Item 17 - Review and Consider FY 2022/2023 CAG Applications

Agenda Item No. 17

CITY OF YUCAIPA

AGENDA REPORT
TO: Honorable Mayor and City Council
FROM: Jennifer Crawford, Assistant City Manager
Kimberly Everts, Deputy Rent Administrator/Records Technician FOR: City Council Meeting of June 27, 2022
SUBJECT: Review and Consider Fiscal Year 2022/2023 Community Activitv Grant Applications RECOMMENDATION:

That City Council:

1. Review and consider the Fiscal Year 2022/2023 Community Activity Grant applications submitted by local applicants requesting financial and/or in -kind support to continue on -going services, proposing new services and/or proposing small to large scale special events that meet the established guidelines; and

2. Determine that the Childhood Cancer Foundation of Southern California should be exempt from the Grant Guideline that requires the organization to be located in Yucaipa if their Community Activity Grant is awarded.

DISCUSSION:

On March 14, 2022, City Council reviewed the Community Activity Grant (CAG) program guidelines and funding levels for Fiscal Year (FY) 2022/2023 and approved the following:
• Allocate the current funding levels of $40,000 for in-kind/fee waiver grants and $17,500 for financial grants.
• Eliminate the previously established term limit of three consecutive years for non-profit financial awards with the non-profit becoming ineligible for funding after year three. • All other program guidelines remain unchanged.

On March 161h, the City issued notices to past applicants and new contacts, announcing the FY 2022/2023 CAG program, the firm deadline of May 121h for applicants seeking financial support, and that all in -kind and fee waiver requests would be reviewed and considered as received. The announcement of the CAG was also posted on the City website, social media platforms and in the local newspaper. The notice also included the approved guidelines stated above.

A total of fifteen applications requesting in -kind and/or financial support were received and processed for Council review and consideration. The table below includes the name of the requesting applicant, a brief description of their proposed project scope, and the total amount of in -kind funding and/or financial support requested. In addition, Exhibit D outlines CAG's awarded to the organizations over the past three years and a section for Council to assist in the award process. .•

Community Activity Grant
FY 2022/2023 Applications
Attachment A
Al -Anon Family Groups (Yucaipa) — Weekly Meetings
Scope
Applicant is seeking in -kind support to cover the costs associated with the use of the Yucaipa Community Center Meeting Room/Kids Club Room to hold weekly meetings through June 2023.

Requested In -kind Amount
$879
Attachment B
Childhood Cancer Foundation of Southern California — 2023 Spring Egg Hunt Scope
Applicant is seeking in -kind support to cover the costs associated with the use of the Yucaipa Community Park Amphitheater to host a Spring Egg Hunt on March 25, 2023, for families experiencing childhood cancer.

Requested In -kind Amount
$310.25
Attachment C
Family Promise of Yucai a/Calimesa — Fundraising Gala
Scope
Applicant is seeking in -kind support to cover the costs associated with the use of the Yucaipa Community Center Banquet Room/Kitchen/Meeting Room to hold a fundraising event that benefit families in crisis and raise funds to establish a permanent location.

Requested In -kind Amount
$940.50
Attachment D
Inland Leaders Charter School — Volleyball Games
Scope
Applicant is seeking in -kind support to cover the costs associated with the use of the Yucaipa Community Center Gymnasium to host volleyball games for the 2022 season.

Requested In -kind Amount
1 $2,835
Attachment E
Rotary Club of Yucaipa — Weekly Meetings
Scope
Applicant is seeking in -kind support to cover the costs associated with the use of the Senior Nutrition Center to hold weekly meetings.

Requested In -kind Amount
$9,126
Attachment F
Yucaipa Valley Art Association YVAA — Twice Monthly Meetings Scope
Applicant is seeking in -kind support to cover the costs associated with the use of the Scherer Senior Center Banquet Room to hold twice monthly meetings through May 2023.

Requested In -kind Amount
$2,624
Attachment G
Yucaipa Valley Art Association YVAA) — Spring Art Show
Scope
Applicant is seeking in -kind support to cover the costs associated with the use of the Scherer Senior Center Banquet Room/Kitchen to set-up and hold the Spring Art Show on 4/28/2023 — 4/29/2023.

Requested In -kind Amount
1 $1,999.50
Community Activity Grant
FY 2022/2023 Applications (continued)
�1

Attachment H
Family Service Association of Redlands — Yucaipa Outreach Project Scope
Applicant is seeking financial support to provide housing assistance for families in crisis (Yucaipa Outreach Project).

Additional financial support in the amount of $5, 000 is included in the FY 202212023 Non -De artment Not -For -Profit drat budget Exhibit B).

Requested Financial Amount
$5,000
Attachment I
Gardenworksforkids — Construction of a Special Needs Patio & Garden Scope
Applicant is seeking financial support to construct a sensory patio learning garden for autistic andspecial needs children located at 10966 Bryant Street.

Requested Financial Amount
$3,000
Attachment J
Smiles for Seniors Foundation — Assistance for Low Income Seniors Scope
Applicant is seeking financial support to assist low-income seniors (65 years & older) with emergency financial assistance safety net services and basic necessities needed to survive, such as food, housing, utility assistance, minor home and auto repairs, lifesaving medication and medical equipment.

Requested Financial Amount
$4,000
Attachment K
The Well Outreach Center — Our Neighbors Clothing Closet Program Scope
Applicant is seeking financial support to cover the costs associated with providing basic clothing needs of at -risk students living within Yucai a/Calimesa.

