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HomeMy WebLinkAbout29A - DONATION AGMT SUPPORT COMMUNITY EVENTS AND PRGMREQUEST FOR COUNCIL ACTION CITY COUNCIL MEETING DATE: JUNE 20, 2017 TITLE: DONATION AGREEMENT WITH VARIOUS ORGANIZATIONS TO SUPPORT COMMUNITY EVENTS AND PROGRAMS (STRATEGIC PLAN NO. 5, 4) CITYMANAGER RECOMMENDED ACTION CLERK OF COUNCIL USE ONLY: APPROVED "E] -As Recommended ❑ As Amended ❑ Ordinance on1� Reading ❑ Ordinance on 2ntl Reading ❑ Implementing Resolution ❑ Set Public Hearing For CONTINUED TO FILE NUMBER Authorize the City Manager and Clerk of the Council to execute agreements with various organizations in support of their community events and programs, subject to nonsubstantive changes approved by the City Manager and the City Attorney, as follows: 1. Segerstrom High School Football Booster Club Inc. to support the Jaguar Prawl 5K event at Segerstrom High School, in the amount of $500 (Councilmember Benavides); 2. Orange County Burrito Project, as fiscal sponsors for Downtown Inc., to support the Hack for Health event, in the amount of $1,000 (Mayor Pro Tem Martinez); 3. Charitable Ventures Orange County Inc., as fiscal sponsor for Project Kinship, to support on-going the transitional age youth leadership summit, in the amount of $1,000 (Councilmember Sarmiento); 4. Community Partners, as fiscal sponsors for Media Arts Santa Ana, to support a youth cinema program, in the amount of $1,000 (Councilmember Sarmiento); 5. Delhi Center to support the summer day camp program, in the amount of $1,000 (Councilmember Sarmiento); 6. Madison Park Neighborhood Association to support the Aspire, Learn, Mentor, Achieve Science Academy at Madison Elementary School, in the amount of $500 (Councilmember Sarmiento); 7. Mariners Church Lighthouse Community Centers, as fiscal sponsor for Cornerstone Village Neighborhood Association, to support the annual community fair, in the amount of $1,000 (Councilmember Sarmiento); 29A-1 Donation Agreement with Various Organizations to Support Community Events and Programs June 20, 2017 Page 2 8. Orange County Community Foundation, as fiscal sponsor for the Santa Ana Police Athletic & Activity League, in support of on-going youth educational and athletic program, in the amount of $500 (Councilmember Sarmiento); 9. Orange County Children's Therapeutic Arts Center in support of the youth arts enrichment program, in the amount of $500 (Councilmember Sarmiento); 10. Santa Ana Unidos Boxing Club to support on-going youth athletic programming, in the amount of $1,0000 (Councilmember Sarmiento); 11. Santa Ana Senior Center Advisory Board to support the Santa Ana Senior Center on-going programs for the elderly, in the amount of $550 in city service credit (Councilmember Sarmiento); 12.Achievement Institute of Scientific Studies to support the INSPIRES program that provides Santa Ana students with STEM activities, workshops, and introductions to businesses within that field, in the amount of $1,200 (Councilmember Solorio); 13. Blackbook Sessions Inc., as fiscal sponsor for the Santa Ana Community Artist Coalition, to support on-going restorative art programs, in the amount of amount of $1,500 (Councilmember Solorio); 14. Charitable Ventures of Orange County Inc., as fiscal sponsor for Riverview West Neighborhood Association, in support of the community movie night event at Rosita Park, in the amount of $500 (Councilmember Solorio); 15. Santa Ana Athletic Foundation, as fiscal sponsor for the Elizabeth G. Macias Legal Studies Academy at Santa Ana High School, which promotes education in in the area of law, in the amount of $500 (Councilmember Solorio); 16.Santa Ana Pony Baseball Inc. to support on-going youth athletic program and annual event, in the amount of $2,000 (Councilmember Tinajero); 17. Charitable Ventures of Orange County Inc., as fiscal sponsor for Saint Peter Evangelical Lutheran Church, in support of the Willard Neighborhood clean-up initiative, in the amount of $500 (Councilmember Villegas); 18. Orange County Community Foundation, as fiscal sponsor for the Santa Ana Police Athletic & Activity League, in support of on-going youth education and athletic program, in the amount of $500 (Councilmember Villegas). 29A-2 Donation Agreement with Various Organizations to Support Community Events and Programs June 20, 2017 Page 3 DISCUSSION On August 4, 2015, City Council adopted Resolution 2015-042, establishing a City Special Event Sponsorship Policy and Guidelines for Disbursement of Discretionary Funds. This resolution and policy outlines the eligibility criteria for neighborhood associations and eligible non-profit entities for consideration of City Council sponsorship. In accordance with this policy, each Councilmember is allowed to appropriate up to $10,000 per fiscal year to support eligible organizations, including neighborhood associations and non-profit organizations. Eligible organizations that are not tax exempt under section 501(c)3 of the Internal Revenue Code are eligible for in-kind funding for City Services. The donation agreements listed above are in response to the Donation Requests (Exhibits 1-18) submitted by various community organizations or neighborhood associations to the specific Councilmembers, seeking sponsorship for community events and/or programs. The Councilmembers, respectively, reviewed and agreed to sponsoring the programs or events through the Special Event Sponsorship funds. Upon approval by City Council, the respective donation agreements (Exhibit 19) will be executed. STRATEGIC PLAN ALIGNMENT Approval of this item supports the City's efforts to meet Goal #5 - Community Health, Livability, Engagement & Sustainability, Objective #4 (support neighborhood vitality and livability). FISCAL IMPACT Funds to support the City Council Sponsorship Policy are available in the Fiscal Year 2016-17 General Non -Departmental account (01105015-62300) as appropriate from each of the following Councilmember's appropriated amounts for Fiscal Year 2016-17: Councilmember Benavides $ 500.00 Councilmember Sarmiento $ 7,050.00 Councilmember Solorio $ 3,700.00 Councilmember Tinajero $ 2,000.00 Councilmember Villegas $ 1,000.00 29A-3 Donation Agreement with Various Organizations to Support Community Events and Programs June 20, 2017 Page 4 APPROVED AS TO FUNDS AND ACCOUNTS: Francisco Gutierrez Executive Director` Finance and Management Services Agency EXHIBITS: 1-18. Donation Request Forms 19. Standard Donation Agreement 29A-4 City Manager's Office- M-31 City of Santa Ana 20 Civic Center Plaza Donation Request P.O. Box 1988 (9) Santa Ana, CA 92702 (714) 647-5200 �Contact Information iN m : Nick Canzone gide: Athletie Director ddress: 2301 W. MacArthur Blvd. ICfty, state, Zip: (Santa Ana Phone: 714-241-5015 Emau: nick.canzone@sausd.us IFax: ---[714-241-5099 !Organization Inform ation Nemo: Segerstrom High School (Fiscal Sponsor: Segerstrom HS Football Booster Club Inc.) Tax-Exempt Status: Is your organization a non-profit or public tax-exempt organization aselect One: a Yes ❑ No defined under Section 501(c)(3) of the Internal Revenue Code? Is If No, you will only qualify for a credit for City-relaled costs for your request (i.e. permit fees, �' staff rental rates for facilities orequipment, If Yes, ere.q Costs forCityse services vary and If I_ �95 G`pproved, 0028.23 provetime, credit may ormay not cover full cost ofrequesfed City services. �ax lD#: cost 509 Donation Request City Services Cretlit Date Needed: MayodCouncilmember: Benavides ,Amount Requested: ' Direct Payment Amount 5Ja� 06 Event Da et 5I27I17— Event Time: I2iAM Requested: I IIIIiiiEvent Location: Segerstrom High School - Jaguar Prowl 5K Address, City, State, Zip 2301 W. MacArthur Blvd. Santa Ana, CA 92704 2nd Annual Jaguar Prowl 5K - This is a fundraiser for the Segerstrom High Description of School Athletics programs. Please visit our website at www.jaguarprowl5k.com. Event / Purpose: Promotes healthy lifestyles and local small businesses will be involved giving away items and Community Benefit: promoting their business. Supports the Athletic programs at Segerstrom High School, money will go to purfh4 equipment, supplies, team meals, and other items as needed. Applicant Signature: i �Dats..1 i1� I I 4(t completed w€ Mail: City Manager's Office-M-31 Email: donationrequest@santa-ana.org—� 20 Civic Center Plaza Fax: (714) 647.6954 P.O Box 1988 Santa Ana, CA 92702 Donation Request#: DR- Council Meeting Date: 06/20/17 '.. i Reference it ai alt mG,aed bPV+ _ _ _ _ ...- .-_. Eligibility diet YES/No YES Approved Amount: $500 City Manager Signature: 1 Date: --., qqgviTg Revised 01/05/2017 City of Santa Ana Donation Request City Manager's Ofrice - 431 20 Civic Center Plaza P.O. Box 1988 Santa Aria, CA 92702 (714) 647.5200 - Name: Charitable Ventures of Orange County/Project Kinship I Tex -Exempt status: Is your o r ganizati o n a non profit or p , u , b , ]!a , tax-exempt , , , o - rg - E , mi - zati - on - as Iect one-,- earned under Section 501(c)(3) of the Internal Revenue Code? i Yes No If No, you will only qualify for a credil for City -related costs far yourrequest (i.e. permit fees, ------- ­­­­­ . .... . - Wait time, rental far facilities orequipment, etc).Coste for City very and iiP '120-8756660 !aPproved, credit may or may not cover full cost of requested City services, (rax ID OP. !City Services Credit mount Requested: i$ Date Needed: !June 2017 ImayorlCounclimember. 1 Sarmiento Direct Payment Amount Requested: 00 $ i 1000. lEvent Date: On -Going !Event Time,. On-going , I Event Location: 1 535 East!7thStreet103 'Santa Ana, CA 92705 ;Address, W State, OP ransit—A'A'_t we iona geY(outhLeai-d(ersh'ip'SummitsuiiiffiiI i 411ante na youth r gatOh- !Descriplion of !between the ages of 17-24 to participate in training and community outreach, 'Event I Purpose: Topics will include restorative practices, community service, leadership and youth 'Community Benefit: Jencourage and engage youth in community service while fostering pro -social activities, Applicant Signature: i Mail: City Managers Oltice - M-31 JEmat: donationmquest@santa-ano.org 20 CIVIC Center Plaza Fix: (714) 647984 P.O. Box 1988 Santa Ana, CA 92702 Drmr4flan Requwt A DP Council PAROing Date: JUNE 20, 2017 01giWity Met: YES i NO YES Approved Amount: $1,000 Revised 01/05=017 OHAIT 3 2 -6 DocuSign Envelope ID: F9D83648-635F-47C1-AOC6-CC3370BEF8EA City of Santa Ana Donation Request Name: Mamie Funahashi �itle: Address: 1000 N. Alameda Street, Suite 240 city, State, zip: Los Angeles, CA 90012 (Phone: Email: mfunahashi@CommunityPartners.org Fax: City Manager's Office — M-31 20 Civic Center Plaza P.O. Box 1988 Santa Ana, CA 92702 (714) 647.5200 Name: ommunity Partners for MASA (Media Arts Santa Ana) ($ (Date Needed: (6/28/17 Sarmiento Tax -Exempt Status: Is your organization a non-profit or public tax-exempt organization as Select One: defined under Section 501(c)(3) of the Internal Revenue Code? � Z Yes ❑ No If No, you will only qualify for a credit for City -related costs for your request (i.e. permit fees, $ 1,00 (Event Date: 6/28/17 Event Time: i 7 weeks staff time, rental rates for facilities or equipment, etc.). Costs for City services vary and if If Yes,g 4302067 approved, credit may or may not cover full cost of requested City services. Tax ID #: Delhi Community Center, 505 E Central Ave, Santa Ana, CA 92707 (city Services Credit ($ (Date Needed: (6/28/17 Sarmiento (Amount Requested: IMayorlCouncilmember: Direct Payment Amount Requested: $ 1,00 (Event Date: 6/28/17 Event Time: i 7 weeks Applicant.Signature: Event Location. Delhi Community Center, 505 E Central Ave, Santa Ana, CA 92707 Address, City, State, Zip —0FX813C0842F468... We are requesting funds to support the 2017 MASA Youth