Agenda — Temecula City Council, November 15, 2022 (part 2 of 6)

Legend: "-" = Applied and Not Awarded
No Number = Did Not Apply

COMMUNITY SERVICE FUNDING

REINVESTMENT IN TEMECULA
SUB-

COMMITTEE
RECOM-

MENDATION
TOTAL$

BOARDDIRECTORS OR
1,090,500
35 NEIGHBORHOOD 1 425 N Date St, Escondido, CA NHC GREAT STARTS PROGRAM. Provides prenatal and baby health and wellness NEW APPLICANT $ 50,000
$ -
HEALTHCARE 92025 education, advertising, community outreach, baby care items to needy families, and Website: NHCARE.ORG two baby wellness events adjacent to the Temecula Health Centers. Funds will purchase: 70 infant car seats, 100 playpens, 120 highchairs, 100 strollers, 150 packages of diapers (size N-3), 300 packages of wipes, 150 new mother kits, 150 welcome baby kits, promotional items, brochures, and advertising & marketing. Estimated number of Temecula residents to benefit: 500. >$5K Covid triggered unemployment caused the percentage of uninsured patients to increase in 2020 and 2021; Medicaid (Med-Cal), the primary insurance for patients was slow in determining reimbursements for telehealth visits. If funds are granted, the program will be extended; will reach out to the Temecula community with critical information related to prenatal and infant care and provide infant supplies including diapers.
36 OAK GROVE
24275 Jefferson Ave., Murrieta,
CULINARY CREATIONS PROGRAM. Unique vocational program designed to build $ 50,000
$ 30,000
CENTER
CA 92562
vocational and hands-on culinary experience/skills, as well as provide jobs for at -risk, Website: OAKGROVECENTER.ORG
vulnerable, special needs and disabled youth and toward maximum independence (TMI) young adults through a retail store in Temecula. Funds will be spent on the operating costs of the Bakery: rent, utilities, food for preparation, marketing, mileage, supplies (baking & kitchen supplies, takeout containers, bags, etc.), and telephone expenses.

Estimated number of Temecula residents to benefit: 70. >$5K We could not accomplish this in 2021 due to pandemic; raising funds for the program will help offset costs and continue an existing program serving 70 Temecula students. 37 dba PROJECT
30141 Antelope Road, D103,
EMERGENCY GAS/FOOD/SHELTER. Program to help (200 homeless) reunite families $ 50,000
$ 35,000
TOUCH
Menifee, CA 92584
together with funding to purchase gasoline cards, bus passes, airline tickets. Program (GOD'S FAN CLUB)
Website:
for homeless prevention with funding to pay for rental assistance, seek and keep PROJECTTOUCHONLINE.COM
employment for self-sufficiency. Program for purchase of food, necessities, and gift cards from local grocery stores for infants, children, seniors, veterans, and diabetics.

Estimated number of Temecula residents to benefit: 200. >$5k clients of Project TOUCH had increased needs (masks, cleaning supplies, food) as many fell ill with COVID; in -kind donations decreased; concerns about funding leases with higher rents or landlords not willing to lease housing to homeless; funds will assist in continuing existing programs and also providing gas cards and bus passes to either be reunited with family or keep/gain employment.
38 ROCK YOUR RED
45571 Ponderosa Court,
ROCK YOUR RED. Organizes defibrillator and blood pressure training to high schools,

NEW APPLICANT
$ 25,000
$ 5,000
Temecula, CA 92592
community, seniors, and those with special needs. Has outreach programs teaching Website: ROCKYOURRED.INFO
warning signs of heart attacks, strokes, provides Blood pressure toolkits, dietitian, fitness coach, TVH, and ADA, has annual screening & assessment event with doctors & nurses. Funding will purchase medical kits, training & education, portable AEDs, dietitian, fitness coach, meal cards for post surgery cardiovascular patients, tickets to health event. Estimated number of Temecula residents to benefit: 15-25. >$5k Due to Pandemic, we were not able to host face to face events and this funding will allow our annual event to occur which provides one on one questions/answers with cardiologist, stroke physicians, nurses; Health fair attendees for Temecula community free of charge; a new program will purchase AED units and train residents, HOAs, schools, etc., on how to use; provide screening to lower income and special needs/disadvantaged.

ANNUAL CSF
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Page 10 of 18 ends

Legend: "-" = Applied and Not Awarded
No Number = Did Not Apply

COMMUNITY SERVICE FUNDING

REINVESTMENT IN TEMECULA
SUB-

COMMITTEE
RECOM-

MENDATION
TOTAL$

BOARDDIRECTORS OR
1,090,500
39 ROTARY CLUB OF PO BOX 64, Temecula, CA 92593 FOOD FOR LOW-INCOME SENIORS, VETERANS, AND STUDENTS. Monthly and/or $ 30,000
$ 30,000
TEMECULA Website: during cold weather months. TRANSPORTATION ASSISTANCE FOR LOW-INCOME FOUNDATION ROTARTYOFTEMECULA.COM SENIORS to access healthcare. Funding will be used for food boxes from local agency 5k, and food from local grocery store 5k, grocery gift cards 5k, transportation vouchers, 15k (for services like GOGO Grandparents, LYFT, UBER, and bus passes). Estimated number of Temecula residents to benefit: 660. >$5K Rotary Club of Temecula began the senior supplemental food box deliveries during COVID to help low income seniors (at risk) receive food at their home; now after the pandemic seniors still need food as food is much more expensive than prior to COVID and transportation is still another challenge.

Funds will expand the existing programs by providing/serving an additional 25% of low income seniors, veterans, military and TVUSD students/families with either food boxes or grocery gift cards on an annual basis. Additional funds will support transportation assistance for low-income seniors needing access to healthcare appointments. 40 SANTA ROSA
PO BOX 941, Murrieta, CA 92564
PROMOTION ENVIRONMENTAL PROTECTION THROUGH EDUCATION (PEPE). Engages $ 13,000
$ 13,000

PLATEAU
Website: SRPNEF.ORG
TVUSD high school students in a year -long research project studying climate change and

EDUCATION
fire on threatened and endangered plants and animals. Funding will purchase

FOUNDATION
equipment and services: transportation, Pocket Labs, backpacks, intern costs (excluding salaries), journaling supplies, chrome notebooks, and binoculars. Estimated number of Temecula residents to benefit: 100. >$5K closure of the Reserve from the Tenaja Fire coupled with COVID presented hardships. Onsite classroom programs were eliminated and we saw first-hand that children learn best about nature in nature in person. This program will focus on high school students gaining knowledge of climate change working with TVUSD and in person.
41 SCORE 503 3985 University Ave., Riverside, CA
ENTREPRENEUR & LEADERSHIP SERIES. Help —150 entrepreneurs in business 0-3 years NEW APPLICANT $ 50,000
$
(SERVICE CORPS OF 92501 Website:
via workshops; certified mentor sessions; expert panels; and resources. Funds will be RETIRED INLANDEMPIRESCORE.ORG
used on a series of workshops; start-up business training materials resource kits 15k;

EXECUTIVES
food for ten days 10k; water & refreshments for 10 days 2k; marketing using social

ASSOCIATION)
media/text services/Alliance Marketing 7.5k; specialized business -related speaker fee; and materials 10k; >$5K SCORE Inland Empire partnered with SBA to respond to businesses in need during pandemic; we are now being asked to help navigate post covid with protocols/new business norms and this has drastically made our budget swell; we will serve Temecula community via webinars and mentoring. Funds will allow us to expand our service offering to include live in -person series of workshops designed to educate and support entrepreneurs in business 0-3 years. 42 SKYROCKET 43406 Calle Carabana, Temecula, PEDIATRIC DEVELOPMENT OUTREACH PROGRAM. Increases knowledge and resources NEW APPLICANT $ 50,000 $ PEDIATRIC THERAPY CA 92592 to identify children who may benefit from developmental services and utilize services FOUNDATION Website: already available in the community. Funds will be used to promote and expand current SKYROCKETTHERAPY.ORG outreach program by purchasing professional design and printing services (for brochures, flyers, signs, etc.), search engine optimization, targeted advertising on social media, educational in -services, equipment & supplies for in -services, and consultation costs. Estimated number of Temecula residents to benefit: 25,000 families. >$5k Skyrocket incorporated in 2021 and was not impacted by COVID; the grant will allow Skyrocket to expand the current capacity and reach of Pediatric Development Outreach Program. Since inception in June 2022, the Pediatric Outreach Program has been met by high demand beyond our capacity of volunteers. Grant funding would allow for expansion of current program to meet growing demand.

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Page 11 of 18 ends

Legend: "-" = Applied and Not Awarded
No Number = Did Not Apply

COMMUNITY SERVICE FUNDING

REINVESTMENT IN TEMECULA
x
Z
a NAME OF ADDRESS TO MAIL CHECK PROGRAM/PROJECT DESCRIPTION REQUESTED Li
Nonprofits located outside Temecula NOTES
J ORGANIZATION can still serve Temecula residents. can $ a „ �
ri
43 SMILES BY ANGELS 42248 Via Nortada, Temecula, CA TEMECULA SMILES. Strengthen and expand relationships with Oak Grove, public FOUNDATION 92590 schools, Koinonia Family Services, Brandywood Foundation, youth of disadvantaged families, foster care, USA armed forces youth, and at -risk youth. Funding will be spent on buying 10,000 books (focused on skill development, community enhancement, self- improvement, diversity, etc.), clothing/food/entertainment for disadvantaged and at - risk students, internships, mentors, curriculum, and tutors. >$5k We moved to Temecula from LA in 2021; COVID impacted our ability to raise funds through events and other types of campaigns; inflation is limiting cash flow; this grant will help us create new programs and partnerships with local organizations for ongoing programs.

NEW APPLICANT
44 SOUTHWEST 41145 Eagelmann Oak Street, EMPOWERING YOUNG WOMEN - FIND YOUR VOICE THROUGH SONG. Community NEW APPLICANT WOMEN'S CHORUS Murrieta, CA 92562 Event teaches three songs (middle and high school students and beyond); a one -day Website: seminar of three songs culminating in a performance at the Old Town Community SOUTHWESTWOMENSCHORUS.OR Theater. Funds will be used for rental of seminar venue, sheet music, meals, t-shirts, G accompanist, office supplies, and publicity. Estimated number of Temecula residents to benefit: 30-50.
45 SPECIAL OLYMPICS 41880 Kalmia St. #140, Murrieta, SPECIAL OLYMPICS SO. CAL TEMECULA. Cover facility rental fees, athlete uniforms, and SOUTHERN CA CA 92562 equipment for basketball, bocce, and flag football. Estimated number of Temecula INLAND EMPIRE residents to benefit: 90.
46 SPEECH & 43385 Business Park Drive #140, DEVELOPMENTAL SCREENINGS / THERAPIES. 80 children from low income families to LANGUAGE Temecula, CA 92590 receive developmental assessments, social skills classes, behavioral counseling and DEVELOPMENT Website: SLDC.NET intervention. Funds will be spent on assessments, screenings, and rent. Virtually all of CENTER INC. the assessment and session costs are to pay licensed teachers and therapists; there is a lack of these services in Temecula. Through our research, we found that families needing these services had to travel 40 miles; we'll deliver in Temecula. Estimated number of Temecula residents to benefit: 80. >$5K we launched Stage 1 of our program in Dec. 2021. The virus impacted us financially and in our physical environment and there is an even greater need for services. The program is now in Stage 2 and SLDC has committed to building out its services in the Temecula Valley over the next 3 years. We look to continue to provide speech, language/behavior services and also provide occupational/physical/mental/family therapy.
47 SPERO VINEYARDS 2076 Lincoln Ave., Pasadena, CA SPERO VINEYARDS. Provides instruction and meaningful workforce development and INC. 91103 training for young adults with disabilities interested in careers in Temecula's wine and hospitality industry including history, science, hospitality, business/marketing, and agriculture aspects of the wine making business. Funds will be used to purchase equipment, and expand curriculum beyond the essential elements of viticulture and hospitality. Estimated number of Temecula residents to benefit: 15-30+. >$5K The pandemic displaced a significant portion of our volunteer and donor base; rising fuel, water and vineyard management costs threaten the program; the wine lab curriculum will expand necessary training opportunities and allow us to offer next level skill training Ito students.
48 dba TEDX

TEMECULA -

INLAND VALLEY

BUSINESS &

COMMUNITY

FOUNDATION
40497 Winsor Road, Temecula, CA TEDX TEMECULA. Local TEDx event in Old Town where public speakers give talks that 92591 have received over 2 million views. Funds will be used to pay for lunch, printing Website: TEDXTEMECULA.COM (program & other promotion), table and chair rental for theater courtyard, and video production.

NEW APPLICANT
$ 1,090,500
50,000 1 $
5,000 I $
$ 5,000 $
$ 10,000 $
N
37,100 1 $
5,000 1 $
5,000
5,000
5,000
37,000
5,000

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[Legend]
"-" = Applied
and N
t Awarde

Page 12 of 18 ends

COMMUNITY SERVICE FUNDING

REINVESTMENT IN TEMECULA
SUB-

COMMITTEE
RECOM-

MENDATION
TOTAL$

BOARDDIRECTORS OR
1,090,500
49 TEMECULA PLAY 42690 Margarita Rd., Temecula, PALS BUDGET RELIEF. Co-op preschool for children ages 3-5 at Temecula United NEW APPLICANT $ 50,000 $ -
AND LEARN CA 92592 Methodist Church. Funds will be invested in learning materials, educational toys, school SCHOOL INC. (PALS) Website: TEMECULAPALS.ORG supplies, parent training, update worn down furniture, office equipment, field trips, school events, and new playground equipment including a new sandbox and a new shade cover. Estimated number of Temecula residents to benefit: 30 families. >$5K Enrollment declined during pandemic but have increased again; as a nonprofit we rely on tuition, fundraising, personal donations and community support. This funding will support continuation of a safe environment, quality school supplies, equipment, furniture, field trip experiences, special events and educational opportunities. 50 TEMECULA SUNRISE
PO BOX 2203 Temecula, CA 92590
CHRISTMAS DINNER. Funding will be used to purchase dinner -related equipment and $ 15,000
$ 15,000
ROTARY
supplies including cargo trailer, oven, restaurant -quality pots/pans/utensils, and food.

FOUNDATION
This year's 2022 dinner will be at the MSJC Cafeteria (since Mary Phillips Senior Center is under construction). There are many Temecula families that depend on the Temecula Community Christmas Dinner. Estimated number of Temecula residents to benefit:
1,200. >$5K In early 2022, our 28 foot cargo trailer with all our equipment was stolen and we need to replace it with the oven, restaurant quality pots, pans and utensils. We need to purchase food and supplies. Estimate cost for all of this is approximately $42K.

COVID restricted our ability to hold sit down dinners in 2020 and full capacity dinner in 2021; Now 2022 inflation has significantly increased the cost of food and supplies for this event. Grant will allow us to purchase necessary equipment to continue this event and provide food and supplies for the 2022 dinner.
51 TEMECULA
42051 Main Street, Temecula, CA ARTS CONNECTION NEW WORKS. Supports and expands outreach offering K-12

NEW APPLICANT
$ 50,000
$ 50,000

THEATER
92590 Temecula students opportunities to experience theatrical productions/see live

FOUNDATION
Website: performances (multi -cultural productions in dance, music, plays, musicals) for free.

TEMECULATHEATERFOUNDATION. Additionally, students will see work in its unfinished phase and be part of the process ORG through discussion, essay critique, and visual appreciation. Funds will be used for expenses including payment to presenting organizations, artists, curriculum materials for the teachers, and in-house production costs. Estimated number of Temecula residents to benefit: 4,000+ annually. >$5K March 2020-Sept. 2022 we have been unable to offer programs to our youth due to school's guidelines of social distancing.

We are starting the program again, now that those restrictions have been lifted.

Additionally, we have been unable to do annual fundraising or galas due to COVID; the addition of funds will supplement our currently depleted reserves, allow us to bring in more students, and create our New Works program.
52 TEMECULA VALLEY
27470 Commerce Center Dr. C,
TV ALANO CLUB. Guides and supports coming out of rehabilitation centers for drugs or

NEW APPLICANT
$ 50,000
$ 5,000

ALANO CLUB
Temecula, CA 92590
alcoholism. Funding will be used on rent for the facility, 12-step books, information pamphlets, workbooks, new coffee bar, new tables & chairs for the meeting hall used for 12-step meetings, pool table for fundraising events, cable & internet, couches, and tables. Estimated number of Temecula residents to benefit: 1,200-1,300. >$5K Most funding came from donations which decreased during COVID; and restrictions lessened the amount of people who could meet so members relapsed; costs of all supplies and utilities have increased. This funding would allow a new fundraising event and continuing to provide literature, books, outreach to those involved in the 12-step

ANNUAL CSF
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Page 13 of 18 ends

Legend: "-" = Applied and Not Awarded
No Number = Did Not Apply

COMMUNITY SERVICE FUNDING

REINVESTMENT IN TEMECULA
53 TEMECULA VALLEY 28780 Old Town Front St., C1, TEMECULA BAND PROJECT. This is an expansion of the Temecula String Project and CONSERVATORY OF Temecula, CA 92593 offers free band class to 5th grade students at 2 TVUSD elementary schools during non - THE ARTS school hours, and open to all students. Funds will be used to purchase band instruments (7 flutes, 7 clarinets, 7 saxophones, 7 trumpets, 2 trombones) and to rent climate - controlled storage space to store instruments during the summer months when not in use. Estimated number of Temecula residents to benefit: 40 students/year. >$5K Pandemic prevented TVCA from conducting in -person events/fundraisers which reduced revenue for 2 years; also restricted TVCA's ability to do string classes in -person.

TVCA will purchase new instruments for the beginning band program which is an expansion of the instrumental music program which has been a string program for the past 5 years. These instruments are expected to last many years. The 5-year goal is to make the 5th grade instrumental music program more equitable by offering either strings or band at every elementary school in the district. 54 TVHS GOLDEN BEAR PO BOX 892072, Temecula, CA AMPLIFY - CELEBRATION OF BLACK HISTORY. Inaugural attempt to bring FOUNDATION 92589-2072 students/families/community member to learn first person account stories from those who rode on the busses that we now refer to as the "The Freedom Riders." An organization from San Diego has artifacts, exhibit featuring a life-size replica of the bus, and a father -and -son -team to speak about their experiences. The 2nd night we hear from Director of Alabama Tourism/author/expert on The Road to Birmingham Lee Sentell. Each night will have music, poetry, reading, dancing, and re-enactments. Funds will be spent on: "The Buses are Coming" exhibit (10k), African drum dancers from Los Angeles (2k), Lee Sentell from Director of Alabama (500), A Poetic Tribute to the Freedom Riders" (500), David Dennis Sr. & Jr. speakers (3k), flights, housing, food for guest speakers (1,750), workshop for 10-12 graders by Miss Misipeka (1.5k). Estimated number of Temecula residents to benefit: 2,000 students/800 community. >$5K Pandemic info N/A. This will be the 1st year TVHS has attempted to host a Black History Celebration that is intentionally serving students and the community. The aim is to charge community members a minimal fee to access the evening programs so the program can expand and aim toward self-sufficiency. The aim is to continue this program year-to-year and have students and the community grow value and respect the contributions and sacrifices to the black community. 55 'TEMECULA VALLEY PO BOX 1293. Temecula, CA 92593
TEMECULA TALENT REVIVED. Funding will be spent on advertising/outreach,

NEW APPLICANT
PLAYHOUSE dba
production costs, sound and lighting design, Penske truck rentals, furniture, costumes,

TEMECULA VALLEY
set items (lumber, paint, brushes, rollers, nails, screws, casters, etc.), set decorating

PLAYERS
items, batteries (for microphones), props, costumes, microphone rentals, dry ice machine and dry ice, rehearsal space, and other rental equipment. Estimated number of (Temecula residents to benefit: 2,500 based on attendance, business, creative team, actors.
>$5K TVP completely shut down 3/20 — 8/21 during the pandemic. The remaining show for the 19/20 season were canceled and all 5 productions for the 20/21 season were canceled. Revenue comes predominately from ticket sales and the financial loss was devastating, reduced from a 190k average to $17,881. To remain solvent, TVP closed the warehouse and rented local storage for items required in future productions.

Warehouse inventory was donated or stored at private residences of Board Members.

TVP is applying for >$5K to create the project "Temecula Talent Revived!" TVP will actively cultivate partners during this time for advertising, fundraising, and other grant opportunities in order to sustain the project after grant funding has ended. Temecula actors will learn from industry professionals/quality theatre performers, providing intensive instruction in all areas of theatre including direction, musical direction, choreography (and receive feedback on acting, vocal and dance capabilities).

SUB-

COMMITTEE
RECOM-

MENDATION
$ 1,090,500
27,000 1 $ 27,000
10,000 1 $
47,000 1 $
5,000
30,000

ANNUAL CSF
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Page 14 of 18 ends

Legend: "-" = Applied and Not Awarded
No Number = Did Not Apply

COMMUNITY SERVICE FUNDING

REINVESTMENT IN TEMECULA
56 'TEMECULA VALLEY 'PO BOX 890367, Temecula, CA 1- PEACE AND FRIENDSHIP GARDEN. Six peace poles with a message: May Peace ROSE SOCIETY Website: Prevail on Earth" in 42 languages. An effort bean in 1955 by a Japanese philosopher TEMECULAVALLEYROSESOCIETY.O after WW2. The message is on each pole. Funds will be used for rose bushes, mulch, RG construction of pathways with maintenance, irrigation system & Equipment with maintenance, 6 peace poles with shipping, addition of 42 languages plus a Braille plaque, display case to recognize donors.
2 - GARDEN GAZEBO REPLACEMENT. For structure after 25 years of deterioration.

Funds will be used for a gazebo unit, shipping, and installation.

BOTH PROGRAMS - Estimated number of Temecula residents to benefit: 1,500. >$5K COVID involvement changed everything. Meetings and activities for both adults and children shut down. Outdoor meetings were attempted with little participation.

Annual dues were not collected in 2021 resulting in a loss of revenue and membership interest.
1- PEACE AND FRIENDSHIP GARDEN was initiated in 2020. It will need constant maintenance by volunteers.
2 - GARDEN GAZEBO REPLACEMENT. The original decorative garden gazebo was installed about 25 years ago. It now needs to be replaced due to deterioration, as simple repair is not possible. This unit is important for income, is it is rented for family events, weddings, proposals, and is one of the main attractions for visitors on a hill for a spectacular view.
57 GFWC TEMECULA PO BOX 1056, Temecula, CA 92593 FUNDRAISER CANCELLATION COMPENSATION PROJECT. will increase membership and VALLEY WOMAN'S Website: TVWC.COM fundraising capabilities to host larger fundraisers, increase volunteering, contributing, CLUB and donating to the community. Funding would pay for operational costs of monthly meetings, fundraising events, membership engagement, public relations and local non- profit projects. Funding will be used for the HOME TOUR FUNDRAISER such as homemade soup/gourmet food/bakery supplies, waste management rentals, van rentals, traffic control rentals, print advertising, brochure printing, ticket & poster printing, catering, rentals (table & chair, portable toilet facility, venue), insurance fees, licenses, and permit costs. Estimated number of Temecula residents to benefit:
250,000. [to double-check; Temecula population—110K). >$5K At the end of 2019 TVWC had 120 members. In 2022, membership has declined to 80 members. The decreased membership reduced the number of charities supported, dollars donated, and hours volunteered to the community. This grant would assist TVWC in increasing membership and paying for fundraising costs to get back to pre -pandemic membership and return TVWC's contribution to the community to the higher level again. 58 THE
27262 Via Industria, Temecula, CA
YOUTH MENTAL HEALTH COMMUNITY HEALTH WORKER PROGRAM. The

EMPOWERMENT
92592
Empowerment Center's Mission is to help youth and families develop the resilience CENTER
Website: THEEMPOWERMENT
necessary to overcome challenges, discover the best of themselves and create healthier, CENTERINTL.COM
happier patterns of living. An innovative approach to providing peer -to -peer mental health support for Temecula's youth. Grant funds will be used to cover the cost of mental health training, curriculum materials, and program participation incentives including meal provision for evening and weekend trainings and gift cards. Estimated number of Temecula residents to benefit: 100.
>$5K The COVID-19 pandemic allowed the TEC to pivot services to virtual platforms, removing the barriers to attendance. Although TEC shut the doors to in -person programming, the pandemic allowed TEC to reach the most youth and families that have been reached in the last 5 years. The pivot has allowed TEC to expand service across the county, state, and country. The grant funds will create new programming.

TEC has been invited by the California Workforce Development Board to provide Mental Health Worker training and employment preparation services to the adult workforce. It is TEC's goal to provide youth with the same opportunities through this Youth Mental Health Worker Project.

SUB-

COMMITTEE
RECOM-

MENDATION
$ 1,090,500
50,000 1 $ 10,000
50,000 1 $
50,000 $
25,000
25,000

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Legend]
"-" = Apollied
and N
t Awarde

Page 15 of 18 ends

No Number = Did Not Apply

COMMUNITY SERVICE FUNDING

REINVESTMENT IN TEMECULA
59a THE SALVATION
ARMY
-1OF2

APPLICATIONS
59L THE SALVATION
ARMY
-2OF2

APPLICATIONS
60 THE SHELLA

FOUNDATION
40270 Los Alamos Rd., Murrieta, 'TEMECULA CHILD SPREE. Back -to -school event gives school aged children books a NEW APPLICANT CA 92562 breakfast and the opportunity to pick out $125 worth of new clothes, shoes, backpacks, Website: i and school supplies. Funding will assist with August 2022 & August 2023 expenses MURRIETA.SALVATIONARMY.ORG —$25/child for school supplies, $125 JC Penny gift cards (spent on the day of the spree).

Targeted recipients are children (in low income families) living in the City of Temecula .

Estimated number of Temecula residents to benefit: 90.
>$5K Over the course of the COVID-19 pandemic TSA was called upon to serve significantly higher numbers of people with food, clothing and financial assistance more than any other time in its 25 years in SW Riverside County. While service needs, and as a result, program expenses increased dramatically, private donations have begun to decrease, combined with inflation (food & fuel), TSA has been challenged in operating its programs. The pandemic further affected the ability to utilize volunteers in carrying out programs, including Child Spree, which now have parents shopping with their children instead of volunteers. With the requested funding, the number of Temecula children served will increase the annual average of 15-50 (and overall total of 200 to 250 each year). The Child Spree will be the 25th year in 2023 and anticipate a big event with news coverage and more participation from Temecula children. 40270 Los Alamos Rd., Murrieta,
TEMECULA HOMELESS PREVENTION. Provides up to 2 months of rental assistance, paid

NEW APPLICANT
CA 92562
directly to landlords (rental property owners and/or management companies) on behalf Website:
of Temecula residents with past -due rent, experiencing financial crisis and are set for MURRIETA.SALVATIONARMY.ORG
eviction, thus preventing homelessness. Estimated number of Temecula residents to benefit: 42. >$5K Over the course of the COVID-19 pandemic TSA was called upon to serve significantly higher numbers of people with food, clothing and financial assistance more than any other time in its 25 years in SW Riverside County. While service needs, and as a result, program expenses increased dramatically, private donations have begun to decrease, combined with inflation (food & fuel), TSA has been challenged in operating its programs. Funding will allow the homeless prevention program to expand from serving —18 Temecula residents annually to 42 residents during the proposed program term.

PO BOX 263, Menifee, CA 92586
Website:

SHELLAFOUNDATION.ORG
IN -HOME PERSONAL CARE RESPITE SCHOLARSHIP. Helps those requiring care either NEW APPLICANT diagnosed at birth with disabilities or have been in an accident that caused a disability, or are senior citizens who cannot care for themselves. Funds will be used to provide —70 families with 24 hours of in -home personal care and respite support to Temecula families. Estimated number of Temecula residents to benefit: 70. >$5K The Shella Foundation receives 100% from donations. The pandemic prevented holding fundraising events due to lockdowns and social distancing. This also prevented providing in -home care. The monies used form this grant will be used to continue an existing program, providing in -home personal care respite reserved exclusively for Temecula populations, and awarding personal care scholarships to those that qualify.

SUB-

COMMITTEE
RECOM-

MENDATION
$ 1,090,500
13,500 1 $ 23,500
36,500 1 $
50,000 1 $
20,000
5,000

ANNUAL CSF
01 1 O N
N N N

O O O O

N N N N
00 of o
N CD 0 N
0 0 0 0

COUNCIL CSF
ON
O
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-I
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14 N
O
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>
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CDBG
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O
N
O
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14 N
O
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Page 16 of 18 ends

Legend: "-" = Applied and Not Awarded
No Number = Did Not Apply

COMMUNITY SERVICE FUNDING

REINVESTMENT IN TEMECULA
61 'THE TEMECULA

VALLEY MASTER

CHORALE
62 THESSALONIKA
PO BOX 890204, Temecula, CA
MASTER CHORALE SEASON 22-23. Provides concerts through collaboration with

I NEW APPLICANT
92589-0204
Temecula schools and businesses. Funding will be spent on concert venues, competition Website:
venues, musical score purchases, program and flyer printing, independent contract

TEMECUALVALLEYMASTERCHORA
instrumentalists, food, and vendors. Estimated number of Temecula residents to LE.ORG
benefit: 500. >$5K When the COVID-19 quarantine first started the season was cut short and not able to have the final concert. The next season had some members patriciate online practices with limited you tube video performance (no public performances). Last season (Sept 2021-April 2022) Master Chorale, with less members returning, practiced with masks, and had outdoor concerts. Fundraising activities were also limited. Grant funds would expand Master Chorale's opportunities to reach more of the Temecula community through involvement in choir, in audience capacity or as vendor of venues, supplies, or services. This creates an opportunity to collaborate with Temecula school choirs (public and private) and orchestras and their families. The dream is to eventually host a fine arts festival at the Community Recreation Center that would include school choirs, orchestras, and local vendors.
38950 Mesa Road, Temecula, CA
FAMILY SERVICES 92592-8753
63 VETERANS

SUPPLEMENTAL

SUPPORT

NETWORK (VSSN)
Website: [email protected]
CMOH FOOD PROGRAMS. Maintains food distribution warehouse and upkeep equipment to provide local food distribution services, paying drivers, rental fees for food delivery vans, workshop supplies, supplemental food items, and volunteer training costs [no salaries]. CMOH HOUSING is a residential program for homeless single mothers and their young children. Funds will be spent on capital expenditures [possibly; City needs more details] to improve classroom and childcare spaces at Empowerment Village - a residential program for homeless single mothers and their young children.

Estimated number of Temecula residents to benefit: 2,000. >$5K Exacerbated by the pandemic, CMOH clients continue to face difficulty paying for basic needs. Today, more families than ever before are turning to CMOH. This increase in demand coupled with rising costs, necessitates that CMOH needs more funding to serve the community.

Funding will allow CMOH to continue the Food Pantry and Housing Programs. CMOH annually spends over 2,700,000 on program costs, funded primarily though the generosity of the philanthropic community and in -kind donations. $50K in support from the City of Temecula will allow CMOH to continue its food pantry and housing programs.
41593 Winchester Rd #200, STOMPING THE STIGMA VETERAN OUTREACH. Hosts military and veteran family Temecula, CA 92590 outreach resource events to include annual Winter Wonderland, Cards for Vets, Daisy Website: VETSUPPORTNET.ORG Monument Walk, and the Hiring and Volunteer Fair. Funding will be used for storage unit rental space—$1800, equipment rental for events (tables, chairs, linen, canopies, sandbags, pipes, drapes) averaging—$6800, postcards printing & distributing (Cards for Vets)—$1400. Estimated number of Temecula residents to benefit: 11,698. >$5K When the COVID-19 pandemic hit, VSSN sprung into action to provide vital services including food deliveries, virtual mental health readjustment, suicide prevention case management, and resource and referrals. Core outreach events, which fuel the service delivery, were halted due to safety and budget restrictions; however, many volunteers continued to play key roles in regular services, including pandemic -related ones: vaccine education, without adequate funding. Since the pandemic VSSN experienced a 33% increase in demand. The rising inflation is continually impacting in -kind and monetary donations. Funds will help cover the costs of VSSN's well -attended outreach events and increasing warehouse storage fees.