Requested Financial Amount
$5,000
Attachment L
Valley Elementary School — Leadership Da
Scope
Applicant is seeking financial support to cover the costs associated with holding a Leadership Day event (April 2023) in order to showcase the hard work and accomplishments of students.

Requested Financial Amount
$1,000
Attachment M
Yucaipa/Calimesa Family Assistance — Refurbish Countertop, Replace Sink, and Paint Cabinetry
Scope
Applicant is seeking financial support to cover the costs associated with refurbishing and rearranging the check-out countertop and replace adjacent sink and paint cabinetry which will facilitate the installation of a display refrigerator for distribution of products.

Requested Financial Amount
$3,950
-150-

Community Activity Grant
FY 2022/2023 Applications (continued)
Attachment N
Yucaipa Elks Club #2389 — National Hoop Shoot and Soccer Shoot Scope
Applicant is seeking financial support to cover the costs associated with holding the Hoop Shoot and Soccer Shoot at their preferred gymnasium and to purchase trophies, medals, back -packs, and t-shirts or the participants.

Requested In -kind Amount
$1,200
Attachment O
Yucaipa Womans Club — On -going Maintenance of Building Scope
Applicant is seeking financial support to cover the costs associated with repairing the ceiling, building windows, gutters and downspouts and exterior doors. The back exterior wall requires improvement, and the utility room needs painting.

Requested Financial Amount
1 $5,425
Total In -Kind Assistance Requested: $18,714.25
Total Financial Assistance Eligible for Award: $28,575.00 FISCAL IMPACT:

Upon adoption of the FY 2022/2023 Budget, the fund for in-kind/fee waiver requests will have a balance of $40,000. The total amount requested for in -kind assistance from the CAG applications submitted with this staff report is $18,714.25, leaving a remaining budget of $21,285.75 if all seven in -kind grant applications are approved.

Upon adoption of the FY 2021 /2022 Budget, the fund for financial requests will have a balance of $17,500.

The total amount requested for financial assistance from the CAG applications submitted with this staff report is $28,575, exceeding the total funds available by the amount of $11,075.

Attachments: Exhibit A: FY 2022/23 CAG Guidelines
Exhibit B: FY 2022/2023 Non -Department, Not -for -Profit Funding Detail Exhibit C: Financial Award Grant Tracker Fiscal years 2010/11 through 2021/22 Exhibit D: Prioritization Worksheet
A: Al -Anon Family Groups Application
B: Childhood Cancer Foundation of Southern California Application C: Family Promise of Yucaipa/Calimesa Application
D: Inland Leaders Charter School Application
E: Rotary Club of Yucaipa Application
F: Yucaipa Valley Art Association Application
G: Yucaipa Valley Art Association Application
H: Family Service Association of Redlands Application
1: Gardenworksforkids Application
J: Smiles for Seniors Foundation Application
K: The Well Outreach Center Application
L: Valley Elementary School Application
M: Yucaipa/Calimesa Family Assistance Application
N: Yucaipa Elks Club #2389 Application
O: Yucaipa Womans Club Application
1 Approved by: A
151-

Exhibit A
CAG Community Activity Grant Program Guidelines — FY2022123 Purpose of the Yucaipa Community Activity Grant Program The purpose of the Yucaipa Community Activity Grant Program is to support the efforts of local non-profit 501(c) agencies/organizations that provide valuable services, programs and/or events to the Yucaipa residents.

Who is eligible for the program?
Applications for the Yucaipa Community Activity Grant will ONLY be accepted from Yucaipa based non-profit 501(c) organizations.

What can be funded?
Local non-profit agencies/organizations may request matching funds for: ongoing programs/services, proposed new programs and/or services, small/large scale special events that meet the established guidelines.

Groups/Programs that are Ineligible?
• Organization is not an established 501(c).
• Organization is located in another community.
• New proposed program, service, or event that is already being provided for in the community. • Program/event will take place in another community.
• Programming for and rental of the Equestrian Center, and the Uptown Park facilities. • Programming for and rental of the Yucaipa Performing Arts Center (YPAC), apart from the Yucaipa High School (YHS) Music and Art Department (production equipment and personnel ineligible).

Requirements and Funding Limitations
• The application must be complete and contain applicant information, amount of request, proof of eligibility, clear statement of need, target population, program description/scope, outcome measurement, applicant background, experience in program area, and financial capabilities/budget is required to ensure grant funds are used to subsidize and not supplant the program. • The grant program will be reviewed on a yearly basis during the budget process to analyze funding availability for the upcoming fiscal year. If Council determines that the budget priorities have changed and funds need to be reallocated, the grant amount may be increased, decreased or deemed unavailable for that fiscal year.
• Grant applications requesting financial support will have a firm deadline. • Applications will not be considered when grant funds are depleted. • Grant applications requesting in -kind support will be reviewed and considered as received until funds are depleted.
• Grant awarded funds must be spent during the grant awarded fiscal year. • The awarded grant recipients must submit a detailed follow-up financial accountability report within one month following the event/project in order to remain eligible for future funding.

Payment Process & Accountability Requirements
Upon City Council award, the City will initiate the approved payment in full (30-45 days).

Following receipt of the grant funds and completion of the awarded project, grant recipients must submit to City Council an event reporting financial worksheet within one month following the event/project. -152-

Community Activity Grant Submittal
Applicants may not submit another application if the funding has not been spent within the effective fiscal year.

