CITY OF FONTANA
COMMUNITY SERVICES DEPARTMENT
DONATION ACCEPTANCE
(For All Donations)
Name of Donor/Organization
Kaiser Permanente
Address
9961 Sierra Ave Fontana, CA 92335
Contact Person, Title Phone No.
Daniel Enz (909) 827-0857
Type of Donation: (Check boxes)
V Monetary Amount S 2,500.00 (Receipt No. 1045234.002
(Attach copy of Receipt)
Goods/Services Estimated Value $ Description
Intended use of Donation:
Specific → Description
General
Fresh, Fit, & Fun Fair: event expenses
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 10/16/24
- = - FOR ADMINISTRATION USE ONLY = = =
City Council Agenda Date
11/12/2024
Entered in Novus by: Date
This form must be filled out for all donations received regardless of value amount. This donation must be approved by City Council prior to any spending or use of the donation. htps:/fontana365-my.sharepoint.com/personal/sarsadias_fontanaca_gov/Documents/Documents/Healthy Fontana/Community Events/2024/Fresh, Fit, & Fur 10-19-24/Sponsors/Donation Acceptance Record - REV04-2018.xIs|10/16/2024\12:42 Pl FONTANA October 16th, 2024
CALIFORNIA C
Daniel Enz, A
Kaiser Permanente
Dear Daniel:
City Council
It is with great gratitude that the City of Fontana, Healthy Fontana program thanks you for the generous donation of $2,500.00 from Kaiser Permanente to implemen Acquanetta Warren a new event, "Fresh, Fit, & Fun Fair" in the community Peter A. Garcia With support from partners like Kaiser Permanente, we can provide much needed Mayor Pro Tem
resources and services to the residents in Fontana. "Fresh, Fit, and Fun Fair" is not Counci. Member only an event that will provide residents with resources and services but also give Fontana families a day to remember filled with fun activities.
Jesus "Jesse" Sandoval
Council Member Thank you again for your support, we look forward to continuing to work with Kaiser Permanente in the future.
Phillip W. Cothran
Council Member
Sincerely,
Jesse Церез
City of Fontana
Senior Community Services Assistant
CITY OF FONTANA COMMUNITY SERVICES DEPARTMENT
16860 VALENCIA AVENUE, FONTANA, CALIFORNIA 92335
WWW.FONTANA.ORG
City of Fontana Receipt #1045234.002
8353 Sierra Avenue
Fontana, CA 92335 Oct 16, 2024 9:51 AM
Phone: (909) 349-6900
FAX: (909) 349-6911
Email: [email protected]
KAISER PERMANENTE FOUNDATION HEALTH
PLAN INC FONTANA
75 N. FAIR OAKS AVENUE
Community
PASADENA, CA 91103 Services
Prepared By: sanchez
Company ID: 174
Primary phone: --, Secondary phone: -
• Payment Summary
Check: $2,500.00 Check # 24607171
Total Received: $2,500.00 Total Payments: $2,500.00
• Transactions
Customer Description Item Unit /Qty Fee Charge
Drop-In Customer Healthy Fontana-Donation
Healthy Each 1.00 $2,500.00 $2,500.00
Action: Product Sale Fontana-
Primary phone: - Donation
Email: -
ID: 1
Total Charges $2,500.00
Total Payments $2,500.00
Balance $0