SUB-

COMMITTEE
RECOM-

MENDATION
$ 1,090,500
22,000 1 $
50,000 $
10,000 1 $
50,000
10,000

ANNUAL CSF
Cn 1 O N
N N N

O O O O

N N N N
00 of o 1-1
N CD 0 N
0 0 0 0

COUNCIL CSF
ON
14 N
r1i
N
N
O
O
O
O
0)
-I
O
N
14 N
N
N
o
N
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N
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>
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2,000
CDBG
C'4
O
N
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Page 17 of 18 ends

Legend: "-" = Applied and Not Awarded
No Number = Did Not Apply

COMMUNITY SERVICE FUNDING

REINVESTMENT IN TEMECULA
SUB-

COMMITTEE
RECOM-

MENDATION
TOTAL$ 1,090,500

BOARDDIRECTORS OR
64 WESTERN EAGLE 40940 County Center Drive, FOOD BOXES. For-220 Temecula residents/month filled with staples: canned NEW APPLICANT $ 50,000 $ 50,000 FOUNDATION Temecula, CA 92591 vegetables and fruits, dry pasta and rice, cereals, spaghetti sauce, dried beans, soups, peanut butter, tostada shells, and packaged dinners. At an operational cost of $25/box times 220 Temecula residents take advantage of the food box a month. $5,500 per month. Annual Cost is $66K. Estimated number of Temecula residents to benefit:
2,640. >$5K COVID-19 affected Western Eagle's ability to get donated food from growers, farmers, and suppliers. Inventory and overflow of food was down; there was a lot of competition for donated food from other food banks ad transportation was costly and not always on schedule. Suppliers began charging for their overstock rather than just giving it away as they did before the pandemic. Western Eagle began buying more "staples" for the food box program and the store. This has caused an increase in operating and program expenses. Inflation has caused Western Eagle to let go of the truck driver, due to high cost of gasoline and employee retention. Western Eagle now uses a transportation service to pick up food and goods from suppliers, which causes delay in getting food picked up and brought back to the Western Eagle store. 65 WISHERS AND 31915 Rancho California Ro 200- VOLUNTEER SEWING EVENTS. Donates gowns to local hospitals. Funds will be used to NEW APPLICANT MUST $ 51000 $ DREAMERS INC 407, Temecula, CA 92591 purchase fabric and supplies including (not limited to) scissors, thread, packaging ONLY SERVE TEMECULA Website: WISHERSAND materials, postage, shipping, and sewing machines. Hosts in -person sewing events in ONLY MEDICAL DREAMERS.ORG the City of Temecula several times a year. Volunteers make and package hundreds of OFFICES/HOSPITALS FOR gowns donated to children and hospitals. The gowns from this grant will be earmarked THE BENEFIT OF TEMECULA to be donated to our local medical community including but not limited to LLUMC, CITIZENS Rady's Children, Temecula Valley Hospital, SW Healthcare System and local pediatric doctors and surgical centers Estimated number of Temecula residents to benefit: 1,000. 66 I WOMEN
PO BOX 1382, Temecula, CA
THE LYDIA PROJECT. Designed to educate, equip, and prepare young women to become self-

NEW APPLICANT
$ 50,000
$ 5,000

ORGANIZING
92593
reliant and/or self-employed. Learn strategies necessary for becoming successful business

WOMEN INC
Webslte:
owners. Aid women in overcoming barriers/codependency on welfare systems; life coaching to become self-sufficient
WOMENORGANIZINGWOMENINC.

THE MOBILE KITCHEN SOCIAL ENTERPRISE. Break generational cycle of poverty. The Mobile ORG
Kitchen is a food truck that is used to bring awareness, resources, tools and support. Food truck that provides revenues to fund local philanthropic missions (mission: evangelical outreach, mentoring/coaching, support for women & children). Funds will be spent on a commercial refrigerator —$2k, double deck commercial oven, commercial fryer, compartment sink —$700, freshwater tank —$200, grey water tank —$350, generator,—$1500, hand sink —$500, burner countertop range —$1k, burner griddle top —$250, countertop with backsplash —4k, pantry shelves—$2100, electric water heater—$1400, propane cylinder —$200, service window—$1500, hood with fan /fire suppression system—$5500, rear door—$1300, engineering & state licenses —$6500, storage fees for 1 year—$3k, maintenance supplies (pots &pans) and gas —$800.

Estimated number of Temecula residents to benefit: 8,144 annually. >$5K Faith -based nonprofit that does not discriminate based on another belief system. Food insecurities are real. Project will create jobs, establish business partnerships, inspire entrepreneurs, work alongside other nonprofits, secure foods sources to local families. COVID-19 affected WOW's ability to serve the Temecula community based on the fear of the pandemic to interact with the public. Although not able to have annual fundraising events, WOW stayed diligent in praying for those grieving and suffering form depression, provided grief counselling, and connected virtually through social media outlets. WOW was able to give 2 grants (for $500 each) in 2021. Community inflationary concerns impact the small business owner and nonprofit organization from receiving business or $20 donations towards an organization mission initiative. The project will be one vehicle in providing a food source to families, income to small business, and donations to nonprofit organizations.

TOTAL
I
I
I
$ 2,278,372
1 $ 1,090,500

ANNUAL CSF
Cn 1 O N
N N N

O O O O

N N N N
00 of o 1-1
N CD 0 N
0 0 0 0

COUNCIL CSF
ON
O
N
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14 N
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Page 18 of 18 ends

Legend: "-" = Applied and Not Awarded
No Number = Did Not Apply

FY 2022/2023

COMMUNITY SERVICE FUNDING

REINVESTMENT IN TEMECULA
GRANT APPLICATION #
la

A PLACE FOR ALL PIECES
(A: YOUTH BASKETBALL)

CITY OF TFAMECUTA
FISCAL YEAR 2022 - 2023

COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA

PROGRAM APPLICATION
(Please Print or Type)
DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022
L__

PROJECT/PROGRAM INFORMATION
Amount Requested: $ 5,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: TEMECULA YOUTH BASKETBALL CHAMPIONS Start Date: 12I0122 End Date: 2111123
Physical Address of Project/Program: TO BE DETERMINED (PREVIOUS LOCATION WAS TEMECULA CRC

INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: A PLACE FOR ALL PIECES Mailing Address: 27880 CLINTON KEITH RD, SUITED 0151
MURRIETA, CA 82562

IORGANIZATION AND GEOGRAPHIC AREA SERVED
Name of Applicant A PLACE FOR ALL PIECES
Organization:

Website: aplaceforallpleces.org
Number of Paid Staff: 0
Year Founded: 2013
Social Media: FACEBOOK, INSTAGRAM
Number of Volunteers: 30+
Geographic Area(s) the Organization Serves: TEMECULA VALLEY Geographic Area(s) the Project/Program Serves: TEMECULA VALLEY NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA.

Contact Name: _ IVY KIRSHBERG _ Title/Position: PRESIDENT Contact Person's Direct Telephone: 714 724 1010
Contact Person's Email: [email protected]

NONPROFIT STATUS
Is this organization incorporated as a nonprofit? Yes K] Date of Incorporation as a Nonprofit: "1212013 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING
Federal Identification Number: 46-2012269 State Identification Number: 3646151 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS:

1. ❑ Attach IRS Deductibility Status using this link: littpllapps.ii-s.gov/apr)/eosi

2. ❑ Attach State Entity Status Letter using this link:

Iit[PS:l/www ftb.ca.gQ%/online/self serve entity status letter/index.asp

3. ❑ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool h tp./Irct__d6 ca.goylVeri€ication/Web/Search_aspx?[aciliiv Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13

Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No 0 Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION:

This Application has been authorized by the organization's:

Executive Committee 0 Board of Directors ❑
Members -at -Large ❑

MISSION STATEMENT OF ORGANIZATION
BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES.

A Place for All Pieces fosters a community of empowered children and adults. Our goal is to Increase the quality of life for people on the spectrum. By providing opportunities for social motivation, initiations, and peer to peer interaction.

FINANCIAL STATEMENTS

UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW.

City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13

FUNDING SOURCES
CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No 0 Yes ❑ IF YES, PROVIDE BELOW.

NAME OF PROGRAM/PROJECT y AMOUNT MONTH + YEAR NAME OF CITY GRANT

FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP $
$ I
$ J
$ I
OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? No [X] Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW.

AMOUNT J f r' MONTH 'YEAR
o�^ 1
.-��„�., NAME OF ENITY J
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13

GRANT PROJECT/PROGRAM DESCRIPTION

IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT

FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT.

TYBL serves the disabled community In the Temecula Valley area. The demand for the program has doubled from last year. The 11 week program is geared towards children K-12 with special needs. Temecula High School volunteers receive volunteers hours, while gaining meaning relationship, learning compassion, and patience. Special Needs players learn social skills, and peer -to -peer Interactions.
2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED.

ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT.

The fee to join the program has increased since Inception. Cost of $120 per player includes court rental, pictures, facilitator, liability insurance. Additional cost for buddy shirts, materials, end of the season party. - -- - -
3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING.

EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS.

Temecula Youth Basketball Champions League Is Temecula based. Temecula residents have participated in the past.

Temecula residents specifically benefits from the program because of the proximity of the court location. Local volunteers have also learned how to peer mentor special needs players. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT 25-40 FROM THIS PROJECT/PROGRAM:
3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 25-50 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13

PROJECT/PROGRAM DESCRIPTION

CONTINUED
4 SUMMARY STATEMENT- SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS.

Our event focuses on a positive environment. It helps develop social skills for the special needs, while {peer volunteers continue to learn compassion and patience. Physical activity is very important for health,especially for the disadvantaged community.
5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC

AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS.
6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL:
(1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM.

City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13

PROJECT/PROGRAM BUDGET (do not fill in shaded areas)

LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES

LIST REVENUES/INCOME FOR PROJECT/PROGRAM
Amount of money requested from this City of Temecula $
Community Services Grant (Not to exceed $50,000) 5,000
Amount contributed to the Project/Program by the Applicant $ Organization
1,000
Other grants or funding already awarded for Project/Program, if any $f D
In -Kind match amount or volunteer credit hours estimated amount $ 560 hrs TOTAL REVENUE $ 6,000

LIST OF EXPENSES FOR PROJECT/PROGRAM
Tools/Equipment
$ 750
Facilities/Rent/Insurance f
$
Supplies
$ soo
Marketing
$
Services
$
Food
1,000
Other cost to Join: $120x40
$ 4,800
Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE.
$
is

TOTAL EXPENSES

TOTAL BUDGET
$
$ 7,050
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13

PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT
IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21/22 (LAST YEAR), THEN SKIP THIS PAGE.

If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. I If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent.

If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022.

1. Fill out table below (make additional copies if needed to explain all expenditures.)

2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3 Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office —CSF Organization:

EXPENDITURE REPORT due on or before September 12, 2022
Name of Project/Program:

FY 2021-2022 Amount of $
CSF Grant Fund Awarded: - Month & Year CSF Grant Received from City:

Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiarles if you do not have precise number):
v 1 Date on
E Name of Company Receipt/invoice
on Receipt or Invoice MUST BE ON OR BETWEEN
JULY 1, 2021 - JUNE 30, 2022
QZ
1 2
3 4 1
5 6
City of Temecula
Amount
Expenditure
Description I Purpose

DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE

EXPENDITURE TOTAL EXPENDITURE TOTAL MUST BE EQUAL TO
(OR GREATER) THAN TOTAL AWARD AMOUNT
Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13

If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page.

1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures.

A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.)
B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds.

2. Attach copies of receipts/invoices (in the same order listed in table below).

3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula"

EXPENDITURE REPORT DATED
Organization:

TOTAL FY 2022-2023
Amount of Grant Fund Awarded: $
Name of Project/Program:,
Month & Year FIRST $6,000 check
was received from City:

1. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted).

2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City

3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) EName of Company
Eon Receipt or Invoice
QZ
OA
3 Date on
Receipt/Invoice

MUST BE ON OR BETWEEN
March 20, 2020 - JUNE 30,
2024
Expenditure

MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER Amount Description Purpose
W
EXPENDITURE TOTAL $

EXPENDITURE TOTAL
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13

ACKNOWLEDGEMENT/SIGNATURE PAGE
The applicant acknowledges and agrees to the following:

Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements.

Every Community Service Funding application is considered individually and on its own merit.

Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval.

Please allow time for checks to be processed.
■ The awarding of Community Service Funding does not constitute an automatic annual allocation.

The recognition for Community Service Funding should accrue to the City of Temecula.

Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately.

Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot.

The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement.

If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete.

I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief.

ORGANIZATION NAME: A PLACE FOR ALL PIECES
MAILING ADDRESS: 27890 CLINTON KEITH RD, SUITE D 8150
MURRIETA, CA 92562
PRESIDENT / AUTHORIZED OFFICER: IVY KIRSHBERG

MAT NAVE
PHONE:( 714 ) 724-1010
EMAIL: [email protected]
SIGNATURE: _ DATE:

IF DIFFERENT THAN ABOVE,
APPICATION PREPARED BY.
-RIr.li �JAPl1F

PRESIDENT
�IfLC.
8/29/2022
iV10liiN W., Y111F.
1iri
SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO:

City of Temecula
Community Service Funding
Attn: City Manager's Office
41000 MAIN STREET
TEMECULA, CA 92590
Questions: [email protected] (951) 694-6413
Betsy. [email protected] (951) 693-3959
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13

INTERNAL REVENUE SERVICE
P. O. BOX 2508
CINCINNATI, OH 45201

DEPARTMENT OF THE TREASURY
Employer Identification Number:

Date: NOV`
46-2012269
u 2013
DLN :
17053098339043

A PLACE FOR ALL PIECES
Contact Person:

C/O JEFFREY KIRSHBERG
MR. DAVIS ID# 31636
27775 BOTTLE

BRUSH WAY
Contact Telephone Number:

MURRIETA, CA
92562
(877) 829-5500
Accounting Period Ending:

December 31
Public Charity Status:
170(b) (1) (A) (vi)
Form 990 Required:

Yes
Effective Date of Exemption:

February 12, 2013
Contribution Deductibility:

Yes
Addendum Applies:

No
Dear Applicant:

We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records.

Organizations exempt under section 501(c)(3) of the Code are further classified as either public charities or private foundations. We determined that you are a public charity under the Code section(s) listed in the heading of this letter.

Please see enclosed Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, for some helpful information about your responsibilities as an exempt organization.

Enclosure: Publication 4221-PC
Sincerely,
Director, Exempt Organizations
Letter 947 (DO/CG)

STATE OF CALIFORNIA
+ FRANCHISE TAX BOARD
C
SABOX 942T57
BJ1 SACRAM 4285 CA 94257-0540
Entity Status Letter
Date: 8/29/2022
ESL ID: 8818358920
Why You Received This Letter
According to our records, the following entity information is true and accurate as of the date of this letter.

Entity ID: 3546151
Entity Name: A PLACE FOR ALL PIECES
0 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board.

3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process.

Important Information
This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body.

If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1).

The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b).

Connect With Us
Web: ftb.ca.gov
Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States
California
Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019)

Q HELPO MENU
Home > Tax ExemptOrpnization Search > A Place For All Pieces < Back to 5ur-r. Results
A Place For All Pieces
E I N: 46-2012269 1 Murrieta, CA, United States
Form 990-N (e-Postcard) 8
Organizations who have filed a 990-N (e-Postcard) annual electronic notice. Most small organizations that receive less than $50,000 fall into this category.

Tax Year 2021 Form 990-N (e-Postcard)
Tax Period:
2021 (01/01/2021 - 12/31/2021)
EIN:
46-2012269
Legal Name (Doing Business as):

A Place For All Pieces
Mailing Address:
27890 Clinton Keith Rd Suite D151
Murrieta, CA 92562
United States
Principal Officer's Name and Address:

Ivy Kirshberg
27890 Clinton Keith Rd Suite D151
Murrieta, CA 92562
United States
Gross receipts not greater than:
$50,000

FY 2022/2023

COMMUNITY SERVICE FUNDING

REINVESTMENT IN TEMECULA
GRANT APPLICATION #
1b

A PLACE FOR ALL PIECES
(B: HALLOWEEN DANCE)

N_w 11b W11) ail 11
FISCAL YEAR 2022 M 2023

COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA

PROGRAM APPLICATION
(Please Print or Type)
DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022
Amount Requested: $

PROJECT/PROGRAM INFORMATION
MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION
Project/Program Title: INCLUSIVE HALLOWEEN TEENIADULT DANCE EVENT Start Date: 10/28122 End Date: 10/28/22 Physical Address of Project/Program: THE CORPORATE ROOM

INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: A PLACE FOR ALL PIECES Mailing Address: 27890 CLINTON KEITH RD, SUITE D 0151
MURRIETA, CA 92662

ORGANIZATION AND GEOGRAPHIC AREA SERVED
Name of Applicant A PLACE FOR ALL PIECES
Organization: _
Website: aplaceforallpleces.org
Number of Paid Staff: 0
Geographic Area(s) the Organization Serves:

Year Founded: 2013
Social Media: FACEBOOK, INSTAGRAM
Number of Volunteers: 26+

TEMECULA VALLEY
Geographic Area(s) the Proiect/Progrram Serves: TEMECULA VALLEY NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA.

Contact Name: IVY KIRSHBERG Title/Position: PRESIDENT
Contact Person's Direct Telephone: _714 7241010
Contact Person's Email: [email protected]

NONPROFIT STATUS
Is this organization incorporated as a nonprofit? Yes F&] Date of Incorporation as a Nonprofit: 21I2r2013 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING
Federal Identification Number: 46-2012269 State Identification Number: 3546151 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS:

1. ❑ Attach IRS Deductibility Status using this link: 17ttts_Ilapps.irs.gov/app/eosl

2. ❑ Attach State Entity Status Letter using this link:
https://www.ftb.ca.clov/otiliiie/self Serve entity StatGIS letterlindex.asr)

3. ❑ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: llti l�rct.[fry:e.covlVBliticali❑nlWctalSe��rrll.a_:1 : '1i.1�:ihry 'r City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13

Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No E] Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION:

This Application has been authorized by the organization's:

Executive Committee 0 Board of Directors ❑
F
Members -at -Large ❑

MISSION STATEMENT OF ORGANIZATION
BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES.

FINANCIAL STATEMENTS

City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13

FUNDING SOURCES
CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No [K] Yes ❑ IF YES, PROVIDE BELOW.

NAME OF PROGRAM/PROJECT
MONTH + YEAR

NAME OF CITY GRANT
AMOUNT

FUNDED BY THE CITY GRANT OR SPONSORSHIP

FUNDING RECEIVED

OR SPONSORSHIP
OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? No [J Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW.

AMOUNT T MONTH + YEAR i

RECEIVED

NAME OF ENITY II

FUNDING RECEIVED
$ 5,000 HAI ADVANCED MATERIALS SPECIALISTS
Q@ 12/2021
P
W
P
W
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13

GRANT PROJECT/PROGRAM DESCRIPTION

IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT

FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT.

A Place for All Pieces Teen Adult Halloween Event will provide much needed social skills, peer to peer support.

Temecula Special Needs families with teens and adults are always In need of programs. This event promotes a positive and safe environment for everyone. With the help of High School volunteers in the Temecula Valley area, special needs families are given the opportunity to enjoy themselves without judgements. They are surrounded by families who are also in need of respite from the daily grind of taking care of someone with special needs. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED,

ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT.

VENUE: $1600
DECORATIONS: $3500
FOOD: $1500
DJ: $300
3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING.

EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS.

Our Halloween stance event Is our biggest event of the year. Temecula Special Needs families and Peer volunteers from Terecula schools have participated in the past. It Is not only geared to benefit tf a special needs families, bUI also the high school peers who have returned yearly to help develop a positive environment for everyone. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT I 50-75 FROM THIS PROJECT/PROGRAM:
3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM:
25-50
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13

PROJECT/PROGRAM DESCRIPTION

CONTINUED
4 SUMMARY STATEMENT- SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. ❑ur event focuses on a positive environment. It helps develop social skills for the special needs, while peer volunteers continue to learn compassion and patience. It is the most sought after event of the year, with attendance growing every year. The cost will he around $6,900 this year.
5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC

City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13

PROJECT/PROGRAM BUDGET (do not fill in shaded areas)

LINE ITEMS FOR PROJECT/PROGRAM REVENUES J

EXPENSES

LIST REVENUES/INCOME FOR PROJECT/PROGRAM
Amount of money requested from this City of Temecula $
Community Services Grant (Not to exceed $50,000) 6,000
Amount contributed to the Project/Program by the Applicant $ Organization
1,900
Other grants or funding already awarded for Project/Program, if any $
0 In -Kind match amount or volunteer credit hours estimated amount $ 45 hrs

TOTAL REVENUE
1 $ 6,900

LIST OF EXPENSES FOR PROJECT/PROGRAM
Tools/Equipment
!
$
Facilities/Rent/Insurance
$
1,600
Supplies
$
Marketing
$
Services
$
300
Food
1,500
$
3,500
Other
Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT, HOWEVER PLEASE INCLUDE.

T
$
$
6,900

TOTAL EXPENSES
$
6,900
TOTAL BUDGET $
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13

PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT
IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE.

If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information.

1. Fill out table below (make additional copies if needed to explain all expenditures_)

2. Attach copies of receipts/invoices (in the same order as listed in this table.)

3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Managers Office —CSF EXPENDITURE REPORT due on or before September 12, 2022
Organization: _ Name of Project/Program:

FY 2021-2022 Amount of $
CSF Grant Fund Awarded: Month & Year CSF Grant Received from City:

Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number):

Name of Company
I-cR E on Receipt or Invoice
F 7
¢a
2 1
3 1
Ez
Date on
ReceiptlInvoice

MUST BE ON OR BETWEEN
JULY 1, 2021 -JUNE 30, 2022

EXPENDITURE TOTAL
Amount
Expenditure
Description Purpose

DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE

EXPENDITURE TOTAL MUST BE EQUAL TO
(OR GREATER) THAN TOTAL AWARD AMOUNT
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13

1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures.

A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000' no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.)
B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds.

2. Attach copies of receiptslinvoices (in the same order listed in table below).

3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula"

EXPENDITURE REPORT DATED
Organization: Name of Project/Program:

TOTAL FY 2022-2023 Month & Year FIRST $5,000 check
Amount of Grant Fund Awarded: $ was received from City:

1. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted).

2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City

3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request S_ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) _ r
d
E
L
" E
4Z
2 3
Name of Company
on Receipt or Invoice
Date on Expenditure
ReceiptlInvoice MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER

MUST BE ON OR BETWEEN
March 20, 2020 - JUNE 30, Amount Description Purpose
2024
EXPENDITURE TOTAL $

EXPENDITURE TOTAL
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13

ACKNOWLEDGEMENT/SIGNATURE PAGE
The applicant acknowledges and agrees to the following:

Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements.

Every Community Service Funding application is considered individually and on its own merit. ■ Awards will be given to organizations and activities that directly benefit the residents of Temecula.

Funding is not immediately available to the recipient, and requires an award letter signature upon approval.

Please allow time for checks to be processed.
* The awarding of Community Service Funding does not constitute an automatic annual allocation. ■ The recognition for Community Service Funding should accrue to the City of Temecula.

Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately.

Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot.

The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. 16 If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete.

I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief.

ORGANIZATION NAME: A PLACE FOR ALL PIECES
MAILING ADDRESS: 27890 CLINTON KEITH RD, SUITE D #160
MURRIETA, CA 92662
PRESIDENT / AUTHORIZED OFFICER: _IVY KIRSHBERG
PHONE: ( 714 ) 724-1010
EMAIL: [email protected]
SIGNATURE:, _ DATE:

IF DIFFERENT THAN ABOVE,
APPICATION PREPARED BY:
8/29/2022

PRESIDENT
1111t
VO I"N I)i"N, yrfAP:

PRGd I NANV T
SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO:

INTERNAL REVENUE SERVICE
P. O. BOX 2508
CINCINNATI, OR 45201
Date:

A PLACE FOR ALL PIECES

C/O KURT GRAVES
3118 WILSHIRE BLVD STE D
SANTA MONICA, CA 90403
Dear Applicant:

DEPARTMENT OF THE TREASURY
Employer Identification Number:
46-2012269
DLN:
17053098339043
Contact Person:

MR. DAVIS ID# 31636
Contact Telephone Number:
(877) 029-5500
Accounting Period Ending:

December 31
Public Charity Status:
170 (b) (1) (A) (vi)
Form 990 Required:

Yes
Effective Date of Exemption:

February 12, 2013
Contribution Deductibility:

Yes
Addendum Applies:

Please see enclosed Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, for some helpful information about your responsibilities as an exempt organization.

Enclosure: Publication 4221-PC
Sincerely,
Director, Exempt Organizations
Letter 947 (DO/CG)

STATE OF CALIFORNIA

FRANCHISE TAX BOARD
F T B PO BOX 942657
SACRAMENTO CA 94257-0540
Entity Status Letter
Date: 8/29/2022
ESL ID: 8818358920
Why You Received This Letter
According to our records, the following entity information is true and accurate as of the date of this letter.

Entity ID: 3546151
Entity Name: A PLACE FOR ALL PIECES

1. The entity is in good standing with the Franchise Tax Board.

2. The entity is not in good standing with the Franchise Tax Board. © 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity.

5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process.

The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b).

Connect With Us
Web: ftb.ca.gov
Phone: 800-852-5711 from 7 a.m. to 5 p-m. weekdays, except state holidays 916-845-6500 from outside the United States
California
Relay Service: f711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019)

Q HELPO MENU
Home > Tax Exempt Organixdtion Search > A Place For All Pieces < Back to Search Result
A Place For All Pieces
EIN: 46-2012269 1 Murrieta, CA, United States
Form 990-N (e-Postcard) 8
Organizations who have filed a 990-N (e-Postcard) annual electronic notice. Most small organizations that receive less than $50,000 fall into this category.

Tax Year 2021 Form 990-N (e-Postcard)
Tax Period:
2021 (01/01/2021 - 12/31/2021)
EIN:
46-2012269
Legal Name (Doing Business as):

A Place For All Pieces
Mailing Address:
27890 Clinton Keith Rd Suite D151
Murrieta, CA 92562
United States
Principal Officer's Name and Address:

Ivy Kirshberg
27890 Clinton Keith Rd Suite D151
M u rri eta, CA 92562
United States
Gross receipts not greater than:
$50,000

FY 2022/2023

COMMUNITY SERVICE FUNDING

REINVESTMENT IN TEMECULA
GRANT APPLICATION #
2 AIM FOR GOOD INC.

► W wirl)Vm'lI�FL- ►i111
FISCAL YEAR 2022.2023

COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA

PROGRAM APPLICATION
(Please Print or Type)
DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022

PROJECT/PROGRAM INFORMATION
Amount Requested: $ 50,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION AIM for Good
Project/Program Title:

Physical Address of Project/Program:

Start Date: 4/20 End Date: indefinite

INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: AIM for Good, Inc.

Mailing Address: 31493 Rancho Pueblo Rd. #205
Temecula, CA 92592

ORGANIZATION AND GEOGRAPHIC AREA SERVED
Name of Applicant AIM for Good, Inc
Organization: _
Website: www.AimForGood.org
Number of Paid Staff: 0
Year Founded: 2020
Social Media: FB/Instagram
Number of Volunteers: 15
Geographic Area(s) the Organization Serves: Temecula Valley Geographic Area(s) the Proiect/Program Serves: Temecula Valley NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA.

Contact Name: Mark Anselmo Title/Position: President/Co-Founder Contact Person's Direct Telephone:9519726680
Contact Person's Email: markanselmo®gmail.c
Of

NONPROFIT STATUS
Is this organization incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit: 4/17/20 No IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING
Federal Identification Number: 850914556
State Identification Number: 4584598
PRINTOUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTS) AS FOLLOWS:

1. ® Attach IRS Deductibility Status using this link: htt :1/a sirs. ov/a Leos/

2. B Attach State Entity Status Letter using this link:
htt s., / www.ftb.ca , ov/online/self serve entitystatus letterlindex.as � {{ �

3. ® Attach first page only of most recent IRS Form 990 or attach print out of detailed infc6W424marity found on this State Registry's Search Tool: htt :1/rct.do .ca. r►111erihcationtWeb/Search.as x?facili =Y

CITYMI 'IAGEP'SOFFICE
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13

Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No N Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION:

This Application has been authorized by the organization's:

Executive Committee ❑ Board of Directors IN Members -at -Large ❑

MISSION STATEMENT OF ORGANIZATION I
BRIEFLY DESCRIBE THE ORGANIZATION's MISSION/GOALS AND OBJECTIVES.

Our goal is to give back to our community wherever the needs may be. Our mission to help local individuals and families in need, local non -profits and to help facilitate events that spread awareness of multiple causes.

Our founder originally started a non-profit, Our Nicholas Foundation, in 2004 to help support the local Autism community when their youngest son was diagnosed. Over the years he has seen needs multiply in many areas including cancer, hunger, autism/special needs, family support and more and wanted a solution to help quickly with no delays...thus AIM for good was started.

FINANCIAL STATEMENTS
UPON REQUEST, COPIES OF THE ORGANIZATION's CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA's AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW.

City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13

FUNDING SOURCES
CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No E Yes ❑ IF YES, PROVIDE BELOW.

NAME OF PROGRAM/PROJECT MONTH + YEARu NAME OF CITY GRANT AMOUNT

FUNDED BY THE CITY GRANTOR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP 1-
OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? NON Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW,

NAME OF ENITY
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13

GRANT PROJECT/PROGRAM DESCRIPTION

IMPORTANT - RECEIPTSANVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT

FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECTIPROGRAM AS DESCRIBED HERE E
DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT.

Simply local individuals, families and non -profits in need ... whether that's financial, public awareness or volunteer support.
2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED.

ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT.

Our goal is to find needs and immediate) fill them it's hunger needs this Y g s
Fall/Winter with the inflation/recession challenges we face... challenges local non -profits face with decreased donations in a recessionary period... providing video marketing for those in need ... charity events or public community support.. -Autism art camps...we are flexible and will fill the need. We have purchased and will be upgrading video production equipments to promote those in need via online marketing, etc. and will help purchase items as needed locally to help whomever we can.
3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING.

EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS.

Our focus is the Temecula Valley. Locally for non -profits we have directly supported Michelle's Place, Community Mission of Hope, Autism & the Arts j Foundation and Jacob's House and plan to expand that further. 3b
3c
ESTIMATED FROM THIS PROJECT/PROGRAM: PROGRAM BER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT Sky's the limit ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM 15 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13

PROJECT/PROGRAM DESCRIPTION

CONTINUED
4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS.

Helping individuals, families and non -profits wherever possible locally. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC

AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS.

Covid, Inflation and Recession will and does impact all non-profit contributions.

We haven't actively fundraised as we didn't want to compete for local dollars as the local non -profits build their strategies going forward... 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL:
(1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM.

Our goal is to help whomever we can locally without any red tape ... so this grant would help us kickstart that goal and funnel much needed support via financial, marketing/promoting of needs, direct partnerships and more.

