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City Manager's Office- M-31 <br />City of Santa Ana 20 Civic Center Plaza <br />Donation Request P.O. Box 1988 <br />(9) <br />Santa Ana, CA 92702 <br />(714) 647-5200 <br />�Contact Information <br />iN m : Nick Canzone <br />gide: Athletie Director <br />ddress: 2301 W. MacArthur Blvd. <br />ICfty, state, Zip: (Santa Ana Phone: 714-241-5015 <br />Emau: nick.canzone@sausd.us <br />IFax: ---[714-241-5099 <br />!Organization <br />Inform ation <br />Nemo: Segerstrom High School (Fiscal Sponsor: Segerstrom HS Football Booster Club Inc.) <br />Tax-Exempt Status: Is your organization a non-profit or public tax-exempt organization aselect One: <br />a Yes ❑ No <br />defined under Section 501(c)(3) of the Internal Revenue Code? Is <br />If No, you will only qualify for a credit for City-relaled costs for your request (i.e. permit fees, �' <br />staff rental rates for facilities orequipment, If Yes, <br />ere.q Costs forCityse services vary and If I_ �95 <br />G`pproved, 0028.23 <br />provetime, <br />credit may ormay not cover full cost ofrequesfed City services. �ax lD#: <br />cost <br />509 <br />Donation Request <br />City Services Cretlit Date Needed: MayodCouncilmember: <br />Benavides <br />,Amount Requested: <br />' <br />Direct Payment Amount 5Ja� 06 Event Da et 5I27I17— Event Time: I2iAM <br />Requested: I <br />IIIIiiiEvent Location: <br />Segerstrom High School - Jaguar Prowl 5K <br />Address, City, State, Zip <br />2301 W. MacArthur Blvd. Santa Ana, CA 92704 <br />2nd Annual Jaguar Prowl 5K - This is a fundraiser for the Segerstrom High <br />Description of <br />School Athletics programs. Please visit our website at www.jaguarprowl5k.com. <br />Event / Purpose: <br />Promotes healthy lifestyles and local small businesses will be involved giving away items and <br />Community Benefit: <br />promoting their business. Supports the Athletic programs at Segerstrom High School, money will <br />go to purfh4 equipment, supplies, team meals, and other items as needed. <br />Applicant Signature: <br />i �Dats..1 i1� <br />I I 4(t <br />completed <br />w€ <br />Mail: City Manager's Office-M-31 Email: donationrequest@santa-ana.org—� <br />20 Civic Center Plaza Fax: (714) 647.6954 <br />P.O Box 1988 <br />Santa Ana, CA 92702 <br />Donation Request#: DR- Council Meeting Date: 06/20/17 '.. <br />i Reference it ai alt mG,aed bPV+ _ _ _ _ ...- <br />.-_. <br />Eligibility diet YES/No YES Approved Amount: $500 <br />City Manager Signature: 1 Date: --., <br />qqgviTg Revised 01/05/2017 <br />