Completed grants can be hand delivered to the General Services/City Clerk Department or emailed/mailed to the following address:

City of Yucaipa
34272 Yucaipa Blvd.

Attn: Kimberly Everts
Yucaipa, CA 92399
[email protected]
-153-

Exhibit B

NON -DEPARTMENT

MAJOR FUNCTIONS
This section of the budget was created to account for those items that are not directly associated with any specific department. These are items such as lease payments, Citywide dues and publications, postage, etc. Also included in this section is the amount set -aside annually for new equipment and equipment replacement.

The Non -Department budget also includes Not -For -Profit Funding. FY 22/23 allocations include:

Contribution to Chamber of Commerce Operations $ 27,500 4th of July Celebration 35,000
Chamber of Commerce - Yucaipa First 13,500
Interfaith 3,000
Veterans Day Ceremony (Cali-Caipa Nooners Lions Club) 500 Yucaipa Animal Placement Society (YAPS) 10,000
Family Services Association Riverside - Senior Nutrition 8,500 Family Services Association Redlands - Yucaipa Outreach 5,000 Christmas Parade (Rotary Club) 1,000
Total Not -For -Profit Funding FY22/23* $ 104,000
* All in -kind requests will continue to process through the Community Activity Grant (CAG).

City of Yucaipa Annual Budget 2022-2023 Page 1
-154-

CITY OF
Community Activity Grant - TRACKER
Exhibit C
Fiscal Yrs 2olo/11 through zo21/22
FY 2010/11 FY 2011/12 FY 2012/13 FY 2013/14 FY 2014/15 FY 2015/16 FY 2o16/17 FY 2017/18 FY 2018/19 FY 2019/220 FY 2020/21 FY 22021/22 Grand Total Applicant 1
Financial Awards
4th of July Celebration
4th of July Celebration
Committee
$6,000
$6,000
_
Audio Vision Radio Reading
_
_
_ _
Radio Reading Services for the Blind
Svcs For The Blind, Inc.
$3,000
$3,000
$6,000
Yucaipa First -Shop Local Program
Chamber of Commerce
$20,000
$26,100
$20,000
$19,000
$13,500
$98,600
_
Budgeted - Non -Department, Not -For -Profit Funding
Farmers Market
$9,440
$9,440
Family Service Association Senior Nutrition Program
Budgeted - Non -Department, Not -For -Profit Funding
$10,625
$6,500
$3,420
$20,545
Family Service Association of Yucaipa Outreach Project
$5,000
$4,000
$2,000
$5,000
$3,587
$19,587
Redlands Roof for Storage Shed
$1,000
$1,000
Gardenworksforkids Children's Garden
$2,500
$2,500
$1,875
$6,875
Interfaith Food for the Needy
Budgeted - Non, Department, Not -For -Profit Funding
$2,500
$2,500
$3,000
$3,000
$3,000
$14,000
Mesa View Middle School Destination Imagination Global Finals $1,500
$1,500
Redlands Bicycle Classic, Inc. Yucaipa Circuit Race
$165
$165
Rotary Club of Yucaipa Christmas Parade
$700
$700
Smiles For Seniors
Low Income Senior Assistance
Foundation
$5,000
$4,000
$4,000
$4,000
$4,000
$3,587
$21,000
Spartans FC YVYSO/Spartans Cup
$1,800
$1,800
Valley Elementary School Leadership Day Event
$1,000
$750
$1,750
Veterans of Foreign War Post
Veterans Day Ceremony
Budgeted -Non-Department, Not -For -Profit Funding
7347
$500
$500
$500
$500
$500
$2,500
Yucaipa Animal Placement EZ-UP Tents and Tables
$1,200
1 1
1 $1,200
Society (YAPS) Spay/Neuter Program
$10,000
$10,000
$10,000
$10,000
$10,000
Budgeted - Non -Department, Not -For -Profit Funding
$50,000
Yucaipa BMX BMX Park Upgrades
$9,580
$9,580
-155-

CITY OF
Community Activity Grant - TRACKER „",,
Fiscal Yrs Zoio/11 through zoai/aa
FY aoio/u FY aoii/u FY 2012/13 FY 2013/14 FY 2014/15 FY 2oi5/16 FY 2W647 FY 2oi748 FY 2018/i9
FY 2019/2o
FY aoao/ai FY 2021/22
urana 1 otal
Applicant1
Financial Awards
Yucaipa Community
Install Brick Pavers in Support of the Arts
Foundation
$4,000
$4,000
Yucaipa Elks Lodge #2389 Elks National Hoop Shoot Free Throw Program $1,000
$1,000
$1,300
$960
$1,000
$4-,999
$5,260
Repair Roof/Rain Gutter and Purchase
Yucaipa Family Assistance
Refrigerator
$2,500
$1,875
$4,375
YHS Baseball Team to travel to INC for NHSI
Yucaipa High School
Invitational
$1,000
$1,000
Yucaipa Valley Gem & Youth Classess for Sciences, Silversmithing, Mineral Society Facetin , etc.
$2,500
$1,875
$4,375
Teaching Children About History Program
$4,850
$4,850
Yucaipa Valley Historical
Society Decades Book
$2,500
$2,500
Firestation Museum
$3,500
$3,500
Yucaipa Valley Lions Club 4th of July Celebration
$500
$500
Yucaipa Valley Welfare, Inc. Security Cameras
$2,500
$2,500
Yucaipa Valley Wine Alliance American Viticultural Area $3,035
$3,035
Yucaipa WomanS Club Facility Improvements
$5,000
$10,000
$9,500
$6,500
$5,500
$4,000
$6,840
$3,935
$2,951
$54,226
$44,500
$51,540
$50,475
$50,000
$50,000
$14,500
$17,500
$17,500
$17,500
$17,500
$17,435
$17,500
$362,363
Fiscal Year Totals
Figures are rounded to the nearest dollar
-156-

