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r City Manager's Office – M•31 <br />��X=+ City of Santa Ana 20 Civic Center Plaza <br />t Donation Request P.O. Box 1988 <br />.t. Santa Ana, CA 92702 <br />-- (714) 647-5200 <br />Name: A.C. Green _ <br />--.— --_ <br />.tie: President &Founder <br />J —__� <br />Address: <br />_J1904 Silver Spur Rd., Ste. # 416 <br />city, state, zipJ <br />Rolling Hills, CA 90274 'Phone: J 800 -A13 -YOUTH j <br />Email: jj <br />acgreenyouthfoundation@gmail.comPax] <br />� <br />: I <br />---- <br />Name: A.C. Green Youth Foundation <br />City Services Credit <br />Date Needed: Ma or/Counalmember.' <br />Y I Martinez <br />[Amount Requested: $ J .] _ _ <br />Tax -Exempt Status: Is your organization a non-profit or public lax -exempt organization as Select One:I <br />defined under Section 501(c)(3) of the Internal Revenue Code? J Yes ❑ No <br />If No, you will only qualify fora credit for City -related costs for your request (i.e. permit fees, <br />if Yes, I <br />staff time, rental rates for facilities or equipment, etc.). Costs for City services vary and if <br />g5-4288507 <br />approved, credit may or may not cover full cost of requested City services. <br />EXHIBIT 2 <br />Revised 01/05/2017 <br />City Services Credit <br />Date Needed: Ma or/Counalmember.' <br />Y I Martinez <br />[Amount Requested: $ J .] _ _ <br />_— <br />Direct Payment Amount $ 1 OQO Event Date: JlJne 1-3 201 Event Time: I All da <br />(Requested:--—�1_--y --- ------ <br />NOVEMBER 7, 2017 <br />Eligibility Met: <br />Event Location: <br />Santa Ana - Leadership Program / Basketball camp for boys and girls ages 9-16 <br />Address, City, State, Zip <br />City Manager Signature: <br />Date: <br />Description of <br />The goal of the Leadership Program is to identify and encourage leaders among j <br />Event/ Purpose: <br />children who might otherwise be forgotten. j <br />ique opportunity for those who lack positive role models, are physically and/or <br />Community Benefit: <br />[emotionallyabused, economically disadvantaged or victims of homelessness. J <br />Applicant signature: <br />A.C. Green <br />Date_ <br />10/18/2017 <br />EXHIBIT 2 <br />Revised 01/05/2017 <br />Donation Request It: <br />Reference#anallrelatedDPVs <br />DR - <br />council Meeting Date: <br />NOVEMBER 7, 2017 <br />Eligibility Met: <br />YES / NO YES <br />Approved Amount: <br />$1,000 <br />City Manager Signature: <br />Date: <br />EXHIBIT 2 <br />Revised 01/05/2017 <br />