Cinema Camp and to offer free instruction to Santa Ana youth in digital Description of media production and skills that promote creativity, leadership, civic engagement, career skills and community expression. The program Event/ Purpose: will take place from June 26 -Aug 11, 2017 and will include a free community screening of youth -produced works. MASA is a fiscally -sponsored project of Community Partners, a 501(c)(3) non-profit organization. This program will provide free summer media -making instruction, programming and access to Santa Ana youth ages 11-17 by award-winning Community Benefit: artists and media -makers. The MASA Cinema Camp will provide critical digital literacy and production skills that will enable participants to create their own community stories, inspire artistic production and the use of technology, promote equity, provide marketable career skills and also increase the capacity of the community to defend itself by documenting abuses and attacks from anti -immigrant groups. Applicant.Signature: Dacus igned by. ` - �4l uutL Y s10605-1-7 IDate: i 0605_ 7 ' —_ —0FX813C0842F468... Mail: City Manager's Office—M-31 20 Civic Center Plaza P.O. Box 1988 Santa Ana, CA 92702 Email: donationrequest@santa-ana.org Fax: (714) 647-6954 I Donation Request #: I DR- Rete, ence V on ali retatexi Dpvs Council Meeting Date: Eligibility Met: I i YES / N0 YES � Approved Amount: 1 JUNE 20, 2017 $1,000 I City Manager Signature: Date: EXHIBIT 4 Revised 01/05/2017 City of Santa Ana ° Donation Request �iNamo: Jenny Rios _. ....... l Acidraes; 505 E. Central Ave. ;city, state, zip: I Santa Ana,CA 82707 �Emau: ijennyrios@delhlcenter.org _ Narna: Delhi Center City Manager's Office — M41 20 Civic Center Plaza P.O. Box 1900 Santa Ana, CA 92702 (714) 647.5200 �ftde: CEO jP ho ne: 1714-481-9601 Fax: 714-481-9698 ._ ... __.. _. .._ _ __.. _. . e I _ __.. Exempt Status: is your argenizailon a non•pro6t or public tax•exempi organization as elect One: ' Id under Seollon 661(c)(3) of the Internal Revenue Code? 1 ® yes ❑ No You will only quality for a credit for Ci related costs for our request l e. permit fees,-��''r`r (—'�ryry— Y yq h'- Y ic L n X952620952 Ime, rental rates for facilities orequipment etc.).Costs for City services vary and N wed, credit may or may not cover full cast of requested City services, ax ID #; CServideacratit tuntRequested: I �(6 fDale Needed: I Fax: (714) 647.6964 (Mayor/Councilmember: •`J (�Y115'1l�Vl)i-c) Direct Payment Amount Requested. I$ ®QQ ' (Event Date: I11 (.lune 26-30 2� (Evont Time: I M -F 7:30 el1'i - 5:30 p111 + Event Location: Delhi Center 505 E, Central Ave. Santa Ana CA 92707 (Address, City, Stara, Zip ISummar I Day Camp: Funds will cover the cost of one week of Summer Day Camp offering challenging enrichment and cultural {Description of an lessons for children ages 6.15 including classes in singing, acting, musical theater, hip hop, breakdance, popping, ballet I Event I purpose: t,Ikiorico. and art, and preparation for an end-of�summer extravaganza, which will Include a musical theater rendition of a � popular movie, an art gallery, a math and science fair, and a video presentation. (lura' Summer Day Camp will enrich the Santa Ana community by engaging young people in the arts and STEM activihea by providing them Vill a Community Benefit: variety of classes to give them maximum exposure to math and science as well as to different visual and performing artistic genres to help them develop a longterm passlon and commitment to the ane and to math and science. The project will also serve as a vehicle to celebrate I�mmenily. an Share le accomplishments of the students with their families and the co Applicant Signature: ` 4 n..w ;Date: i� �r���41ITr Mail: City Manager's off- lcu—M•31 (Email: donatimlroquaat(Qeanta-ano.org 20 Civic Center Plaza I Fax: (714) 647.6964 Ro, Dox 1906 I Santa Ana, CA 92702 i cE l Donation requom DR - 6FaJoeenA�l'on ea ralataR Dr'J• :oufi AeflYgDate, 2-0-3_ Eiiginilly Vat; TC51 _l \\�"l% ApP ntluti imwnll � Cily 0.lanagsr sig,wtum (lura' Revised 0110512017 2 AT8 •City of Santa AnaDonationRequest Jose J. Rea Address: 616E Occidental City Manager's Office - M-31 20 Civic Center Plaza P.O. Box 1988 Santa Ana, CA 92702 (714) 647-9200 Executive Director (volunteer) 714-367-6697 -- _-_ _—_— _._. __._- l Tax -Exempt Status: Is your organization anon -profit or public tax-exempt organization as !Select One ,defined under Section 501(c)(3) of the Internal Revenue Code? Yes No If No, you will only qualify for a credit for City -related costs for your request (i.e. permit fees, - --------------' -'-" !staff time, rental rates for facilities or equipment, etc.). Costs for City services vary and if Iif Yes, � approved credit may or may not cover full cast of requested City services. tiTax ID #: 80-0201690 City Services Credit i ykmount Requested: �S Date Needed: _.._______ ....____.__ ...___.___._ _.._ !Direct Payment Amount !$500 Q� �EvenY pate ,Requested. ! , Ev�nttooatson I ALMA Science Academy Address, City, state, Zip ;James Madison Elementary, Time: 1124 E. Hobart St., Santa Ana, CA 92707 IALMA: Aspire, Learn, Mentor & Achieve Science Academy Description of I Youth academic enrichment and parental/resident engagement - offered during school year as ':EvenYlPurpas®, 1well as during the summer. Promote science careers, strong academics and higher education among neighborhood as well Community Benefit: !as parental engagement, civic participation and community building. I ' r 'Applicant Signatures: -- Mall: City Manager's Office- M31 Emall: donationrequest@santaana.org 20 Civic Center Plaza Fax: (714) 647.6954 P.O. Box 1966 Santa Ana, CA 62702 Revised 01/06/2017 City of Santa Ana Donation Request iName: CGloria Bashara �ddrasr. 