Community Promotional Fund Application
APPLICANT INFORMATION:
Name of applicant: Elizabeth Givens
Name of organization or group represented: Growing Outreach Grassing Opportartes Mailing address: P.o. Box 92. Barstow. CA 92312
Contact phone numbers): Email Address:
323•237.3900 info@ gogoberston. org
Non-Profit? Yes]No If no, are you partnering with a non-profit:_ PROJECT DESCRIPTION:
Spirit of Giving - Together We Can Collaboration
Name of Event:
3,000.00
Amount requested: $
Request waiver
What will the funds be used for and/or what are the waiver of fees for? for the use of the Cora Harper Community Center. Also request the City of Barstow be a monetary sponsor in support of event.
Supports all Community members. It will include school supply giveaways. clothing and food donations and information from over 20 non-profits.
When wil the activity take place? November 23rd, 2024
Where will the activity take place? Cora Harper Center
To offset the costs to hold the event
Why are the funds/waiver of fees/in-kind services needed? because this is a Community collaboration there's NO fundraising. This is an event to provide resources and information. 60 How many Barstow area residents are involved with this organization? We expect over 600 to 700 people that will come through.
How many spectators will watch this activity?
Please describe how this activity will benefit Barstow. If additional space is necessary, please attach additional sheets:
This activity benefits Barstow by bringing numerous nonprofit organizations together to provide resources to our Community. We will be giving away back-packs to support the United Way food programs as well as other goods that the Community members may need.
This is not a fundraising event. This event is to help our Community members know what resources are available so to help sustain them.
We are aiso hoping to get donations to help provide Thanksgiving food items as well as hygiene kits before the school break begins Rev. April 2020 Community Promotional Fund Application Page 1 Community Promotional Fund Application
With this application, please attach the following:
1. A detailed budget stating the total cost of the activity or event, all sources and amounts of funding, and all expenses;
2. A description of the organization's or group's purpose or objective.
3. A copy of the organization's non-profit determination.
By signing below, I declare that I have read the City's Community Promotional Fund Policy and agree to all its terms and conditions. I agree that there is a formal process in place to conduct background checks on all employees and volunteers who work with persons under the age of 18 years and senior citizens.
I understand that an incomplete application will not be accepted and that the organization or applicant will not be considered for funding. (If the application is being submitted on behalf of an organization or school, an additional signature is required.)
Lus Elizabeth Givens - 9-15-24
Signature of Applicant Applicant Name (printed) & Date
School Principal or Organization
President/Director Signature
(if applicable)
**Please note that the fiscal year 2020-2021 budget will likely be impacted by the COVID-19 crisis. While the City recognizes the value of the Community Promotional Fund, awards will be contingent on the availability of funds.
Rev. April 2020 Community Promotional Fund Application Page 2 Department of the Treasury Date:
Internal Revenue Service 05/18/2022
Tax Exempt and Government Entities Employer ID number:
TRS P.O. Box 2508 88-1772738
Cincinnati, OH 45201
rame: Customer Service
ID number: 31954
Telephone: 877-829-5500
GROWING OUTREACH GROWING OPPORTUNITIES Accounting period ending:
27744 DE ANZA STREET December 31
BARSTOW, CA 92311 Public charity status:
509(a)(2)
Form 990 / 990-EZ / 990-N required:
Yes
Effective date of exemption:
April 21, 2022
Contribution deductibility:
Yes
Addendum apples:
No
DLN:
26053530001062
Dear Applicant:
We're pleased to tell you we determined you're exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). Donors can deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106, or 2522. This letter could help resolve questions on your exempt status. Please keep it for your records.
Organizations exempt under IRC Section 501(c)(3) are further classified as either public charities or private foundations. We determined you're a public charity under the IRC Section listed at the top of this letter.
If we indicated at the top of this letter that you're required to file Form 990/990-EZ/990-N, our records show you're required to file an annual information return (Form 990 or Form 990-EZ) or electronic notice (Form 990-N, the e-Postcard). If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked.