CITY OF YUCAIPA
FY 2021/22 COMMUNITY ACTIVITY GRANT PROGRAM
Exhibit D

PRIORITIZATION WORKSHEET

IN-KIND/FEE WAIVER REQUESTS
FY 2022/23
ZZ
Description of
In -Kind
Awards Granted
<
0 M
Applicant
Event/Program
Support
(Last 3 Years)
-
U
Requested
Grant Award
Grant Award
Grant Award
U
Al -Anon
Weekly Meetings
$ 879.00
$496.50
$285.00
$1,314.00
Childhood Cancer Foundation of Southern
California
2023 Spring Egg Hunt
$ 310.25
$525.00
$646
S684
Family Promise of Yucaipa/Calimesa
Fundraising Gala
$ 940.50
N/A
N/A
N/A
Inland Leaders Charter School
Volleyball Games
$ 2,835.00
$3,969
N/A
$3,118.50
Rotary Club of Yucaipa
Weekly Meetings
$ 9,126.00
$438
$962.00
55,454.00
Twice Monthly
Yucaipa Valley Art Association
Meetings/Art Class
S 1624.00
$1,996.50
N/A
5687
Yucaipa Valley Art Association
I Spring Art Show
$ 1,999.50
$1,976
$3,220
$1,441
Total In -Kind Requests
$ 18,714.25
$0
$0
$0
SO
$0
Total Awarded $0
Balance Remaining $40,000

CITY OF YUCAIPA
Exhibit D
FY 2021/22 COMMUNITY ACTIVITY GRANT PROGRAM

PRIORITIZATION WORKSHEET

FINANCIAL REQUESTS
Description of
FY 2022/23
Awards Granted
Applicant
Event/Program
Financial
(Last 3 Years)
=
`.

Support
-
Requested
FY 2019/20
FY 2020/21
FY 2021/22
Grant Award
Grant Award
Grant Award
Family Service Association of Redlands
Yucaipa Outreach Project
$5,000
$5,000
N/A
$3,587
Construction of a Special
Gardenworksforkids
Nees Patio & Garden
$3,000
N/A
$2,500
$1,875
Assistance for Low
Smiles for Seniors Foundation
Income Seniors
$4,000
$4,000
N/A
$3,587
Our Neighbors Clothing
The Well Outreach Center
Closet Program
$5,000
N/A
N/A
N/A
Valley Elementary School
Leadership Day
S 1,000
N/A
$1,000.00
S750.00
Refurbish Countertop,
Replace Sink, and Paint
Yucaipa/Calimesa Family Assistance
Cabinetry
$3,950
N/A
$2,500
$1,875
>
(returned grant
>
(returned grant
National Hoop Shoot and
award due to event
award due to event
Yucaipa Elks Club #2389
Soccer Shoot
$1,200
$960
cancellation)
cancellation )
On -going Maintenance o
Yucaipa Womans Club
Building
$5,425
$6,840
$3,935
S2,951
Total Financial Requests
$28,575
SO
$0
$0
SO
SO
$0
Total Awarded $0.00
Balance Remaining $17,500.00
Pp28-1

Attachment A
Fiscal Year:

Date Application submitted:

COMMUNITY ACTIVITY GRANT
FINANCIAL IIN-KIN© I FEE WAIVER

APPLICATION
2022/2023
Submit to:

City of Yucaipa
General Services/City Clerk Department
34272 Yucaipa Blvd..

Yucaipa, CA 92399
Attn: Kimberly Everts
4/25/2022
Received
City of Yucaipa
APR 2 8 2022
r Vj�-" r'rnent
Name of Applicant/Organization:

Al Anon Family Groups (Yucaipa)
Applicant/Organization Elmwood Lane, Yucaipa CA 92399
Organization Mailing Address: _
Applicant/Organization Phone Number:

Contact (1)
Contact (2)
- (714 ) 290-7341
John Muller
(714 ) 290-7341
Name Phone Number
[email protected]
E-mail address
Kristina Pamias
Name
glitterfist aicloud.com
E-mail address
Is your organization located in another community?
Will the program/event take place in another community? Are you aware of any other City program providing this service? If so, which one?
9p( 9 )708-b953
Phone Number
Yes
No
❑
n
❑
a
❑
0 *if you answered "Yes" to any of the questions listed above, your request is not eligible for the Community Activity Grant.

City of Yucaipa Community Activity Grants Application, Rev. 03/2021 -159-
Page i

Your organization must be an established 501(c) to be considered for Community Activity Grant funding.

Please submit documentation verifying organization 501(c) status along with this application.

Yes No
Is your organization a 501(c)? Q ❑
95-3424517
If yes, please provide Tax ID# and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? ❑✓ ❑ 2007
How long has your 501(c) organization been in existence? 2 Number of Employees working for organization:

Number of Volunteers working for organization:

Is a current City Council Member on your board? ❑ ❑✓
15+
How many Yucaipa residents does your organization currently serve? Does the organization charge admission, membership fees, dues, etc.? ❑ ❑✓ If yes, please describe: we pass the basket to pay for literature/supplies Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available John Muller, Business Chair
Kristina Pamias, Group Rep
Barbara B, Treasurer
SECTION 4 - P:iiIll:Lw ■ lI Di.`tr N 1 ■ U)N;i.`irMt
Name of the program/event: AI -Anon Family Group Meeting Date(s) of prograrn/event: Saturday 1Oam-11:3Oam (except Xmas/new years Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) Al -Anon Family Groups provide support for friends and relitives of alcoholics. It is a 12 step program based on the principles/format of Alcoholics Annonyznous (AA).