5001 Newport Coast Drive City Manager's Office - M-31 20 Civic Center Plaza P.O. Box 1988 Santa Ana, CA 92702 (714) 647-5200 of LCC City, State, zip. I Irvine, CA -8410 Email: fgbaihara6WrTr�erschu-rch-.o—rg-- Fax: n Name, Mariners Church Lighthouse Community Centers / cORNERSTONE VILLAGE NEIGHBORHOOD nPtStRtUS: IS your organization a non-profitoi—pu-b�le—tax-eXempt—o-rga—niza—tio-n —as ider Section 601(c)(3) Of the Internal Revenue Code? elect One: ✓ Yes ®Na t will only quality far a credit for City -related costs for your raque3t # 0 permit fees, r -- — [ — rental fates libri8cillitIrs Or equipment efc) Costs for City servkOs very andif f yes, f 195241990 credit may or may not coverial cost of requested City services, ax 10 if: -4 'City Services credit Amount Requested: —S 1 000 �Dafif Needed: TVMayor/Counclimaimbar: 3 Sarmiento IDIroct Payment Amount [ ,Requested: :—jSpring 2017 lEvent'Thmix. 0:00-1:00 Fevents vant atlo"j, 010 S. Minnie Street, Santa Ana, CA Addlrr!`O,C��y, Stiqe, ZjP �1' Description of The Cornerstone Village Block Party is a community event hosted in partnership with local Event I Purpose: organizations and residents of the Cornerstone Village Neighborhood to celebrate the progress and restoration of the community, 1commurifty-an"arit: This event promotes community livability, engagement, and community pride. Applicant Signature: &VA ( 00 �Shn 166/ Iiii7 Limm".rm"", rMall: City Manager's office—M-31 Smalk do"mIOnrQquQSt@%ama-anaorg 20 Civic Center Plaza Fax: (714) $47-6964 P.O. Box 1988 Santa Ana, CA 92702 I Donation Request c OR- -- I Council Meeting Date; JUNE 20, 2017 1 Eligibility met: YES I NO YES Approved Amount $$1,000 City Manager Signaturs: Date! Revised 01105/2017 City Manager's Office- M31 cltr) City of Santa Ana 20 Civic Center Plaza Donation Request Santa P.O. n , ca e27oz (714) 047-5200 M e q a a $000 Date Needed: JUNE 2017 "Mayor/councnmember. Sarmiento Name: Ot2ANGE COUNTY COMMUNITY FOUNDATION (for SAPAAL) Tax -Exempt Status: Is your organizatlon a non-profit or public tax-exempt organization as ,defined under Section 501(c)(3) of the Interval Revenue Code? selectone: � YJ Yes ❑ No If No, you will only qualify for a credit for Ciry-related costs for your request ii. e. permit fees, 'If Yes, staff time, rental miss for facilities or equipment, etc.). Costs for City services vary and if �i 7 Q �? Q 3 33-0378778 Q approved, credit may or may not cover full cost of requested City services. Tax ID #: J _O J 18 / v city services credit ;Amount Requested: $000 Date Needed: JUNE 2017 "Mayor/councnmember. Sarmiento :Direct e uestod ®fit Amount __.. .. (y 500.00 'Event Date: ;CONTINUOUS Event Time: :CONTINUOUS; q ''.Event Location 12627 W. MCFADDEN AVE., SANTA ANA, CA 92704 Address, Clty, State, Zip Supplemental Santa Ana Police Athletic & Activity League program service Description of EventlPurpose: delivery. (SAPAAL) Direct service delivery of school, art, and program project supplies to Community Benefit approximately 200 at -risk Santa Ana youth. Applicant Signature; ..�..-� Moate: -6/5/2017 Mail: City Manager's Office -M-31 'Email: donationrequestssamaana.org 20 Civic Center Plaza "I Fax: (714) 047-0954 P.O. Box 1988 Santa Ana, CA 92702 Dovt flkm Reqwst DR,. c., it„etingf4_r< JUNE 20, 2017 F imp , tp M"L Y11 --S i N1C YES r4idq., .eQ,n'rso,tnt $5500 . laY t( ti Cr ll}t'£Lff9- Dal, Revised 11/18/2015 29-A111 City ®f Santa Ana City Manager's Office - M-31 20 Civic Center Plaza Donation Request (9) P.O. Box 1988 Santa Ana, CA 92702 (714) 647-5200 Contact Name: ( Dr. Ana Jimenez-HamiTitle: [Executive Director Aadress: 2215 North Broadway Icity, state, zip: Santa AnaPhone: ( 714-296-2191 rEmali: Kana@occtac.org Pax: (714-564 9690 rName: ---[Orange County Children-'s Therapeutic Arts Center Tax-Exempt Status: Is your organization a non-profit or public tax-exempt organization as defined under Section 501(c)(3) of the Internal Revenue Code? Select One: Fv/1 Yes ❑ No If No, you will only qualify for a credit for City-related costs for your request (i. e. permit fees, If Yes, staff time, rental rates for facilities or equipment, etc.). Costs for City services vary and if 3 3-0 9 303 91 approved, credit may or may not cover full cost of requested City services. ax ID #: ®a — City Services Credit $ Date Needed: 06-09-2017 Mayoricouncilmember: Sarmiento Amount Requested: ;D:mot Payment Amount $ 500_[, ent Date: Requested:06-16-2017 Event Time: �+ 6.00-8.00 ply Event Location: Heritage Museum of Orange County Address, city, state, Zip 310 West Harvard street, Santa Ana CA 92704 The End of the School Year Art Show will showcase selected works from elementary and middle Description of Event I Purpose: school students who participated in the After School Arts enrichment program at OCCTAC and the Arts program taught at SAUSD extended learning program, Engage 360. This free community event and Art Exhibition will feature Art created by students from Santa Ana that learned the works of great Latin American Masters they studied during the year. This is an excellent educational opportunity for Community Benefit: the parents of the students and the community to learn more about these great Latino masters and feel proud of their Cultural Heritage. Also, this event will benefit the community by bringing more awareness of Artistic activities that help youth express their talents and engage in positive life experiences) — Applicant Signature; j DR ANA JIMENEZ-HAMI Date; i6--017 ----- Mall. City Manager's Office- M-31 Email: donationrequest@santa-ana.org [Pax. 20 Civic Center Plaza (714) 647.6954 P.O. Box 1988 Santa Ana, CA 92702 Donation Request #: DR;. _, I :• ., ercnce on enret,re,au uw Council Meeting Date: _ _. JUNE 20, 2017 l; Eligibility Met: YES I NO YES Approved Amount: $500 City Manager Signature =' Data: X IBITA A LVP%— 14 "i City of Santa Ana t Donation Request (Name: Johnathan Hernandez Address: 422 E Chestnut Ave. Unit A. City State, zip I Santa Ana Ca 92701 Email: SantanaUnldoS@gmall