CITY OF FONTANA
COMMUNITY SERVICES DEPARTMENT
DONATION ACCEPTANCE
(For All Donations)
Name of Donor/Organization
Kaiser Permanente
Address
75 N. Fair Oaks Avenue, 4th Fl Pasadena, CA 91103
Contact Person, Title Phone No.
Elizabeth Pia, Public Affairs Representative 909-427-5269 (Tie 8-250) Type of Donation: (Check boxes)
Monetary Amount $ 1,000 (Receipt No. Invoice No. 78088
(Attach copy of Receipt)
Goods/Services Estimated Value $ Description
Intended use of Donation:
V specific → Description Let's Move on the Trail 2021 Sponsorship General
Thank you/acknowledgement letter sent to Donor? (Required for ALL donations) Attach copy of acknowledgement letter to this form.
G.E.T. Online Donation Tracking Form Has Been Completed. (Required for ALL donations with a value equal to or greater than $500.00) Received By Date
Jasmine Sarsadias 4/26/21
Copy of this form sent to Supervisor/Manager
= = = FOR ADMINISTRATION USE ONLY = = =
City Council Agenda Date
Entered in Novus by: Date
'his form must be filled out for all donations received regardless of value amount. This donation must e approved by City Council prior to any spending or use of the donation Ilcity-fileservershared\Forms|CSD\Intranet|Donation Acceptance Record.x/s\10/15/201913:58 PM City of Fontana
FONTANA COMMUNITY SERVICES DEPARTMENT
CALIFORNIA
April 26, 2021
Elizabeth Pia, Public Affairs Representative
Kaiser Permanente, San Bernardino County Area COPY
Dear Elizabeth:
It is with great gratitude that the City of Fontana, Healthy Fontana program thanks you for your generous donation of $1,000 (Invoice No. 78088) from Kaiser Permanente to support our Let's Move on the Trail event this year.
With support from partners like Kaiser Permanente, we are able to provide much needed resources and services to the Fontana community. The Let's Move on the Trail event highlights the Pacific Electric Trail as a means of active transportation, opportunities for physical activity, and recreation and connectivity to valuable resources like community centers, schools, parks, and more.
Thank you again for your support, we look forward to continuing to work with you in the future.
Sincerely,
sle
City of Fontana
Community Services Coordinator
City of Fontana
Community Services Department • 16860 Valencia Ave • Fontana, CA • 92335 Phone: 909.349 6900 • Fax: 909.349.6965
4/28/2021 https://fontanaca.perfectmind.com/Menu/StoreApplication/CheckoutComplete?transactionld=0879dece-f266-481f-b820-c7fe2fac3320&cu..
FONTANA
CALIFORNIA
Community Services Department
16860 Valencia Ave
Fontana
California
United States, 92336
Tel: 909-349-6900
1 QTY General $1,000.00
Donations
(3/01/21)
Event ID: 00057924
Attendee(s): Kaiser Permanente
SUBTOTAL $1,000.00
TOTAL $1,000.00
INITIAL PAYMENT $1,000.00
---
CHECK TEND $1,000.00
STATUS Success
Payment# PYMT-403518
Payment Date 4/28/21 10:40:27
Customer Kaiser Permanente
Telephone (626) 381-2200
Type Sale
Transaction# 372367
Transaction Date 4/28/21 10:40:28
Clerk NBrooks
See Refund Policy at:,
http://www.fontana.org/index.as
px?NID=159, No Camp Refunds
372367
1/2
https://fontanaca.perfectmind.com/Menu/StoreApplication/CheckoutComplete?transactionld=0879dece-f266-481f-b820-c7fe2fac3320&customerRecor...