City of San Bernardino
Arts and Historical Preservation Commission
Parks, Recreation & Community Services Department
Visual and Performing Arts Grant
Dear Award Recipient,
Your organization received a grant from the City of San Bernardino to be utilized for project(s) during the period of (date to be listed). In order to monitor the effectiveness of the grant award process in the city, it is required that you complete this form with detailed information about your project(s). Please comment on programs, services, and events that have been completed in the first half of your award year.
SEMI-ANNUAL PERFORMANCE REPORT- (add year)
Name of Organization: ______________________________Phone: _______________________ Mailing Address: _____________________________________________Zip: _______________ Report Preparer: __________________________________
Title: ______________________________
Contact Number: __________________________________
Email: ______________________________
Specify Report Period: 6-month Report, (first half of year) 6-month Report, (2nd half of year) (Due: TBD)) (Due: TBD)
Funds Approved: $________
Funds expended per report period: $________
Funds remaining: $________
PERFORMANCE INFORMATION
1. Describe how grant funds have been used this report period. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
2. List dates of activities/services/trainings and method of service delivery i.e. (virtual, on-site or both) City of San Bernardino
Arts and Historical Preservation Commission
Parks, Recreation & Community Services Department
Visual and Performing Arts Grant
_____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ (Note: attach activity fliers/advertisement/agendas, as relevant to funded activities)
3. Total Number of Individuals Served: ________
Number of City Residents Served: ___________
4. City In-kind services received/utilized, if any:
_____________________________________________________________________________________ _____________________________________________________________________________________
5. City- Agency Partnerships Implemented, if any:
_____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
6. List the goals that were achieved by your project during this report period:
_____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
7. Using the budget worksheet below, note expenses charged to the grant program this report period.
Direct Costs: (Project Specific Costs) AMOUNT
Salaries & Benefits $____________________________________________ Supplies $____________________________________________
Printing $____________________________________________
Professional Services $____________________________________________ City of San Bernardino
Arts and Historical Preservation Commission
Parks, Recreation & Community Services Department
Visual and Performing Arts Grant
Materials and Supplies $____________________________________________ Insurance/Permits $____________________________________________ Capital Purchases $____________________________________________ Other (Please Specify) $____________________________________________ Indirect Costs (applicable to grant program only, as noted in grant budget) Administration Costs $_________________
Facility Rents/ Maintenance $ _________________
Utilities- gas, electricity, telephone $_________________ Depreciation $_________________
Other: Specify: __________________ $ _________________
GRAND TOTAL EXPENSES $_________________
8. Authorizations:
I hereby certify the information contained in this report is true to the best of my knowledge and belief. I also hereby certify that our organization is in compliance with all state, federal, and local laws regarding licensing and employment practices.
Print Name of Report Preparer: ___________________________________________ Title: __________________________________
Preparer Signature:
____________________________________________________Date:____________________ Print name of President or Authorized Officer: ___________________________________ Title: ______________________________
President Signature: ______________________________________________________________ Date: ________________________
Please return by (DATE) to:
Arts and Historical Preservation Commission
Parks, Recreation and Community Services Department
209 North D St.
San Bernardino, CA 92401