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Manager's <br />rtCity <br />C Civic Center Plaza <br />�.x.; City of Santa Ana 0 <br />1988 <br />Donation Request P.O. CA 92702 <br />Q Santa Ana, GA 92702 <br />(714) 647.5200 <br />Contact Information <br />INam�e: —+I Raul Ramos - Santa Ana Memorial Park N.A. Ige: President <br />Address s: 2140 S. Birch Street <br />(city, state, I Santa Ana, CA 92707 Pnon�e: (714) 651-6176 <br />Emai�— raulramos9906@gmail.com Fax: (--_---_ <br />organizationIIIIIIIi <br />Name: I Charitable Venture of Orange County - Santa Ana Grants for Blocks <br />Tax -Exempt Status: Is your organization a non-profit or public tax-exempt organization as Select One <br />Z Yes ❑ No <br />defined under Section 501(c)(3) of the Internal Revenue Code? <br />! <br />If No, you will only quality for a credit for City -related costs for your request (i.e. permil fees, f <br />,D <br />staff time, rental rates for facilities or equipment, etc.).Costs for City services very and ff ,ax <br />I 120-8756660 <br />lapproved, credit may or may not cover full cost of requested City services. ax #: <br />Donation Re. <br />CityServi es Credit <br />S <br />— <br />I <br />Date Needed: <br />7/1 6/2017 MayorlCou�dlmember: Martinez <br />Amount Requested: j <br />j <br />DnaetPaymentAraunt _In,n�r�nn <br />Requested: h00 <br />Event Date: <br />�— <br />7/16/2017 (Event Time: <br />10am - 4pm <br />ent location: S. Broadway PI between W. Anahurst Pl. and S. Main Street <br />F <br />dress, Clty, state, Zip <br />Santa Ana Memorial Park NA is organizing a public safety awareness and gang prevention event <br />Description of by having community resources and activities for children available with special Bike pedal car - <br />Event I Purpose: Stroller and model car show in partnership with Afterlife OC, Memories OC, Temptations OC clubs. <br />Santa Ana Memorial Park N. A wants to bring awareness to the entire neighborhood on options to prevent gang Involvement with <br />Community Benefit: our youth, improve relationship between community and police, and to provide fun activities foryouth and families through creative <br />evbike and stroller cars, and partners will share on job preparation and employment with young people in attendance. <br />Applicant Slgn'ttl <br />'Return <br />completed.form via, <br />Mail: City Managers Office–M-31 Email: donatlonrequest@sante-ana.org <br />20 Civic Center Plaza Fax: (714) 647.6854 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />L,- i .;, <br />- <br />Donation Request A: DR - <br />I Council Meeting Date: OCTOBER 3, 2017 <br />RMarence a orr all relafxd DPYs <br />YES 1$250 <br />$250 <br />Eligibility Met: <br />YES I NO Approved Amount: <br />City Manager Signature: Date: <br />Revised 01105/2017 <br />