There is only one other Al -Anon meeting a week in Yuicaipa (compared to 21 plus meeting of AA) City of Yucaipa Community Activity Grants Application, Rev. 03/2021 -160-

Page 2 ends

Describe how the program/event benefits the residents and/or community of Yucaipa:

Alcoholism causes harm and destruction to the family and workplace. M-Anon is a proven resourse to help families and friends of alcoholics deal with these problems using the same 12 steps of recovery that AA uses.

Program/Event Primary Target Population (check all that apply):
❑ Children or Youth
❑ Low Income
❑ Persons with Disabilities
Number of Residents Projected to Serve: 15
❑
Seniors
❑
Victims
❑
Welfare Recipients
Please identify what your organization is seeking:

Financial Support: ❑ Yes 0 No $
$16.25 SEP Fee
Waiver: ❑ Yes ❑ No
In -kind Support: Police S Fire $_
Reassigned
Staff $
In -Kind
Total Amount of Request: $998
Other $
Financial Support
e
Public
Works S
Explain
$16.25 SEP
Fee Waiver
Provide a detailed description of how the financial support will be used:

Room rental
❑ Women
❑ Homeless
Entire Community
CS/Rental $998
Total Overall'
Request
City of Yucaipa Community Activity Grants Application, Rev. 03/2021 Page 3 -161-

What other in-kind/financial contributions has your organization received to fund this event/prograin (separate from City funding)`.'
In -Kind
Amount
N/A
Total Funds Received To Date:

Total Funds Requested Via Grant Application:

Remaining Balance That Will Be Funded By
Organization:

Financial
Support Amount
SECTION 6 — FINANCIAL CAPABILITIES/BUDGET i i
Provide City funding received by organization in the past three years (required):

Program In -Kind Financial $16.25 SEP Date Total Received Support Fee Waiver Received
Al -Anon Family Group
$
I, the undersigned hereby attest that the above information is true and correct to the best of my knowledge, and understand that the awariTeRd f ancial ant a needs to be spent prior to submitting another grant request.

Business Chair 4/25/20220
Sigtta e Title Date
Date Received: 4- — 7_5 — ", Date Reviewed:

Amount Funded: $
Type of Grant: EIn-Kind
Date City Council received follow up report:

City Council Meeting:
❑ Financial Support
❑ Fee Waiver
City of Yucaipa Community Activity Grants Application, Rev. 03/2021 Page 4 -162-

John Muller June 8, 2021
34745 Elmwood Lane
Yucaipa, CA 92399
City of Yucaipa, Community Services
Re: Al -Anon Family Groups
For your information, Al -Anon -Family Groups is an intemational fellowship of men and women which provides literature and support for individual groups. Our groups provide support for people who have been affected by their relationship with alcoholics. AI - Anon is not part of Alcoholics Anonymous but has sis own parallel program of recovery.

Our organizational structure Isis World Headquarters in Florida, and a Central Office for the Island Empire in Colton, CA. This central office is "postage stamp" sized open part time with a part time manager and unpaid helper. No meetings are held there. They distribute literature and answer phone inquiries.

AI -Anon meetings are held in various cities in the Inland Empire such as Yucaipa, Redlands, etc. Yucaipa has one weekly meeting (currently held at the Community Center) @ 10am Saturday mornings. We have approximately 50 members with approximately 15 attending at any one time (the actual range would be 10-20). We "pass the basket" to collect donations which pays for literature, and nominal expenses.

We appreciate your support with in kind rent assistance. Please feel free to contact me should you have -,any questions.

Reg ,
Jo n Muller
-163-

internal Revenue Service
Date: May 16, 2007

AL -ANON INLAND R EMPIRE
J2 SERVICE CENT
1012 E COOL
C,OLTON CA 92324-3959
Dear Sir or Madam:

Department of the Treasury
p. ©. Box 2508
Cincinnati, OH 45201
Person to Contact:

Ms. Benson #31-07273
Customer Service Representative
Toll Free Telephone Number:
877-829-5500
Federal identification Number;
95-3424517
This is in response to your request of May 16, 2007,
exempt status.
regarding your organization's tax-
ur
In March 1980 we issued a determinationolyds ' dicate that youetter that r o�ga� at onas� urarently exempt from federal income tax. o�herinternal Revenue Code. exempt under section Sol (c)( )
Our records indicate that your organization is also classified as a public charity under section 509(a)(2) of the Internal Revenue Code.

Our records indicate that contributions to your organsat ontax are d table under e lion
170 of the Code, and that you are qualified to receive
transfers or gifts under section 2055, 2106 or 2522 of the Internal Revenue Code.

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

Sincerely,
Michele M. Sullivan, Oper. Mgr.