City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13

PROJECT/PROGRAM $UDGET (dQ not fill In shaded prqss)
LINE ITEMS FOR PROJECT/PROGRAM ___TREVENUES EXPENSES

LIST REVENUES/INCOME FOR PROJECT/PROGRAM
Amount of money requested from this City of Temecula $ 50000 Community Services Grant (Not to exceed $S0,000)
Amount contributed to the Project/Program by the Applicant $ Organization
Other grants or funding already awarded for Project/Program, if any $ 10000 In -Kind match amount or volunteer credit hours estimated amount $ 0 TOTAL REVENUE $ 60000

LIST OF EXPENSES FOR PROJECT/PROGRAM
r
s/Equipment
ities/Rent/Insurance
Supplies
Marketing
Services
Food
Other
Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT, HOWEVER PLEASE INCLUDE.

TOTAL EXPENSES
TOTAL BUDGET $60000
$5000
$55000
$60000
$60000
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13

PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT
IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21/22 (LAST YEAR), THEN SKIP THIS PAGE.

If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information.

If the funds were not spent in accordance with the approvedlawarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022.

1. Fill out table below (make additional copies if needed to explain all expenditures.)

2. Attach copies of receipts/invoices (in the same order as listed in this table.)

3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office —CSF EXPENDITURE REPORT due on or before September 12, 2022
AIM for Good Inc AIM for Good
Organization: _' Name of Project/Program:

FY 2021-2022 Amount of 'N/A
CSF Grant Fund Awarded: Month & Year CSF Grant Received from City:

Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this ProgramlProject (approximate number of beneficiaries if you do not have precise number):

Date on E'
E Name of Company Receiptllnvoice
iture
u on Receipt or Invoice MUST BE ON OR BETWEEN Amount Description Purpose Q z JULY 1, 2021 -,TUNE 30, 2022 DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE 1 R
EXPENDITURE TOTAL $

EXPENDITURE TOTAL MUST BE EQUAL TO
(OR GREATER) THAN TOTAL AWARD AMOUNT
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13

If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive andlor will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page.

1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures.

A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.)
B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the reraining balance of award to demonstrate finds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds.

2. Attach copies of receipts/invoices (in the same order listed in table below).

3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula"

EXPENDITURE REPORT DATED
Organization: AIM for Good, Inc
Name of ProjectlProgram: AIM for Good
TOTAL FY 2022-2023 Month & Year FIRST $5,000 check
Amount of Grant Fund Awarded: $ was received from City:

1. Is this Expenditure Report is to provide documentation for first $6,000 awarded and received? Yes or No (already submitted).

2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City

3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request S Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) Date on Expenditure
E Name of Company Receipt/invoice MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER u E on Receipt or Invoice MUST BE ON OR BETWEEN
92 March 20,2020-JUNE30, Amount 1 Descri tion Pur ose
a z 2024 p p
�_
rs
I EXPENDITURE TOTAL $ EXPENDITURE TOTAL
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13

ACKNOWLEDGEMENT/SIGNATURE PAGE
The applicant acknowledges and agrees to the following:

Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements.

Every Community Service Funding application is considered individually and on its own merit.

Please allow time for checks to be processed.
m The awarding of Community Service Funding does not constitute an automatic annual allocation.

The recognition for Community Service Funding should accrue to the City of Temecula.

Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot.

The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete.

I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief.

ORGANIZATION NAME: AIM for Good, Inc
MAILING ADDRESS: 31493 Rancho Pueblo Rd. #205
Temecula, CA 92592
PHONE: (951 ) 9726680
EMAIL: [email protected]
PRESIDENT / AUTHORIZED OFFICER: Mark Anselmo
izirdi N�,P1F
SIGNATURE: O—A:�, ` — DATE: 09/1 1 /22

IF DIFFERENT THAN ABOVE,
APPICATION PREPARED BY:

V f-J N f P - -
SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO:

City of Temecula
Community Service Funding
Attn: City Manager's Office
41000 MAIN STREET
TEMECULA, CA 92590
Questions: Stacey. [email protected] (951) 694-6413
Betsy. [email protected] (951) 693-3959
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13

Department of the Treasury
Internal Revenue Service
Date:
04/07/2021
Tax Exempt and Government Entities
I RS P.O. Box 2508
Employer ID number:

Cincinnati, OH 45201
85-0914556
Person to contact:

Name: Customer Service
ID number: 31954
Telephone: (877) 829-5500

AIM FOR GOOD INC
Accounting period ending:
31493 RANCHO PUEBLO ROAD 205
December 31
TEMECU LA, CA 92592
Public charity status:
170(b)(1)(A)(vi)
Form 990 1990-EZ / 990-N required:

Yes
Effective date of exemption:

April 17, 2020
Contribution deductibility:

Yes
Addendum applies:

No
DLN:
26053414002361
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 Linder 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,
a- - t4t0f�
Stephen A. Martin
Director, Exempt Organizations
Rulings and Agreements
Letter 947 (Rev. 2-2020)
Catalog Number 35152P

STATE OF CALIFORNIA

FRANCHISE TAX BOARD
F T B PO BOX 942657
SACRAMENTO CA 94257-0540
Entity Status Letter
Date: 9/11/2022
ESL ID: 5184525432
Why You Received This Letter
According to our records, the following entity information is true and accurate as of the date of this letter Entity ID: 4584598
Entity Name: AIM FOR GOOD, INC.
® 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. ❑ 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 . ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process.

The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b).

Connect With Us
Web: ftb.ca.gov
Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States
California
Relay Service: 1711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019)

Q HELPB MENU
Home > Tax Exempt Qrganix ion r h > Aim For Good Inc.
39TR-V'-VTTTR11;MM
Aim For Good Inc.

EIN: 85-0914556 1 Temecula, CA, United States
Other Names
Determination Letter o
A favorable determination letter is issued by the IRS if an organization meets the requirements for tax-exempt status under the Code section the organization applied.

Final Letters
Publication 78 Data o
Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions.

On Publication 78 Data List: Yes
Deductibility Code: PC
Form 990-N (e-Postcard)-o
Organizations who have filed a 990-N (e-Postcard) annual electronic notice. Most small organizations that receive less than $50,000 fall into this category.

Tax Year 2021 Form 990-N (e-Postcard)
Tax Period:
2021 (01/01/2021 - 12/31/2021)
EIN:
95-0914556
Legal Name (Doing Business as):

Aim For Good Inc
Mailing Address:
31493 Rancho Pueblo Road Suite 205
Temecula, CA 92592
United States
Principal Officer's Name and Address:

Mark Anselmo
31493 Rancho Pueblo Road Suite 205
Temecula, CA 92592
United States
Gross receipts not greater than:
$50,000
Organization has terminated:

No
Website URL:
www.AimForGood.org
Page Last Reviewed or Updated. 20-November-2020 f* Share $ Print

e
Home > Tax Exempt Organization Search > Our Nicholas Foundation Inc < $ack to Search R se ults
Our Nicholas Foundation Inc
EIN: 20-3348800 1 Temecula, CA, United States
Auto -Revocation list o

HELPO MENU
Organizations whose federal tax exempt status was automatically revoked for not filing a Form 990-series return or notice for three consecutive years. Important note: Just because an organization appears on this list, it does not mean the organization is currently revoked, as they may have been reinstated.

Posted Date: 08-10-2015
Exemption Type: 501(c)(3)
Exemption Reinstatement Date:

Revocation Date: 05-15-2015
Revocation Posting Date: 08-10-2015
Page Last Reviewed or Updated; 20-November-2020 F f* Share I Print

STATE OF CALIFORNIA

FRANCHISE TAX BOARD
('F T B FO BOX 942857
SACRAMENTO CA 94257-0540
Entity Status Letter
Date: 9/13/2022
ESL ID: 2107018787
Why You Received This Letter
According to our records, the following entity information is true and accurate as of the date of this letter.

Entity ID: 2784676
Entity Name: OUR NICHOLAS FOUNDATION, INC.

1. The entity is in good standing with the Franchise Tax Board. 0 2. The entity is not in good standing with the Franchise Tax Board,

3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 .

4. We do not have current information about the entity.

5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process.

The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b).

Connect With Us
Web: ftb.ca.gov
Phone: 800-852-5711 from 7 a.m, to 5 p.m, weekdays, except state holidays 916-845-6500 from outside the United States

FY 2022/2023

COMMUNITY SERVICE FUNDING

REINVESTMENT IN TEMECULA
GRANT APPLICATION #
3 ANIMAL FRIENDS

OF THE VALLEYS

CITY OF TEMECULA
FISCAL YEAR 2022.. 2023
COMMUNITY SERVICE FUNDING.. REINVESTMENT IN TEMECULA

PROGRAM APPLICATION
(Please Print or Type)
DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022

PROJECT/PROGRAM INFORMATION
Amount FZ,1ecquqasted: $5o,000 IlvAximum ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: Temecula Has Heart for the Animals Start Date: 0710122 End Date: 07/01/24 Physical Address of Project/Program: City of Temecula

INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Animal Friends of the Valleys Mailing Address: 33571 Mission Trail Rd
Wildomar, Ca. 92595 Attn: Beth Soltysiak

ORGANIZATION AND GEOGRAPHIC AREA SERVED
Name of Applicant
Organization: Animal Friends of the Valleys Year Founded: 1987 Website: animalfriendsofthevalleys.com
Social Media: animaKdendsoffheyalleys
Number of Paid Staff: 84 Number of Volunteers: 3752
Geographic Area(s) the Organization Serves: Temecula, Murrieta, Wildomar, Lake Elsinore, Canyon Lake, Menifee and surroundina rural county areas
Geographic Area(s) the P.rograrn Serves: Citizens residing in the City of Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Beth Solt sick Title/Position: Director of Development Contact Person's Direct Telephone: 951-805-6239_Contact Person's Email: beth(&Dafv,org City of Temecula Community Service Funding- Reinvestment in Temecula GRANT APPLICATION Page 5 of 13

NONPROFIT STATUS
Is this organization incorporated as a nonprofit? Yes O Date of Incorporation as a Nonprofit: 1987____ No O IF NO, THE INELIGIBLE TO RECEIVE CITY FUNDING
Federal Identification Number:33-0276892 State Identification Number: 1611141 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS:

I. D Attach IRS Deductibility Status using this link: http://apps.irs.gov/app/eos/

2. D Attach State Entity Status Letter using this link:
https://www.ftb.ca,gov/online/self serve entity status letter/i dex.asp

3. D Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: http://rct.doj.ca,govNerification/Web/Search.aspx?facility=Y City of Temecula Community Service Funding- Reinvestment in Temecula GRANT APPLICATION Page 6 of 13

Self Serve Entity Status Letter
Entity Search Result
Results displayed below.

Entities matching the search criteria
Entity ID Entity Name city
.-ka.1.4.1 ANIMAL FRIENDS OF THE VALLEYS, INC. WILDOMAR Back
Copyright© 2022 State of Callfornia
ill

Internal Revenue Service
P.O. Box 2508
Cincinnati, OH 45201
nn
Date: [LIAR IS JU07

ANIMAL FRIENDS OF THE VALLEY INC
PO BOX 1143
LAKE ELSINORE, CA 92531-1143
Dear Sir or Madam:

Department of the Treasury
Person to Contact:

Roger Meyer
ID# 31-07707
Toll Free Telephone Number:
877-829-5500
Employer Identification Number:
33-0276892
This is in response to your request of January 30, 2007, regarding your tax-exempt status.

Our records indicate that a determination letter was issued in December 1988 that recognized you as exempt from Federal income tax, and reflect that you are currently exempt under section 501(c)(3) of the Internal Revenue Code.

Our records also indicate you are not a private Foundation within the meaning of section 509(a) of the Code because you are described in section 509(a)(1) and 170(b)(1)(A)(vi).

Donors may deduct contributions to you as provided In section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code.

If you have any questions, please call us at the telephone number shown in the heading of this letter.

Sincerely,
Cindy estcolt
Manager, Exempt Organizations
Determinations

Form 990 Return of Qrganization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) OMB No. 1545-0047
2020
► Do not enter social security numbers on this form as it may be made public.

Open to Public
Department of the Treasury
Internal Revanuo service
■ Go to www.frs . ovlForrn990 for instructions and
the latest Information,
Ins colon
A For the 2020 calendar
ear or tax year be innln 07-01
c Name of aMxalloaNIM L FRIENDS OF THE VALLEYS
2020. and ondln 06-30 2021
INC D Employer Identification number
B check if applicable:
❑ Address change
qfthut,619sas
33-0276892
❑ Name change
Number and street (or P.O. box if mail Is not delivered to street address) Roemfsulte E Telephone number
❑ In! tat return
33751 MISSION TRAIL
951 674-0618
❑ Final retumllarminated
City or town, state or province, country, and ZIP or foreign postal coda G Gross receipts
❑ Amended return
WILDOMAR CA 92595-8430
S 6,486,943
❑ Application pending
F Name and address of principal offlcer:

H(al is this a group retum (msuhordinates9 ❑ Yes ❑g No
H(b) Are all subordinates Included? ❑ Yes ❑ No
1 Tax-exempt status:
0 501(o)s) 501(n) ( ) aPrl rre. 4947 a 1 or 527
If "No," attach a [!at. See Instructions
J ftb$lie: ► WWWW . ANIMALFRIEND�SOFTHEVALiL-IEYS . COM H c ►
Group exompWn number
K Form ofomanlration-
M C u..roticn I r-y 1 Trust I fyAssociation 1 1 other ► f- Year of formation: 1987 1 M State of (apfd domicile: CA Part
1 I
Summary_
1 Briefly describe the organization's mission or mostsignificant activities; DEDICATED TO PROMOTING HUMANE CARE OF ANIMALS THROUGH EDUCATION AND A HUMANE, PRO -ACTIVE ANIMAL SERVICES PROGRAM. COMMITTED

TO PREVENTING
m
c

THE SUFFERING OF ANIMALS AND TO ENDING PET OVERPOPULATION 4-
2 Check this box ► ❑ if the organization discontinued its operations or disposed of more than 25% of its net assets. 0 3
Number of voting members of the governing body (Part VI, line 1a) .. , ........ . . .. . ....
3 7
y4
Number of independent voting members of the governing body (Part VI, line 1 b) .... .. ........ .
4 7
5 122
5 Total number of individuals employed in calendar year 2020 (Part V, line 2a) ..... .. .. ..... 5 6
4,959
�-,
6 Total number of volunteers (estimate If necessary) ... . . .. ...... . ....... .. . ....
7a
0 Q
7a
Total unrelated business revenue from Part Vlll, column (C), line 12 . ......... .. .. ......
71lb
33 418
b Net unrelated business taxable income from Form 990-T Part i line 11 Prior Year
Current Year
912,088
825,791
8 Contributions and grants (Part VIII, fine 111) . . . . . . ... . .. .. . . . . . . . . 4 , 720
024
9 Program service revenue (Part VIII, line 2g) ... ..... . . . ............ 5,412,806
_
65,799
58 343
10 Investment income (Part Vlll, column (A), lines 3, 4, and 7d) .... .......... 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and Ile) . .. . . .. . . . 80,006
124. 116
5,877,917
6,421,136
12 Total revenue - add lines 8 through 11 musts ual Part Vlll, Column (A), line 12 13 Grants and similar amounts paid (Part IX, column (A), lines 1-3) . . .. . . . ...... 208,816
220,137
0 14
Benefits paid to or for members (Part IX, column (A), line 4) . . . . .. . .. .... . 3,481,504
3,602, 602, 564
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) ... .. 16a
Professional fundraising fees (Part IX, column (A), line 1 le) .... ..... ..... . 0 a
b Total fundraising expenses (Part IX, column (D), line 25) ► 224,282 17 Other expenses (Part IX, column (A), lines 11a-1Id, 11f-24e) .. • • . • • . • • 1 981,930
2,105,589
5,672,250
51928,290
18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) .. ..... 205,667
492,846
19 Revenue less expenses. Subtract line 18 from line 12 $
Beginning of Current
Year
8nd or year
5 598,692
6,453, 827
92 '20 Total assets (PartX, line 16) . . . . . . . . . . . . . . .. . . . .. . . . . .. . . 1m
21 Total liabilities (Part X, line 26) . . .. . .. . ........ . . . .. .. ...... 1,067,599
1,132,842
Aar:
22 Net assets or fund balances. Subtract line 21 from line 20 4 531093
5320 985
111
Sianature Block
Under penalties of perjury, I declare [hat I have examined this return, Including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and eompiole: Declaration of preparer (other than officer) Is based on all information of which preparer has any knowledge.

TAMMI BOYD 1 05-11-2022
Sign Signature of officer Date
Mere TAMMI BOYD, PRESIDENT -
Typo or print name and title
Print/Type preparees name Preperees signature Date Check R if PTIN Paid KRISTINE M ANDERSON t7-08-2022 sWemployed P00226669 Preparer Firm'sname ► ANDERSON PROFESSIONAL SERVICES Firm'sEIN ► Use Only Flrm'saddress ► 17620 GRAND AVENUE Phone no.

Lake Elsinore CA 92530-53914 951-678-2165
May the IRS discuss this return with the prepareir shown above? see Instructions . X Yes No For Paperwork Reduction Act Notice, see the separate instructions. Form 990 (2020) EEA

Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No X Yes D IF YES, PROVIDE council MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION:

Maryann Edwards is the current JPA Board member that oversees the Animal Friends of the Valleys Board of Directors.

There is a city representative on the JPA Board from each of the & cities we serve.

MISSION STATEMENT OF ORGANIZATION
I BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. I Animal Friends of the Valleys is dedicated to promoting humane care of animals through education and proactive animal service programs. We are committed to preventing the suffering of animals and to help end pet overpopulation in the communities we serve. AFV's vision is to be recognized as the leading shelter by providing a safe haven for all animals, while becoming a full -service animal care facility that offers quality and affordable care.

Through community education and involvement, AFV will reach our vision to help end pet overpopulation and find a loving and forever home for all adoptable pets in our shelter.

FINANCIAL STATEMENTS

UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW.

City of Temecula Community Service Funding- Reinvestment in Temecula GRANT APPLICATION Page 7 of 13

FUNDING SOURCES
CITY OF TEMECULA-SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? NoD Yes D IF YES, PROVIDE BELOW
NAME OF PROGRAM/PROJECT AMOUNT MONTH+ YEAR NAME OF CITY GRANT FUNDED By THE CITY GRANT OR SPONSORSHIP FUND NG RECEIVED OR SPONSORSHIP Community Service Grant Spay. /neuter grant $5000 09/2020 (ISpay/neuter grant 4-ommunity service grant
$
$
OTHER OUTSIDE SOURCES -SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE: CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? No YesX IF YES, PROVIDE INFORMATION IN TABLE BELOW,
AMOUNT MONTH+YEAR

RECEIVED NAME OF ENITY FUNDING RECEIVED
$20,000 T (Rachel Ray COVID Relief Grant for all cities D5/2021 $15,000 (Matching grant for all local cities for spay/neuter fees. 07/2021 $$20,00 CDFA Spay/neuter grant 2022-2023 for all six cities 05/2022 City of Temecula Community Service Funding- Reinvestment in Temecula GRANT APPLICATION Page 8 of 13

GRANT PROJECT/PROGRAM DESCRIPTION

IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT

FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. • Free Spay/neuter vouchers Days to the citizens of Temecula • Free Pet Micro- chipping day or days 2022-2023 for Temecula Residents • Low cost pet adoptions at various business locations throughout the city of Temecula for Temecula residents only. Must show proof of residency.

Expanded senior living visits with trained shelter pets within the city if Temecula • expanded pet education and reading program to school age children at both Temecula City Libraries.
• Community Pet Walk within the city of Temecula
2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED,

ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT.

The funds from this award will be spent with great regard. Every dollar will be spent helping the animals and the the citizens that reside in Temecula. The Temecula reinvestment Community Service grant will be allocated for Temecula residents only.

AFV's low -cast spay/neuter clinic offers pet sterilization for $60-$130 depending on size and sex of Dog. 0n average it costs $So per dog. For cats AFV charges $50-$60 dependent on sex of the cat. For the Temecula spay neuter vouchers we are allocating 25% of the funds to help curb spay/neuter fees for the residents of Temecula. The funds will help cover over 100 spay/neuter surgeries and will help stop on average an extra 570 from roaming the streets or ending up in the shelter. Last year we offered City of Temecula Community Service Funding- Reinvestment in Temecula GRANT APPLICATION Page 9 of 13

3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING, EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. 1FV serves all local cities in southwest Riverside County, with Temecula being the largest with the highest )opulation. Most of all of our events are hosted in the city of Temecula. Every year on February 23 World Spay lay, AFV hosts a Spay/Neuter free voucher day for the residents residing in each city. Last year, we hosted World ;pay Day at Mary S. Roberts Senior Center. Because of funding we had to cap off at 100 free vouchers. With this einvestment grant of $50,000, AFV can help more Temecula citizens alter their pets. Since COVID and the rate of nflation many pet owners are forgoing spay/neutering their pet and have had to relinquish litters of puppies and :ittens to the shelter. This grant will help the citizens of Temecula from unwanted litters and keep the number of trays down in the city. All those applying for a free voucher have to show proof of residency with a current driver tense and utility bill. AFV would also offer free micro -chipping at these events. Currently the average cost to ;pay a dog $100 and $80 to neuter at AFV's low cost spay/neuter clinic. AFV Micro -chips are $20. 85% of all nimals that become lost without a micro -chip will never find their way back home. It costs AFV $628 an hour to are, feed and house over 200 pets at the shelter a day. This funding would dramatically decrease the number of inwanted pet litters in the city of Temecula. Last year alone, from the city of Temecula, AFV took in 218 stray cats, 32 owner relinquished cats of those 172 were adopted, 30 returned to owners, 98 adopted by rescues. Stray emecula dogs were at 246, owner relinquished 334. 255 Temecula dogs were adopted, 176 returned to owners nd 65 were adopted by rescues. Continuing to increase spay/neuter surgeries would decrease these animals ever inding their way into the shelter. This also illustrates the importance of micro -chipping Temecula pets. urrently, AFV hosts many off -site adoption events at various businesses in Temecula to accommodate Temecula tizens from making the drive to Wildomar. Some of these Businesses are Pet Co, Paradise Chevrolet Cadillac, ello Temecula Subaru, Promenade Mall, Mexico Cafe and various other Temecula Businesses.

The citizens of Temecula are still dealing with the effects from COVID especially senior citizens living in assisted living homes. AFV would like to increase our foster service animal program to visit the assisted living in Temecula proper. It has proven that animals especially dogs' offsets loneliness, increases mobility, and increases cognitive ability while interacting with a dog or cat. This holds true for the school age children in Temecula. Many children are feeling anxious with the world around them. AFV would like to reinstate Dog Daze reading program at both City of Temecula Libraries. These days would be coordinated with the city of Temecula. Every Wednesday AFV hosts Huey's reading program from 3-4:30 free to school age children. We would like to expand a version of this program to the Temecula Libraries. This program helps children learn the proper way to approach an animal, how to care and feed a pet. It also allows them to read to the animals without peer judgment and increases reading skills and public speaking while have a good time.
stly, AFV would like to host a Temecula Pet Walk during both years of the grant funding to bring the community 3b E S T I M AT E D NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM:
3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM:
1400 with all program:

City of Temecula Community Service Funding- Reinvestment in Temecula GRANT APPLICATION Page 10 of

PROJECT/PROGRAM DESCRIPTION

CONTINUED
4 SUMMARY STATEMENT- SUMMARIZE ANSWERS 1 —3 ABOVE IN 50 WORDS OR LESS - An ima I Friends of the Valleys has been serving the cities of southwest Riverside County for over 35 years. In current reports from Animal Welfare Association 70% of households have. 1 nr 2 pets residing in the Kamp. It is vital to help those citizens in Temecula that need extra help offsetting the cast of spay/neutering their pet.

AFV already offers low cost spay/neuter surgery but with times the way they are many need additional assistance. These programs are greatly needed in the city of Temecula and if awarded will be able to help hundreds of Temecula residents young and old alike.
5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC

AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS.

AFV was deemed at) essential business by the Governor of California, That meant we were to remain open to to the public while abiding to all COViD guidelines. Duringthe peak time of COVID we were open by appointment only and had to adhere social distancing and sanitizing protocols. During 2021 until 2022 AFV had to postpone all major community fundraising events. AFV hosts three signature events. Wines for Canines and kitties, FORE the Animals Golf Tournament, and Paws on the Promenade Spooktacular which are all held at venues in Temecula. AFV lost over $170,000 possibly more by not having these events.

We are trying to mace -up For lost revenue. AFV had to reduce or suspend the afore mentioned programs we are suggesting in this funding application. During COVID we had many people adopt due to the ability to work remotely, however once people started to go back to work pet intake increased. Now with people forgoing spay/neuter surgeries because of financial hardships we are getting more litters of puppies and kittens than in the past few years. Inflation accompanied with COVID has put a strain on many Temecula residents.

The demographists in Temecula vary greatly and AFV would like to accommodate all citizens and their pets.

While it helps the citizens in Temecula it also helps AFV reduce the number of animals entering the shelter.

AFV currently has an average 241 animals at the shelter looking for loving and forever homes. These are dogs, cats, rabbits, guinea pigs, small farm animals reptiles and various wildlife. Our mission is to find a loving home for all adoptable pets. We are pleased to report we are at the highest adoption rate in our 35 years. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL:
(1) CREATE NEW PROJECTIPROGRAM, (2) EM0EXISTING PROJECTIPROGRAM, _ANDIQR_(a)_C7 TNLE.EXISTING PR- DJEC'.TIRRO RAM
1) The funds from this 2022-2023 reinvestment Grant from the City of Temecula will allow Animal Friends of the Valleys to create a new Pet Walk event for the citizens in Temecula. This will bring in much needed funding to the shelter for other Temecula events while supporting Temecula citizens their pets and local Temecula businesses. It encourages the focus on animal welfare in the city of Temecula while helping Temecula businesses and welcomes community gathering for all ages including pets. Temecula events such as these will help Temecula residents become more aware of the community programs offered at or through AFV. The new reading and pet education program will be offered to all Temecula elementary school children at both Temecula libraries. This will encourage children to learn to love to read while reading to a live pet.

Funding from this grant will allow AFV to be able to offer this program a few times a year while offering it free of charge to Temecula families. Reading is fundamental and a fun way to encourae-e children and narents to utill7P TemPrula`s hPautlful libraries.

City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13

2) In the past few years AN had to suspend or eliminate existing programs that help serve the city of Temecula due to lack of funding. Our micro -chipping events had to be suspended due to the lack of funding and social distancing. Micro -chipping is imperative in all domestic pets so they can find their way home. Every July 4th there are hundreds of dogs that run away due to City fireworks in Temecula alone. The ones with micro -chips get reunited 90% faster than those without micro -chips, It is imperative to help those Temecula pets and their owners.

I
Free Spay/neuter voucher program for the city of Temecula will help all Temecula citizens help offset the cost of ' altering their pet and ending unwanted litters. Many families will forgo the extra cost of altering their pet due to the high cost of living and supporting their children. It is mandatory in Temecula to have your pet licensed and to receive licensing, a pet must be vaccinated and spayed or neutered. With the newly adopted city mandatory spay/neuter laws, this grant is priceless in helping Temecula members afford the cost to spay/neuter their pets.

The new ordinance is modeled after a fix -it ticket allowing pet owners that have been citied to come into compliance by spay/neutering their pet to avoid fines. This grant will offset the number of Temecula pets surrendered because of the financial burden on the owners. This will help those owners who cannot afford the cost of surgery and ultimately not be fined. The vouchers are good for dogs, cats, and rabbits. These programs will help deter Temecula residents from relinquishing their pets due to financial hardships. By offsetting these costs, it will help the economy in Temecula as residents will be able to spend more on local groceries, apparel stores, and gas to name a few. AFV is continually exploring new ways to encourage every community member to be responsible pet owners and help reduce pet overpopulation. 3) AFV would also use this funding to expand on existing pet adoption events in the city of Temecula. Currently we have offsite adoptions to help bring shelter pets to the city of Temecula to be adopted by Temecula residents.

AN would like to expand on pet adoptions in the city of Temecula at various local businesses. On average at every off -site pet adoption there are over 10 adoptions per event. That is 10 less mouths to feed for AFV. While bringing a new family member into 10 Temecula homes.

AFV's goals to help animals find loving homes while reducing the number of animals in the shelter. We would encourage other Temecula businesses to offer adoption events at their location. This helps the animals the shelter and the Temecula business with added marketing and flow of traffic onto their business.

There are many new assisted living apartments in the city of Temecula. This population has been affected the most by COVID. Those in assisted living were under strict quarantine guidelines. Even family members could not visit their loved ones even if the senior was ill, This increased anxiety levels and depression among the residents, Many therapists that worked at the assisted living homes were cancelled due to COVID. This ultimately hurt the residences physically and mentally. Before COVID AFV had trained foster pets visit the elderly for companionship and to ease loneliness. Once an animal greeted each resident they would become happier and would interact with the animal which would increase mobility. Seeing the dog would emote past memories of their own pet and cognitively they would remember past experiences. To our delight many of the assisted living homes are pet friendly and the restrictions from COVID are lessening. Pets help the elderly increase memory, widen mobility by throwing a toy and by bending if possible to pet the animal. All pets ease loneliness and depression. These foster pets show unconditional love and affection. This is a must needed service to the elderly of Temecula, City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of

Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval.

The recipient shall provide a full accounting with documentation o the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement.

If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this aapplication may be rejected as incomplete- 1/we hereby certify the information contained in this Application is true to the best of our knowledge and belief.

Animal Friends of the Valleys
ORGANIZATION NAME:

MAILING ADDRESS: 33751 Mission Trail Rd. Wildomar CA. 92595 PHONE 051) 805.6239 EMAIL: befli(@_afv.org
PRESIDENT/ AUTHORIZED OFFICER: �� SD I`t'vS t & K-'.
n TIrLE(11 {
SIGNATUR y DATE: 09/10/2022

MONTH, DAY, YEAR

IF DIFFERENT THAN ABOVE,
APPICATION PREPARED BY:

PRINT MAME. TITLE
SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO:

City of Temecula
Community Service Funding
Attn: City Manager's Office
41000 MAIN STREET
TEMECUiA, CA 92590
Questions: Stacey. [email protected] (951) 694-6413
Betsy. [email protected] (951) 693-3959
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 elf

FY 2022/2023

COMMUNITY SERVICE FUNDING

REINVESTMENT IN TEMECULA
GRANT APPLICATION #

ASSISTANCE LEAGUE

OF TEMECULA

CITY OF TE1%fCCtlLII
FISCAL YEAR 2022.2023

COMMUNITY SERVICE FUNDING M REINVESTMENT IN TEMECULA

PROGRAM APPLICATION
(Please Print or Type)
DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022

PROJECT/PROGRAM INFORMATION
Amount Requested: $ bo7 000
Project/Program Title: 5 Points
Physical Address of Project/Program:

MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION
3/20/202Q 6/30/2023
Start Date: End Date:

INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable x Assistance League of Temecula Valley Mailing Address: 74120 Via Montezuma
i emecula, CA 92590

ORGANIZATION AND GEOGRAPHIC AREA SERVED
Name of Applicant
Organization: Assistance League of Temecula Valley 1989 9 Year Founded:

Website: assistanceleague.org/temecula-valley
Number of Paid Staff: None
Social Media: Facebook & Instagram
Number of Volunteers: 200
Geographic Area(s) the Organization Serves: Temecula
Geographic Area(s) the Pro ect/Pro ram Serves: Temecula _ NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA.

