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a City of Santa Ana <br />Donation Request <br />State, zip: <br />.org <br />City <br />Office- M-31 <br />Center Plaza <br />W. Box 1988 <br />na, CA 92702 <br />F74) 647-5200 <br />Name: UC Berkeley Chicano LatinoAlumniAssociation on behalf of Affordable Cleari "g -House <br />--> 11 <br />Tax -Exempt Status: Is your organization a non-profit or public tax-exempt organization as I1Sele—ct ones: <br />defined under Section 501(c)(3) of the Intemal Revenue Code? I - I Yes— —� No <br />1f No, you will only qualify for a credit for City -related costs for your request (i.e. permittees, If Yes, <br />tafftime,rentalratesforfadlitiesorequipment,etaQ.CostsforCityservicesvaryaodif L 47=1688249 +f <br />approved, credit may ormay not cover full cost of requested Cit services. I ax Ip�R: <br />(City Services CreditSarmiento <br />Date Needed: a <br />Myor/Couneilmember. <br />mount Requested: � <br />( 1 11 <br />DRierqeuctePayment Amount 'F-_55100) SL_5_0_0��JIIhEv—ent a_e2.-_/.2._�1/-2-01-- !�jE�vent T_._._j_�J <br />bmme, <br />n II <br />Event Location: - <br />Address, City, State, Zip <br />_ I C IcanFi —o Latino Alumni Association Chapter launchOrange County)- <br />Description of organize chapter to host yielding events for <br />Event IPurpose: pity college students and to engage alumni, <br />Benefit: <br />Mail: City Manager's Office -M-31 <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Email: donation7equest@santaana.org <br />Fax: (714) 647.6954 <br />school a' d commu <br />EXHIBIT <br />29A-5 I !evised011052017 <br />Donation Request #: <br />f •. pp, -. �d nPli <br />IDR • <br />Meeting Date: I APRIL 17, 2018 <br />Eligibility Met: <br />I YES I NO YES <br />EApprovedAmount: I $500 <br />City Manager Signature: <br />Date: ` <br />EXHIBIT <br />29A-5 I !evised011052017 <br />