CITY OF FONTANA
COMMUNITY SERVICES DEPARTMENT
DONATION ACCEPTANCE
(For All Donations)
Name of Donor/Organization
Kaiser Permanente
Address
9961 Sierra Avenue Fontana, CA 92335
Contact Person, Title Phone No.
Martha Valencia, MPH, Community Health Manager (909) 549-1541 Type of Donation: (Check boxes)
Monetary Amount $ 10,0000 1 Receipt No. 1036665.002
(Attach copy of Receipt)
Goods/Services Estimated Value $ Description
Intended use of Donation:
Specific Description
General
Farm to Table: Fontana Flavor Academy, Community Grant
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 8/21/24
1 ep3/224868/28121
Copy of this form sent to Supervisor/Ma
- = - FOR ADMINISTRATION USE ONLY = - -
City Council Agenda Date
9/24/24
Entered in Novus by: Date
Thaprovedby code pral d any pes ree be se arded or value amount. This donation must Ilcity-fileservertshared FormsICSD\intranetDonation Acceptance Record.xis10/15/201913:58 PM.
FONTANA August 21, 2024
CALIFORNIA
Martha Valencia, MPH, Community Health Manager
Kaiser Permanente, San Bernardino County Area
9961 Sierra Ave. Fontana, CA 92335
City Council Dear Martha:
It is with great gratitude that the City of Fontana, Healthy Fontana program thanks Acquanetta Warren rou for the generous donation of $10,000 from Kaiser Permanente to implemen new proiect, "From Garden to Table: Fontana Flavor Academy" in th eter A. Garci
layor Pro Ter
Councit Member With support from partners like Kaiser Permanente, we can provide much needed resources and services to the residents in Fontana. "From Garden to Table" will esus "Jesse" Sandova provide the community with the resources to learn how to grow their own food ouncil Membe and create healthy recipes for themselves and their families.
Puny Member Thank you again for your support, we look forward to continuing to work with Kaiser Permanente in the future.
Sincerely,
Jasmine Sarsadias
City of Fontana
Community Services Coordinator
CITY OF FONTANA COMMUNITY SERVICES DEPARTMENT
16860 VALENCIA AVENUE, FONTANA, CALIFORNIA 92335
WWW.FONTANA.ORG
City of Fontana Receipt #1036665.002
8353 Sierra Avenue Aug 21, 2024 3:14 PM
Fontana, CA 92335
Phone: (909) 349-6900
FAX: (909) 349-6911
Email: [email protected]
KAISER PERMANENTE FOUNDATION HEALTH PLAN INC
75 N. FAIR OAKS AVENUE FONTANA
PASADENA, CA 91103 Community
Services
Prepared By: ssmith
Company ID: 174
Primary phone: -, Secondary phone: --
Payment Summary
Check: $10,000.00 Check # 0024429080
Total Received: $10,000.00 Total Payments: $10,000.00
y Transactions
Customer Description Item Unit Qty Fee Charge
Drop-In Customer Healthy Fontana-Donation Healthy Each 1.00 $10,000.00 $10,000.00 Action: Product Sale Fontana-
Primary phone: -- Donation
Email: -
ID: 1
Total Charges $10,000.00
Total Payments $10,000.00
Balance $0