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.`t City of Santa Ana <br />Donation Request <br />w <br />Contact•information -" - - <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 />Name: Ramona Alvarez iti,: <br />MPNA President <br />adrass: <br />1441 Orange Ave <br />Pity, State, <br />Santa Ana Phone: (714)760 5693 <br />Email- <br />alvarezramona08@yahoo.com <br />Fax: <br />Requested: r <br />IName: IMadison Park Neighborhood Association I <br />Tax -Exempt Status: Is your organization a non-profit or public tax-exempt organization aslect <br />SeOne: <br />MayorlCoul ncilmember: <br />Sarmiento <br />Yes ❑ No <br />defined under Section 501(c)(3) of the Internal Revenue Code? <br />_ <br />Approved Amount: <br />.1 <br />Direct Payment Amount s733.62 Event Date: 09/30/17 Event Time: Earp—IZnm <br />Requested: r <br />if No, you will only qualify for a credit for City -related costs for yourrequest (i.e. permit fees, <br />staff time, rentalcredit ratemay for facilities over equipment, for Citys'vary and if <br />If Yes, <br />EIN-80-0201690 <br />freq este vices. <br />approved, credit mayor may not cover full cost of requested City services. <br />ax ID #: <br />: <br />City Services Credit <br />$ 733.62 Date Needed: O9/3O/17 <br />MayorlCoul ncilmember: <br />Sarmiento <br />ount Re uested: <br />Eligibility Met: <br />_ <br />Approved Amount: <br />.1 <br />Direct Payment Amount s733.62 Event Date: 09/30/17 Event Time: Earp—IZnm <br />Requested: r <br />Exhibit 4 <br />Date: <br />Event Location:1528 <br />S Standard Ave Santa Ana, CA <br />Address, City, State, Zip <br />The Walk-a-Thon & Resource Fair is organized by volunteers and provides Santa Ana residents with <br />Description of <br />the resources and support they need to build a healthy community. Each year close to 50 agencies & <br />Event/ Purpose: <br />businesses offer free services & information on health, youth programs, & education and much more. <br />The Walk-a-Thon provides the Madison Park residents with free informations about youth programs, <br />Community Benefit: <br />health, education, job training as well as free medical services and resources. The event also <br />showcases various cultural performances in an effort to promote diversity in the community. <br />Applicant Signature: <br />109/08/17 <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 />Revised 0110512017 <br />Donation Request #: <br />Reference q on all related OPVs <br />DR <br />Council Meeting Date: <br />Eligibility Met: <br />YES I NO <br />Approved Amount: <br />City Manager Signature: <br />Exhibit 4 <br />Date: <br />Revised 0110512017 <br />