Accounts Management Operations 1
-164-

AI -Anon meetings
Saturdays 1OAM
Yucaipa Comrnuni
Center
IEALANON.ORG
909-824-1516
For over 60
years Al -Anon
& Alateen
`Easy Does it
`Just for today
*Let it Begin with me
*Live & let live
*Progress not perfection
*One day at a time
*Feelings aren't facts
*Keep coming back
-165-

4s25122, 11:24 Alai
PermitContract
COMMUNITY rCe
Permit

SERVICES
;
City of Yucaipa Community
PHON_1909) 790-7460
Permit # R4321
Services
FAX:(909) 790-2589
Status Tentative
34272 Yucaipa Blvd
EI%Ii ILxommunityservices-dyucalpa.org
Date Apr 25, 202210:45 AM
Yucaipa, CA 92399
Expiration Date Apr 25, 2023
Customer Name
John Muller -29740
Home Phone Number (714) 290-7341
Customer Type
General Public
Email Address landKmuller03-agmail.com
Mailing Address
347=5 Elmwood Ln
Yucaipa, CA 92399
System User
Tish Christian
Rental Fee $998.00
Discounts $0.00
Subtotal 8998.00
TLL � di� [i� �•{� ,
u+, r
`0+ ( q Deposits $54.00
Deposit Discounts
$0.00
Total Permit Fee $1,052.00
Total Payment $0.00
Refunds $0.00
Balance $1,052.00
Al Anon Meetings
2 resource(s) 52 booking(s) Subtotal: $1,052.00
Booking Summary

START DATE/TIME

END DATE/TIME

ATTENDEE

AMT W/O TAX
Jul 2, 202210:00 AM
Jun 24, 202311:30 AM
--
Occurs every Saturday effective Jul 2, 2022 unfit
Jun 24, 2023 from 10,OO AM to 11:30 AM
Exception:

Jul 9, 2022
Jul 2, 202210:00 AM
Jul 2, 2022 11:30 AM
15 $135.50
Rental - Hourly (R)
$11.00 / Hour x 1.5
$16.50
Liability insurance
$119.00 / Each x 1'-
$119.00 (OlenewC �t JrCtFt li
?
Jul 16, 202210:00 AM
Jul 16, 202211:30 AM
15 $16.50
Rental - Hourly (R)
$11.00 / Hour x 1.5
$16.50
Jul 23, 202210:00 AM
Jul 23, 202211:30 AM
15 $16.50
Rental - Hourly (R)
$11.00 / Hour x 1.5
$16.50
Jul 30, 2022 10:00 AM
Jul 30, 202211:30 AM
15 $16.50
Rental - Hourly (R)
$11.00 / Hour x 1.5
S16.50
https:/ anprod.active.comlyucalpalui.do?method=show,PermitContract&permit_id=C4BDO886OC39 115

4125122, 1124 kM
PermitContract
Aug 6, 2022 10:00 AM
Aug 6, 2022 11:30 AM
Rental - Hourly (R)
$11.001 Hour x 1.5
S16.50
Aug 13, 2022 10:00 AIA
Aug 13, 2022 11:30 AM
Rental - Hourly (R)
$11.001 Hour x 1.5
S16.50
Aug 20, 2022 10:00 AM
Aug 20, 2022 11:30 AM
Rental - Hourly (R)
$11.001 Hour x 1.5
S16.50
Aug 27, 2022 10:00 AM
Aug 27, 2022 1i: �U At'z4
Rental - Hourly (R)
$11.001 Hour x 1.5
$16.50
Sep 3, 202210:00 AM
Sep 3, 2022 11:30 AM
Rental - Hourly (R)
$11.00 / Hour x 1.5
$16.50
Sep 10, 2022 10:00 AM
Sep 10, 2022 11:30 AM
Rental - Hourly (R)
$11.001 Hour x 1.5
S16.50
Sep 17, 202210.00 AM
Sep 17, 202211:30 AM
Rental - Hourly (R)
S11.00 / Hour x 1.5
$16.50
Sep 24, 202210:00 AM
Sep 24, 202211:30 AM
Rental - Hourly (R)
$11.001 Hour x 1.5
S16.50
Oct 1, 2022 10:00 AM
Oct 1, 2022 11:30 AM
Rental - Hourly (R)
$11.00 / Hour x 1.5
516.50
Oct 8, 2022 10:00 AM
Oct 8, 2022 11:30 AM
Rental - Hourly (R)
$11.001 Hour x 1.5
S16.50
Oct 15, 2022 10:00 AM
Oct 15, 2022 11:30 AM
Rental - Hourly (R)
S11.001 Hour x 1.5
S16.50
Oct 22, 202210:00 AM
Oct 22, 2022 11:30 AM
Rental - Hourly (R)
$11.001 Hour x 1.5
S16.50
Oct 29, 202210:00 AM
Oct 29, 2022 11:30 AM
Rental - Hourly (R)
S11.00 f Hour x 1.5
$16.50
Nov 5, 202210:00 AM
Nov 5, 202211:30 AM
Rental - Hourly (R)
$11.00 t Hour x 1.5
$16.50
Nov 12, 2022 10:00 AM
Nov 12, 2022 11:30 AM
Rental - Hourly (R)
$11.001 Hour x 1.5
S16.50
Nov 19, 202210:00 AM
Nov 19, 202211:30 AM
Rental - Hourly (R)
$11.00 / Hour x 1.5
S16.50
Nov 26, 202210:00 AM
Nov 26, 202211:30 AM
Rental - Hourly (R)
$11.00 / Hour x 1.5
$16.50
Dec 3, 2022 10:00 AM
Dec 3, 202211:30 AM
Rental - Hourly (R)
$11.00 I Hour x 1.5
$16.50
https:i.?anprod.active.comlyuca ipalui.do?method=s
hotivPermitContra ct&permit_id=C4 B D08860C39
-167-
15 $16.50
15 S16.50
15 S16.50
15 $16.50
15 $16.50
15 $16.50
15 S16.50
15 $16.50
15 $16.50
15 $16.50
15 $16.50
15 $16.50
15 $16.50
15 $16.50
15 $16.50
15 $16.50
15 816,50
15 S16.50
215