Contact Name: Diane Sitar Title/Position: Grants Coordinator Contact Person's Direct Telephone: k'951) 526-6771 Contact Person's Email: altemeculaayahoo.com

NONPROFIT STATUS
Is this organization incorporated as a nonprofit? Yes ® Date of Incorporation as a Nonprofit: 6/15/1989 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING
Federal Identification Number: 33-0360419 State Identification Number: 1463456 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS:

1. n Attach IRS Deductibility Status using this link: h :/la sirs, ovla /eos/

2. M Attach State Entity Status Letter using this link:
https:/I www.ftb.ca.gov/onfine/self serve entity status ietterlindex.asp.

3. ® Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Taal: h1p:11rct.doi.ca.gaVNerilica[ionlVllehl5eerch.asnX?FaClllty�Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13

APPLICATION AUTHORIZATION
Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No E] Yes ❑ IF YES, BRIEFLY DESCRIBE.
i
Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ® Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION:

This Application has been authorized by the organization's:

Executive Committee ❑ Board of Directors ® Members -at -Large ❑

MISSION STATEMENT OF ORGANIZATION

BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES, Assistance League of Temecula Valley (ALTV) ® is celebrating 34 years of service in Southwest Riverside County, ALTV is an all -volunteer, 501(c)(3) nonprofit organization that transforms lives and strengthens our communities through philanthropic programs in Southwest Riverside County. Member volunteers are dedicated to identifying and serving the needs of Temecula, Murrieta, Menifee, Lake Elsinore, Wildomar and Romoland communities through philanthropic programs developed and administered by our members.

FINANCIAL STATEMENTS

UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW.

City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13

FUNDING SOURCES
CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes ® IF YES, PROVIDE BELOW.

NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT

FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP Operation Schocl Bell $ 6,sI0 April 2021 CDBG
Operation School Bell $ 5,000 December 2020 CSF
Operation School Bell $ 7,226 April 2022 CDBC�
5 Points $ 920 July 2022 Council member
di •rr n r� CSF
Operation School Bell $ .9,491 April 2020 CDBG
Operatioii School Bell $ 5,o00 December 2021 CSF
$
OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? NO ® Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW.

MONTH + YEAR

FUNDING RECEIVED
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13

GRANT PROJECT/PROGRAM DESCRIPTION

IMPORTANT -RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT

FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT.

All TV idontlfuos the needs of chilrren rind families in Temecula and develops piulaat;uopic progrrrm.n ro be adrninrstered independently as well vis in parnership with other non-prorits.

ALTV's 5 Points Pro ram proVIdes varous basic needs in the area of clothing, food, heaith, literacy and supplies 007N,,iij is provided to iovv to moderate income families, fo-sterihorncicsz3 youth, as weii as emergency lothing to students in need. Food is provided for school prograrns and local food pantries rleaith services provide hygiene kits for foster/horneless and teddy bears to local hospitr.iIs to comfort children in crisis. �Ne al°,3o provide supplies to the schools (such as backpacks) school supplies, fidget (oys, etc) as needed +Nhcn LCAP school counselors identify specific needs. Please see rite attached list for more specific information regarding the service and supplies we have provides and expert to provide in the future
2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED.

ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAMMROJECT.

Approximately $17,000 of the requested grant funds will reimburse At -TV for a variety of services and supplies that directly benefit those residing in Temecula from March 20, 2020 to the present. We have attached a list of those items to give examples of what we provide and will provide receipts with our Compliance Report. The remaining funds from this $50,000 grant request will be used to fund additional similar services and supplies between now and June 30, 2023. Going forward; it is our intention to purchase supplies from stores and vendors in the City of Temecula whenever possible.

ALTV works closely with Temecula middle and high schools to provide supplies for the LCAP program, the special needs preschool program and foster youth as well as elementary school support. In addition, we work closely with Temecula transitional housing and the community pantry.

TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. J EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS.

Services provided and supplies purchased directly benefit Temecula residents. Services and supplies were, and will continue to be, distributed to residents through LCAP counselors, Rancho Darnacitas Empowerment Village, foster youth agencies; Community Mission of Hope, Temecula transitional housing, Non Minor Dependents, Temecula Valley Hospital, and Temecula schools for various basic needs. 1 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 2,
3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 25 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13

PROJECT/PROGRAM DESCRIPTION

CONTINUED
4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. �rUC(.?eCls r-IYn ti'i= ClUlf1C'M,'i ':R de � �r'.iIC :.� and 7lwanals `that dl cctiy hcdi' C '�� 1 � r' r tit �:h Grr:,n �nr. talili�:s �n
Z��grn r,Ulc,.-lar1Cal'??l lrr;rlt fi^iIS g1'a11t In cl`l:diJorl to ncoryle Imn, our Stol;_" `i'v!ll r�kjk'v AL1"/ i0 I1-,o'eas2 filat'?l'�ci S In 7022-2023 til Provide f(l( if; r� eed fl T%f"UlCU �l. All ALTV c`;vF,n1.j8 13 Sri•: � S
'�7 I1C9 Qc?]I CC;f;"1"!-'t��ltl?S ,. _?r''1r_ tiir'jLlijil C)Jr;7t"il7[l'.I1�Jlsl(; �?�pgr_11t1a 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC

AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA J COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS.

ALTV has faced several challenges in its operations. When ALTV was forced to close its thrift shop under COVID mandates, it inhibited our ability to generate income from our thrift shop, which is cur primary source of revenue. ALTV has been in recovery mode since that time.

We also faced challenges in providing services and distributing materials due to the mandates. ALTV collaborated with local LCAP school counselors, food pantries, and foster/homeless agencies to provide services and materials to the best of our ability during those challenging times. We were successful in our efforts to help the community.

Inflation has also significantly increased the cost to operate our philanthropic programs. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL:
(1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM.

Proceeds from this grant will allow ALTV to continue providing basic needs services and materials to children and families of Temecula.

City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13

PROJECT/PROGRAM BUDGET (do not fill in shaded areas)

LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES

LIST REVENUES/INCOME FOR PROJECT/PROGRAM
Amount of money requested from this City of Temecula $ 50.000 Community Services Grant (Not to exceed $50,000)
Amount contributed to the Project/Program by the Applicant $ 316,2` 0 Organization
Other grants or funding already awarded for Project/Program, if any I $ In -Kind match amount or volunteer credit hours estimated amount _ $ 10,000 TOTAL REVENUE $ 86,250

LIST OF EXPENSES FOR PROJECT/PROGRAM
Tools/Equipment $
Facilities/Rent/Insurance $
Supplies $ 59,250
Marketing $
Services $
Food 1 1 27,000
Other $
Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; $ J HOWEVER PLEASE INCLUDE.

TOTALEXPENSES $
TOTAL BUDGET $ j $ 86,250
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13

Services and supplies provided between Marcie 20 2020 and resent:

Christmas presents for Moms and children residing at Rancho Damacitas Empowerment Village
* Emergency clothing for a foster child
Supplies for the Exceptional Children's Christmas Program in Temecula Christmas presents for Temecula Transitional Housing - Non -Minor Dependents • Household items for Temecula Transitional Housing — Non -Minor Dependents • Backpacks for Community Mission of Hope
• Food and hygiene supplies for Community Mission of Hope • Fidget toys & stress balls for Temecula school counselors to distribute as needed • Clothing for students at Temecula Elementary school
• Movie tickets for HUGS Foster Family Agency (summer activities for foster youth) • Teddy Bears for Temecula Valley Hospital for children in crisis • Computer tablets for youth residing at Rancho Damacitas Empowerment Village • Student Body cards for foster/homeless youth at Great Oak High School • Famous Footwear gift cards for families residing at Rancho Damacitas Empowerment Village
• Mini refrigerator & microwave for Great Oaks High School's ROOTS program (LCAP) ■ Old Navy gift cards for students at Temecula Middle Schools

Examples of Support, Supplies and Food to be provided from present to June 30 2023:

Support for LCAP Program (Local Control and Accountability Plan) at Temecula schools. • Program addressed the needs of foster/homeless youth, second language learners and youth living in poverty.
• All middle and high schools in Temecula have an LCAP counselor on site.

Support for all LCAP programs in Temecula schools (3 high schools and 6 middle schools) which provide the following services for foster/homeless youth:
* School supplies
• Food/healthy snacks
■ Student Body cards
• Senior package (valued at $200 each) that include a choice of a yearbook, prom ticket, grad night ticket, etc.
* Funds for special classes
* Hygiene kits
* Computer tablet or other necessary electronics
• Emergency clothing
* Incentives for learning
* Support for extra programs
* Stress relievers (fidget toys, stress balls, etc.) for counseling sessions Food voucher for Western Eagle Foundation
Support for Temecula Elementary Schools:

Food for Vail Elementary's "pantry closet" which is available to families with food insecurity. Other Temecula schools may have a similar program that we would support.

Support for Special Needs Preschools. There are 11 Special Education Preschool (PreK) Classrooms in TVUSD, teaching over 200 students at Jackson Elementary and Alamos Elementary:
* School supplies
• Emergency clothing
* Enrichment activities
* Books for classroom libraries
* Manipulatives for hands-on learning
* STEM items (i.e. Magnetic Building Tiles, STEM kits, Butterfly/Ladybug habitats, etc.)

• Social Emotional Learning (SEL) supports (i.e. Lakeshore Feelings and Emotions items, pretend play items, cooperative games, etc.)
■ Flexible Seating (floor seats, wobble cushions, balance balls, bean bags, etc.) • Sensory Manipulatives and supports
• Gross Motor/Fine Motor equipment or supplies
Support for Foster/Homeless Youth:

Household items for young adults in Transitional Housing in Temecula through Foster Family Agencies
Food vouchers
■ Educational support (special classes or counseling)
• Christmas gifts
Support for Rancho Damacitas Empowerment Village:
• Food vouchers
• Christmas gifts for Moms and children
• Grocery/gas cards
• Special classes or programs as requested by staff
Support for Exceptional Children's Christmas Program. This program is designed for special needs children who get a visit with Santa and have activities in which they participate while waiting for their turn to see Santa. ALTV's "Assisteens" auxiliary (7th-12th graders) administer the program:
• An appropriate toy or activity for children waiting to speak with Santa • Goodie bag for each child
Book for each child
Support for Community Mission of Hope:
• Backpacks
• Food as needed
Support for Temecula Valley Hospital:
• ALTV provides Teddy Bears on a monthly basis for children receiving care in the hospital

ACKNOWLEDGEMENT/SIGNATURE PAGE
The applicant acknowledges and agrees to the following:
■ Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements.
• Every Community Service Funding application is considered individually and on its own merit. ■ Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval.

Please allow time for checks to be processed.

The awarding of Community Service Funding does not constitute an automatic annual allocation. ■ The recognition for Community Service Funding should accrue to the City of Temecula.

Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. ■ Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot.
■ The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete.

I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief.

ORGANIZATION NAME: Assistance League of Temecula Valley MAILING ADDRESS: 28720 Via Montezuma
Temecula, CA 92590
PHONE: (951 ) 111-6771
EMAIL: _;sip -me i1ladVhtu1) coin
PRESIDENT/AUTHORIZED OFFICER: Mary Murphy President
jllrt �
SIGNATURE: ! Ir f '•r ,,? 1 r+.
/�' DATE: Au ust 17, 2022
IF DIFFERENT THAN ABOFVE; Diane Sitar
APPICATION PREPARED BY:

SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO:

Q HELP® MENU
Home > Tax Exempt Qrganixation Search > Assistance League Of Temecula Valley Assistance League Of Temecula Valley
EIN: 33-0360419 1 Temecula, CA, United States
Publication 78 Data e
Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions.

On Publication 78 Data List: Yes
Deductibility Code: PC
Copies of Returns (990,990-EZ, 990-PF, 990-T) v
Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non- profits.

Tax Year 2020 Form 990
Tax Year 2019 Form 990
Tax Year 2017 Form 990
Tax Year 2016 Form 990

STATE OF CALIFORNIA

FRANCHISE TAX BOARD
F"GB PO BOX 942857
SACRAMENTO CA 94257-0540
Entity Status Letter
Date: 7/29/2022
ESL ID: 4849707501
Why You Received This Letter
According to our records, the following entity information is true and accurate as of the date of this letter.

Entity ID: 1463456
Entity Name: ASSISTANCE LEAGUE OF TEMECULA VALLEY
❑X 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board.

X3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process.

Important Information
• This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. • If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1).
■ The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b).

efile GRAPHIC print - DO NOT PROCESS I As Filed Data - I DLN: 93493283011090 Q
Form 0
Return of Organization Exempt From Income Tax OMB No. 1545-0047 V
t►�
2019
Under section 501(c), 627, or 4947(a)(1) of the Internal Revenue Code (except private fou7iii ► Do not enter social security numbers on this form as it may be made public. 0,1—o cent of lbc
Tr wnw
► Go to V
WIVW, 4aV/al`arnt-r7 for instructions and the latest information.

Imemnl Revenue S—ice
A For the 2010 catendar vear. or tax Koar beginning 06.01-2,019 and ending 05.31-2020 B Check if applicable: C Name of ugarazaS ten D Employer identification number

ASSISTANCE LEAGUE OF TEMECULA VALLEY
❑ Address change
❑ Name change 33-0360419
❑ Initial - etm n Doing 4ual4tasa as
❑ FinalrMwNlel minnpl
❑ Amended return Numbor and streot (of P.O. box if rnad Is not deliviuvil to street e4rlrey7) Room(suile E Telephone number Q Application p",Iil 28720 VIA MCNIEIUMA (951) 694-8016 CAy or town, State or province, country, and ZIP or fu4ipn pt t," coda TEMECUTA, CA 92590
G Gross receipts$ 1,196,835
F Name and address of prindpal ofiieer: H(a) Is this a group return for 28720 VIA MONTEZUMA subordinates? ❑Yes RNo
TEMECULA CA 9259D2510 H(b) Are all subordinates
❑Yes []No
included?
I Tax-exempt status: 21)O c 501( 3 ❑ 501 c ( ) 4 (insert no,) ❑ 4947(a)(1) or ❑ 527 If "No," attach a list. (see instructions) 3 Website: • www,te+rtecu3avaltey.asylstanealaapue.erp H(c) Group exemption number ► K Form of organization: I] Corporation ❑ Trust ❑ Association ❑ Other ► L Year of formation: 1989 1 M State of legal domicile: CA SUMM,3ry
1 Briefly describe the organization's mission or most significant activities:

ASSISTANCE LEAGUE OF TEMECULA VALLEY IS A VOLUNTEER PHILANTHROPIC ORGANIZATION DEDICATED TO SERVING THE NEEDS OF m
FAMILIES IN SOUTHWEST RIVERSIDE COUNTY. VOLUNTEERS ARE COMMITTED TO COMMUNITY SERVICE AND SPECIAL PROGRAMS TO HELP LOCAL. CHILDREN AND FAMILIES IN NEED.
ti
C
Q
s
0 0
2 Check this box ► ❑ if the organization discontinued its operations or disposed of more than 251/o of Its net asse 9. 4 3 Number of voting members of the governing body (Part VI, line la) . 3 12 y
4 Number of independent voting members of the governing body (Part VI, line lb) . . . . . 4 12 5 Total number of individuals employed in calendar year 2019 (Part V, line 2a) . 5 0 Q
6 Total number of volunteers (estimate if necessary) . . . . 6 220 7a Total unrelated business revenue from Part Vlll, column (C), line 12 . 7a 0 b Net unrelated business taxable income from Form 990-T, line 39 . . . . . 7b Prior Year
Current Year
8 Contributions and grants (Part VIII, line 1h) . . .
866,804
759,835
6,970
5,318
9 Program service revenue (Part VIII, line 2g) . . .
284
234
n,
SO Investment income (Pert VIII, column (A), lines 3, 4, and 7d ) . 0 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and Ile) 12 Total revenue —add lines 8 through it (must equal Part VIII, column (A), line 12) 874,058
765,387
13 Grants and similar amounts paid (Part IX, column (A), lines 1-3 ) . . . 413,579
321,838
0 14 Benefits paid to or for members (Pert IX, column (A), line 4) . . . . . 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) 0 0
v'
16a Professional Fundraising fees (Part IX, column (A), line lie) .

C.
b Total fundraising expenses (Part IX, column (D), line 25) 0169,249 17 Other expenses (Part IX, column (A), lines 11a-11d, Ilf-24e) . . . . 443,295
408,940
18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) 856,874
730,778
17,164
34,609
19 Revenue less expenses. Subtract line 18 from line 12 . b t
IBepinning of Current Year
End of Year
arc
71 20 Total assets (Part X, line 16) . . .

E173,2831
860,753
m
59,534
12,395
a
21 Total liabilities (Part X, line 26) . . . . . .
x411.
22 Net assets or fund balances. Subtract line 21 from line 20 813,7491
846,356
HIS Signature f6fatk
Ulider penalties of perjury, I declare that I have examined this return, Including Accompanying sehedulos and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer(othgr than officer) is based on all information of which preparer has sign
••• Q10.1o.
5lynature of ofcar Date
Here 11
E1
1 19E WilEIL pretxleat
Type or print name and title
Print/ I ype preparers name Preparer's signature Dare t z, Check El if p00449291
Paid self-
Preparer Firrr's name ► LESLIE A DOHERTY CPA APC Firm's EIN ► 20-20B2661 Use Only I Firm's address ► 41680 KALMIA ST STE 115 Phone no- (951) 698-2260 MURRIETA, CA 92562
May the IRS discuss this return with the preparer shown above? (see instructions) . © Yes ❑ No For Paperwork Reduction Act Notice, see the separate instructions. Cat. No, 11282Y Form 990 (2019)

FY 2022/2023

COMMUNITY SERVICE FUNDING

REINVESTMENT IN TEMECULA
GRANT APPLICATION #
5 BIKE TEMECULA VALLEY CORP

CITY OF TEMECULA
FISCAL YEAR 2022.2023

COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA

PROGRAM APPLICATION
(Please Print or Type)
DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022

PROJECT/PROGRAM INFORMATION
Amount Requested: $ 5,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title:

Cycle For Hope
Start Date: 08/10/22 End Date: I LN03122
Physical Address of Project/Program. 2736 Ynez Road, L-7 #205 Temecula, California 92591

INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Bike Temecula Valley, Corp.

Mailing Address: 31311 Canterbury Court
Temecula, Ca. 92591

ORGANIZATION AND GEOGRAPHIC AREA SERVED
Name of Applicant
Organization: Bike Temecula Vall , Corp. Year Founded: 2021 htt s // www.tvbikecoalition.com/ https://www.facebook.com/biketemeculavalley Website: P = Social Media: roalitinni
Number of Paid Staff:

Number of Volunteers: 51
Geographic Area(s) the Organization Serves: Primarily Temecula Geographic Area(s) the Project/Program Serves: Primarily Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA.

Contact Name: Gary Oddi
Contact Person's Direct Telephone: 951-970-8034
Title/Position: President of the Board of Directors
Contact Person's Email: [email protected]

NONPROFIT STATUS
Is this organization incorporated as a nonprofit? Yes x❑ Date of Incorporation as a Nonprofit: June 10, 2021 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING
Federal Identification Number: 87-1364605 State Identification Number: 4755644 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS:

1. ❑ Attach IRS Deductibility Status using this link: http://apf)s.irs.gov/a; ]p/eos/

2. ❑ Attach State Entity Status Letter using this link:
https://www.ftb.ca.govlonline/self serve entity status letter/index.aso

3. ❑ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: h t : /r a , v/V rili anon/Web/Search.aspx?facility=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13

APPLICATION AUTHORIZATION j
Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No 0 Yes ❑ IF YES, BRIEFLY DESCRIBE:

Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ❑x Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION:

This Application has been authorized by the organization's:

Executive Committee ❑ Board of Directors ❑x Members -at -Large ❑

MISSION STATEMENT OF ORGANIZATION
BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. -71
Bike Temecula Valley (BTV) Is an engaged Inclusive coalition of cyclists, dedlcated to advocating for a safe, fun, and accessible network of cycling infrastructure and treatments that promote human powered recreation and transportation.

We proactively work to assure the safety of the cycling and human powered community. Protecting from auto v cycle collisions and other dangers of the road, through the installation of facilities and treatments. such as protected bike lanes, bike crossings, cycle tracks, class - I bike lanes, at. Also, be a leader in safe riding and driving practices, such as sharing the road, eye contact, hand signals, rolling stops. distracted or impaired driving or riding. Ultimately. develop a vision "0" culture for active transportation.

Positively fostering the growth and development of cycling in the region through marketing, fund — raising, educating, and advising. Listen to the community and collectively share their voice regarding cycling to the city, county, and community at large.

Make everything we do and advocate for available to all, consciously removing all obstacles. Such as, facilities made available for people with disabiiitias, low-income neighborhoods, et. And trails being reached easily from all neighborhoods and accessible to wheelchairs or mobility scooters,
Advancing cycling as a pleasurable pursuit. It Is whatever brings joy to those participating with the coalition [hat is cycling related, for Instance; when your bike or other human powered vehicle brings happiness, including slow sociable riding experiences; endurance endorphin release rides, single track adrenaline eustress runs, pump track skills confidence building laps, nature rides, tow stress facilities use, aesthetically pleasing rides, et Constructively, pragmatically, tenaciously, and In n

FINANCIAL STATEMENTS

City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13

FUNDING SOURCES
CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑x Yes ❑ IF YES, PROVIDE BELOW.

NAME OF PROGRAM/PROJECT
AMOUNT
MONTH + YEAR

NAME OF CITY GRANT

FUNDED BY THE CITY GRANT OR SPONSORSHIP

FUNDING RECEIVED

OR SPONSORSHIP
Cycle For Hope Event, Funds submitted
$ 900
June, 2022
City Council CS Grant,
to Community Mission of Hope (CMOH) not BTV
Council Member Stewart
$ 2500
City Council CS Grant,
Mayor Protem Schwank
Cycle For Hope Event, Funds submitted
y P
June, 2022
to CMOH not BTV
BTV is currently requesting funds from City
Council CS Grant from all 5 Council Members
OounsA-Men*e
an application, while one has declined our
$ "2500"
(Amount
applied for. Funding
2022 -23 City Council CS
proposal, and 3 have not yet responded.

NOT re eiv d1-
Grant
OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? NO X❑ Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW.

City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13

GRANT PROJECT/PROGRAM DESCRIPTION

IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT

FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT.

Our major event this year will be the "Cycle for Hope" bike rides on October 2. This is a cycling event supported by BTV in collaboration with Community Mission of Hope / Rancho Damacitas.

This event includes three rides, 50 - 25 - 15 milers, where participants will be given an opportunity to ride their bicycles through the neighborhoods of Temecula and on the roads of Temecula Valley Wine Country for a great cause_ Though these rides are simply rides, chip timing will be provided so riders can have access to their performance results. The event ultimately is to benefit The Community Mission of Hope / Rancho Damacitas to help end homelessness and hunger In our community.

Secondarily BTV is dedicated to supporting events and programs that encourage healthy activities. The Cycle For Hope will demonstrate the benefits of an active community. In an event of this magnitude, volunteers are key to success. The support of volunteers from Temecula brings our community together to promote health, wellness, and a higher quality of life. 12 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED.

ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT.

If granted the Funding, we would supplement the "Cycle For Hope" event budget.

Within this budget we will be purchasing route signage, sign frame holders, volunteer high visibility vests and shirts, participant commemorative shirts, and bike racks, (as designated in the Program/Project Budget sheet provided in this Application).

The largest cost from the Budget is support from California Highway Patrol and Temecula Police, Traffic Division for route safety, which is not covered in the CS Grant funding. Yet this extreme expense puts a strain on our budget expenditures, therefore increasing the need to fund the above listed expenditures. �1
3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING.

EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS.

The ultimate goal for all proceeds from this event will benefit the Community Mission of Hope and will be allocated to feed the hungry and help the homeless. The proceeds will be directly infused to The Community Mission of Hope's system that helps feed the hungry and support a better life for the homeless. These proceeds will provide direct assistance to those needful populations of Temecula.

Residual benefits are:
- Bringing community together at a healthy event to benefit our most vulnerable residents. - Including Temecula youth / students in the activity and in the volunteer force for community service. - Educating Temecula about the benefits of cycling.
3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT 500+ FROM THIS PROJECT/PROGRAM: (Base on how many people CMOH can help with the roceeds-froali.jtclp.For Hopei
3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 100+ City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13

PROJECT/PROGRAM DESCRIPTION

CONTINUED
4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS.

Partnering with CMOH, BTV is excited to provide a healthy event for Temecula Residents. Cycle For Hope includes diverse volunteer opportunities, will trumpet Temecula's bicycle routes, and assures all proceeds are channeled to help end homelessness and feed the hungry. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC

City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13

PROJECT/PROGRAM BUDGET (do not fill in shaded areas)

LINE ITEMS FOR PROJECT/PROGRAM REVENUES

LIST REVENUES/INCOME FOR PROJECT/PROGRAM
Amount of money requested from this City of Temecula $
Community Services Grant (Not to exceed $50,000) 5,000
Amount contributed to the Project/Program by the Applicant $ Organization 0
Other grants or funding already awarded for Project/Program, if any $ 3400 (2021 - 22 City Council Community
Service Grants, Stewart &
Schwank allocated to Community
Mission of Hope for Cycle For Hn _
In -Kind match amount or volunteer credit hours estimated amount $ 0 TOTAL REVENUE $ 8,400

LIST OF EXPENSES FOR PROJECT/PROGRAM
Tools/Equipment Bike Racks, sign holders
Facilities/Rent/Insurance Insurance Flyer for City of Temecula & Riverside Count
Volunteer high visibility Shirt I Vest,
Supplies Course Signage and Markers, radios, Participant Marketing Socalcycling.com, Pierson Print Flyers
& Posters
Services Registration Service, BikeSignup.com
Food
Other
Staffing Expense
THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT;
HOWEVER PLEASE INCLUDE. (Temecula PD & CHIP & Gemini Tir

TOTAL EXPENSES
TOTAL BUDGET $

EXPENSES
$ 1000
$ 300
$ 4500
$ 800
$ 1750
250
$ 0
Ing) $17,000
$ 25,600
$ 25,600
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13

PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT
IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21/22 (LAST YEAR), THEN SKIP THIS PAGE.

If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. ` If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent.

1. Fill out table below (make additional copies if needed to explain all expenditures.)

2. Attach copies of receipts/invoices (in the same order as listed in this table.)

3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022
Organization:

FY 2021-2022 Amount of $
CSF Grant Fund Awarded:

Name of Project/Program.

Month & Year CSF Grant Received from City:

Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number):
- Date on _ Expenditure
Name of Company Receipt/Inv,
Eon Receipt or Invoice MUST BE ON OR BETWEEN Amount Description Purpose Q = JULY 1, 2021 - JUNE 30, 2022 ` DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE 1 2
3 4
I
5 6
Is

EXPENDITURE TOTAL EXPENDITURE TOTAL MUST BE EQUAL TO
(OR GREATER) THAN TOTAL AWARD AMOUNT
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13

If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit andlor require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page.

1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures.

A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.)
B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the fuilowing Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount Is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds.

2. Attach copies of receipts/invoices (in the same order listed in table below).

3. Send to:

Organization:

City of Temecula, 41000 Main St., Temecula, CA 92590,
Attn: City Manager's Dept. "CSF-Reinvestment in Temecula"

EXPENDITURE REPORT DATED
Name of Project/Program:

TOTAL FY 2022-2023 Month & Year FIRST $5,000 check
Amount of Grant Fund Awarded: $ was received from City:

1. Is this Expenditure Report Is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted).

2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by tho City

3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yos If yes, Amount of Request $ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) i Date on Expenditure

MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER E Name of Company Receiptllnvoice
on Receipt or Invoice MUST BE ON OR BETWEEN
rto E
, March 20, 2020-JUNE 30. Amount Description Purpose
Q z 2024
EXPENDITURE TOTAL�$
EXPENDITURE TOTAL i
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13

Please allow time for checks to be processed.
• The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. ■ Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot,
• The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete- I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief.

ORGANIZATION NAME: Bike Temecula Valley, Corp.

MAILING ADDRESS: 31311 Canterbury Court
Temecula, Ca. 92591
PRESIDENT / AUTHORIZED OFFICER: Gary A. Oddi
PHONE;( 951 ) 970-8034
EMAIL: [email protected]
President, Board of Directors
_..} 7 PRINT NAME
SIGNATURE: • _ DATE: August 12, 2022

MONTH, DAY, YEAR

IF DIFFERENT THAN ABOVE,
APPICATION PREPARED BY:

PRINT NAME TITLE
SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO:

City of Temecula
Community Service Funding
Attn: City Manager's Office
41000 MAIN STREET
TEMECU LA, CA 92590
Questions. [email protected] (951) 694-6413
Betsy. [email protected] (951) 693-3959
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13

Department of the Treasury
Date:

Internal Revenue Service
07/19/2022
Tax Exempt and Government Entities
Employer ID number.

I� P.O. Box 2508
87-1364605
Cincinnati, OH 45201
Person to contact:

Name: Customer Service
ID number: 31954
Telephone: (877) 829-5500

BIKE TEMECULA VALLEY CORD
Accounting period ending:
27636 YNEZ ROAD L-7 205
December 31
TEMECULA, CA 92591
Public charity status:
509(a)(2)
Form 9901990-EZ 1990-N required:

Yes
Effective date of exemption:

June 1a-, -2-021'
Contribution deductibility:

Yes
Addendum applies:

No
DLN:
26053582002322
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.

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-revok
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,
Stephen A. Martin
Director, Exempt Organizations
Rulings and Agreements
Letter 947 (Rev. 2-2020)
Catalog Number 35152P

r
Secretary of State
r Certificate of Status
44ppoft Kl
I, SHIRLEY N. WEBER, PH.D., California Secretary of State, hereby certify:

Entity Name:

BIKE TEMECULA VALLEY, CORP.

Entity No.:
4755644
Registration Date:
06/10/2021
Entity Type:

Nonprofit Corporation - CA - Public Benefit
Formed In:

CALIFORNIA
Status:

Active
The above referenced entity is active on the Secretary of State's records and is authorized to exercise all its powers, rights and privileges in California.

This certificate relates to the status of the entity on the Secretary of State's records as of the date of this certificate and does not reflect documents that are pending review or other events that may impact status.

No information is available from this office regarding the financial condition, status of licenses, if any, business activities or practices of the entity.

IN WITNESS WHEREOF, I execute this certificate and affix the Great Seal of the State of California this day of June 27, 2022.

SHIRLEY N. WEBER, PH.D.

Secretary of State
Certificate No.: 024913933
To verify the issuance of this Certificate, use the Certificate No, above with the Secretary of State Certification Verification Search available at bizfileOnline.sos.ca.gov.

oil

Bicycle Coalition Bike Temecula Valle Nbikecoalitionx
Cycle For Hope Pro Ride Half
Century
o"$125
8:OOAM PDT
11:00PM PDT
Price increases after September 1, 2022 at 7:59am
PDT
Sign Up
EVENTS
Cycle For Hope Intermediate Ride
Quarter Century
$85
8:30AM PDT
11:00PM PDT
Registration ends October 2, 2022 at 8:29am PDT

RIDE WEBSITE
Additional ride Information can be found at https://www.bikesignup.com/Race/CA/Temecula/CycleForHope .

PLACE
Community Mission of Hope, 41760 Rider Way
Temecula, CA US 92590

DESCRIPTION
Cycle For Hope Local Ride 15
Miler
$39
9:OOAM PDT
11:OOPM PDT
Registration ends October 2, 2022 at 8:59am PDT
Cycle For Hope is a cycling event to help end homelessness and hunger in our community. There will be three ride distances, 15, 25, and 50 miles through thf city of Temecula and The Temecula Valley Wine Country. Ride results will be provided by Gemini Timing. A commemorative T-shirt and goodie bag will be provided.

