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City Manager's Offrce— M-31 <br />Clty of Santa Tina 20 Civic Center Plaza <br />Donation Re uest P.O. Box 1988 <br />Q Santa Ana, CA 92702 <br />a <br />(714) 647.5200 <br />Contact, Informatiorr <br />Name: —'John Herpy lue: President <br />Address: 18632 Masters Drive, Suite 1000 <br />City, state, zip: I Huntington Beach — IPhon� e: 1562.221.7145 <br />Email: ijherpy@ix.netcom.com Fa <br />s .. <br />Name: Roadrunner Football Boosters <br />Tax -Exempt Status: Is your organization a non-profit or public tax-exempt organization as I <br />Select One: Yes No <br />❑ <br />defined under Section 501(c)(3) of the Internal Revenue Code? <br />If No, you will only qualify for a credit for City-ralated costs for yourrequest (i.e. permit fees, <br />staff time, rental rates forfacilitles orequipment, etc.).Costs for City services vary andif Yes, <br />if 147_3090546 <br />approved, credit may or may not cover full cost of requested City services. Tax ID 9: <br />1• <br />City Services CreditDate Fall MyorlCnemember. <br />Tnajero <br />!Amount Requested: IS <br />Direct Payment Amount - <br />52500.00 Event Date: <br />I <br />Fall 2017 Event Time: <br />Requested: i <br />I <br />Event Location: Saddleback High School, 2802 South Flower St, Santa Ana, CA 92707 <br />Address, City, Stare, Zip <br />Saddleback High School Varsity Football Team support. <br />Description of <br />Event I Purpose: <br />PROVIDING SUPPORT FOR ON-GOING SERVICES TO THE SADDLEBACK HIGH <br />Community Benefit: SCHOOL FOOTBALL TEAM, WHICH PROMOTES HEALTH, FITNESS, AND ACADEMICS. j <br />_ <br />Applicant Signature: ' ! <br />,;Date: 1 09/05/2017 <br />.-i__ _ <br />Mail: City Manager's Ofrice—M-31 Email: donationrequest@santa•ana.org j <br />20 Civic Center Plaza Fax: (714) 647-6954 I <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />ea <br />Donation Request #. DR- Council Meeting Date: SEPTEMBER 19, 2017 <br />L <br />Rrfer enee=ar., 11 rel.,ted �P V-5 <br />Eligibility Met: YES I NO YES Approved Amount: $2,500 <br />City Manager Signature: Date: <br />X BIT <br />Revised 01/0512017 <br />