4,25122, 11:24 AM
PermitContract
Dec 10, 2022 10:00 AM
Dec 10, 2022 11:30 AM
15 $16.50
Rental - Hourly (R)
$11.00 / Hour x 1.5
S16.50
Dec 17, 2022 10:00 AM
Dec 17, 2022 11:30 AM
15 S16.50
Rental - Hourly (R)
$11.00 r Hour x 1.5
S16.50
Dec 24, 2022 10:00 AM
Dec 24, 2022 11:30 AM
15 $16.50
Rental - Hourly (R)
$11.00 / Hour x 1.5
S16.50
Dec 31, 2022 10:00 AM
Dec 31, 2022 11:30 AM
15 S16.50
Rental - Hourly (R)
$11.00 / Hour x 1.5
Si6.50
Jan 7, 2023 10:00 AM
Jan 7, 202311:30 AM
15 $16.50
Rental - Hourly (R)
$11.00 / Hour x 1.5
S16.50
Jan 14, 202310:00 AM
Jan 14, 202311:30 AM
15 $1650
Rental - Hourly (R)
$11.00 / Hour x 1.5
$16.50
Jan 21, 202310:00 AM
Jan 21, 2023 11:30 AM
15 S16.50
Rental - Hourly (R)
$11.00 / Hour x 1.5
$16.50
Jan 28, 202310:00 AM
Jan 28, 2023 11:30 AN4
15 S16.50
Rental - Hourly (R)
$11.00 / Hour x 1.5
$16.50
Feb 4, 202310:00 AM
Feb 4, 202311.30 AM
15 $16.50
Rental - Hourly (R)
$11.00 / Hour x 1.5
$16.50
Feb 11, 2023 10:00 AM
Feb 11, 2023 11:30 AM
15 $16.50
Rental - Hourly (R)
$11.00 / Hour x 1.5
$16.50
Feb 18, 202310:00 AM
Feb 18, 2023 11:30 AM
15 $16.50
Rental - Hourly (R)
$11.00 / Hour x 1.5
S16.50
Feb 25, 2023 10:00 AM
Feb 25, 2023 11:30 AM
15 $16.50
Rental - Hourly (R)
$11.00 / Hour x 1.5
S16.50
Mar 4, 2023 10:00 AM
Mar 4, 2023 11:30 AM
15 S16.50
Rental - Hourly (R)
$11.00 / Hour x 1.5
S16.50
Mar 11, 2023 10:00 AM
Mar 11, 2023 11:30 AM
15 $16.50
Rental - Hourly (R)
$11.00 / Hour x 1.5
S16.50
Mar 18, 202310:00 AM
Mar 18, 2023 11:30 AM
15 S16.50
Rental - Hourly (R)
$11.00 / Hour x 1.5
$16.50
Mar 25, 2023 10:00 AM
Mar 25, 202311:30 AM
15 $16.50
Rental - Hourly (R)
$11.00 / Hour x 1.5
$16.50
Apr 1, 2023 10:00 AM
Apr 1, 2023 11:30 AM
15 $16.50
Rental - Hourly (R)
S 11.00 / Hour x 1.5
$16.50
Apr 8, 202310:00 AM
Apr 8, 202311:30 AM
15 $16.50
Rental - Hourly (R)
$11.00 / Hour x 1.5
$16.50
Apr 15, 2023 10:00 AM
Apr 15, 2023 11:30 AM
15 S16.50
https:ttanprod.active.comlyucaipafui.do?method=shoe,!PerniitContract&permit id=C48D08860C39

3.15 -168-

4125/22, 11:24 Ali{ Perrnitcontract
Rental - Hourly (R)
$11,00 / Hour x 1.5
$16.50
Apr 22, 2023 10:00 AM
Apr 22, 2023 11:30 AM
15 S16.SO
Rental - Hourly (R)
$11.00 / Hour x 1.5
S16.50
Apr 29, 202310:00 AM
Apr 29, 2023 11:30 AM
15 $16.50
Rental - Hourly (R)
$11.00 / Hour x 1.5
S16.50
May 6, 2023 10:00 AM
May 6, 202311:30 AM
15 S16.50
Rental - Hourly (R)
$11.00 / Hour x 1.5
$16.50
May 13, 2023 10:00 AM
May 13, 2023 11:30 AIJ
15 S16.50
Rental - Hourly (R)
$11.00 / Hour x 1.5
$16.50
May 20, 2023 10:00 Atli
Itifay 20, 2023 11:30 AM
i5
S16.50
Rental - Hourly (R)
$11,00 / Hour x 1.5
$16.50
May 27, 202310:00 AM
May 27, 2023 11:30 AM
15 S16.50
Rental - Hourly (R)
$11.00 / Hour x 1.5
$16.50
Jun 3, 2023 10:00 AM
Jun 3, 2023 11:30 AM
15 $16.50
Rental - Hourly (R)
$11.00 / Hour x 1.5
$16.50
Jun 10. 2023 10:00 AM
Jun 10, 202311:30 AM
15 $16.50
Rental - Hourly (R)
$11.00 / Hour x 1.5
S16.50
Jun 17, 2023 10:00 AM
Jun 17, 2023 11:30 AM
15 $16.50
Rental - Hourly (R)
$11.00 / Hour x 1.5
$16.50
Jun 24, 2023 10:00 AM
Jun 24, 2023 11:30 AM
15 $16.50
Rental - Hourly (R)
S 1i.00 / Hour x 1.5
S16.50
Resource level fees
S54.00
Deposit
Kid%, Club Room)
$54.00 / Each x 1
$54.00
Reservations)
Center. Yucaipa Commun-dy
Center
(ActiVity
(Indoor