The courses will take cyclists through Temecula's finest neighborhoods and trails and the 25 and 50 milers will ride through the beautiful Temecula Valley Wine Country. Post race celebration will be held at Refuge Brewery.

RIDE CONTACT INFO
If you have any questions about this ride, click the button below.

BIKE TEMECULA VALLEY IS A S01C, NON-PROFIT
ORGANIZATION. WE THANK OUR COMMUNITY

PARTNERS AND WELCOME YOUR CONTRIBUTIONS TO
CYCLING IN THE VALLEY.
tveducators.org
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MT. SAN )ACINTO COLLEGE
0 0B
0� �B

TEMECULA, CA
11 901

COMMUNITY MISSION OF HOPE

RANCHO DAMACITAS
CHILDR(=N & FAMILY SIRVIUS

FY 2022/2023

COMMUNITY SERVICE FUNDING

REINVESTMENT IN TEMECULA
GRANT APPLICATION #
•
1 BIRTH CHOICE

OF TEMECULA

CITY OF TEMECUI.A
FISCAL YEAR 2022.2023
COMMUNITY SERVICE FUNDING • REINVESTMENT IN TEMECULA

PROGRAM APPLICATION
(Please Print or Type)
DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022
1 PROJECT/PROGRAM INFORMATION
Amount Requested: $ 50.000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: Client Care Programs Start Date:Ongoing End Date: Ongoing Physical Address of Project/Program: 41750 Winchester Rd. Suite O, Temecula Ca. 92590 INCLUDE IF DIFFERENT THAN ORGANIZATION's MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Birth Choice Centers Mailing Address:1jdge Gate Dr. Suite 220

I ORGANIZATION AND GEOGRAPHIC AREA SERVED
Name of Applicant
Organization: Birth Choice of Temecula _ Year Founded. _ 1989 Website; www_bifthchoicecenter%grg Social Media: _0-birthchoiceoftemecula Number of Paid Staff: 3 Number of Volunteers: 1.2
Geographic Area(s) the Organization Serves: Temecula Valley/Riverside County Geographic Area(s) the Proiect/Program Serves: Temecula Valle /Riv0!2!jnty NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA.

Contact Name: Janette Chun Title/Position: CEO
Contact Person's Direct Telephone: 951-234-6140 Contact Person's Email: contact@ bi rthch o ice, center

NONPROFIT STATUS
Is this organization incorporated as a nonprofit? Yes ® Date of Incorporation as a Nonprofit: 1989 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING
Federal Identification Number: 33-0302353 State Identification Number: CI800935 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS:

1. ❑ Attach IRS Deductibility Status using this link: htto://ai3i)s.irs.gQv/82 /eos/

2. ❑ Attach State Entity Status Letter using this link:
https-/I www.ftb.ca.gov/online/self serve entity status letter/index.as

3. ❑ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: htt :Ilrct.doi.ca. ovNeNficationA(Veb/Search.as x?facilit =Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13

Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ® Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION:

This Application has been authorized by the organization's:

Executive Committee ❑ Board of Directors
Members -at -Large ❑

MISSION STATEMENT OF ORGANIZATION

BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES To support people facing pregnancy, parenting and reproductive health concerns.

Birth Choice of Temecula's goal is to allow families a place to go to deal with unplanned pregnancy and parenting concerns. We also want to allow women and men a place to deal with reproductive loss through a support group program.

It is our objective to offer education, mentorship and material needs support to families that are struggling with providing for their children and are desiring rentorship and parenting support. We never want a family to feel as if they cannot parent due to lack of goods and services.

FINANCIAL STATEMENTS

City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13

FUNDING SOURCES
CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes ❑ IF YES, PROVIDE BELOW.

NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT

FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP Client Care Program $ 500 June 2021 Council Member Grant Client Care Program i $ 2000 June 2021 Council Member Grant Client Care Program $ 1000 July 2022 Council Member Grant I$
$
OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? No ® Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW
AMOUNT MONTH + YEAR

RECEIVED

NAME OF ENITY FUNDING RECEIVED
$
$
I$
$ 1
$ 1
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13

GRANT PROJECT/PROGRAM DESCRIPTION

IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT

FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 11 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. I This funding will go to support our centers programs to include the following:

Client Care Program and Fatherhood Program
The Client Care and Fatherhood Programs offer pregnancy, parenting and life skills education, one on one mentoring, material assistance, grief and loss support and related services. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED,

ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT.

For our 2023 Budget Year, our Client Care and Fatherhood Programs will use these funds to purchase the following goods, equipment and services:
- Upgraded technology (i.e. computers as ours are 7 years old and need to be updated) - IT professionals to install said computers and monitor them - Goods such as: Hygiene Kits, Diapers, Wipes, Formula, Car Seats, Pak n Plays, Strollers, clothing, gas and food cards and various other parenting needs. - Brochures, paper goods and materials needed for these programs - Update some office furniture (Need a few new chairs)
- Offset a portion of building lease (at least 35%)
3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING.

EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS.

Our center services around 120 Temecula residents annually.

They come for regular monthly visits and enjoy our services at no cost.

Many other Temecula residents avail themselves of our pregnancy testing and ultrasound services as well as the services that we are requesting funding for.

Being able to have baby items, mentors, courses and upgraded technology will allow them to receive maximum benefit so that Temecula farnilies feel strong so that we can assist with building safe and great communities.

I
3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT 120 FROM THIS PROJECT/PROGRAM:
3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM 12 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13

PROJECT/PROGRAM DESCRIPTION

CONTINUED
4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS.

Birth Choice Centers is a place of help that provides assistance to families who need help to provide for them and their children. Our programs provide them with the goods and services they need. Without such help, they would not be able to build thriving families. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC

AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS.
he CV-19 Pandemic was an incredible difficulty for us. Previously our center was operating 4 ays a week and we serviced close to 1600 appointments a year. We had 25 volunteers and 5 taff. Once the pandemic hit we went down to 3 staff and 2 volunteers as well as our donations rasticaIly reducing to the paint that we had to shut down 2 days of service each week. he needs of the families did not stop however and with 2 days of service and 3 staff we still ad 1,279 appointments that year, that meant that we had close to 10 appointments every day. was an incredible feat that was only possible because of our great love for our clients and a lot IF prayer.

Now we are operating 3 days a week with 3 staff and have 12 volunteers. ;Our clientele continues to grow and the need is incredible, especially during this time of inflation land steep prices.
6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL:
(1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM.

For our 2023 budget year, it is our intention to expand our existing programs and projects. Our reality is that our programs are expanding without us trying to expand them. This grant will give us the ability to serve all residents without having to decrease supplies to make them last.

These last 2 years we provided families with over 15k diapers, around 500 cans of formula and 600 bags of clothing as well as hundreds of other goods We are only in August of 2022 and we are already near bypassing that amount.

This grant will allow us to not only upgrade our serious) outdated technologybut also provide for much needed goods for our families as our services are greatly expanding.

These funds would also allow us to offset a portion of our building lease up to 35%. If the board wishes that the funds to offset leasing charges should be allocated differently, we would then adjust the apportionment to the boards preference.

City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13

PROJECT/PROGRAM BUDGET (do not fill in shaded areas)
LINE ITEMS FOR PROJECT/PROGRAM IiI REVENUES

EXPENSES
In -Kind match amount or volunteer credit hours estimated amount $ 30,000 TOTAL REVENUE $ 202,000

LIST OF EXPENSES FOR PROJECT/PROGRAM
Tools/Equipment i — $ 15,000
Facilities/Rent/Insurance 1111 $ 65,000
Supplies $ 40,000
I
I 1
Marketing $ 5,500
Services $ 3,500
Food $ 20,000
Other F $ 5,500
Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; $ 68 000 HOWEVER PLEASE INCLUDE.

TOTAL EXPENSES $ 223,500
TOTAL BUDGET $ $ 200,000
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13

PREVIOUS` FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT
IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21/22 (LAST YEAR), THEN SKIP THIS PAGE.

If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information.

1. Fill out table below (make additional copies if needed to explain all expenditures.)

2. Attach copies of receipts/invoices (in the same order as listed in this table.)

3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office —CSF EXPENDITURE REPORT due on or before September 12, 2022
Organization: Name of Project/Program:

FY 2021-2022 Amount of $
CSF Grant Fund Awarded: Month & Year CSF Grant Received from City:

Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number):

Date on Expenditure
E Name of Company Receipt/invoice
.9 on Receipt or Invoice MUST BE ON OR BETWEEN Amount Description Purpose JULY 1, 2021 - JUNE 30. 2022 DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE ¢z
1 2
3 4
5 1A
EXPENDITURE TOTAL $

EXPENDITURE TOTAL MUST BE EQUAL TO
(OR GREATER) THAN TOTAL AWARD AMOUNT
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13

FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT
If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant' FY2022-2023 by the City of Temecula, follow these instructions.

1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures.

2. Attach copies of receipts/invoices (in the same order listed in table below).

3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula"

EXPENDITURE REPORT DATED
Organization:

TOTAL FY 2022-2023
Amount of Grant Fund Awarded: $
Name of Project/Program:

Month & Year FIRST $5,000 check
was received from City:

1. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes._ or No (already submitted).

2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City

3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request 5 Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number).

Date on
tName of Company Receipt/invoice
E on Receipt or Invoice MUST BE ON OR BETWEEN
:0 3 March 20, 2020 - JUNE 30,
Q Z 2024
Expenditure

MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER Amount I Description Purpose
1 I$
1 _
2 $
3 $
EXPENDITURE TOTAL $

EXPENDITURE TOTAL
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13

ACKNOWLEDGEMENT/SIGNATURE PAGE
The applicant acknowledges and agrees to the following:
■ Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements.
• Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval.

Please allow time for checks to be processed.
• The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot.
■ The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete.

I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief.

ORGANIZATION NAME: Birth Choice of Temecula
MAILING ADDRESS: 1 Ridgegate Dr. Suite 220
Temecula, Ca. 92590
PRESIDENT / AUTHORIZED OFFICER:

Janette Chun
°RINT NAME

SIGNATURE

IF DIFFERENTTHAN ABOVE,
APPICATION PREPARED BY:

PHONE: (951) 240-3006
EMAIL: [email protected]
CEO
TITLE
DATE: 9/1 /2022
MON`N, DAY, YEAR
PRINrNAiMf TIf E
SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO:

STATE OF CALIFORNIA

FRANCHISE TAX BOARD
F T 8 PO BOX 942857
SACRAMENTO CA 94257-0540
Entity Status Letter
Date: 8/18/2022
ESL ID: 2469572054
Why You Received This Letter
According to our records, the following entity information is true and accurate as of the date of this letter Entity ID: 1800935
Entity Name: BIRTH CHOICE CENTERS, INC.
0 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. a3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process.

The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b).

Q HELPB MENU
Home > Tax Exempl-ftanIzation Search > Birth Choice Centers Inc.

Birth Choice Centers Inc.

EIN: 33-0302353 1 Temecula, CA, United States
Other Names
Publication 78 Data o
Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions.

On Publication 78 Data List: Yes
Deductibility Code: PC
Copies of Returns (990, 990-EZ, 990-PF, 990-T) e
Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non- profits.

Tax Year 2019 Form 990
Tax Year 2018 Form 990
Tax Year 2016 Form 990

Form 990
OMB No. 1545-0047
Return of Organization Exempt From Income Tax
2020
-'•tlnder"ctft§01(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) dpor t,to Pu(allc
ooparlmont of the Treasury
► Do not enter social security numtters an this form as it may be made public, Inleriler Revenue Service
► Go to wwwdrs.gov1ftrmM tar instructions and the latest Information.

Insisectfon
A For the 2020 calendar
year, or tax year beginning , 2020, and ending , 20
B Check if applicable: C D Employer identification number Address change BIRTH CHOICE CENTERS, INC. 33-0302353
Name change 1 RIDGE GATE DR. #22D E Telephone number
Initial return TEMECULA, CA 92590
951-699-9808
Final return/terminated
Amended return G Gross receipts $ 822,629.

F Name and address of principal officer: JANETTE CHUN H(a) Is This a group return for suboedlnalos? Yes Application pending["SAME
No
AS C ABOVE H(b) Are all subordinates included? Yes
No
If "No," attach a list. See instructions
Tax-exempt status: }{ 501(c)(3) 501(e) ( )� (insert no.) 4947(a)(1) or 527 J Website: ► WWW. BIRTHCHOICECENTERS . ORG H(c) Group exemption number ► K Form of organizafion: }C Corporation Trust Association Other► L Year of formation; 1989 M State of legal domicile; CA Part I I Summaty
1 Briefly describe the organi2alion's mission or most significant activities -CRISIS PREGNANCY COUNSELING AND v PARENTAL SUPPORT INCLUDING CLOTHES FOOD AND OTHER MEANS, _______ -----
-- —-------------- ----- ___----•-------------_----
c
o _�'—-----------
0 2 Check this box ► If the organization discontinued its operations or disposed of more than 25% of its net assets. a 3 Number of voting members of the governing body (Part VI, line 1a) ......................... ......... 3 9 ed 4 Number of independent voting members of the governing body (Part VI, line 1 b) 4 W) .......... .........
r 5 Total number of individuals employed in calendar year 2020 (Part V, line 2a)........................... 5 13 z 6 Total number of volunteers (estimate if necessary) ................................................... 6 30 a 7a Total unrelated business revenue from Part VIII, column (C), line 12.. .. ........ . . . .......... ....... 7a

0. b Net unrelated business taxable income from Form 990-T, Part I, line 11. ............................... I 7b

0. Prior Year
Current Year
8 Contributions and grants (Part VIII, line 1 h).......... ...... , ... . � ti•••• •••••••-••••--•-
573 969.
822
629.
9 Program service revenue (Part VIII, line 2g). . .................... . .. . ............... 10 Investment income (Part VIII, column (A), lines 3, 4, and 7d) . .. .................. . 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and l le) .............. 12 Total revenue — add lines 8 through 11 (must equal Part VIII, column (A), line 12) -- -. 573 969.
822,629.
13 Grants and similar amounts paid (Part IX, column (A), lines 1-3) .................... 122 028.
75,863.
14 Benefits paid to or for members (Part IX, column (A), line 4)........ . . ........ . . . ... . h 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10)...-- 236 845.
169
618.
° 16a Professional fundraising fees (Part IX, column (A), line 11 e) .. . . . . . ........... . . . .. . b Total fundraising expenses (Part IX, column (D), line 25) ► 9 777. "' 17 Other expenses (Part IX, column (A), lines 11a-11d, 11f-24e)........................ 296 443.
297
198.
18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) . - - - . - - - - . 655,316.
542
679.
19 Revenue less expenses. Subtract line 18 from line 12 ......... .... ............. . —81, 347 .

Beginningof Current Year
279 950.

End of Year
20 Total assets (Part X, line 16). . . ...... . ......... . ... ... .. ....... , ............ 118,546.
426,675.
21 Total liabilities (Part X, line 26).......... ....... . ........ ......... , , ..

Net
17,620.
45,799.
100 926.
380, 876.
22 assets or fund balances. Subtract line 21 from line 20 . - -. ....................

Part 11 1 Slgnature Block
Under penalties of perjury, I declare that I I+ exantln this Mum, rKl d�lr accompanying stherhdas and slalonlenh, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other I + d 1f , of „filch limparor Nis any hsrowtadpa.

Sign signatures ofoilrecr'Rmm► --
ifala
Here DOUGLAS MACRAE TREASURER
ype or print name and tirlo
Print/Type preparer's name Preparer's sir dies Dale CheckX if PTIN
Paid DOUGLAS C. MACRAE 1 tP00438711
Preparer Firm's name ► SHAFER & MACRAE CPAS
Use Only Firm'saddress ► 43385 BUSINESS PARK DR STE 150 Firm's EIN ► 33-0884861 TEMECULA CA 92590 Phoneno, 951-296-0785
May the IRS discuss this return with the preparer shown above? See instructions- . . .. X Yes No BAA For Paperwork Reduction Act Notice, see the separate instructions- TEEA01011- 01/19/21 Form 990 (2020)

FY 2022/2023

COMMUNITY SERVICE FUNDING

REINVESTMENT IN TEMECULA
GRANT APPLICATION #
7 BNAI CHIAM

i A,. I K, k 1
�y `l FISCAL, YEAR {��r 2 - 202233 �+�� + �r� �r `
COMMUNITY SERVICE ICE FUNDING - REINVES T �1ii..i7 1 IN , EMEVYI...i"A

PROGRAM APPLICATION
(Please PrW or Type)
DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2.022

PROJECT/PROGRAM INFORMATION
Amount Requested $ 3 .L .0 k i ti MA)UMUM ALLOWABLE $50,OW PER ORGANIZATION � ' r �Drrin1�f12 ��
PrajectlPrngraln Title: >"� [� • tivl V � � �� WI sw bate: End Date:

Physical Address of ProjectlProgrsm: V 1Ca 1Y1 P_ A . UYCIQ. L Li INCLUd6 IF DIFFMENT T14AN GrGANIZA us KuL*4G ApcAE`:s
If Grant is Awa(dad, Make Check Payable to: Com CLt on B nain ,I Che l
Mailing Address: 2 -! ��\Jia 9r1netsc-t

ORGANIZATION AND GEOGRAPHIC AREA SERVED
Name of Applicant
Organization: Q r e G [r JQ Y1 4) hAl l 0"M I (Near Founded:

Website: r i �= , l' 1.) I ] a .t7 r1'1 Soaial Media: G lx*r k „� !.. ��4i i m r h can Number of Paid Staff -3 Number of Volurftem _
GeOgraphic Area(s) the Organization Serves: 7crn �wlel , [fly (1" 6A ,}1� � [ (� C lots f °�} I z i 11 b rL)d �e�1

2. Attach State Entity Status Letter using this link:

Laos f .o flb sefve eqM status letterlsnclex.3s

3. d Attach fast page only of most recant IRS Form 990 or attach print out of detailed info about your charity Found on this State RegisWs Search Taol: lrrct- ca- NC'�iliG3tidrr/111k+biSf3adPS —Y Cary of Temewla Caren undy ,%Nke Funding - Reinvestment in T(-n-eeu'-a GRANT APPLICATION Page 5 of 13

APPLICATION AUTI#OR1.ZA1'10N
Has IRc organization or any menftm of Me Sowd of Direaol-; of the orgw'xation been invoMed wrih any personal bminess Iransadions valued over $6W inducting any business transactions, negotiations, invest nts, or interests in real property with a Temecula City Gourd Member during the P2912 months? Nn ,Yes ❑ LF YES, BRIEFLY OESCR1t3E
is a Te cula City Council Member a member VIM Bbitrd of Dftct0r3 Wig Off VA the organization? No Y?S ❑ tF YES, PROME COUNCIL irEMBER'S NAUC AND TITLE VWTHIN THE ORGANIZATION:

Tics Applicabon has been authorized by the orgaNzationr'sL;:

Executive Committee ❑ Board of Directors Members -at Lame ❑ MISSION STATrINEIE?ff OF ORGANIZATION
BRtE=FLY DESCRIBE THE ORCANIZATION'S MISSIONAGOAL S AND OBJECTIVES- V1�f'gCAt;or Vic;+ cWAIr+� i5 \m2 pit( JCAr)dj
�,>>1 ° +�- o
zn L ,fir
1ti YU� e. C� S tide
y �
edo 6 +c
bjQtrQ a
*4
��hYhillJ �U� CiJ
IJ 16ml =f p") /� V,

FINANCIAL STATEMENTS
iI7C'�!I jiGr! ��7
UPON REQUEST, COPIES OF THE ORGANiZATIOMS CURRENT BUDGETIFINANCLAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DE NMSTRATE SOUND FIMANCIAL MANAGEMENT- DO NOT SUBMIT NOW.

City & Temccula Cwywnun4y %"vote h-unaln,7 - Ki9ww=Z&M"L Wr I WIMlk14 f-MIAN I /V -r-Uc'^TIC+r+I rey. 0 ..r 10

FUNDING SOURCES
CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

CONCURRENTLY REQ STING) ANY OTHER SOURCES OF FUNDI NO FROM THE CITY FOR ANY PROGRAM? NO 94 Yes ❑ IFYES. PROMDE BELOW,

MAW OF PROGRAM/PROJECT

FUNDED BY THE CITY GRANT OR SPONSORSHIP
AMOUNT
MONTIJ + YEAR

FUNDING RECEIVED
I NAME OF C" GRANT
OR 5FON50RSHIP
_
I
I
�
OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR TIME-SAMEIN THIS APPLICATION?
No [ Yes [] IF YES. PROVIDE INF047MA11ON INTABLE BELOW.

AMOUNT

RECEIVED
NAME Cif EfIf1Y
&"TN +YEAR

FUNDING RECEIVED
M of Temecula Comnturity St11ViCt Funding - Relm+enwt in Temewle CiRANT APPLICATION Page 7 of 13

GRANT PR0,ffCT/PR0GRW DESCREMOY
P PORTANT-RECEIPTMMVUfCESISRVOUIREDTOEESUBMITTEDTOTHEMYTOVAUOATETHEORGANIZATIONSPENTGRANT

FUNDING AMRDED RY THE CITY TOSUPPORT THE PROXCPPROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM TI-iE TEMEGULA GRANT FUNDING WILL SUPPORT. �or�� : on x i ► ► 1 On K5 +d �, aV
on -f!� �� E 5 �, r �� tl��vv� � i c1 C v oit Il dPSk5 �0 I�I� t' k i s
u (}eki d i)vr c�nnvI Awl v� v y � �U �I
a SSova., S pde r a vi 0 n
2 DESCRIBE HOW THE ORGANISATION WILL SPEND THE GRANT FUNDING, IF AWARDED, ALSO, INCLUDE A LIST OF 00005, EQUPWMENT, ANDIOR SERVICES THIS ORGAN9ZATION HAS PURCHMED OR PLANS TO PURCHASE VIKM AYORDED FUNDS TO SUPPORT THIS PROGRAMIPROJECT. -lo 1'Y? aln;cftn scq il e. PYOJ 1��jC�1r'1�.Y45r Eli►@�j�^G�j }met! aeeP s sckFe- C�00Y. J ,J
.�1 Ge the n t- &) 'ry'),lf Cot-�A-
-'� � � Imo*, �i � �`� � �,} FS ►'o(2 C� ct�l"�;
�OpipIlIxej loci decor fiOr
3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAMIPRQIECT IF A~DED CTIY FUNDING_ EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFIT y TEMECULA RESIDENTS. and
(-5 �w on l� Sync go�U�.

SyL��!
i c> K. 4D j5 rj �v j I�V q
Ilk�r�c�i ��c��l
n"" erl t- � f off a fT 6067i
3D ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT

FRAM THIS PROJECTIPROGRAM
3C ESTIMATED NUMBER OF VOLUNTEERS INVOLVM IN THIS PR0JC-CT"0C-pRAFA 30 , � o
City of TamaG:la Camwnly Service Funding - Reinveatnert in Temsada GRANT APPLICATION Page B of 13

PROJECTIPROGRAM DESCRIPTION
t'O,'VnA lUED
4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1- 3 ABOVE IN 50 WORDS OR LESS. here iS o17Ij a
Pw
CUm fyluk-ri i�„
or voy)*1 510
'ie, d bu I t a S a
,�'/)a
I�
-rIvrPtv 11Ja(e fri 'J� '
fi t' /�`r�e?CUIC rPSI alb s.
5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC

AFFECTED THIS NONPROFIT ORGANIZATIOWS ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS.
6 C'c) r�C�Gf��nn p3'Y)'v 'hrrr lo. Pp d C WIr.f U-s sbon 7"'? elderly peopfb yjo-� abkc-
�n,? Asp tag Pkit d,( wn a.s
incorne, . 3coee, fvOi reopo01f1 C)jy-
1'r� (-5 1 c� " )qa f oTv r f was
' y'ron
IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL= (7) NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECTIPROGRAM, AND/OR (3) CONTINUE EXISTING PROJECTIPROGRAM.
aS Y r 11C.c� Ianr� j � f �j -c � ro s �n
r4 r(a), tie,ors �l ��+� ��'`�!'rS�
G�',1�'� le-
�jol.)!'� L s) �'lor � ��
' ,Pl or t 5 q �'
P Cf uL '' /7e P r r7 Q f0
I A r`'-9 �'j C M� u
uy of Temecula Community Service FundMg - Ri .nvestmentin iernrr_ula GRANT APPLICATION Page 9 of 13

PROJK7/PROGRAM BUDGET tdo not fill in shaded areas)
LINE rFEMS FOR PRWECT/PROGRAiM — REVENUES D7MEMSFS
LIST REVENUES/1NOOME FOR PROJECT/PROGRAM
Amount of money requested from this City of Temecula
$
Community Senricm Grant (Not to exceed W,000)
3 Amount contributed to the PrVJiect/Progmm by the Applicant $ Organization
Other grants or funding already awarded for Project/Program, if any $ -
�I
In -Kind match amount or volunteer credit hours estimated amount $ TOTAL REVENUE $2 0 Z7iJ

LIST OF UPENSES FOR MMECF/PROGRAM
Tools/Equipment
$
Facilitias/Rentlinsurance
Supplies
$ 6
Marketing
$
Services
$
Food
V
Other
Staffing Expense THIS 15 INELIGIBLE TO BE FUNDED BY idM GRANT; HOWEVER PLEASE INCLUDE_
$

TOTAL EXPENSO
4 TOTAL BUDGET
$ .
$ Kati
Cn of Temecula Community Service Fundog • kemveurrerrt in Temecula GRANT APPLICATION Pape 10 of 13

f — ACKNZ OWLEUGEN ENTISIGIIATURE PAGE
The applicant acknowledges and agrees to the following:
• Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements_
• Every Community Service Funding application is considered individually and on its own merit.

Awards will be given bo organizations and activities that directly benefit the residents of Temecula_ • Funding is nolt Imirnediately available to the recipient, and requires an award letter signature upon approval_ Please allow time for checks to be processed_
• The awarding of Community Service Funding does not oonstltube an automatic annual allocation. • The recognition for Community Service funding should accrue by the City of Temecula. • Cornmundty Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately, • Community Service Funding grants wiH not be awarded or arrvounced within the f;0 days before an election in which an awarding Council Member is on the ballot.
• The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this applicadon's due date or this appliicrtion may be rejected as incomplete.

I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief.

ORGANIZATION NAME: On&I I DI
MAILIK ADDRf:SS: 21.15 1 D c l 'l [,f.Snl PHOf#E: 5I 42-7-7 ,- -73 t1Vri 5( EAMI:bm T chgl M I g1nail, um
PRESIDENT / AUTHORIZED OFFICEFL r 1�u-S b' 1(/,(") p' sidew t SIGNATU RL _ j/� 9561{•�",-' DATE-1 +'I

IF DIFFERENT THAN ABOVE,
APPICATIDIH PREPARED BY:
ir'^+!h H A M F
SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO:

City of Temecula
Corn m inity Service Funding
Attn: City Manager's Mce
41000 MAIN STREET
TEMECULA, CA 92590
Questions: Stacey,[email protected] (951) 694.6413 B",Lowrey@Temem[aCA.gov (951) 69L�3959
City of Temecula Comnu'ity &errioe Funding , Reinve9brre4t in Tem v::o GRANT APPLICATION Page 13 of 13

STATE OF CALtF40MA
~ FFLW4CWRETAXFXVJD
F" B PO BOX % 2957
SACRAMENTO CA 94257A540
Entity Status Letter
ESL ID: &M554520
Why You RaONved This LeWr
According to our records, the following entity information is true wW a wnde a5 of The dale oflhis letter, ErMy ID_ 0722510
Enft Name: CONGREGATION FINAi C HAIM OF MURRIETA HOT SWfNGS

1. The entity is in good standing wet the FfaWNM Tax hoard_

2. ThO amity i5 root in good standing with the Franchise Taos Board_ ® 3. The entity is curerdly exempt loom tax under Revenue and Taxation Code (R&TQ Sedion 23701 d- 4- VA do not have ounent Wommlion aboiA The entlty-

5. The entity was administratiwety di5solvedlcxncelled on throuo the FmncWe Tax Board AdndnlstrallNe Dfss,WuWn proem,
kepostard informmMon
+ This infomiatfon does not necessa* refkd ThO cniiiy's current legal or administrative status with any other agency of the stale of California or other governmental agency (w body. • if the erffdy% powers, rights, and pfMbges were suspended or forleRed at any time in the past or if the errllity did business in California at a time when It was not qualffied or not registered to do business in Catfomia, this inforrnxtiori does not rated the status or voidabiiiily of contracts made by The entity in Callfonlia during the perW Tile erlft was suspended or forfeded (R&TC SecbDm 23304.1. Z3304.5, 23305a. 23305-1),
The entity Canute of reviver may have a Erne !-amnion or mwy limit fha furKdons the n,,Aved annoy can periomr, or both (RUG Section 233Q5b).

Cormert With Us
Web, ftkC4Lgmr
Phone: 800-852.5711 from 7 d.rrt.1* 5 psm, weekdays, except state holidays Qlf �500 hum outside the United States
California
Relay Service: 711 or t3-735-2M (For pwsons with hearfirtla or speech i npaimmmrts) F1`13 42MA WED (REY 12-2019)

NF-LP8 MENU =
ffQ= > Tax pA OTganixation Search > Congregation Snai Chaim Of Murrieta Hot Springs Congregation Bnai Chaim Of Murrieta Hot Springs
EIN: 95-30941901 Murrieta, CA, United States
Publication 78 Data o
organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions.

On PubUcatiarr 78 Data List: Yes
Deductibility Code: PC
Po_qe lost ReWewedor Updated 10-N0vembar-2= � r", Shiro $ Mrrt

W Lim, 956 MA
DCLAM,
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Registrant Details
(as Wjcim N� (XN(WJXj.NI'I0N BMeU CHAIM OF UUMELA H(Yr SM1sc:3 fRS MM� VAtbe r Tn- Rdigicv;
Rcgistry Status: Exempt - Religious Renewal Dw/Exp. Date:

NUMLOur; EX(IMWI b..%w.
]Record Tyv.,-, (7hanoty Xtjj.-b-aU?,n Firattift Dow
INAC of LA* IU'ft-W4&LEMA7
Mia-ding Address
(MY, N-W Z* %ft WRIM CA 425O
Corr Fifing I ,,s & espondence
2010 Raffic APP %NoI.%bpd
An-nual Renewal Data
No AnimeW R&wwal Dam
Related R-P-.�!qistratjons & Event Reports
No Related Records
6"PaPffo.j0jrA &W31MM
VA

FY 2022/2023

COMMUNITY SERVICE FUNDING

REINVESTMENT IN TEMECULA
GRANT APPLICATION #

BOY SCOUTS OF AMERICAY
CA IE COUNCIL 045

TAHQUITZ DISTRICT

CrrYOFTENECULA
FISCAL YEAR 2022 - 2023
COMMUNITY SERVICE FUNDING • REINVMWTMENT IN TEMECULA

PROGRAM APPLICATION
(Pisa so Pant or Type)
DUE ON OR BEFORE: MONDAY, SEPTEMBER 129 2022

PROJECT/PROGRAM INFORMATION
Amount Requested: $ 50,000.00 MAXIMUM ALLOWABLE: $50.000 PER ORGANIZATION Scouting In Temecula
Project/Program Title: Start Date: 9-12-22 End Date: 8-30-24 Physical Address of Project/Program: Same as mailing address

INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Boy Scouts Of America, Tahquitz District Mailing Address: 2351 W. Lugonla Ave. Suite F
Redlands, Ca.92374

ORGANIZATION AND GEOGRAPHIC AREA SERVED
Name of Applicant Tahqultz District, Boy
Scouts of America
Organization: Year Founded.. 1910
Website: clecbsa.org Social Media: facebvok.comltahquitz.district Number of Paid Staff: 1 Number of Volunteers: 230
Geographic Area(s) the QLaaakgion Serves: Riverside and San Bernardino Countines Geographic Area(s) the Prolecypr2gram Serves: Temecula
NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVE v USED TO SERVE TEMECULA.