COm Name: Santa Ana Unidos Boxing Club City Manager's Office — M-31 20 Civic Center Plaza P.O. Box 1988 Santa Ana, CA 92702 (714) 647.5200 Executive Director and Founder 714.815.1099 Status: Is your organization a non-proft or public tax-exempt organization as Select One: Section 501(c)(3) of the Internal Revenue Code? W Yes El No If No, you will only qualify for a credit for City -related costs for your request (i.e. permit fees, f — —_---- ltaff time, rental rates for facilities or equipment, etc.). Costs for City services vary and if If Yes, 47-5211563 approved, credit may or may not cover full cost of requested City services. Tax ID #: City Services Credit Amount Requested: Is (Date Needed: (Asap (Mayor/Councilmember. (Sarmiento I Direct Payment Amount 1 Requested: $1,000 lEvent Date: Ongoing IEvent Time: I going Location: 1 3, City, State, Zip 602 E. 4th Street, Santa Ana, CA 92701 PROMOTE INTERVENTION AND PREVENTION SERVICES FOR YOUTH IN SANTA iption of I PurpANA THROUGH THE SANTA ANA BOXING CLUB YOUTH ATHLETIC PROGRAM ose: SUPPORTING ON-GOING YOUTH ATHLETIC PROGRAM AT SANTA ANA BOXING CLUB THAT Community Benefit: PROMOTES HEALTH SAFETY AND POSITIVE COMMUNITY ENGAGEMENT I I Applicant Signature: lJOhnathan Hernandez Date: 106/07/2017 Mail: City Manager's Office—M-31 20 Civic Center Plaza P.O. Box 1988 Santa Ana, CA 92702 Donation Request#: DR-� Rate enae 4 an all elated 0pvs Eligibility Met: YES I NO YE. City Manager Signature: Email: donationrequest@santa-ana.org Fax: (714) 647.6954 City Manager's Office—M-31 City of Santa Ana 20 Civic Center Plaza Donation Request P.O. Box 1988 Santa Ana, CA 92702 (9) (714) 647.6200 (Address: 200 S. Sycamore Street, Apt. 305 (Clty, State, zip: Santa Ana, CA 92701 Phone: Email: [fjharris49@gmail.com Fax: Name: (Santa Ana Senior Center Advisory Board Tax -Exempt Status: Is your organization a non-profit or public tax-exempt organization as Select One: lefined under Section 501(c)(3) of the Internal Revenue Code? will only qualify for a credit for City -related costs for your request (i.e. permit fees, If Yes, rental rates for facilities or equipment, etc.). Costs for City services vary and if credit may or may not cover full cost of requested City services. ax ID #: (714) 975-3968 ❑ Yes FZ No City Services Credit Amount Requested: I$ 550 Date Needed: 6/15/17 MayorlCouncilmember: Sarmiento Direct Payment Amount $ N/A Event Date: 6/15/17 (Event Time: B:O Dam - 10;30am lRequested: Event Location: ( Santa Ana Senior Center, 424 W 3rd Street, Santa Ana, CA 92701 Address, City, State, Zip i ' On the second Thursday of every month, the Santa Ana Senior Center Advisory Board collaborates to host a rummage Description of 'sale to help raise funds to support activitles and various projects at the Santa Ana Senior Center. Specific to this request, Event / Purpose: the Advisory Board will be raising funds for the Birch Park restroom and fence project. Additional fundraising events include the Snack Sale, which will take place on Thursday, June 15, 2017 from 8:00am to 10:30am. This project will help maintain our public facilities, while ensuring a safe, clean Community Benefit: park for the community to enjoy. (Applicant Signature: I FRANCINE HARRIS Date: 16/8/17 Mail: City Manager's Office—M-31 Email: donationrequest@santa-ana.org 20 Civic Center Plaza Fax: (714) 647-6954 P.O. Box 1988 Santa Ana, CA 92702 City of Santa Ana Donation Request City Manager's Office — M-31 20 Civic Center Plaza P.O. Box 1988 Santa Ana, CA 92762 (794) 547.5200 e c a Name: Debbie Wells 'Title: - Executive Director Address: ',1621 Bullard Lane -._..._ city, state, zip: , Santa Ana Phone: 7143362061 Email: idewelis(_w-pacbell.net Fax: _... ._... Name: Achievement Institute of Scientific Studies ITax-ExemptStatus: Is your organization a non-profit or public tax-exempt organization as - --- select One: defined under Section 501(c)(3) of the Internal Revenue Code? ❑/ Yes ❑ No Y If No, you will only qualify fora credit for City -related costs for your request (i.e. pannit tees, f Yes, :staff time, rental rates for Facilities or equipment etc.). Costs for City services vary and if '330734877 'approved, credit may ormay not cover full cost ofrequested Cityservices. Tax ID #: i Services Credit ,City jAmount Requested: ��' ate Needed: 106/23/17 MayorlCouncilmember: Solarie Direct Requested: ont Amount Event Data: 06/23/17 Event Time: 8.30-A.M........ $1,200— IEventLocation: '.Address, ',Chapman University, One University Drive, Orange, CA 92866 City, state, zip Chapman INSPIRES 4 -Day Weekend Kick -Off with STEM activities and workshops, joint DesAISS iEventI Purtion of ,Event/ Purpose: business mixer with OC Hispanic Chamber and STEM Panel Dinner! Expose new AISS Class p P of 2019 student scholars to Chapman University, business community and STEM professional, AISS is providing services to youth in Santa Ana for its AISS College to Career Readiness STEM (!Community Benefit: Program. AISS' program will benefit 48 youth in Santa Ana. AISS is 100% successful with guiding '. students in getting into a quality university, with a 99% success rate for college completion. Applicant Signature: Date: 619/17 _.. _... _.. mail: City managers office -M-31 Email: dauationrequost@sama-ana.org 29 Civic Center Plaza Fax: (714) 647.8954 P.O. Box 1988 Santa Ana, CA 92702 '.. Ct. maTou, r)p- YE81iHo YES 29AIT'�5 JUNE 20, 2017 $1,200 Revised 01/0512017 City of Santa Ana Donation Request City Manager's Office— M-31 20 Civic Center Plaza P.O. Box 1988 Santa Apia, CA 92702 (714) 847-5200 .. ........... ... . !:Nama: jAlicia Rojas mtfo: lArlist /Cc -founder Address: 12202 1/2 Main St. ste-200 ;city, State, Zip: ISanta Ana, CA 92706 Emall: �alicitarojas@yahoo.com Phone: 714 907 5468 ,Fax: owanization Information I Name: !Santa Ana Community Artist(a) Coalition (Fiscal Sponsor Blackbook Sessions Non Profit) -TaxExam P- Status: is your organization a non-profit or public tax-exempt organization as it '- Select One: defined under Section 601(c)(3) of the Internal Revenue Code? IFV Yes F] No If No, you will only quality for a credit for City-paltdod costs for your request (i.e. permit less, If Y I lstet/time, rental rates thrlecififiest or equipment, stc).Cosui fe), City services very and if as, opproved, cirditt mayor may not coverfull cost of requested City services. Tax ID #: 126-291 5498 I - ,City ServicesCredit mount Requested: Date Needed; mayorlCounclimember: 18alorlo Direct Payment Amount 1$1500.00 "Event Date: Requested: Event Time: . ..... .. . .. lEvent Location: ';Santa Ana Mural Restorations I Address City. State, Zip The donation would go towards, paint, materials, and artist stipends. 