If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of this letter.
For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities.
Enter "4221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements.
Sincerely,
sephore a. marten
Stephen A. Martin
Director, Exempt Organizations
Rulings and Agreements
Letter 947 (Rev. 2-2020)
Catalog Number 35152P
Spirit of Giving Itemized Budget
Facility Rental (tables and chairs)- $750.00
Printing-$100.00
250 Giving Boxes- $15,000.00
Toiletry Bags-$2500.00
Bags for clothing-$200
Total Costs- $18, 550.00
Permit
City of Barstow Parks and PHONE: (760) 256-5617 Permit # R4089 Recreation EMAIL:[email protected] Status Tentative 841 Barstow Rd Date Sep 3, 202412:42 PM
Barstow, CA 92311
Customer Name Elizabeth Givens - 7700 Home Phone Number (323) 237-3900 Customer Type General Public Emall Address [email protected] System User 00846
Rental Fee $750.00
Discounts $0.00
Subtotal $750.00
Deposits $500.00
Deposit Discounts $0.00
Total Permit Fee $1,250.00
Total Payment $0.00
Refunds $0.00
Balance $1,250.00
Holiday-Giveaway 1 recource(s) 1 booking(s) Subtotal: $1,250.00 Booking Summary
Basketball Court - Full (Community Events) Center: Cora Harper Fitness Center
START DATE/TIME END DATE/TIME ATTENDEE AMT W/O TAX
Sat, Nov 23, 2024 7:00 AM Sat, Nov 23, 20245:00 PM 1 $0.00 Resource level fees $1,250.00
Refundable Security Deposit $500.00 / Each × 1 $500.00
Rental Fee 8 Hours $750.00 / Each × 1 $750.00
Waivers and Information
WAIVER NAME DUE DATE FOR SIGNING STATUS
Facility Waiver Nov 23, 2024 Elizabeth Givens Waiver Signed by:
Elizabeth Givens on Sep 3,
2024
• I am aware that recreational activities can be hazardous and l am voluntarily participating in these activities with knowledge of the hazards involved and hereby agree to accept any and all risks of injury or death. • The City of Barstow is not responsible for participants' injuries or damages occurring from "hazardous recreation activities" (CA Government Code 831.7).
• The City of Barstow does not provide participants with medical insurance or treatment for injuries. •I agree to hold harmless and release the City of Barstow, its officers, agents, and employees from any and all liability arising from or related to my participation in the City of Barstow's program activities. This release includes, but is not limited to, all liability for death, personal injury or property damage resulting from the active or passive negligence of the City of Barstow or its agents or any defective or hazardous condition of any property or equipment owned, operated or maintained by the City of Barstow. • I am responsible for any loss, theft or damage to either personal of City of Barstow's equipment, articles and/or facilities while using said # R4089 Status Tentative Page 1 of 2
equipment, articles and/or facilities.
• I give permission to the City of Barstow to photograph or video tape me in the program for use in future City publications and understand that I will not receive any compensation for such use.
Deposit
EVENT RESOURCE DEPOSIT FEE CHARGE TAX AMOUNT PAID REFUNDS BALANCE Holiday- Basketball Refundable $500.00 $0.00 $0.00 $0.00 $500.00 Giveaway Court - Full Security
Deposit
Payment Schedules Original Balance: $1,250.00 Current Balance: $1,250.00
DUE DATE AMOUNT DUE AMOUNT PAID WITHDRAWAL ADJUSTMENT BALANCE Nov 23, 2024 $1,250.00 $0.00 $0.00 $1,250.00
X: X:
Date: Date:
City of Barstow Parks and Recreation Elizabeth Givens
Mailing Address: 841 Barstow Rd, Barstow, CA Customer Id: 7700 92311 Home Phone Number: (323) 237-3900
Phone Number: (760) 256-5617 Email Address: [email protected] Email Address: [email protected]
# R4089 Status Tentative Page 2 of 2