Contact Name: Tim Long Title/Position: District Executive Contact Person's Direct Telephone:951-453-3666 Contact Person's Email: [email protected]

NONPROFIT STATUS
Is this organization incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit: 1910 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING
Federal Identification Number. 95-1744350
State Identification Number. 7689144562
PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTS) AS FOLLOWS:

1. ❑ Attach IRS Deductibility Status using this link: htt :Ila sirs, ovla Leos/

2. ❑ Attach State Entity Status Letter using this link:
htt sL www.ftb.ca . ov/amine/self serve entit s atus ;etterlindex.as

3. ❑ Attach first page only of most recent IRS Form 990 pr attach print out of detailed info about your charity found on this State Registry's Search Tool: t n .ca. avN�rilica EonMlehlSearch as x7facl I =� City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13

Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No M Yes ❑ IF YES, PROVIDE COUNCIL MEMBERS NAME AND TITLE WITHIN THE ORGANIZATION:

This Application has been authorized by the organization's:

Executive Committee 0 Board of Directors ❑ Members -at -Lange ❑

MISSION STATEMENT OF ORGANIZATION
BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES.

The mission of the Boy Scouts of America is the porepare young people to make ethical and moral choices over their lifetimes by instilling in them the values of the Scout Oath and Law.

The goal of Scouting is to encourage the physical, intellectual, social, emotional and spiritual developments of young people so that they take a constructive place in society as responsible citizens, and as members of their local, national and international communities.

FINANCIAL STATEMENTS

UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPNS AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW.

City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13

FUNDING SOURCES
CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes ■ IF YES, PROVIDE BELOW.

NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT

FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP Day Camp/Outdoor-Adventure -7500 f
i
$
$
OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? No E Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW.

AMOUNT MONTH + YEAR

RECEIVED NAME OF ENITY

FUNDING RECEIVED
G.

City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13

GRANT PROJECT/PROGRAM DESCRIPTION

IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT

FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT.

The Boy Scouts of America is active and looking to grow membership within the timeframe of this grant not only in the number of Temecula residents, but in our international relationships. We are looking to accomplish this by bringing BSA Scouts and/or groups from Temecula's sister city in Japan to Temecula, as we aim to expand out diversity and inclusion goals as an organization. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED.

ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT.

Boy Scouts of America is looking to help cover the costs of membership for Scouts and their families in Temecula as well as cover the costs of bringing Scouts from our sister city in Japan, to Temecula, to enhance the City's existing relationship.

This may include shipping costs for materials sent, covering the cost of food and host family supplies, etc.
3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING, EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS.

This grant will specifically enable Temecula residents to participate in the Scouting program in a much less -personal finances way. Our goal is to use these funds to cover registration costs for Scouts. Secondarily, this grant will fund the transporation costs and food costs for Scouts from Japan bringing international tourism revenue through site -seeing and local businesses and shops in the city. 3b
3c

ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 50-100
ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 30_40 City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 8 of 13

PROJECT/PROGRAM DESCRIPTION

CONTINUED
4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS.

Boy Scouts of America is looking to increase our membership numbers within the City of Temecula by covering costs associated with joining or remaining in the program. Scouting teaches Temecula residents the value of community and we'd like to expand that internationally through diversity and inclusion to our sister city in Japan.

LCOPPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC

ECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA MMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS.

The COVID-19 pandemic had a significant Impact on our program in Temecula.

Boy Scouts saw a double-digit percentage reduction in membership and participation across the board. With the increased costs associated with simply providing for a family, Temecula residents are expressing challenges in covering costs of the program and being able to keep their child in the program that they know makes a positive and tangible difference.

1.9 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL:
(1) CREATE NEW PROJECT/PROGRAM, (2) 9,XPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PRO,IECTIPROGRAM.

These funds will help the Boy Scouts of America continue and expand out engagement with the residents of Temecula by providing a program that gives back to the community through Eagle Scout projects, and a variety of other community service/impact opportunities. These funds will additionally enable our program to provide Temecula's sister city in Japan the opportunity to visit the city of Temecula, learn more about it and bring international awareness and knowledge of all Temecula has to offer back to Japan.

City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13

PROJECT/PROGRAM BUDGET (do not flll In shaded arem)

LINE ITEMS FOR PROJECT/PROGRAM FREVENUES-

LIST REVENUES/INCOME FOR PROJECT/PROGRAM
Amount of money requested from this City of Temecula $ 50,000 Community Services Grant (Not to exceed $50,000)
Amount contributed to the Project/Program by the Applicant $ 4,000.00 Organization
Other grants or funding already awarded for Project/Program, if any $ 0 In -Kind match amount or volunteer credit hours estimated amount $ 5,000.00 TOTAL REVENUE $ 59,000

LIST OF EXPENSES FOR PROJECT/PROGRAM
Tools/Equipment
Facilities/Rent/Insurance
Supplies
Marketing
Services
Food
Other
Staffing Expense

EXPENSES
$15,000.00
$4,500.00
$5,000.00
$3,000.00
$1,500.00
$5,000.00
$30,000.00
THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT;
HOWEVER PLEASE INCLUDE. $20,000.00
TOTAL EXPENSES $84,000.00
TOTAL BUDGET $59,000.00 $84,000.00
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13

PREVIOUS* FISCAL YEAR (FY) 2021-+2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE.

If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information.

If your organization was awarded a Carnmunity Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, ail grant funds received must have been expended anytime on or between July 1, 2021. and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received Frorn the City were spent If the funds were not spent in accordance with the a p p rovedlawe rd ad application, the 0rgaalzation will be required to retum the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper hack -up documentation including the completed table below with accompanying receiptslinvoices, most be submitted to the City on or before due date: September 12, 2022.

1. Fill out table below (make additional copies if needed to explain all expenditures.)

2. Attach copies of recetptslinvoices (in the same order as listed in this table.)

3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office - CSF EXPENDITURE REPORT due on or before September 12, 2022
Organization: Tahquitz District, Boy Scouting In Temecula Scouts--Cf-Amer 1.0 —Name of ProJact/Program:

FY 2021-2022 Amount of '2500
CSF Grant Fund Awarded: _ Month & Year CSF Grant Received from City: 06/2022 Number of Beneficiaries Living In 92590, 92591, 92592 that Directly Benefftted 50 from this PfogramfProject (approximate number of benanoiaries If you do not have precise number):

Name of Company Date on __ Ex nditure
on Recelpt or Invoice MUSTBE OIN OR BVETWEEN Amount
Description Purpose
JULY t, 2021 -DUNE 30, Z022 DESCRIBE THE EXPENDITURE I PURPOSE OF EXPENDITURE z r � - — -
T��J>."A3"par� 6r $ c4 S�"+s(r"P�lres
2 A)A-5 P. rho. rh�� , 2-o-jz $ zap. 64u'w-e« >�
3 6on4-k e Tor zo11.
4 $
AA-4 cea, (S "erde' U
C'* Dar e."op.

ALT$h{.,r �7uii5WPKf
t �iE � eue rrt
a c.�.y.•�i e t
EXPENDITURE TOTAL $ S�`I 11 26 EXPENDITURE TOTAL MUST BE EQUAL TO

OR GREATER) THAN TOTAL AWARD AMOUNT,
Cfty of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13

M,oftqPTFQd= 0jp 5fo2
6371 Haven Avis Sb 3-213
Randw Cucamonga, CA
91737-OW US
(909) NS-7671
www.ThelEJAz
THE IMAgEMpORium
BILL.TO

BOY SCOUTS OF AMERICA
California Inland Empire
Council
1230 Indian Cl.

Redlands, CA 92374
P.MNUMBER SAIM NEP
Per Edits Ham pa
Cu MMApp" 351 6.0981197 2.140.44T
2M Cab Soaat Day Camp
Rod wlBlack toga Prka
Youth. 49s. 133m, 105L
- Adult: 39st 14m, 71., 4XI
CUOM 200 6.7822 1,366.44T
2M Cub Swut Day Camp
Kaye" wMa k Logo PdM
Ad —A 1183, Mn- 58L. 5ft. 22 2YJ 6 34 4 4xt
Dbowwt - - - f-874.22-874.22T
'r & Promotional Discount
M- $tD3--I1tp-21
2 s0.7 6
SUBTOTAL 2.622.66
TAX (7.75%) 203.26
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Monday, September 12, 2022 at 15.51:14 Pacific Daylight Time Subject: FW: Your BoothPop Order Confirmation (#10057)
Date: Monday, September 12, 2022 at 12:34:23 PM Pacific Daylight Time From: Matt Bear
To: Tim Long
Attachments: Image001.png, image002.png
Matt Bear I Scout Executive, CEO

BOY SCOUTS OF AMERICA
Callfornia Inland Empire Council
2351 W Lugonla Ave. Ste F
Redlands, CA 92374
P 909.793.2463 x302 1 C 909.544.9796
- - - - - ��.-a-n-x-x•!1'►s��li=[ez inn•11_it�'L','�Slr:.i•1'[�Ili4!IC=#l'L�l-1:i�3LR�•�� ter »y

CAMP RMRRSOM
CALWIGHIA INLAND IV•I•N ,DV%Q"
i
CONFIAENMAUry NOVICE This message is lnten*d to ba 09+4"Od only by UM listod mdPent(a). It may contain Inb7 mtlon that is privileged. conlWandal ondPorexampt from dlsdosum underappircobte law. Any dissemination, dls6fbution or copying of this massege is st►tcflyplroR�ltad withouf nry(lrlpr pam7lSSi0I7. If you 3ltl not the fntarrdad R?C}�ifan� or if yvu tie VB n)COIIRRd Ahls oommunkatxNf In e►ror, please notify me Immediataly byreturn e-may end pennananlly remove the ontinel message and any oopias bum yDarowputor and all back-up systams,
From: BoothPop
Sent: Thursday, June 30, 2022 3:28 PM
To: Matt Bear
Subject: Your BoothPop Order Confirmation (#10057)
Thanks for Your Order
Your order ID is #10057. A summary of your order is shown below. To view the status of your orders(ick bm•
Shipping Address
Billing Address

Page 2 of 2 ends

Matt Bear John ®ear
Callfomia Inland Empire Council, Boy Scouts of America 2033 E BROOKSIDE DR 2351 W Lugoinle Ave. Ste F Ontario, CA, California 91761 Redlands, California 92374 United States
United States 9090449796
DON"9796
Your Order Contains...
10114 east
Custom Full
Color Event
Canopy
Tents
(Add Backwall?
No Thanksl,
Add sidewalls?
No Thanksl.

Select
Production
7irm Standard
Production-7 CAN10F 2 $900.000SD $1,800.00U5D
Buslaeas Days,
Are Your Files
Print -Ready?
Yes, I desWed
the files
myself.,
Carrying Case
Optlons., Black
Nylon Beg,
Desired In -
Hand Date? Jul
15th 2022)
Boothpop
L
CopyraglttD 2017 Boothpop
STOP. THINK, CLICK.

Subtotal: $1,800.00 USD
Shipping: $0.00 USD
Tax: $139.50 USD
Grand Total: $1.939.50 USD
Payment Method: Credit Card

Page 2 of 2 ends

ACKNOWLEDGEMENT/SIGNATURE PAGE
The applicant acknowledges and agrees to the following:

Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements.
• Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval.

Please allow time for checks to be processed.
• The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member Is on the ballot.
• The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. i/we hereby certify the information contained in this Application is true to the best of our knowledge and belief.

ORGANIZATION NAME: Tahquitz District, Boy Scouts of America MAILING ADDRESS: 2351 W. Lugonla Ave, Ste F
Redlands, Ca. 92374
PHONE: 951 1 ` 53-3666
EMAIL: [email protected]
PRESIDENT AUTHORIZED OFFICER: Tim Long, District Executive SIGNATURE DATE: 09/1 L/LOLL
IF DIFFERENT THAN Ail3O
APPICATION PREPARED BY:

SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 20221 TO:

City of Temecula
Community Service Funding
Attn: City Manager's Office
41000 MAIN STREET
TEMECULA, CA 92590
Questions: Stacey. [email protected] (951) 694-6413
[email protected] (951) 693-3959
City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 13 of 13

ralRs jniern ! Rovohus sprVicv
0264e4
CINCINNATI ON 45999-0038

SOY SCOUTS OF AMERICA

STEPHANIE PHILLIPS
1325 W WALNUT HILL LN
IRVING TX 75038-3008
In reply refer tot 02 48219434
Jan. 21, 2020 I.TR 4167C 0
22-1576300 000000 00
130010850
BODC s TE
OY Scouts of Ameft Callfornle Inland Empire Coundl 045
B5
EIN N 95-1744350
Eerployer identification numbers 22-1976300
Group exemption numbers 1761
Dear Taxpayers
This is in response to your request dated Jan. 09. 2020, for Information about your tax-exempt status.

Our records indicate we issued a determination letter to you in November 1965, and you're currently exempt under Internal Revenue Code (IRC) Section 501(c)(3).

We also recognized the subordinates on the list you submitted as eXearpt frow federal Income tax under IRC Section 501(c)(3).

For federal incope tax purposes, donors can deduct contributions they make to you as provided in IRC Section 170. You're also qualified to receive tax deductible bequests, legacies, devises, transfers, or gifts under IRC Sections 2059, 2106 and 2522.

Please refer to wtrw.irs.gov/charities for information about filing requirements. Specifically, IRC Section 60331(j) provides that, 11 you don't file a required return Or notice for three consecutive years, Your exempt status will be automatically revoked on the filing due date of the third required return or notice.

In addition, each subordinate organization is subject to automatic revocation if it doean+t'file a required return oe Rat'ics for thr•tt' consecutive years. Subordinate organizations can file required°returns or notices individually or as part of a group return.

For tax forest instructions, and publications, visit www.irs.gov or call 1-800-TAX-FORM (1-800-829-3676).

If you have questions, call 1-877-829-5500 between 8 none and 5 p.m., local time, Monday through Friday (Alaska and Hawaii follow Pacific Time I .

STATE OF CALIFORNIA

FRANCHISE TAX BOARD
FTB PO BOX942857
SACRAMENTO CA 94257-0540
Entity Status Letter
Date: 10/12/2022
ESL ID: 1908321967
Why You Received This Letter
According to our records, the following entity information is true and accurate as of the date of this letter.

Entity ID: 0094468
Entity Name: CALIFORNIA INLAND EMPIRE COUNCIL, INC., BOY SCOUTS OF AMERICA ® 1. The entity is in good standing with the Franchise Tax Board.

2. The entity is not in good standing with the Franchise Tax Board. a3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d

4. We do not have current information about the entity.

5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process.

The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b).

Connect With Us
Web: ftb.ca.gov
Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States

1990 Return of Organization Exempt From Income Tax OMB
�No. 1545-0047
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) / 0, Do not enter social security numbers on this form as it may be made public. .1..101 ruttnent ol'the fl Sll y ► Go to www.1rs.rgov/Farni990 , for instructions and the latest information. mind Revenue Sen,icc
For the 2019 calendar year, or tax year beginning I
heck if applicable:

C Name of organization

BOY SCOUTS OF AMERICA
Address change
CALIFORNIA INLAND EMPIRE COUNCIL 045
Name change
Initial return
Doing business as
Final return/terminarxl
Amended ietui n
Number and street (ur P.O. bux if mall is nc
Application pending
1230 INDIANA COURT
City or town, state or province, country, and ZIP or
REDLANDS, CA 92374
F Name and address of principal

MATT MYERS
1230 INDIANA COURT
REDLANDS,CA 92374
Tax-exempt status: 0 501(c)(3) ❑ 501(c) ( ) (insert no
Website; ► WWW.BSA-CIEC.ORG
and endlnn 12-31-2019
street
D Employer identification number
95-1744350
E Telephone number
(909) 793-2463
G Gross receipts $ 5,2.87,572
H(a) Is this a group return for
subordinates? ❑ Yes 0 No
H(b) Are all subordinates
included? ❑ Yes ❑No
❑ 4947(a)(1) or ❑ 527 If "No," attach a list. (see instructions) H(c) Group exemption number ►
:orm of organization: W Corporation ❑ Trust ❑ Association ❑ Other ► L Year of formation: 1972 1 M State of legal domicile: CA 1 Briefly describe the organization's mission or most significant activities:

To prepare younQ people to make ethical and moral choices over their lifetimes by iri in them the values of the scout oath and law. 2 Check this box ► ❑ if the organization discontinued its operations or disposed of more than 25% of its net assets. 3 Number of voting members of the governing body (Part VI, line la) . 3 28 4 Number of independent voting members of the governing body (Part Vl, line lb) . 4 27 5 Total number of individuals employed in calendar year 2019 (Part V, line 2a) . 5 51 6 Total number of volunteers (estimate if necessary) 6 7,500 7a Total unrelated business revenue from Part VIII, column (C), line 12 . 7a 0 b Net unrelated business taxable income from Form 990-T, line 39 . 7b Prior Year
Current Year
8 Contributions and grants (Part VIII, line lh) .
882,430
1,209,552
9 Program service revenue (Part VIII, line 2g) .
826,140
1,182,412
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) . 1,151,801
289,333
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and Ile) 996,616
1,229,474
12 Total revenue —add lines 8 through 11 (must equal Part VIII, column (A), line 12) 3,856,987
3,910,776
13 Grants and similar amounts paid (Part IX, column (A), lines 1-3) 20,776
30,274
14 Benefits paid to or for members (Part IX, column (A), line 4) 0 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) 1,366,133
1,340,520
16a Professional fundraising fees (Part IX, column (A), line Ile) 0 t b Total fundralsing expenses (Part IX, column (D), line 25) ►344,942 17 Other expenses (Part IX, column (A), lines lla-lld, llf-24e) 1,254,888
1,531,487
18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) 2,641,797
2,902,281
19 Revenue less expenses. Subtract line 18 from line 12 . 1,215,190
1,008,495
N
Beginning of Current Year End of Year
.v
20 Total assets (PartX, line 16) . . 3,801,789 4,841,080 n
g 21 Total liabilities (Part X, line 26) . . 612,414 742,180 22 Net assets or fund balances, Subtract line 21 from line 20 3,189,375 4,098,900 ii
M Si nature Block
der penalties of perjury, I decla•e that I have examined this return, including accompanying schedules and statements, and to the best of my Dwledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has knowledge.
it

FY 2022/2023

COMMUNITY SERVICE FUNDING

REINVESTMENT IN TEMECULA
GRANT APPLICATION #
a I

BOYS & GIRLS CLUB

OF SOUTHWEST COUNTY

f 4 kj I K01-11"
FISCAL YEAR 2022 - 2023

COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA

PROGRAM APPLICATION
(Please Print or Type)
DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022

PROJECT/PROGRAM INFORMATION
Amount Requested: $ 50,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Before & After School Day Camp
Project/Program Title: Programs Start Date: 1/1/22 End Date: 6/30/23 Physical Address of Project/Program: 31465 Via Cordoba, Temecula, CA 92592

INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Boys & Girls Clubs of Southwest County Mailing Address: PO Box 892349
Temecula, CA 92589

ORGANIZATION AND GEOGRAPHIC AREA SERVED
Name of Applicant Boys & Girls Club of
Organization: Southwest County
Website: www.becswc.org
Number of Paid Staff: 31
Geographic Area(s) the Organization Serves:

Year Founded: 1990
Social Media: @becswc
Number of Volunteers, 100
Temecula, Murrieta, Lake Elsinore
Geographic Area(s) the Proiect/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA.

Contact Name: Carly Bennett -Valle Title/Position: CEO/CFO Contact Person's Direct Telephone:951-699-1526 Contact Person's Email: [email protected]

NONPROFIT STATUS
Is this organization incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit. 1996 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING
Federal Identification Number: 33-0475756 State Identification Number: 1671809 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FWIjAg �&i! s:

1. K Attach IRS Deductibility Status using this link: http://apps.irs.aov/anti/eos/ sEp 12 2022

2. 0 Attach State Entity Status Letter using this link:
htips:// www.ftb.ca.govionline/self serve entity status letter/index.ask C, . nr 1 =n�t_t;'SorrKI.

3. ® Attach first page only of most recent IRS Form 990 or attach print out of detaile�tPfol4your charity found on this State Registry's Search Tool: http://rct.do'.ca.gov/Verification/Web/Search.asox?far.illty=Y City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 5 of 13

Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No q Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION:

This Application has been authorized by the organization's:

Executive Committee ❑ Board of Directors ❑ Members -at -Large ❑

MISSION STATEMENT OF ORGANIZATION
BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES.

The mission of the Boys & Girls Club of Southwest County is to inspire, enable, and support all youth to realize their full potential as successful, responsible, and impactful members of the community.

FINANCIAL STATEMENTS

UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW.

City or Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13

FUNDING SOURCES
CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes E IF YES, PROVIDE BELOW.

NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP �Y FUNDING RECEIVED F OR SPONSORSHIP Before & After School Program $7226
Awarded
CDBG 22-23
Great Futures Breakfast $1080
7/2022
CM CSF 21-22
Great Futures Breakfast $1080
7/2022
CM CSF 21-22
Before & After School Program $6969
4/2022
CDBG 21-22
Ultimate STEM $5000
CSF 21-22
CDBG 20-21
CSF 20-21
2/2022
8/2021
4/2021
Before & After School Program
$5491
Ultimate STEM
$5000
is l
OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? NO ❑ Yes N IF YES, PROVIDE INFORMATION IN TABLE BELOW.

AMOUNT

RECEIVED

NAME OF ENITY
$ 1125
1Walrrlart
$ 5000
SCE
$ 10000
f TJX Foundation
MONTH + YEAR

I FUNDING RECEIVED
12/2020
12/2020
1 /2021
$ 1500
$ 20000
$ 3333
$ 3567
lWalmart
OJJDP
TJX Foundation
Nano Bank
RCTC
3/2021
12/2021
1/2022
6/2022
$ 18780
Ongoing
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13

GRANT PROJECT/PROGRAM DESCRIPTION

IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT

FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT.

Boys & Girls Club of Southwest County (BGCSWC) provides year-round academic support, sports, arts, STEM, career readiness, and leadership programs through our Before & After -School and Day Camp Programs. Our programs consist of high quality integrated academic, behavioral, and social -emotional learning practices that help address issues faced by our youth today. BGCSWC enriches the lives of young people and provides a safe haven in which they can learn and grow. We are committed to ensuring that Club members stay inschool, build healthy relationships, have a strong sense of self, and that they are prepared for adulthood 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED.

ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT.

The BCGSWC will utilize grant funds to support programming efforts for the Before & After School and Day Camp programs for youth ages 6-17. Funds awarded will be used to purchase program and food supplies, equipment (including safety equipment), cover some transportation expenses from transporting youth to/from school, and other necessary expenses (including insurance costs) required to run our high quality, safety focused programs year-round.
3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING.

EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS.

Grant funding for our programs will benefit youth members ages 6-17 who are Temecula residents. The grant funding will provide needed supplies, equipment, and other necessary expenses required to run safe, quality Before and After School and Day Camp Programs for Temecula's youth at our Pechanga Great Oak Clubhouse.
3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT $O FROM THIS PROJECT/PROGRAM:
3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 5 _J
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13

PROJECT/PROGRAM DESCRIPTION

CONTINUED
4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS.

BGCSWC will provide Before/After School and Day Camp Programming year-round to youth ages 6-17. Youth will participate in high quality, safety focused youth development programs daily. Funds awarded will be used for supplies, equipment, transportation, food, marketing and other necessary costs required to run these programs.
5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC

AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS.

During the pandemic, we temporarily closed 2 of our 3 clubhouses.With the support of our community, we were able to keep our doors open at our Pechanga Great Oak Clubhouse in Temecula. We adjusted and adapted a new Learning Hub Program where youth could come to the Club, use our wiFi and participate in their virtual classes during the day. Our staff assisted each child to make sure they could log in and stayed on task each school day, then helped with homework after class.The organization's annual revenue in 2020 decreased 60% or $900,000 from 2019, and in November of 2020 the Board of Directors made the tough decision to lay-off the President & CEO and Director of Marketing & Special Events to help decrease expenses.We have also faced capacity restrictions due to social distancing practices over the last 2 vears. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL:
(1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM.

Awarded funds will allow BGCSWC to continue existing programming. Our Before & After School and Day Camp Programs are the main umbrella that make up our programming structure. Through both of these programs youth are provided the opportunity to learn and grow in a safe, fun environment with the support of professionally trained mentors.

City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13

PROJECT/PROGRAM BUDGET (do not fill In shaded areas)

LINE ITEMS FOR PROJECT/PROGRAM REVENUES

LIST REVENUES/INCOME FOR PROJECT/PROGRAM
Amount of money requested from this City of Temecula $ 50,000 Community Services Grant (Not to exceed $50,000)
Amount contributed to the Project/Program by the Applicant $ 233,630 Organization
Other grants or funding already awarded for Project/Program, if any $ 38,900 CDBG; CSF; RCTC; TJX FOUNDATION; UNITED WAY; NANO BANK
In -Kind match amount or volunteer credit hours estimated amount $ TOTAL REVENUE $ 322,530

LIST OF EXPENSES FOR PROJECT/PROGRAM
Tools/Equipment INCLUDING SAFETY EQUIPMENT
Facilities/Rent/Insurance " lI�IV�J!\/�IYVC - VV-Nr-MML

LIABILITY/PROPERTYM/ORKERS COMP
Supplies INCLUDING PROGRAM
Marketing
Services
Food
Other INCLUDING UTILITIES; TRANSPORTATION
Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; _HOWEVER PLEASE INCLUDE.

EXPENSES
$8,520
1 $30,180 i1
$11,000
$1, 000
$4, 000
30,000
$237,830
TOTAL EXPENSES $322,530
TOTAL BUDGET $322,530 $322,530 ;
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13

Please allow time for checks to be processed.
• The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. ■ Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot.
• The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete.

I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief.

ORGANIZATION NAME: Boys & Girls Club of Southwest County MAILING ADDRESS: PO Box 892349
Temecula, CA 92589
PHONE: (951, 699-1526 x109
EMAIL: [email protected]
PRESIDENT/AUTHORIZED OFFICER: Carly Bennett -Valle

PRI,V F
L-7
SIGNATURE: jf�7)-_

IF DIFFERENT THAN ABOVE,
APPICATION PREPARED BY:

DATE: 9/11 /22

CEO/CFO
TIM-F
!v"ofi l,, No, YFAR
rL_
SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO:

Q HELPO MENU
Home > Tax Exempt 0 ganization Search > Boys & Girls Club Of Southwest County < Back to Search Results
Boys & Girls Club Of Southwest County
EIN: 33-0475756 1 Murrieta, CA, United States
Other Names
Publication 78 Data o
Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions.

On Publication 78 Data List: Yes
Deductibility Code: PC
Copies of Returns (990, 990-EZ, 990-PF, 990-T) o
Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non- profits.

Tax Year 2019 Form 990
Tax Year 2018 Form 990
Tax Year 2017 Form 990
Tax Year 2016 Form 990

STATE OF CALIFORNIA

FRANCHISE TAX BOARD
FTB PO BOX 942957
SACRAMENTO CA 94257-0540
Entity Status Letter
Date: 9/12/2022
ESL ID: 5296811263
Why You Received This Letter
According to our records, the following entity information is true and accurate as of the date of this letter.

Entity ID: 1671809
Entity Name: BOYS & GIRLS CLUBS OF SOUTHWEST COUNTY
X❑ 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. 0 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process.

The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b).

Connect With Us
Web: ftb.ca.gov
Phone 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States
California
Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019)

EXTENDED TO NOVEMBER 15, 2021
Return of Organization Exempt From Income Tax OMB No. 1545-0047 Form 99D Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) 21320 Department of the Treasury ■ Do not enter social security numbers on this form as it may be made public. pen to Pub] lc Ininnal Revenuesevrce Go to www.irs . ov/Form990 for instructions and the latest information. Inspection A For the 2020 calendar year, or tax year beginning and ending 8 chock n C Name of organization D Employer identification number appllrnbfe:
®Gik"e BOYS & GIRLS CLUB OF SOUTHWEST COUNTY
[]mange Doing business as 3 3- 0 4 7 5 7 5 6
�Initlal
rsturn Number and street (or P.O. box if mail is not delivered to street address) Roam/suite E Telephone number Dictum/ 25090 JEFFERSON AVE SUITE A 951-699-1526
termfn-
aled City or town, state or province, country, and ZIP or foreign postal code G Grosso, mjo+ T $ 1 , 0 9 8 , 2 4 6 .

Amended MURR I ETA CA 9 2 5 6 2 return H(a) Is this a group return Otronlina- F Name and address of principal officer: AMANTE P�,ie1rg P P for subordinates? .,-.., DYes ®No
25090 JEFFERSON AVE STE A, MURRIETA, CA 925 H(b) Are all subordinates included70Yes ONo Tax -axe m t status: W 501(c)(3) Q 501 c) }■ Insert no.) 4947(a)(1) or 527 If "No," attach a list. See instructions J Website, ■ WWW . BGCSWC . ORG H c Group exem Lion number K Form of orolnixation: LX1 Corporation I I Trust I I Association 1 7 other■ I L Year of formation: I QQn M et of Is al domicile: CA 1 Briefly describe the organization's mission or most significant activities: THE MISSION OF THE BOYS & GIRLS to

CLUB OF SOUTHWEST COUNTY IS TO INSPIRE, ENABLE, AND SUPPORT ALL 2 Check this box ■ !. 1 if the organization discontinued its operations or disposed of more than 25% of its net assets. 3 Number of voting members of the governing body (Part VI, line 1 a) 3 22 ,e
4 Number of independent voting members of the governing body (Part VI, line 1 b) ,. ,,...., 4 22 5 Total number of individuals employed in calendar year 2020 (Part V, line 2a) 5 6 Total number of volunteers (estimate if necessary) ,.. 6 a7
a Total unrelated business revenue from Part VIII, column (C), line 12 7a 0. b Net unrelated business taxable income from Form 990-T, Part I, line 11................................ .... 7b 0.

Prior Year
Current Year
d
8 Contributions and grants (Part VIII, line 1 h)
686,867.
9 Program service revenue (Part VIII, line 2g) ....773,433. 225 , ,
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d)

0. 7 , 5 21 .
15 9 ,
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) .... 12 Total revenue - add lines 8 through 11 (must equal Part VIII, column A , line 121 , ,
, 683,527.
13 Grants and similar amounts paid (Part IX, column (A), lines 1.3)

0. 14 Benefits paid to or for members (Part IX, column (A), line 4) -67
in
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5.10) 1 , , 9 2 2 .
,
r
16a Professional fundraising fees (Part IX, column (A), line 11 e) .., _

0. b Total fundraising expenses (Part IX, column (D), line 25) ■ 16 7 , 3 3 6 .

W
17 Other expenses (Part IX, column (A), lines 11 a-11 d, 11 f-24e) 7 18 Total expenses. Add lines 13.17 (must equal Part IX, column (A), line 25) ...... 1,952,
--f712,449.
19 Revenue less ex erases. Subtract line 18 from line 12................. ............... ....... .„__.._ -1 3 , $ 2 .
— 32 , 9 22 .

N
Beginning of Current Year
End of Year
�; R
20 Total assets (Part X, line 16)
2,140,262.

