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City of Santa Ana <br />Donation Request <br />CifyManager's Office— M-31 <br />20 CIVIC Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />(714) 647.5200 <br />Oil= lAmerica Bracho CEO <br />Pddros� s: 450 W Fourth St. <br />ity, smote, zip: I Santa Ana, CA 92701 hone: (714) 642-7792 ext 1009 <br />malt: Iruiz@latinohealthaccess.org, cachamaure@aol.com Fimc. (714) 542-4853 <br />• .. <br />Direct Paymont Amount S ICJOO Event Date: 4/7/2018 Event Tlme: 8:00 aM <br />Name: Latino Health Access (Latino en er or reven ton c ton toea th &e are <br />Tax -Exempt Status: Is your organization a non-profit or public lax -exempt orgenizalion as <br />defined under Section 501(c)(3) of the Internal Revenue Code? <br />elect One: W1 Yes ❑ No <br />It No, you 8411 only quality fora cmdif for City -related costs far yourrequest (Le. permit fees, <br />staff time, rental rates forla�9es or equipment, etd.).Costs for City services Vary andg33-0562943 <br />5K Health Walk - Caminata por la Salud <br />pproved, credit may or may not coverfu8 cost of requested City services. <br />F -Y -0,s471 <br />Ciry Services Credit IC Date Needed: tayor/Councllmembar. Senavfdes <br />mount Requested: I' <br />Direct Paymont Amount S ICJOO Event Date: 4/7/2018 Event Tlme: 8:00 aM <br />Requastod: <br />Event Location: —Centennial Regional Park, 3000 W Edinger, Santa Ana, CA 92704 <br />$mires; Ciry. State. Zip <br />Description of <br />5K Health Walk - Caminata por la Salud <br />Frond Purpose: <br />To promote awareness among Santa Ana residents on the importance of physical and <br />community Bonofit: <br />emotional wellbeing, its impact on our community, and the growth of a healthier city. <br />Applicant Signature: <br />r <br />Date: -O4JO5J2O1-8 <br />(Mail: City Manager's Office—M-31 Email: donationrequest@santaana.org <br />20 Civic Center Plaza Fax: (714) 647.6954 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Donation Request M I DR- <br />Reforence x on all related DPVs I _ _ _ _ _ Council Mooting Data: <br />Eligibility fact: i YES I NO Yes f Approved Amount: <br />City Manager Signature: Data: <br />May 15, 2018 <br />$1,500 <br />Revised 01/052017 <br />