'Description of Event I Purprisa: r ;The mission of the Santa Ana Community Artist(a) Coalition is to connect local artists to their community Benefit: communities in a collaborative process to create aft that transforms public spaces, generates icivic engagement and promotes personal and social change, !Applicant Sfifinatuns; A 160ta tljkoja/� bate: 513 9/17 Mpletedilho— Mail: City Manager's Office—M•31 m-aEmail: donallonrequt@santano.org 20 civic Center Plaza Fax: (714) 647.6954 P.O. Box 1988 Santa Ana, CA 92702 Donation Request 9: DR - Council Meeting Date: Lo -2,0 --1—+ U01WItty Mot: YES,! NO Amm�nt cily Manager siqnalmor DoW Revised 0110512017 '16 City Manager's Office — M-39 Ana City of Santa 20 Civic Center Plaza 0P.O. Box 1988 ®OYlaffOf9 frBG'Ue5% Santa Ana, CA 92702 (714) 647-5200 o a a Name:arla SandOVal 'Iritle President '..I [Address: 5009 W Sixth St. Gity, state z,p: I Santa Ana, CA 92703 iPhone: (714-791-9274 , Fri 'm1 m sandova1201371@gmail.c0m jPax.� Name: Rivervlew West N,A. (Charitable Ventures OC)I Tax-Exempt Status; Is your organlzation a non-profit or public tax-exempt organization as Select One: defined under Section 501(c)(3) of the Internal Revenue Code? Yes No If No, you will only quality for a credit for Cit -related costs for our request (i.e. permit fees, Y a q fl' Y Y IF Yes, staff time, rental rates for fay not orequipment, fort' services, vary and if �20-8756660 cost approved, credit may or may not cover full cost of requested qty services. ax ID #: KIM= C,ty Services Credit .$500.00 mount Requested: Date Needed., .tune 30 (Mayor/Counciimember: Sotorio Direct PaymentAmount� Requested Is IS Date: JUNE 30 (Event Time: AFTER-BUSK FEvent Locatlon Address, Gity State, Zip [R�ta Park (Newhope and Hazard, Santa Ana, CA. 92703) _ j :, Movie Night in the park for the community. Money will be used for park Description Description of Purpose: - reservation and movie licensing fees. f c°mm°mtyBeneti°` The community and local schools will be invited to attend the Movie Night and enjoy Rosita Park. lic t.Sr nature:.- PP�ar-� r'4ar iw �(e�a S S -k'4 ¢` r mt ,* xN s c?-,.n avr ,g• a a e Mail: City Manager's Office—M-31 Email: donatlonrequest@samo-ana.org 20 Civic Center Plaza Fax: (714) 647.6954 P.O. Box 1988 Santa Ana, CA 92702 01 Donation Request.#: OR -_ Connell Meeting Date: ,JUNE 20, 2017 Reverence # on all.rehted 0PVs - - - T Eilgibllity Met YES I NO YES '- - Approved Amount $500 1 City Manager Signature. - bate: Revised 01/05/2017 29A147 ,'{� Ci/l Of $RflfB A/18. City Manager's Office" -M -7t ,r~.� y 20 Civic Cerirur Plaza Donation Request P o Box rhea " � � Santa Ana. CA 92702 „•., (714)647-5200 ;Name; ;Mona Konstan ;Tale Teachers Address. 1520 W. Walnut St. _ ,City, state, zip; Santa Ana, CA, 92701 'Phone: x(714) 567-4900 Email: jmona.konstan@sausd.us. .Fax: __. -..... ;Name: lEl zabeth G. Macias Legal Studies Academy at Santa Ana High School I 'T '"E Status;is-your organization a non-prori! or public tax-exempt organization as Select One: i ❑ o IdeMed under Section 501(c)(3) of the Internal Revenue Code? Yes No • It No, you will only quality for a credit for City -related costs for your request (re. permit lees, staff time, rental ratesterfacddles or equipment,etc.).Costs rer cilysemices very andit /f Yes, 91-2163665 approved, credit may or may not cover lite cost or requested City services, Tax ID #: "Fiscal Sponsor: Santa AnaAthletic Foundation ';City Services Credit i D Amount Requested! S atO Needed: MayorlCouncilmember. 5 pto ` O Joireot,Payment Amount 's500 Event Date: .06/08/2017 Event Time: ,Requested: 6:00 PM Event Location: f520 W. Walnut St, Santa Ana CA 92701 (Address, City, state, zip p j A banquet celebrating the first year of the Legal Studies academy and the students involved. Description of Awards will be given to the top students and sashes to the graduating seniors. Event l Purpose: I The academy has been named after a judge who grew up in Santa Ana, Elizabeth G. Macias. The academy serves as a 'Community Benefit: runnel to help support students who want to go into the legal profession and provide a direct pathway to college, granting I !special admissions and consideration by. SAC, joined four year colleges, and joined law schools. iAP,PtIp`ant 6lgnaturtr I Date: �i ) ,017 Mail: �iCity Managers Office— M-31 Email: dohationrequest@santa-ana.org 20 Civic Center Plaza ! F -yM1 100 ax. (7 14) 647.6054 P.O. Box lose Banta Ana, CA 92702 ,. battalion Raquoat tl ' DR -- f rNryyv c• c F a i r k t° n I EIIOitS)Ifty Mat YES a Council Meeting Date. C� Approved Amount: " • - fCity Marvager5ignatrao: Da1u. " Revised 0110512017 -yM1 100 City Managor's Office - M-31 el City of Santa Ana 20 Civic Center Plaza r� Donation Request P.O. Box 1988 abZ� Santa Ana, CA 92702 -- (714) 647.5200 [Name ��Cory Nelson Thio: —president — ddraae: 1911 N. Olive Street rcity,State,Zip, [Santa Ana, CA 92703 (Phone: 503-490 2446 Emau: president@santannapony.com Pax: - — � Name: I Santa Ana Pony Baseball 'xempt Status: is your organization a non-profit or public tax-exempt organization as I under