Sa Sa
21 Total liabilities (Part X, line 26)
126,060.
2 3 0 7M.
985,2W
22 Net assets or fund balances. Subtract line 21 from line 20 . ..... ...ZP. w. ....

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than olliter) is based on all information of which preparef has any knowledge. —10 Sign Iglu ure o officer Date
Here \ STEVE AMANTE, TREASURER
ype or print name and title
Print/Type preparer's name Preparer's signature a e Check PTIN Paid 3REGORY J. PRUDHOMME , CPA if r ern to ed 0 0 2 3 4 5 2 5 Preparer Firm's name b, PRUDHOMME ASSOCIATES CPAs^ , INC. Firm's EIN Use Only Firm's address ■ 43460 RIDGE PARK DRIVE, SUITE TEMECULA , CA 92590 Phone no. ( 9 51) 6 7 6— 3131
May the IRS discuss this return with the preparer shown above? See instructions X 1 Yes I 7 N, 032001 12-23-20 LHA For Paperwork Reduction Act Notice, see the separate instructions. Form 990 (2020) SEE SCHEDULE 0 FOR ORGANIZATION MISSION STATEMENT CONTINUATION

FY 2022/2023

COMMUNITY SERVICE FUNDING

REINVESTMENT IN TEMECULA
GRANT APPLICATION #
10 CADENZA

STRING ORCHESTRA

CITY OF TTwMEC[)LA►
FISCAL YEAR 2022 - 2023

COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA

PROGRAM APPLICATION
(Please Print or Type)
DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022

I PROJECT/PROGRAM INFORMATION
Amount Requested: $ ,wj al) MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: Y&,An I��iS�Oan el f+� FU14
p Start Date
Physical Address of Project) rogram: _a1g1
1011/2012 End Date: 51,3112&'Z
fog
INCLUDE IF DIFFERENT THAN ORGANIZATION's MAILING
If Grant is Awarded, Make Check Payable to: OIJOI ��IrI(k (90 Mailing Address:

ORGANIZATION AND GEOGRAPHIC AREA SERVED
Name of Applicant rr __
Organization: TTtri ord�Iym Year Founded: 2��g
Website A CG YI S7iI r ICY S Social Media: _ f0c_&b&V[<', _hidaCj�Gt1l� Number of Paid Staff:J Number of Volunteers:

Geographic Area(s) the Organization Serves: �tlVet ids GUA Geographic Area(s) the Proiect/Program Serves: efil eL(l NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE E_XCL�U$IVELY USED TO SERVE TEMECULA.

Contact Name: 1 oZ cQGlI r) Title/Position: Tr' 5( fer

0. Contact Person's Direct Telephone: �`1oWkontact Person's Email: 2-C-CO IiQ4 �•

NONPROFIT STATUS
Is this organization incorporated as a nonprofit? Yes [Date of Incorporation as a Nonprofit: - A •24a No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING
Federal Identification Number: 93 �O State Identification Number: _c q tg6Jr0q PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS:

1. [Attach IRS Deductibility Status using this link: I7tt ./icif12ti +I-, oovlapL/eos/

2. Attach State Entity Status Letter using this link:
itttfls IIwwW Ill) C&A.'JOV/r,rilinelself serve elitity statLIS letter/index-asp

3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: �7.rtt3 I�rC! dci.ca.croylVerifips;tir:��IW Y�I;r:�rr..l7.aspx?facility=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13

Is a 7Yes
ula City Council Member a member of the Board of Directors or an Officer of the organization? No
❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION:

This Application has been authorized by the organization's:

Executive Committee ❑ Board of Directors ❑ Members -at -Large

I MISSION STATEMENT OF ORGANIZATION

BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES I 10, rudel lxu�)(d ed-vt0honl arvt
f(9 ut1fI h Gall
7 FINANCIAL STATEMENTS

City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13

FUNDING SOURCES
CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No /Yes ❑ IF YES, PROVIDE BELOW,
NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT

FUNDED BY THE CITY GRANTOR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP 8 OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? No ❑ Yes IF YES, PROVIDE INFORMATION IN TABLE BELOW
AMOUNT MONTH + YEAR

RECEIVED NAME OF ENITY

FUNDING RECEIVED
$ - )and 6061- hs istrxu
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13

GRANT PROJECT/PROGRAM DESCRIPTION

IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT

FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT 1� /b 4 /rcuc /& /xz* a
100i ►'rru�L
far V 7Lh a nrura��i
kc
2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED.

ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. —

1.cC�
punt
4Y
n�
,,4 y
3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING.

EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS win
% U C c • r� �' a, i ��r tea C-#Ip
3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 30
3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: X City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13

PROJECT/PROGRAM DESCRIPTION

CONTINUED
4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. �l (v19all a �t ► 11.a1 f�1 u G V f �1 a I� ,u�E�LI •
� tit
flan/ &ljW*c/ Gov �$ ' f-eir ��h�c�cPA• l��P�, .
/Atp �4-0 OW aakl la�, 49- 6enhaf,
5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC

AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS.

IIlCGi '�
0 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL:
(1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM.

W d loam >f f0 AcZ-1nalitc, tex-Aw v
kticlvo n r c-
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13

PROJECT/PROGRAM BUDGET (do not fill in shaded areas)

LINE ITEMS FOR PROJECT/PROGRAM REVENUES

EXPENSES

LIST REVENUES/INCOME FOR PROJECT/PROGRAM
Amount of money requested from this City of Temecula
$/a ��
Community Services Grant (Not to exceed $50,000)
Amount contributed to the Project/Program by the Applicant $
VVD
Organization
Other grants or funding already awarded for Project/Program, if any $
In -Kind match amount or volunteer credit hours estimated amount $ / ' m

TOTAL REVENUE
$ /tj� 6VD

LIST OF EXPENSES FOR PROJECT/PROGRAM
Tools/Equipment
$
$
5�
Facilities/Rent/Insurance
Supplies
$
it 6M
Marketing
$
/I6M
Services
$
.150v
$
Food
Other
$
1i5�
Staffing Expense
THIS 15 INELIGIBLE TO BE FUNDED BY CITY'S GRANT;
$
HOWEVER PLEASE INCLUDE.
_

TOTAL EXPENSES

TOTAL BUDGET
$
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13

i -
PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT
*IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21/22 (LAST YEAR), THEN SKIP THIS PAGE.

If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information.

If the funds were not spent in accordance with the approved/awarded application, the organization will be regUired to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022.

1. Fill out table below (make additional copies if needed to explain all expenditures.)

2. Attach copies of receipts/invoices (in the same order as listed in this table.)

3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022
Organization:

FY 2021-2022 Amount of $
CSF Grant Fund Awarded:

Name of Project/Program:

Month & Year CSF Grant Received from City:

Number of Beneficiaries Living in 92690, 92691, 92692 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number):

Date on Expenditure
E Name of Company Receipt/invoice
Eon Receipt or Invoice MUST BE ON OR BETWEEN Amount Description Purpose a = JULY 1, 2021 - JUNE 30. 2022 DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE i
I
2 I
3 4
5 0
EXPENDITURE TOTAL .P EXPENDITURE TOTAL MUST BE EQUAL TO { (OR GREATER) THAN TOTAL AWARD AMOUNT i1
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13

FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT
If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 b the Cit of Temecula, follow these instructions.

If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds From the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page.

1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures.

A. If awarded $6,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.)
B. If awarded grant funds exceeding $6,000. A) Follow #1,A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $1 DK). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds.

2. Attach copies of receipts/invoices (in the same order listed in table below).

3. Send to
Organization:

City of Temecula, 41000 Main St., Temecula, CA 92690,
Attn: City Manager's Dept. "CSF-Reinvestment in Temecula"

EXPENDITURE REPORT DATED
Name of Project/Prog
TOTAL FY 2022-2023 Month & Year FIRST $5,000 check
Amount of Grant Fund Awarded: $. was received from City:

1. Is this Expenditure Report is to provide documentation for first $6,000 awarded and received? Yes_ or No (already submitted).

2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City

3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92690, 92691, 92692 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) E Name of Company
az on Receipt or Invoice
I
2 3
Date on
ReceiptlInvoice

MUST BE ON OR BETWEEN
March 20, 2020 - JUNE 30.
2024

EXPENDITURE TOTAL
Expenditure

MUST SUPPORT PROJECTIPROGRAM IN APPLICATION & AWARD LETTER Amount Description Purpose
W I

EXPENDITURE TOTAL
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13

Please allow time for checks to be processed.
• The awarding of Community Service Funding does not constitute an automatic annual allocation.

The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot,
• The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement.

I/we hereby certify the information contained in this Application is true to the best o^f our knowledge and belief.
�j 1
ORGANIZATION NAME: Lalrn1 . Av iJ►G�ii L ISfr
MAILING ADDRESS:

C'erf 01c
mu
7 EMAIL:

PRESIDENT / AUTHORIZED OFFICER:

PHONE: (&) --c-)400m.3
SIGNATURE: DATE: o

IF DIFFERENT THAN ABOVE,
APPICATION PREPARED BY:

SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO:

City of Temecula
Community Service Funding
Attn: City Manager's Office
41000 MAIN STREET
TEMECULA, CA 92590
Questions: Stacey. [email protected] (951) 694-6413
Betsy. [email protected] (951) 693-3959
I,c&n
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13

STATE OF CALIFORNIA

FRANCHISE TAX BOARD
FTB PO BOX 942857
SACRAMENTO CA 94257-0540
Entity Status Letter
Date: 9/7/2022
ESL ID: 1281837848
Why You Received This Letter
According to our records, the following entity information is true and accurate as of the date of this letter Entity ID: 4196509
Entity Name: CADENZA STRING ORCHESTRA
0 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. ® 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process.

The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b).

Connect With Us
Web: ftb.ca.gov
Phone: 800-852-5711 from 7 a m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States
California
Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019)

INTERNAL REVENUE SERVICE
P. O. BOX 2508
CINCINNATI, OH 45201
Date: WAY 2 0 2019

CADENZA STRING ORCHESTRA

C/O SANDIWA DEL ROSARIO
31927 CORTE POLLENSA
TEMECULA, CA 92592-0000
Dear Applicant:

DEPARTMENT O? THE TREASURY'
Employer Identification Number:
83-4606030
DLN:
26053530002529
Contact Person:

CUSTOMER SERVICE ID# 31954
Contact Telephone Number:
(877) 829-5500
Accounting Period Ending:

May 31
Public Charity Status:
170(b) (1) (A) (vi)
Form 990/990-EZ/990-N Required:

Yes
Effective Date of Exemption:

September 20, 2018
Contribution Deductibility:

Yes
Addendum Applies:

No
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 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 114221-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.

Lette-- 947

HOME ABOUT MEDIA CAREERS REGULATIONS RESOURCES PROGRAMS CONTACT Registrant Details
Entity type: Corporate Class as registered wlth the Secretary of State or based on founding & reglstratlon documents, Mailing Address
Filings & Correspondence
Annual Renewal Data
Related Registrations & Event Reports
The related records shown below depend on the record type being viewed:
• Charity Registrations relate to Professional Fundralsing Events which relate to Professional Fundralser Registrations. • Raffle Reglstratlons relate to Raffle Reports.
• Click on the RCT Registration No to navigate to the related record.

FY 2022/2023

COMMUNITY SERVICE FUNDING

REINVESTMENT IN TEMECULA
GRANT APPLICATION #
11 CANINE SUPPORT TEAMS INC.

CITY OF TE ECUTA
FISCAL, YEAR 2022 M 2023

COMMUNITY SERVICE FUNDING M REINVESTMENT IN TEMECULA

PROGRAM APPLICATION
(Please Print or Type)
DUE ON OR BEFORE: MOND", SEPTEMBER 12, 2022
Amount Requested: $
Project/Program Title

PROJECT/PROGRAM INFORMATION I
50,000
MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION
PAWZ for Wounded Veterans Program
Physical Address of Project/Program:

Start Date: 01 1 3 End Date: 12/31/23

INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Canine Support Teams, Inc.

Mailing Address: 24480 Jenny Ln, Murrieta, CA 92562

I ORGANIZATION AND GEOGRAPHIC AREA SERVED I
Name of Applicant
Organization: Canine Support Teams Inc. Year Founded: 1989 F: @caninesupportteamsl I: @k9supportteams/
Website: caninesu ortteams.or Social Media: Ts QKgSuponrtTeams Number of Paid Staff:

Number of Volunteers: 40+
Geographic Area(s) the Organization Serves: Southern California 84%, AZ, CO, HI, ID, NV, OR, TX, and WA Geographic Area(s) the Project/Program Serves: Southern California 87% and HI, NV, OR, TX, WV NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA.

Contact Name: Judy Hernandez Title/Position: Client Service/Donor Relations/Admin.

Contact Person's Direct Telephone: _951 301-3625 Relations/Administration Contact Person's Email: [email protected]

NONPROFIT STATUS
Is this organization incorporated as a nonprofit? Yes ® Date of Incorporation as a Nonprofit: 1991 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING
Federal Identification Number: 33-0434821 State Identification Number: 1484828 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS:

1. ❑ Attach IRS Deductibility Status using this link: htto://aQps,irs.gov/aPPleos/

2. ❑ Attach State Entity Status Letter using this link:
httos:// www.ftb.ca.gov/online/self serve entity status letterlindex.as

3. ❑ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: http_1/rct.dQi.ca,aavNedfica$ionM 1Search.aspx?facility=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13

Is a Temecula City Council Member a member of the Board of Directors or fficer of the organization? No® Yes ❑ IF YES, PROVIDE COUNCIL MEMBERS NAME AND TITLE WITHIN THE ORGANIZATION:

This Application has been authorized by the organization's:

Executive Committee ❑ Board of Directors ® Members -at -Large ❑

MISSION STATEMENT OF ORGANIZATION
BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES.

Mission: To provide specially trained dogs to persons with disabilities to support their personal, social, and occupational independence.

Canine Support Team's (CST) goal is to place 30 dogs annually with individuals who have various disabilities including, but not limited to, multiple sclerosis, cerebral palsy, cystic fibrosis, traumatic brain injury (TBI), spinal cord injury, post -traumatic stress disorder (PTSD), and limited mobility. By delivering expertly trained service dogs, we seek to provide disabled individuals with enhanced mobility, independence, and companionship. CST accomplishes this by individually training each dog to assist with: walking with and beside a wheelchair or walker, retrieving dropped items, turning lights on and off, opening and closing doors, pressing elevator buttons, pulling off socks and sweaters, and barking to alert for help in emergencies, and serving as an ice -breaker in public situations. For eligible veteran clients, CST provides the service dog at no cost to the recipients.

FINANCIAL STATEMENTS

UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT, DO NOT SUBMIT NOW.

City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13

FUNDING SOURCES
CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes X❑ IF YES, PROVIDE BELOW.

NAME OF PROGRAM/PROJECT

FUNDED BYTHE CITY GRANT OR SPONSORSHIP
AMOUNT
MONTH + YEAR

FUNDING RECEIVED

NAME OF CITY GRANT

OR SPONSORSHIP
PAWZ for Wounded Veterans
$ 5,491.75
September 2020
City of Temecula
OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? NO ❑ Yes R IF YES, PROVIDE INFORMATION IN TABLE BELOW,
AMOUNT

RECEIVED

NAME OF ENITY
MONTH + YEAR

FUNDING RECEIVED
$ 15,000
California Relief Grant Program
March 2021
$ 2,800
Fredrick and Lorine Taylor Foundation
September 2020
$ 15,000
Mary Jo & Hank Greenberg Animal Welfare Foundation
November 2020
$ 10,000
Inland Empire Community Foundation
October 2020
$ 5,000
Linda I. Smith Foundation
November 2020
$3,500
Sidney Stern Memorial Trust
May 2021
$5,000
The Armrod Charitable Foundation
May 2021
$ 525,827
Wounded Warriors Service Dog Program (US Treasury)
January 2022
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13

GRANT PROJECT/PROGRAM DESCRIPTION

IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT

FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE I DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT.

CST launched the PAWZ for Wounded Veterans Program to address the increasing number of men and women who, after serving our country in the United States military, require a service dog (SD). At no cost to the recipients, CST trains service dogs to support disabled veterans who are seeking enhanced mobility, independence, and companionship. Whether their disability is obvious or invisible, CST is committed to helping veterans reclaim their independence.

At around 8 weeks, SDs are placed with Volunteer Puppy Raisers (VPR), who work directly with CST trainers to socialize the puppies through outings and experiences (e.g-, navigating restaurants and shopping centers, using public transportation, processing through TSA, handling crowded events, etc.) VPRs participate in CST -led trainings twice per month. At 18 months, dogs enter Advanced Training (AT) with our Inmate Trainers (IT) through our Prison Pup Program. SDs learn the specific tasks necessary to support a disabled client. ITs meet weekly for training sessions with CST's professional trainers. After AT, dogs are matched with disabled veterans and start the t 0-day Team Training at CST's facility. Upon completion, the dog and veteran receive the Assistance Dogs International (ADI) Public Access Certification.

For the "working life" of their SDs, clients are encouraged to contact CST for supplemental training and required to complete a CST Veterinary Health Certificate and to recertify with ADI. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED.

ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT.

The funds provided by this grant will help CST to provide two additional Temecula veterans with a service dog. It costs an estimated $25,000 to prepare a dog for a life of service. The bulk of CST's expenses are related to the physical care and training of our service dogs. The money awarded will pay for the training, training equipment (e.g., leashes, collars, harnesses, vests, and training tools), canine care equipment (e.g., grooming equipment, crates, microchips, housing), dog food, supplies for the advanced training program (e.g., training treats, consumable tools, equipment), kennel supplies (e.g., food dishes, storage containers, specialized cleaning supplies), and veterinary care and prescriptions (e.g., monthly flea, tick, and heartworm pills, general health, and emergency illnesses).
3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING.

EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS.

According to the CDC, one in four adults in the U.S. has a disability, including impairments with vision, hearing, mobility, and cognition. These individuals face many challenges, particularly relating to their access to quality jobs, education, and other social functions. Yet, with the assistance of expertly trained service dogs, disabled individuals have been able return to the activities that enrich their lives. For instance, one recent study concluded that "vets with service dogs reported a 22 percent higher rate of life satisfaction, as well as similarly increased rates of mental health, resilience, and ability to participate in social activities." This same study also found that veterans with service dogs "indicated having fewer post -traumatic stress disorder (PTSD) symptoms and lower levels of depression." (rebootcamp.militarytimes.com) The City of Temecula has more than 8,000 veterans, of which more than 6,000 are under the age of 64. With the generous funding from this grant, CST will be able to provide two additional veterans from Temecula with a professionally trained service dog to help support their personal, social, and occupational independence. Furthermore, CST currently has 7 other veteran clients who reside in Temecula, who we will be able to continue to provide supplemental training and re -certify with ADI.
3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 1 9
3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 1 10 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13

PROJECT/PROGRAM DESCRIPTION

CONTINUED
4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS.

At no cost to the recipient, CST's PAWZ program trains dogs to support disabled veterans who are seeking enhanced mobility, -independence, -and -companionship. —This -grant will-help-OST-provide-two-Temecula-veterans-with-a service-d costs an estimated $25,000 to prepare a dog for a life of service. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC

AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS.

Due to California COVID state mandates, which precluded CST from meeting with clients, conducting the prison training program, and holding our Team Training intensives, our number of placements declined for 2020, Beginning in July 2020, we were able to resume training in a limited capacity (1:1 team trainings) and were pleased to place eight dogs with veterans in such a short time. In 2021, ten dogs were placed with veterans. Again, COVID restrictions hampered our ability to conduct much of our advanced training, especially within the prison. Today, we are back to our pre-COVID placement levels with an anticipated 30 dogs being placed with veterans this year.

It should be noted, that while we were under COVID restrictions, CST did take a number of steps to ensure the safety and well-being of our clients, pups, and staff. Most notable, CST initiated supplemental, specialized virtual training, including:
(1) helping clients with PTSD mitigate symptoms being exacerbated by their isolation using their service dog; (2) offering new methods for navigating stores and for exercising with social distancing; and (3) providing solutions, especially for those suffering from compromised immune systems, for caring for their dog and themselves. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL:
(1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM.

The approximate cost to raise and train a dog for a life of service is $25,000. Over the next year, CST will identify two eligible veterans from within Temecula who would benefit from the partnership of a service dog. With the generous funds provided by the City of Temecula, CST will be able to provide these two individuals with an expertly trained service dog at no cost to the individual.

City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13

PROJECT/PROGRAM BUDGET (do not fill in shaded areas)
LINE ITEMS FOR PROJECT/PROGRAM j REVENUES EXPENSES

LIST REVENUES/INCOME FOR PROJECT/PROGRAM
Amount of money requested from this City of Temecula $50,000 Community Services Grant (Not to exceed $50,000)
Amount contributed to the Project/Program by the Applicant Organization
Other grants or funding already awarded for Project/Program, if any In -Kind match amount or volunteer credit hours estimated amount $
$ 525,827
$

TOTAL REVENUE
$575,827

LIST OF EXPENSES FOR PROJECT/PROGRAM
Tools/Equipment
Facilities/Rent/Insurance
Supplies
$ 47,040
$ 57,680
$ 8,080
Marketing
$68,800
Services
$ 60,320
Food
Other
$18,690
Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE.

TOTAL EXPENSES

TOTAL BUDGET
$218,250
$478,940
$
$478,940
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13

PREVIOUS` FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT
IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21/22 (LAST YEAR), THEN SKIP THIS PAGE.

If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information.

If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to -substantiate how funds received -from the City were Spent: - If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022.

1. Fill out table below (make additional copies if needed to explain all expenditures.)

2. Attach copies of receipts/invoices (in the same order as listed in this table.)

3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022
Organization:

FY 2021-2022 Amount of $
CSF Grant Fund Awarded:

Name of Project/Program:

Month & Year CSF Grant Received from City:

Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number):

Date on
£ Name of Company Receipt/Invoice
E on Receipt or Invoice MUST BE ON OR BETWEEN Amount
JULY 1, 2021 - JUNE 30, 2022
QZ
Lt I
3 4
5 6

EXPENDITURE TOTAL
diture
Description

DESCRIBE THE EXPENDITURE
Purpose

PURPOSE OF EXPENDITURE

EXPENDITURE TOTAL MUST BE EQUAL TO
(nR r,RFATFRI THAN TnTAI AWARrI AAAnI IMT
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13

FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT
If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these instructions, If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024, In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up domimentatinn innliidin0 the tahle below with accompanying receipts/invoices, must be submitted to the City as outlined on this page.

1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures.

2. Attach copies of receipts/invoices (in the same order listed in table below).

3. Send to
Organization:

City of Temecula, 41000 Main St., Temecula, CA 92590,
Attn: City Manager's Dept. "CSF-Reinvestment in Temecula"

EXPENDITURE REPORT DATED
Name of Project/Program-
TOTAL FY 2022-2023 Month & Year FIRST $5,000 check
Amount of Grant Fund Awarded: $ was received from City:

1. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted).

2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City

3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number] E Name of Company
Eon Receipt or Invoice
Q Z
2 Date on
Receipt/Invoice

MUST BE ON OR BETWEEN
March 20, 2020 - JUNE 30,
2024

EXPENDITURE TOTAL
Expenditure

MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER Amount I Description I Purpose

EXPENDITURE TOTAL
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13

ACKNOWLEDGEMENT/SIGNATURE PAGE
The applicant acknowledges and agrees to the following:
• Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements.
• Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval, Please allow time for checks to be processed.
• The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot.
• The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete.

I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief.

ORGANIZATION NAME: Canine Support Teams, Inc.

MAILING ADDRESS: 24480 Jenny Ln, Murrieta, CA 92562
951-301-3625
PHONE: ( )
EMAIL- cstmain@caninesupportteams,org
PRESIDENT / AUTHORIZED OFFICER: _ C O- fuk QQQ jAQ,1nQf L _

PRINT NAME TITLE
SIGNATURE• PTE: a-x

MONTH, DAY, YEAR

IF DIFFEREN THAN ABOVE,
APPICATION PREPARED BY: Nye 5 -t &figu—

PRINT NAME TITLE
SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO:

City of Temecula
Community Service Funding
Attn: City Manager's Office
41000 MAIN STREET
TEMECULA, CA 92590
Questions: [email protected] (951) 694-6413
[email protected] (951) 693-3959
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13

Q HELPO MENU
Home > Tax Exempt Organiza#ion Search > Canine Support Teams Inc. aI: s I : M
Canine Support Teams Inc,
E I N: 33-0434821 1 M u rri eta, CA, United States
Other Names
Publication 78 Data
Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions.

Tax Year 2019 Form 990
Tax Year 2018 Form 990
Tax Year 2017 Form 990
Tax Year 2016 Form 990

Page Last Reviewed or Updated: 20-November-2020 r# Share $ Print

STATE OF CALIFORNIA

FRANCHISE TAX BOARD
PO BOX 942857
SACRAMENTO CA 94257-0540
Entity Status Letter
Date: 9/4/2022
ESL ID: 8084017744
Why You Received This Letter
According to our records, the following entity information is true and accurate as of the date of this letter.

Entity ID: 1484828
Entity Name: CANINE SUPPORT TEAMS, INC.

X❑ 1. The entity is in good standing with the Franchise Tax Board.

El2. The entity is not in good standing with the Franchise Tax Board.

X❑ 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d.

4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process.

The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b).

** PUBLIC DISCLOSURE COPY **
Return of Organization Exempt From Income Tax
Form 990 Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) Depart1110- Do not enter social security numbers on this form as it may be made public. tatarnatmenf of U. Bury 110� Go to www.irs.gov/FormOgO for instructions and the latest information.

A For the 2020 calendar yanr, or tax year beginning
B ctsw* if C Name of organization
,volcabW
j IMMW CANINE SUPPORT TEAMS INC.
[-6r am*!
wu a Doing business as
iavun Number and street (or P.O. box if mail Is not delivered to street address) [�],r= P.O. BOX 891767
termin-
ated City or town, state or province, country, and ZIP or foreign postal code [�A"""'�°''LN!me
ECULA CA 92589-1767
I JI�P II
�:k�inito�� and address of principal officer: CAROL ROQUEMORE Pend`' AS C ABOVE
Tax-exempt status: 501 e 3 5U 1 c ■ inswt on, 4947
J Website: Ill WWW.CANINESUPPORTTEAMS.ORG
K Farm} of or anizallon: LXj Cnrparalion Trust Association El Other 0- Part l I Sui rtmaty
and
2020
Open to Public
Inspection
D Employer identification number
33-0434821
Room/suite E Telephone number
951)-301-3625
G Glosslwolp%s 784 460.

H(a) Is this a group return
for subordinates? I J Yes X1 No
H(b) Are all suhordlnates includod? [::] Yes [::] No
r 527 If "No," attach a list. See instructions
19 9 01 M State of local domicile' CA
1 Briefly describe the organization's mission or most significant activities: CANINE SUPPORT TEAMS ( CST) IS
A
0 G
CALIFORNIA BASED NON—PROFIT ORGANIZATION THAT PROVIDES SPECIALLY c2
Check this box 0 if the organization discontinued its operations or disposed of more than 25% of its net assets. c3
Number of voting members of the governing body (Part VI, line 1 a) g
8 0
4 Number of independent voting members of the governing body (Part VI, line 1 b) 4 6
am--
w
5 Total number of individuals employed in calendar year 2020 (Part V, line 2a) ..............
5 14
14 6
Total number of volunteers (estimate if necessary) ,-
a7
a Total unrelated business revenue from Part VIII, column (C), line 12 7a

0. b Not unrelated business taxahle income from Form 990-f Part I line 11 7b
0 .

Prior Year
Current Year
650,543.
781,283.
0 8 Contributions and grants (Part VII I, line 1 h)
m9
Program service revenue (Part VIII, line 2g)
3,602.
2,950.
10 .......... ,_ ._.....................................

Investment income (Part VIII, column (A), lines 3 4, and 7d) ,,,,,, „ 752.
227.
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 1 Oc, and 11 e) ............ 8 641.
—5,
334.
12 Total revenue - add lines 8 thr h 11 must equal part Vill column (A). line 121 663, 538.
779,126.
13 Grants and similar amounts paid (Part IX, column (A), lines 1.3) _ . , .--• _

0. 0.
14 Benefits paid to or for members (Part IX, column (A), line 4) ..-- - .

0. 0.
385,795.
360,815.
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) 2 16a Professional fundraising fees (Part IX, column (A), line 1le) ,.,,, ., „ 0 .

0. n
b Total fundraising expenses (Part IX, column (D), line 25) 68 991 . 17 Other expenses (Part IX, column (A), lines 11a-1Id, 1 lf-24e) ------------ -- 304 631.
397,514
.
690 426.
758,329.
18 Total expenses. Add lines 13-17 (Must equal Part IX, column (A), line 25) 19 .--, -. • .,
Revenue less expenses. Subtract line 18 from line 12 ............. .. ........... ... ..... .. — 2 6 8 8 8 .
20,797.

Beginialno of Current Year
End of Year
20 Total assets (Part X, line 16) . _. ....
341,292.
605,226
.
10,000.
253,137
.
a 21 Total liabilities (Part X, line 26) .................. .... 22 Not assets or fund balances. Subtract fine 21 from line 20 331,292.
352,089 .
rdr4 IN I -agdglakulu 01FJU1i
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is Irue, currect, and complete. Declaration of Rreparar outer than officer is Mae on all information of which prqaftr has any knowledge.

Sign Signalum of officer Dare
Here CAROL RO UEMORE, VICE PRESIDENT/CEO
lype or print narnc and title
PrintiType preparer's name Preparer's signature 13aio ec Pl'IN Paid OVEPREET BUTTAR CPA OVEPREET BUTTAR CPI1/10/2]ilm e 01329403 Preparer Firin's name MERCAD I EN , P.C. line's N 2 2 — 3 2 71712 Use Only Firm's address P. 0. BOX 7648
PRINCETON, NJ 08543-7648 1PIwn-!ro.609--689-9700
May the iRS discuss this return with the prepare?, shown above? See irtstnrctions X1 Yes 032001 12-23-20 LHA For Paperwork Reduction Act Notice, see the separate instructions. Form 990 (2020) SEE SCHEDULE 0 FOR ORGANIZATION MISSION STATEMENT CONTINUATION

FY 2022/2023

COMMUNITY SERVICE FUNDING

REINVESTMENT IN TEMECULA

GRANT APPLICATION
12 CAUSE FUR PAWS INC

CITY OF TEMECUI[A
FISCAL YEAR 2022.2023

COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA

PROGRAM APPLICATION
(Please Print or Type)
DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022

PROJECT/PROGRAM INFORMATION
Amount Requested: $ 10,000
MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION
Cause Fur Paws Helping animals
Project/Program Title: with diabetes Start Date: 01 /01 /209�d Date: 12/1 /2022 36522 Via er e
Physical Address of Project/Program:Terniecitla r;l 9259

INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Cause Fur Paws, Inc Mailing Address: 47200 De Portola
Temecula, Ca 92592

ORGANIZATION AND GEOGRAPHIC AREA SERVED
Name of Applicant
Organization: Cause Fur Paws, Inc
Website: www.causefurpaws.org
Number of Paid Staff: 0
Year Founded: 2011
Social Media: https://Www.facebook.com/causeforpawstemect Number of Volunteers: 3
Geographic Area(s) the Organization Serves: Riverside County Geographic Area(s) the Proiect/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA.

