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City of Santa Ana <br />Donation Request <br />City Manager's Office— M-31 <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Apia, CA 92702 <br />(714) 847-5200 <br />.. ........... ... . <br />!:Nama: jAlicia Rojas mtfo: lArlist /Cc -founder <br />Address: 12202 1/2 Main St. ste-200 <br />;city, State, Zip: ISanta Ana, CA 92706 <br />Emall: �alicitarojas@yahoo.com <br />Phone: 714 907 5468 <br />,Fax: <br />owanization Information <br />I <br />Name: !Santa Ana Community Artist(a) Coalition (Fiscal Sponsor Blackbook Sessions Non Profit) <br />-TaxExam P- Status: is your organization a non-profit or public tax-exempt organization as <br />it '- <br />Select One: <br />defined under Section 601(c)(3) of the Internal Revenue Code? IFV Yes F] No <br />If No, you will only quality for a credit for City-paltdod costs for your request (i.e. permit less, If Y I <br />lstet/time, rental rates thrlecififiest or equipment, stc).Cosui fe), City services very and if as, <br />opproved, cirditt mayor may not coverfull cost of requested City services. Tax ID #: 126-291 5498 <br />I - <br />,City ServicesCredit <br />mount Requested: Date Needed; mayorlCounclimember: 18alorlo <br />Direct Payment Amount 1$1500.00 "Event Date: <br />Requested: Event Time: <br />. ..... .. . .. <br />lEvent Location: ';Santa Ana Mural Restorations <br />I <br />Address City. State, Zip <br />The donation would go towards, paint, materials, and artist stipends. <br />'Description of <br />Event I Purprisa: r <br />;The mission of the Santa Ana Community Artist(a) Coalition is to connect local artists to their <br />community Benefit: communities in a collaborative process to create aft that transforms public spaces, generates <br />icivic engagement and promotes personal and social change, <br />!Applicant Sfifinatuns; <br />A 160ta tljkoja/� bate: 513 9/17 <br />Mpletedilho— <br />Mail: City Manager's Office—M•31 m-aEmail: donallonrequt@santano.org <br />20 civic Center Plaza Fax: (714) 647.6954 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Donation Request 9: DR - <br />Council Meeting Date: Lo -2,0 --1—+ <br />U01WItty Mot: YES,! NO Amm�nt <br />cily Manager siqnalmor DoW <br />Revised 0110512017 <br />'16 <br />