Section 501(c)(3) of the Internal Revenue Code? you will only qualify for a credit for City -related costs for your request (le. permit fees, vo, rental rates for facilities or equipment, etc.). Casts for City services vary and If ,ad, credit may or may not cover full cost of requested City services. lot One: 110 Yes ❑ No S, ID ft: 46-1054416 ICity Services Credit [ [ [ [ Amount Requested: $ Date Noodotl: 5/20/2017 Mayor/Councilmember: 7inajero Payment Amount sled: �" � 2000 [Event Date: 15/20/2017 (Evont Time: �__ Location: 1999 W. 19th Street, Santa Ana, CA 92703 :, CttY, Siete, Zlp tion of Purpose: Closing Ceremonies and Family movie night [WinaortvOeombraint v50 families with In Santa Ana will be able to see a movie on the field for free. This is an exiting Community Donofit; ng the everyone together to showcase the sense of community, sportsmanship and overall that suppliedthrough SAPB. ReturmcomjDletedforfri`Jiar7 Mail: City Manager's Office -M-81 Email: donationrequest@santa-ana.org 29 Civic Center Plaza Fax; (714) 647-6954 P.O. Box 1988 Santa Ana, CA 92762 t SSp�r r(dt iIS "`. :€i,RtT+ iF' ''� ?"'°�a 3^+r -,n. ,f ulw YDR xa. v. fi- 3��s•. F _ 'b�rtn, lr ,g �:b j""'q Donation Request#: Rctarcnre a on Ml related upVs - Council Mooting Date. 06/20/20 /2017 Eligibility Met: YES / NO YES Approved Amount: $2,000 City Manager Signature: ...... ..._....... _._. Date: _._..._._.._,_._.._..-�._.....__._._____..._ Revised 01/05/2017 29A649 City Manager's Office - M-31 City of Santa Ana 20 Civic Center Plaza Donation Request P.C. Box 1988 L. Santa Ana, CA 92702 (714) 647.5200 Information 71t1a: Name: 1�.,/i Gl.!L:C 1.1� `�t C jf'Y1`I l✓l l S-��� -..—._.I_.. `....��AP n,�}/._..�.__-._..-._.._�—__ —' Address_ -- -- City, State, Zip: _ S a✓�.E-G, ��,�__-��!__�--�o � I � �� �1�& 1.—__ _._- __ .., _� (..—J._6(t V rt7(i�"�(' 5 Organization Informati. UC— Tax -Exempt Status: Is your organization a non-profit or public tax-exempt organization as defined under Section 501(c)(3) of the Internal Revenue Code? Select Ono: � r—,r{ I N I Yea No L_I If No, you will only qualify for a credit for City -related costs for your request (i.e. permit fees, staff time, rental rates for facilities or equipment, etc).Costs for City services vary and if credit may or may not cover full cost of City ��.� le I' if Y®s, Tax ID N;o-- approved, requested services. !Donation •. City Services Credit AmoOnt Requested: �I�-------- r id Date Needed: "r Ma or/Councilmember. 'BBeBwdee `' t I" s "" ('- Direct Payment Amount Requested: ^ I$ Event Date: (Event Time: Ij CI,YVI •_ `'L -..,(,dry -I U nt Location:ess, FVe --� Clty, 3lalo, Zip CyCtifvt-,�l /l 1,\�l ��J� �i�Z.�yo Dosorlpilon of•t-U,L+ Gkct7, cC..DAAC%o 4r'�7-t�"�-..C>�"� Event/Purpose: V N-rVl7C�c�.+YS 'a-'�-V- `�` Y^) G(?/" C_ y1..JJl��G-1 I Community Benefit: �rt�rv' �7iti Ftp(e �(PQ VLQ,tCJ'_A'�ra.�6 �^ �• �Appticant Signature; -mm I /} - %�� r�',�n - Date5 Maih City Manager's Office-M-31Email: donationrequest@santa-ana.org —� 20 Civic Center Plaza Fax: (714) 647.6954 , P.O, Box 1980 Santa Ana, CA 92702 Donadon Request a DR • r ,tet „, 1-y - r{a natio ll all 5t 4; d0nu _ Council Meeting Dato -- __ _. - `__._ k"Ilglbllity Met YENO Approved Amount �i City Managor Signature: Data: Revised 01/05/2017 City of Santa Ana j" Donation Request City Manager's Office— M-31 20 Civic Center Plata P.O. Box 1988 Santa Ana, CA 92702 (799) 047-5200 t a a Direct Payment Amount ;Requested: Name: . KENNEY AGUILAR Title: POLICE OFFICER/DIRECTOR Address: 2627 W. McFADDEN AVE. !Address, City, State, zip p city, state, zip: SANTA ANA, CA 92704 phone: (714) 647-6591 jEmali: ',KAguilar@santa-ana.org _..... __.., Fax:. (714)..835-2289 , Name: LORANGE COUNTY COMMUNITY FOUNDATION/ SAPAAL defined uncle Status: Is your organization a al Revenue or -public tax-exempt organization as select One., deOned under Section 501(c)(3) of the Internal Revenue Cotle7 �,. � Yes ❑ No If No, you will only qualify for a credit for City-rela led costs for your request 0.e, permit fees, If Yes, staff time, rental rates for facilities or equipment,etc.).Costs for City services very and if 3�.i_/13isi78 approved, credit may or may not cover full cost of requested City services. Tax I6 #: 3J l�•,JJ // Q (( Fiscal Sponsor 'City Services Credit 'Amount Requested: Rp•Do Data Needed: }JUNE 2017 �Mayar/Cnunalimombor: '.Ullegea Direct Payment Amount ;Requested: ,$55®®•00 Event Date: CONTI NUOUi Event Threat CONTINUOUS 'iEvent Locafion: 1'.2627 W. MCFADDEN AVE., SANTA ANA, CA 92704 !Address, City, State, zip p Supplemental Santa Ana Police Athletic & Activity League program service Description of .,;.Event/ Purpose: ;delivery. Direct service delivery of school, art, and program project supplies to community Benefit: :,approximately 200 at -risk Santa Ana youth. .,Applicant Signature: Date: 6/5/201.7 _ 8 0 i ,Mall; City Manager's Office— W21i Email: donationrequest@santa-ana.org 20 Civic Center Plaza Fax: (714) 647-5954 j P.O. Sox %980'. Santa Ana, CA 92702 t ar ,Eornrg' ""' _ cv. -vcmiEm r'� JUNE 20, 2017 ,:,.,ry int o YES „, I a,„c„.,t, $500 Revised 01/0612017 2MAi=21 CITY OF SANTA ANA DONATION AGREEMENT WITH ORGANIZATION OR NEIGHBORHOOD ASSOCIATION 1. PARTIES AND DATE This Donation Agreement ("Agreement") is entered into on JUNE 20, 2017 by and between the City of Santa Ana, a municipal corporation ("City") and ORGANIZATION OR NEIGHBORHOOD ASSOCIATION, a California 501(c)3 NON-PROFIT ORGANIZATION ("Recipient"). City and Recipient are sometimes individually referred to as "Party" and collectively as "Parties" in this Agreement. 2. RECITALS 2.1 Community Benefit. The City wishes to provide Recipient with funding to assist Recipient in PROMOTING, DELIVERING, HOSTING XYZ PROJECT, PROGRAM, EVENT, ETC ("Community Benefit"). The Parties wish to enter into this Agreement to establish the terms and conditions under which the City will provide funding. 