tax-exempt organization as Select One: <br />Section 501(c)(3) of the Internal Revenue Code? W Yes El No <br />If No, you will only qualify for a credit for City -related costs for your request (i.e. permit fees, f — —_---- <br />ltaff time, rental rates for facilities or equipment, etc.). Costs for City services vary and if If Yes, 47-5211563 <br />approved, credit may or may not cover full cost of requested City services. Tax ID #: <br />City Services Credit <br />Amount Requested: Is (Date Needed: (Asap (Mayor/Councilmember. (Sarmiento <br />I <br />Direct Payment Amount 1 <br />Requested: $1,000 lEvent Date: Ongoing IEvent Time: I going <br />Location: 1 <br />3, City, State, Zip 602 E. 4th Street, Santa Ana, CA 92701 <br />PROMOTE INTERVENTION AND PREVENTION SERVICES FOR YOUTH IN SANTA <br />iption of <br />I PurpANA THROUGH THE SANTA ANA BOXING CLUB YOUTH ATHLETIC PROGRAM <br />ose: <br />SUPPORTING ON-GOING YOUTH ATHLETIC PROGRAM AT SANTA ANA BOXING CLUB THAT <br />Community Benefit: PROMOTES HEALTH SAFETY AND POSITIVE COMMUNITY ENGAGEMENT <br />I <br />I <br />Applicant Signature: lJOhnathan Hernandez Date: 106/07/2017 <br />Mail: City Manager's Office—M-31 <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Donation Request#: <br />DR-� <br />Rate enae 4 an all elated 0pvs <br />Eligibility Met: <br />YES I NO YE. <br />City Manager Signature: <br />Email: donationrequest@santa-ana.org <br />Fax: (714) 647.6954 <br />