Contact Name: Valerie Andrews
Title/Position: President
Contact Person's Direct Telephone: 951 775-7275 Contact Person's Email: vall @causeefurpaws.org

NONPROFIT STATUS
Is this organization incorporated as a nonprofit? Yes ® Date of Incorporation as a Nonprofit: 2011 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING
Federal Identification Number: 27-5415050
State Identification Number: 3354176
PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS:

1. ❑ Attach IRS Deductibility Status using this link: http://apps,irs.gov/app/� �eos/

2. ❑ Attach State Entity Status Letter using this link:
https://www.ftb.ca.gov/online/self serve entity status letter/index.asD

3. ❑ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: httQ//rcl.doi.ca.govfVrificationNVeb/Search.asnx?facility=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13

Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ® Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION:

This Application has been authorized by the organization's:

Executive Committee ® Board of Directors ❑ Members -at -Large ❑

MISSION STATEMENT OF ORGANIZATION
BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES.

To provide donated funds to veterinarians and animal hospitals that directly benefits the immediate physical well-being of animal diabetes. These funds wili help finance costs for medicine, veterinarian services and hospitalization expenses, due to the effects of diabetes on the animals and/or prevent euthanasia due to inability to meet the costs of medical care.

Upon appiication, approval and fund availability, Cause for Paws will disperse funds to pay the bill received from the veterinarian or animal hospital with eligibility criteria met and availability of funds.

To provide appropriate referrals for health or behavioral care for Animals with Diabetes.

To provide education and to inform the public about Diabetes in animals

FINANCIAL STATEMENTS

UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW, City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13

FUNDING SOURCES
CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ® Yes ❑ IF YES, PROVIDE BELOW.
f NAME OF PROGRAM/PROJECT AMOUNT MONTH +YEAR NAME OF CITY GRANT + FUNDED BY THE CITY GRANTOR SPONSORSHIP I FUNDING RECEIVED OR SPONSORSHIP I
OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13

GRANT PROJECT/PROGRAM DESCRIPTION

IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT

FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT.

Our program is to get the word out by local publications, social media outreach and direct emaili that this organization can help with the costs associated to animal diabetes. They don't need to -euthanize their pets we can help_ We have been helping for over 11 years. -We also hold a fund raiser at Oak Mountain Winery on August 21st to raise money, have a dog carnival for the dogs to enjoy and educate the people about canine diabetes, treatments and funding. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. i ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT.

We will use this money to reach out to all of the local Temecula Veterinarians, animal hospitals,pet stores and animal supply stores to let them know we will help any needy pet owners with the costs of diabetes control to include insulin, needles, glucose testing and test kits as well as precription food as long as the funds last. Helping our local pet owners. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING.

EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS.

Any animals in Temecula with diabetes will benefit with our support in paying for insulin and need special diets,vet bills and testing. The people will benefit by not only the finaciai support but the community being educated what to look for in their pets and get them help before they get very sick or loose their eyesight. The education will reach the whole community with out outreach 1 in 500 dogs suffer from diabetes.
3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM:
3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 114 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13

PROJECT/PROGRAM DESCRIPTION

CONTINUED
4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS.

It has been our goal to be_able _to_reach more_people to educate them on canine —I diabetes and let them know we are here to help financially with the treatment of their pets. We are also experienced with our own diabetic dog symptoms and treatments and help give comfort and suggestions for everyday care and giving shots to animals. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC

AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS.

During covid we were not able to do any fundraising ( it is still not easy to raise funds and get donations). The Veterinarian situation is still not good as many retired so people have long waits to get an appointment for their pets. We are able to help in referring vets that specialize in diabetes and eye issues which is common with diabetic dogs. With people having to pay higher prices for everything they don't have the fund it takes for Insulin and needles and therefore are forced to Euthanize their furry friends.That is where we come in and can pay for the services the animals need with your help. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL:
(1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM.

The funds will enable us to continue helping the animals and will give us the money to promote what we do and gain support to continue growing and helping the community, We have been self supporting for over 11 years but we want to reach everyone and not have to turn anyone down for lack of funds. We will have the fund to put together phamphl with information about canine diabetes and distribute to all local animal hospitals, Vet offices, petco etc.

City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13

PROJECT/PROGRAM BUDGET (do not fill in shaded areas)

LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES

LIST REVENUES/INCOME FOR PROJECT/PROGRAM
Amount of money requested from this City of Temecula
$
Community Services Grant(Not to exceed $50�000)-
10, 000
Amount contributed to the Project/Program by the Applicant $
Organization
1500
Other grants or funding already awarded for Project/Program, if any $
I
In -Kind match amount or volunteer credit hours estimated amount $
TOTAL REVENUE $ 11500.00

LIST OF EXPENSES FOR PROJECT/PROGRAM
Tools/Equipment
(-
$
Facilities/Rent/Insurance
$ 500
Supplies
$ 500
Marketing
$1500
Services
$
Food
1000
$
Other
Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; $
HOWEVER PLEASE INCLUDE.

TOTAL EXPENSES
$ 3500.00
TOTAL BUDGET $
$ 3500.00
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13

PREVIOUSFISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT
IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21/22 (LAST YEAR), THEN SKIP THIS PAGE.

If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may -jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent.

If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022.

1. Fill out table below (make additional copies if needed to explain all expenditures.)

2. Attach copies of receipts/invoices (in the same order as listed in this table.)

3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022
Organization. _ Name of Project/Program:

FY 2021-2022 Amount of $
CSF Grant Fund Awarded: Month & Year CSF Grant Received from City:

Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number):

E d Date on Expenditure
e Name of Company Receipt/invoice
Description Purpose
Q Y z' on Receipt or Invoice MUST BE ON OR BETWEEN Amount I DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE JULY 1, 2021 - JUNE 30. 2022
5 $
I
6 $
EXPENDITURE TOTAL $

EXPENDITURE TOTAL MUST BE EQUAL TO
(OR GREATER) THAN TOTAL AWARD AMOUNT
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13

If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation, Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount -of -funds-to-the-City-.To-substantiate-that-grant funds-from-the--City-are-spent-appropriatelyi-proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page.

1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures.

2. Attach copies of receipts/invoices (in the same order listed in table below).

3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula"

EXPENDITURE REPORT DATED
Organization: _ Name of Project/Program:,. ,
TOTAL FY 2022-2023 Month & Year FIRST $5,000 check
Amount of Grant Fund Awarded: $ was received from City:

1. Is this Expenditure Report Is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted).

2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City

3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92590, 92691, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) -
a) Date on Expenditure
t W Name of Company Receiptlinvoice MUST SUPPORT PROJECT/PROGRAM IN APPLICATION &AWARD LETTER E on Receipt or Invoice MUST BE ON OR BETWEEN
Q Z March 20, 2020 - JUNE 30, 2024 Amount Description Purpose 1 011
Ea J
-I.. --L$ I
EXPENDITURE TOTAL $ EXPENDITURE TOTAL
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13

Every Community Service Funding application is considered individually and on its own merit. ■ Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval.

Please allow time for checks to be processed.

The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot,
• The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete.

I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief.

ORGANIZATION NAME:.l12��
MAILING ADDRESS: t PHONE:

EMAIL
PRESIDENT / AUTHORIZED OFFICER:11`r.T['t�%�,

PRINT NAME
SIGNATURE: )J41t�Q.

IF DIFFERENTTHAN ABOVE,
APPICATION PREPARED BY:

DATE: 7 1:;�.I q Q,—
SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO:

STATE OF CALIFORNIA
Tpp FRANCHISE TAX BOARD
FIR PO BOX 942857
SACRAMENTO CA 94257-0540
Entity Status Letter
Date: 7/2/2022
ESL ID: 2469901519
Why You Received This Letter
According to our records, the following entity information is true and accurate as of the date of this letter.

Entity ID: 3354176
Entity Name: CAUSE FUR PAWS, INC.

1. The entity is in good standing with the Franchise Tax Board.

2. The entity is not in good standing with the Franchise Tax Board.

3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d.

4. We do not have current information about the entity.

5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process.

The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b).

INTERNAL REVENUE SERVICE
P. O. BOX 2508
CINCINNATI, OH 45201
Date: QEPZ52o11

CAUSE FUR PAWS INC
-- C-/O-VALERI-EANDREWS
47200 DE PORTOLA
TEMECULA, CA 92592
Dear Applicant:

DEPARTMENT OF THE TREASURY
Employer Identification Number:
27-5415050
DLN:
17053227305011
Contact Person:

YVONNE-LIGGET-T ID9 31296
Contact Telephone Number:
(877) 829-5500
Accounting Period Ending:

December 31
Public Charity Status:
509 (a) (2)
Form 990 Required:

Yes
Effective Date of Exemption:

January 25, 2011
Contribution Deductibility:

Yes
Addendum Applies:

No
We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records. organizations exempt under section 501(c)(3) of the Code are further classified as either public charities or private foundations. We determined that you are a public charity under the Code section(s) listed in the heading of this letter.

Please see enclosed Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, for some helpful information about your responsibilities as an exempt organization.

Enclosure: Publication 4221-PC
Sincerely,
Lois G. Lerner
Director, Exempt Organizations
Letter 947 (DO/CG)

W
2021 - 990-N (e-Postcard) ACCEPTANCE LETTER
Form 990-N (e-Postcard) Online Filing
Congratulations! Your 2021 tax return has been accepted by the IRS. Thank you for preparing your exempt tax return, IRS Form 990-N, with ExpressTaxExempt. Your return information is listed below and we hope you had a pleasant experience e-filing with ExpressTaxExempt.

FORM INFORMATION
TAX YEAR: 2021
IRS SUBMISSION ID: 32101820220322000136

TAXPAYER INFORMATION
NAME: Cause Fur PAws Inc
DBA NAME: Cause Fur Paws
ADDRESS: 47200 De Portola Rd
STATE/COUNTRY: California
PHONE: (951) 767-2116
RETURN ID: 4B00032229517-4
E-FILE TIME STAMP: 2/1/2022 2:03:58 PM
TAX ID: 27-5415050
CITY: Temecula
ZIP: 92592
EMAIL: [email protected]

PLEASE PRINT A COPY OF THIS LETTER FOR YOUR RECORDS
Thank you again for your business. If you have any questions or need any assistance, please contact our customer support via live online chat, email at [email protected], or by phone at 704-839-2321. We're here to help!
Sincerely,
ExpressTaxExempt Support Team
(704)839-2321
[email protected]
Span Enterprises • (704) 839-2321 • 2685 Celanese Road Suite 103 • Rock Hill, SC - 29732

Rie-gustrant
Details
Organization Name: CAUSE FUR PAWS, INC.

IRS FEIN:
275415050
Entity Type: Public Benefit
SOS/FTB Corporate/Organization Number:
3354176
Registry Status: Delinquent
Renewal Due/Exp. Date:
5/15/2018
RCI' Registration Number: CT0251190
Issue Date:
7/17/2017
Record Type: Charity Registration
Effective Date:
7/17/2017
Date of Last Renewal:

DBA:

Ma hog Address
Strect: 47200 DE PORTOLA
Street Line 2:

City, State Zip: TEMECULA CA 92592
F;4rVi v gs &
Corriespond ence
, sing Reports Letter
Missing Reports Letter
Incom
Incomplete RRF-I Letter
Founding Documents
Founding Documents
ConCrttifltign of Registration j,,etter
Confirmation of Registration Letter
Form RRF-1
2020
s —tDs I ir 1-Q uency Letter
Ist Delinquency Letter
,Founding Document
Click on Document Type at the Icfl to open PDF
2-].J FarM REE-1
Click on DOCrlmCnt Type at the left to open PDF
2016 E4rir1 RELI
Click on Document Type at the left to open PDF
2M Form RU-11
Click on Document Type at the left to open PDF
2414 ForM RRF=1
Click on Document Type at the left to open PDF
2012 Form RRF-1
Click on Document Type at the left to open PDF
12011 Form RRF-I
Click on Document Type at the left to open PDF
+1 ' . mL a s:

R e ' -,e w a 1`a D "„ a
Status of Filing:

Accepted
Accounting Period Begin Date:
1 /l,/201 1
Accounting Period End Date:
12/3 1 "201 I
Filing Received Date:
8;21/20I7
Form RRF-1 RejectAneomplete Reason:

Form CT-TR-I Reject/Incomplete Reason:

IRS Form 990 Reject/Incomplete Reason:

Notes From Registry Staff;
!status of Filing: �
Accepted
Accounting Period Begin Date:
l'1/2012
Accounting Period End Date:
12/31/2012
Filing Received Date:
3/21"2017

Form RRF-1 Reject/Incomplete Reason;
Form CT-TR-I Reject/Incomplete Reaso
IRS Form 990 Reject/lneomplete Reasoi
Notes From Registry Staff:

Status of Filing:

Accounting Period Begin Date:

Accounting Period End Date:

Filing Received Date:

Form RRF-1 Reject/Incomplete Reason:

Form CT-TR-I Reject/Incomplete Reasc
IRS form 990 Reject/Incomplete Reasoi
Notes From Registry Staff:

Status of Filing:

Accounting Period Begin Date. -
Accounting Period End Date:

Filing Received Date:

Form RRF-1 RejectAncomplete Reason:

Form CT-TR-1 Reject/Incomplete Reasn
IRS Form 990 RejectAncomplete Reaso►
Notes From Registry Staff:

Status of Filing:

Accounting Period Begin Date:

Accounting Period End Date. -
Filing Received Date:

Form RRF-1 Reject/Incomplete Reason:

Form CT-TR-I Reject/Incomplete Reaso
IRS Form 990 Reject/Incomplete Reason
Notes From Registry Staff:

Status of Filing:

Accounting Period Begin Date:

Accounting Period End Date:

Filing Received Date:

Form RRF-1 Reject/fneomplete Reason:

Form CT-TR-I Reject/Incomplete Reaso
IRS Form 990 Reject/Incomplete Reason
Notes From Registry Staff:

Status of Filing:

Accounting Period Begin Date:

Accounting Period End Date:

Filing Received Date:

Form RRF-I Reject/Incomplete Reason:

Form CT TR-1 Reject/Incomplete Reasoi
IRS Form 990 RejecOncomplete Reason
Notes From Registry Staff:

Status of Filing:

Accounting Period Begin Date:

Accounting Period End Date:

Filing Received Date:

Form RRF-1 Reject/Incomplete Reason:

Form CT-TR-I Reject/Incomplete Reaso►
IRS Form 990 Reject/Incomplete Reason;
Notes From Registry Staff:

Status of Filing:

Accounting Period Begin Date:

Accounting Period End Date:

Filing Received Date:

Form RRF-I Reject/Incomplete Reason:

Form CT-"rR-1 Reject/Incomplete Reasor

IRS Form 990 Reject/Incomplete Reason:

Notes From Registry Staff:

Status of Filing: Incomplete
Accounting Period Begin Date: 1 /1 /2020
Accounting Period End Date: 12/3 1;20)0
Filing Received Date. 8; l8i"2021
Form RRF-I Reject/Incomplete Reason:

Form CT TR-I RejecOncomplete Reason:

IRS Form 991) Reject/Incomplete Reason:

Notes From Registry Staff:

Related Registrations & Even ept �.

No Related Records

FY 2022/2023

COMMUNITY SERVICE FUNDING

REINVESTMENT IN TEMECULA
GRANT APPLICATION #
13 CULTIVATING INCLUSION INC.

CITY OF TEMECULA
FISCAL YEAR 2022.2023

COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA

PROGRAM APPLICATION
(Please Print or Type)
DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022

PROJECT/PROGRAM INFORMATION
Amount Requested: $ 7,500.00
Project/Program Title: cultivating Inclusion Inc.

MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION
Start Date: 02-02-2015 End Date: ongoing
Physical Address of Project/Program 39775 Alta Murrieta Dr., Murrieta, CA 92563 - "no mail should be sent to physical address.

INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Cultivating Inclusion Go Mary Ann Tams •• Mailing Address: 31430 Loma Linda Rd.,
Temecula, CA 92592-1604 **all correspondence needs to go to this address,

ORGANIZATION AND GEOGRAPHIC AREA SERVED
Name of Applicant
Organization: Cultivating Inclusion Inc.

Website: http:11 www.cultivatingindusionfarm.com
Number of Paid Staff. zero
Year Founded: 2015
Social Media: Facebook, Instagram
Number of Volunteers: 15 to 20
Geographic Area(s) the Organization Serves: southwest Riverside County Geographic Area(s) the Proiect/Program Serves: Southwest Riverside county NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA.

Contact Name: Mary Ann Tams Title/Position: Garden Director Contact Person's Direct Telephone: 951-296-7756 Contact Person's Email: [email protected]

NONPROFIT STATUS
Is this organization incorporated as a nonprofit? Yes ® Date of Incorporation as a Nonprofit: 06-26.2018 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING
Federal Identification Number: e2-06o9510 State Identification Number: =� "7 �3 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTEl) AS FOLLOWS:

1. XAttach IRS Deductibility Status using this link: littp:ltclpl)s.irs.gov/app/co 1

2. l)�Attach State Entity Status Letter using this link:
htt s:1/ A.ftb.ca.gov/onfine/seif serve entity status lettedindex.as

3. J9 Attach first page only of most recent IRS Form 990 # attach print out of detailed info about your charity found on this State Registry's Search Tool: ht ://rc .do'.ca. ovNeriri do /W 1 rc s x?f ilit =Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13

Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No �Z Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION:

This Application has been authorized by the organization's:

Executive Committee ❑ Board of Directors Members -at -Large ❑

MISSION STATEMENT OF ORGANIZATION
BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES.

Cultivating Inclusion is a one of a kind project that provides vocational training opportunities for youth and adults with special needs throughout our valley. We provide a job site location for day programs, two of which, Care -Rite Vocational Services and TMI Vocational Services are located in the City of Temecula. We work side by side with special needs adults as they learn how to prepare, plant, nurture and ultimately harvest produce. The feeling of satisfaction and accomplisment is palatable upon their faces- Not only do our special needs adult visitors learn the rudiments of gardening, they know that the produce they have cared for goes to local food banks. We have been able to bring nearly 1,200 Ibs of citurss and produce to St. Vincent de Paul (St. Catherine's Catholic Church chapter) and Western Eagle Foundation this year alone
Together we learn to work as a team and socialize with a bit of fun in between through snacks, games and crafts. All of the above is brought together by a wonderful group of volunteers who believe that our special needs adults involved in Cultivating Inclusion are a necessary and vital part of our community.

FINANCIAL STATEMENTS

City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13

FUNDING SOURCES
CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No kZ Yes ❑ IF YES, PROVIDE BELOW.

NAME OF PROGRAM/PROJECT

FUNDED BY THE CITY GRANT OR SPONSORSHIP
City of Temecula
AMOUNT
t
MONTH + YEAR

FUNDING RECEIVED
01-2022

NAME OF CITY GRANT

OR SPONSORSHIP
$ 5,000.00
$
Community Sery Reinvesting
in Temecula Grant
$
$
i
$
$
$
OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS

CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? No ❑ Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW
AMOUNT
MONTH + YEAR

NAME OF ENITY

RECEIVED

FUNDING RECEIVED
Heritgae Hills Event Ctr.
$ 1,000.00
01-2020
$
Inland Empire Community
9-2020
660.00
Foundation
$ 5,000.00
Lendistry - State of CA Grant Coalition - California Relief Program 02-2021
$ 1,420,00
Rodgers Seed Money
01-2021
$ 3,500.00
Vines Christian Fellowship
03-2021
$ 1,450.00
Network for Good
06-2022
Q 300.00
Vines Christian Fellowship
06-2022
06-2022
$ 217.00
The Habit - Fundraiser percentage of sales
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13

GRANT PROJECT/PROGRAM DESCRIPTION

IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT

FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT.

The Cultivating Inclusion farm is spedficatly designed for special needs adults. We literally give our special needs adult visitors the tools to care for and nurture produce In a community garden setting. We welcome adults who are part of State of California licensed day programs and students in the Adult Transition Programs in Temecula Valley USD. Together we harvest a variety of produce which in turn is donated to local food banks, i.e. St Vincent de Paul, Western Eagle Foundation and Community Mission of Hope. In this positive outdoor environment our patient volunteers work side by side with our farmhands, and when we take a break together, socializing skills are honed and enjoyed. The unique combination of co-workers is real and friendships are formed, united in a great cause to provide fresh produce to our neighbors in need- 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED.

ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT.

Keeping our landscape clear of weeds and vermin is of primary concern. Because when both of these pests are present our produce is threatened and the beauty is blighted on the property. As this is very vital, keeping our farm neat and healthy, we require both weed abatement and pest control services.

In addition, we supply our special needs adults with water, healthy Snacks, arcs and crafts, copy services for different information and adult coloring books, For promotional purposes funds are spent on flyers for events, business and post cards, Not to mention signage so that our garden is one that can be located easily. We recently had a theft of our previous heavy aluminum sign at the farm which was a $700.00 purchase.

The tools and replacements that are required of gardening is also one in which monies are spent. Along with the buying starter plants, shrubs and trees to shade our garden and provide beauty. Soils of all variety to enrich our indigenous soil are required and this too is an expense.

All in all —any resources received will be put to goad use and will very much help our farm grow 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING.

EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS.

Temecula residents who attend either a day program like Care Rite, TMI or ATP programs in TVUSD benefit from the Cultivating Inclusion farm experience Once our special needs adults walk through our garden gate they are greeted with a smile and hello. This is sometimes not always the case when they enter locations, but at the farm all are welcome and appreciated by their presence. We become friends and co-workers, bringing life to our soil and harvesting the produce, it is a sense of accomplishment that is palpable and necessary feeling for everyone to experience.
3b ESTIMATED NUMBER OF PEOPLE FROM THIS PROJECT PROGRAM FROM TEMECULA EXPECTED TO BENEFIT I 350 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: I 15to20 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13

PROJECT/PROGRAM DESCRIPTION

CONTINUED
4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS.

We are a community garden set up to teach our special needs adults about growing produce. Fresh produce that we in turn donate to fellow neighbors in need of fresh food who welcome afresh alternative In this growing process we we show our special needs adults they have purpose-
5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC

AFFECTED THIS NONPROFIT ORGANIZATIONS ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS.

Covid 19 specifically affected our non profit due to the fact that our adults in both day programs and ATP classes with TVUSD were not meeting in person. Therefore, like the rest of the word, they had to resort to communicating with those outside of their home via zoom.

In 2020, though the Cultivating Inclusion farm was being maintained we were not being visited by our special needs communities because of the restrictions. When w321 came around, we greeted sporadically special needs adults whose day programs limited to being open three days a week. We would also host special events around holidays, wherein folks picked out pumpkins, made pine cone ornaments and valentines with sunflower seeds. In June of 2021, we were able once again to greet our day programs and we were thrilled to have them back we had missed them and our mission of working together to grow produce for our neighbors in need.

Since the pandemic is ongo�nq even now, I notice that plants, delivery or soils, seeds and snacks that we provide have all increased in price, More often than not, nur dear volunteers will donate snacks and craft supplies to an effort to decrease having Cultivating Inclusion funds used for this reason-
6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL:
(1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM.

In addition to promotional items, supplies and general repairs, we would like to make the Cultivating inclusion farm accessible for those special needs adults who have mobility issues. It has been suggested that perhaps our center lane of the farm, meaning from front fence to the back fence a strip of concrete to enable all of our special needs adults can have a garder,.ng experience_ Lasl ye It we had a girt named Jessica who was part of an ATP program had an electric track chair but she became mire in some weller soil and we almost could not get her out, And Jessica really loved coming to the farm so she did return but we were more diligent about where she could travel to avoid getting stuck again. This request for mobility has come from leachers and parents of special needs adults.

I could not in good conscience omit this need as being very important.

For this above reason Cultivating Inclusion is asking for the additional $2,500.00 for the sole purpose of providing a centenualk for all our special needs adults. As in 2021 we requested $5,000.00 and happily gratefully received it in January 2022, but this year we are requesting the additional monies for the above purpose..

City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13

PROJECT/PROGRAM BUDGET (do not fill in shaded areas)

LINE ITEMS FOR PROJECT/PROGRAM REVENUES

EXPENSES

LIST REVENUES/INCOME FOR PROJECT/PROGRAM
Amount of money requested from this City of Temecula $ 7.500,00 Community Services Grant (Not to exceed $50,000)
Amount contributed to the Project/Program by the Applicant $ 6.000.00 Organization --
Other grants or funding already awarded for Project/Program, if any $ 3.500.00 In -Kind match amount or volunteer credit hours estimated amount $ TOTAL REVENUE $ 16,00000

LIST OF EXPENSES FOR PROJECT/PROGRAM
Tools/Equipment
$ 300.00
Facilities/Rent/Insurance"
$ 834,00
Supplies
$ 700,00
Marketing
$ 1,500.00
Services
$ 0.

Food
$1,e66.00
Other Accessibility
$ 2,500M
$ 0
Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE.
$ $7,500.00

TOTAL EXPENSES

TOTAL BUDGET
$
$ 5,000.00
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13

PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT
IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21/22 (LAST YEAR), THEN SKIP THIS PAGE.

If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information.

I If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent.

1. Fill out table below (make additional copies if needed to explain all expenditures.)

2. Attach copies of receipts/invoices (in the same order as listed in this table.)

3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022
Organization: — Cultivating Inclusion Inc. Name of Project/Program; Cultivating Inclusion FY 2021-2022 Amount of $
CSF Grant Fund Awarded: $5,000.00 Month & Year CSF Grant Received from City: 01-2022 Number of Beneficiaries Living In 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not 1,200 have precise number): Previously submltled and approved before see attached confirmation dated 08-27-202Y.

E Date on _ Expenditure
Name of Company Receipt/Invotce Description Purpose
on Receipt or Invoice MUST BE ON OR BETWEEN Amount DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE JULY 1, 2021 - JUNE 30, 2022
1 $
2 $
3 $

EXPENDITURE TOTAL MUST BE EQUAL TO
EXPENDITURE TOTAL $
(OR GREATER) THAN TOTAL AWARD AMOUNT.

City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13

FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT
If your organization is awarded a Community Service Funding Grant in FY 2021.2022 by the City of Temecula, then this information is not due until Monday, September 12, 2022 If your organization is awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding_ City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent.

If the funds are not spent in accordance with the approved purpose stated on the Application,4be organization will be required to refund the amount of Funds. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back -tap documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: Monday, September 12, 2022_ EXPENDITURE REPORT due on or before Monday, September 12, 2022

1. Provide the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted 1200 From this program (approximate number of beneficiaries if you don't have a precise number):

2. Fill out this table (include additional copies if needed to explain all expenditures) 3, Attach Receipts/Invoices (in the same order as listed In this table)

4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Cultivating Inclusion Inc.

Amount of Grant Fund Awarded: $ 5,000.00
Name of Company
E on Receipt/invoice
az'I
1 Home Depot
I
2 Home Depot
3 Date (Mo/DayNr)
on Receipt/lnvoice
Must be dated on or
between July 1, 2021 -
June 30, 2022
11 /09/21
01 /26/22
Home Depot 02/15/22
Amount
of
Expenditure
$ 38.44
$ 52.20
4 Home Depot 103/14/22 J $ 17.36
Louie's Nursery10/13/21 1 $ 77.94
Louie's Nursery 11 /09/21 ' $277.50
7 Louie's Nursery� 02/ �/22

EXPENDITURE TOTAL
Note: Expenditure Total must be equal to
(or greater than) the "Amount of Grant Fund
Awarded" (above) provided by the City
$ 39.98
Name of Project/Program: Cultivating Inclusion Inc.

Month + Year Grant Received from City: 01 /2022
Describe...

Explain ...
(1) what the expenditure was
I how the expenditure
(2) purpose of the expenditure
specifically benefitted
Temecula residents
MUST support Project/Program
If namesladdresses of Temecula
description on Application + Award Letter
beneficiaries are available,
Alensu attach. --
1 cu foot citrus fertilizer
"use
Keeping our grove thriving
cols lertifizer specTcauy to enrich sail in our grove.
for food banks and clients
rosemary, lettuce, cabbage starter plants
Winter crops for food banks~
to ensure a winter crop
and cllsnte learn io nurture plants
steer manure for winter crop plants,
Winter crops for food banks
amending soil is key to productivity
and clients learn the rare of veg.

Petunia easy way plant 4 pack
To make our farm pretty for
to beautify the garden.
clients and visitors
Native blackberry bushes, for spring
crop of berries for clients to harvest.
8 yards of organic planting mix soil
to ensure the health of soil for prodrloe.
2 Flats of sirawherry plants so that a sweet
treat is available for food banks.
$ `;4� 9:"I / p i1
of 3
To ensure a variety of
produce Is given to food hanks.

Needed to keep our crop
healthy for food banks/clients
Healthy options for clients to
harvest for food bank needy.

City of Temecula Community Service Funding Grant APPLICATION Page 6 of 7

FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT
If your organization is awarded a Community Service Funding Grant in FY 2021-2022 by the City of Temecula, then this information is not due until Monday, September 12, 2022 If your organization is awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/oi require additional back-up information to substantiate how funds received from the City were spent.

If the funds are not spent in accordance with the approved purpose stated on the Application,.the organization will be required to refund the amount of funds, To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: Monday, September 12, 2022.

EXPENDITURE REPORT due on or before Monday, September 12, 2022

1. Provide the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted 1200 from this program (approximate number of beneficiaries if you don't have a precise number): _

2. Fill out this table (include additional copies if needed to explain all expenditures)

3. Attach Receipts/Invoices (in the same order as listed in this table)

4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Cultivating Inclusion Inc.

Amount of Grant Fund Awarded: $ 5,000.00
Date (MolDaylYr)
Name of Company
E Recelpt/lnvoice
on Receiptlinvoice
Amount
.Ion
u
E
2 Must be dated on or
between July 1, 2021 -
of
Expenditure
p
Z
June 30, 2022
2 Orozco Gen Maint. 1 08/30/2021 $ 385.00
3 Orozco Gen Maint. 09/28/202 1 $ 385.00
4 LOrozco
Gen Maint. I O/26/202
5 Orozco Gen Maint. 1 1 /30/202 1 $ 385.00
6 Orozco Gen Maint. 1 2/28/2021 1 $ 385.00
7 Orozco Gen Maint. 0 1 /31 /2022 1 $ 385.00
Name of Project/Program: Cultivating Inclusion Inc.

Month + Year Grant Received from city: 01 /2022
Describe... Explain ...
(1) what the expenditure was how the expenditure 1
(2) purpose of the expenditure specifically benefitted
Temecula residents
MUST support Project/Program If namesladdresses of Temecula description on Application + Award Lefterl beneficiaries are available, i Initial cost of weed clean up in order M ry TC4C�eililtt foLqur for our farm to be neat in appearance.
clients and visitors in appearance.

Keeping our farm clean so that it is neat
More accessible for our
and accessible for our visitors and clients.
clianw and Wallora in appearance,
Keeping our farm clean so that is neat and
More accessible for our
accessible for our visitors and clients.
clients and visitors.

Repair and replacement of
Produce to nurture for clients
irrigation drip system to keep farm green.
and food for food banks.

Keeping our farm free of weeds so that
I More accessible and easy
it has a neat and pleasant appearance.
for clients to harvest produce.

Keeping our farm free of weeds so that
More accessible and easy
it has a neat and pleasant appeafance,
for clients to harvest produce.

Keeping our farm free of weeds so,het
More accessible and easy
It has a neat and pleasant appearance.
for clients to harvest produce.

EXPENDITURE TOTAL
Note: Expenditure Total must be equal to $ 2:7,0e'00 f pg 2 (or greater than) the "Amount of Grant Fund of 3
Awarded" (above) provided by the City
City of Temecula Community Service Funding Grant APPLICATION

Page 6 of 7 ends

Temecula City CouncilNovember 15, 2022

Temecula City Council
November 15, 2022