2.2 Public Purpose. The City, by recommendation of COUNCILMEMBER believes there is a public purpose in supporting the Community Benefit because it will THE FOLLOWING ACCESS OR RESOURCES FOR THE COMMUNITY ON SUCH DATE/TIME AND LOCATION. The foregoing is a general description of the public purpose, and is not necessarily the only public purpose to be gained from the Community Benefit. 3. TERMS AND CONDITIONS 3.1 Use of Funds. The City has chosen to provide Recipient with a one-time payment of DOLLARS ($000), because the City has determined that there is a public purpose to be served in supporting the Community Benefit. In executing this Agreement and receiving the funds, Recipient agrees to use the funds only for the purpose described and subject to the terms and conditions provided for in this Agreement. Should Recipient fail to use the funds for such purpose or otherwise comply fully with the terms of this Agreement, City shall have the right to terminate this Agreement and demand the return of the funds pursuant to Section 3.2 below. 3.2 Term; Termination of Agreement. This Agreement shall take effect on the date first above written and remain in effect unless and until terminated by the City. The City has the right to terminate this Agreement upon one day's notice, with or without cause. Should the City terminate this Agreement, it shall also have the right to demand the immediate return of all funds provided to Recipient pursuant to this Agreement, as well as interest at the rate of ten percent (10%) per annum. Notwithstanding the foregoing, the indemnification provisions of this Agreement shall survive any expiration or termination of this Agreement. 3.3 Waivers, Insurance or Other Obligations. For purposes of the City's protection, if the City deternunes that the funds will be used for a purpose which may cause a significant risk of injury, the City may, in its sole discretion, require Recipient to provide certain insurance and EXHIBIT 19 29A-22 CITY OF SANTA ANA DONATION AGREEMENT Page 2 of 3 participant waiver/release protections. This right shall be on-going and may be implemented by the City at any time, and all insurance and waiver/release forms shall be provided on forms, in amounts and with provisions acceptable to City. 3.4 No Oversight by City. Nothing in this Agreement shall be implied or interpreted as City establishing or providing oversight, control or approval of the Community Benefit or any activities conducted by the Recipient. 3.5 Indemnification. Recipient understands, acknowledges and agrees that Recipient shall assume all risks associated with the Community Benefit, including, but not limited to, the possibility of death or serious trauma or injury. To this end, therefore, Recipient shall defend, indemnify and hold City and its officials, officers, employees, agents and volunteers free and harmless from and against any and all claims, demands, causes of action, costs, expenses, liabilities, losses, damages or injuries, in law or equity, to property or persons, including wrongful death, in any manner arising out of or incident to any and all acts, omissions, willful misconduct or other activities of the Recipient or its officials, officers, employees, agents, guests, participants attendees, and contractors, including the performance of the Commrmity Benefit or this Agreement, including without limitation the payment of all consequential damages and attorneys fees and other related costs and expenses. The only exception to the Recipient's obligations hereunder shall be for claims, demands, causes of action, costs, expenses, liabilities, losses, damages or injuries caused by the sole negligence, sole willful misconduct or sole active negligence of the City. Recipient shall defend, at Recipient's own cost, expense and risk, any and all such aforesaid suits, actions or other legal proceedings of every kind that may be brought or instituted against the City, its officials, officers, employees, agents, or volunteers. Recipient shall pay and satisfy any judgment, award or decree that may be rendered against the City or its officials, officers, employees, agents, or volunteers, in any such suit, action or other legal proceeding. Recipient shall reimburse City and its officials, officers, employees, agents, and/or volunteers, for any and all legal expenses and costs incurred by each of them in connection therewith or in enforcing the indemnity herein provided. Recipient's obligation to indemnify shall not be restricted or limited by insurance proceeds, if any, received by the City, its officials, officers, employers, agents or volunteers. The indemnification provisions of this Agreement shall survive any expiration or termination of this Agreement. 3.6 Entire Contract/Modification. This Agreement contains the entire agreement of the Parties with respect to the subject matter hereof, and supersedes all prior negotiations, understandings or agreements. The terms and conditions of this Agreement may be altered, modified or amended only by written agreement signed by both Parties. 3.7 Authority to Enter Agreement. The person executing below on behalf of Recipient represents and warrants that the Recipient has all requisite power and authority to conduct its business and to execute, deliver and perform this Agreement. Each Party warrants that the individuals who have signed this Agreement have the legal power, right and authority to make this Agreement bind each respective Party. 7 29A-23 CITY OF SANTA ANA DONATION AGREEMENT Page 3 of 3 go Robert C. Cortez Deputy City Manager City Manager's Office CITY OF SANTA ANA By: David Cavazos City Manager Attest: By: Maria D. Huizar Clerk of the Council Approved as to Form: By: Name of Attorney City Attorney ORGANIZATION OR NEIGHBORHOOD ASSOCIATION a 501(c)3 NON-PROFIT ORGANIZATION By: Signature Name Title 29A-24