END DATE/TIME
( ATTENDEE I
AMT W10 TAX

START DATE/TIME
Jul 9, 2022 10:00 AM Jul 9, 2022 11:30 AM 15 $37.50
Rental - Hourly (R) $25.00 / Hour x 1.5 $37.50
Waivers and Information

INFORMATION DESCRIPTION

SIGNING STATUS
Alcohol Sales Lic
Checked
Proof of Liability Insurance
Checked
Security Guard Contract
Checked
Proof of Non Profit Status
Checked

WAIVER NAME DUE DATE FOR

SIGNING STATUS
Facility Usage Waiver Jul 2, 2022
Waiver Signed
https:/?anprod.active. com.`yucaipatui.do?method=showPermitContract&permit_id=C4 B DO886OC39 -169-
415

4i25i22, 11:24 AIJ; Permilcontract
Facility user hereby agrees to indemnify, defend and hold harmless City of Yucaipa, its officers, officials, employees and volunteers from and against all claims, damages, losses and expenses that may arise during or be caused in any way by such occupancy or use of facilities, but the facility user shall not be liable for any claims, damages, losses and expenses caused by the sole negligence or v.,iilfui misconduct of the City of Yucaipa. Permittee shall have received any and all permission or license(s) as may be r-qui-ed to perform or use any protected nateriais in 1-s use of the Premises. Perminee agrees to protect and save harmless the City, its elected officials, employees and agents from and against any and all claims, penalties. and 'or damages :;'hick may accrue as a result of Permlttee's failure to comply with this requirement.

I have read the rules and regulations relating to use of facilities and accept respo `sioility for meeting the requirements stated herein.

Signature
Deposit

EVENT I

RESOURCE

I DEPOSIT FEE I
CHARGE 1 TAXI AMOUNT PAID

I REFUNDS I
EA,LnNCE
At Anon
Community
Deposit
$54.00 S0.00 $0.00
S0.00
S54.00
Meetings
Meeting
Room
Payment Schedules
Original Balance: $1,052.00
Current Balance:

S1,052.00

DUE DATE
'

AMOUNT DUE

AMOUNT PAID I WITHDRAWAL ADJUSTMENT I

BALANCE
Apr 25, 2022
$156.50
$0.00
S0.00
$156.50
Jun 18, 2022
S895.50
$0.00
$0.00
$895.50
X: K
Date:

City of Yucaipa Community Services
Mailing Address: 34272 Yucaipa Blvd, Yucaipa, CA
92399
Phone Number: (909) 790-7460
Fax Number. (909) 790-2589
Email Address: communityservices iyucaips.org
Date:

John Muller
Customer ID: 29740
Home Phone Number: (714) 290-7341
Email Address: JandKmullerW-agmail.com
https:(ianprod.active.com!yucaipa!ui.do?method=shov,,PermitCont.,act&permit_id=C4BDO886OC39 515 -170-

Attachment B
DocuSign Envelope ID: F1CC95EF-209D-43FB-A20E-75AACOFB2EID °m COMMUNITY ACTIVITY GRANT
f FINANCIAL / IN -KIND / FEE WAIVER

APPLICATION
Fiscal Year:
2022-2023
Date- Application submitted: 5/10/2022
Submit to:

City of Yucaipa
General Services/City Clerk Department
34272 Yucaipa Blvd.

Yucaipa, CA 92399
Attn: Kimberly Everts
Received
City of Yucaipa
MAY 10 2022
General Services/
City Clerk's
All sections of the application must be returned complete and all supporting documentation provided prior to City Council review. Incomplete applications received will be returned to the applicant.

Name of Applicant/Organization:

Applicant/Organization Availing Address:

Applicant/Organization Phone Number:

Contact (1)
Contact (2)
Childhood Cancer Foundation of Southern California, Inc. 11155 Mountain View Ave. Sse 105, Loma Linda CA 92354
(909 ) 5;8-3419
Stephanie Avila
Name
[email protected]
E-mail address
Angelica Tapia
Name
[email protected]
ccfsocal.org
E-mail address
Is your organization located in another community?
Will the program/event take place in another conununity? Are you aware of any other City program providing this service? If so, which one?
(909 ) 558-3419
Phone Number
(909 ) 558-3419
Phone Number
Yes
No
0 ❑
❑
d
❑
ED
*If you answered "Yes" to any of the questions listed above, your request is not eligible for the Community Activity Grant.

City of Yucaipa Community Activity Grants Application, Rev. 03/2022 Pa,e 1
-171-

DocuSign Envelope ID: F1CC95EF-209D-43FB-A20E-75AACOFB2E1D ■a xw u�.�s��;texwY r�� r c�xn� a&I fI a =W , t e t
Your organization must be an established 501(c) to be considered for Community Activity Grant funding.

Please submit documentation verif-ing organization 501(c) status along with this application.

Yes
No
Is your organization a 501(c)?
✓V
❑
If yes, please provide Tax ID# 33-0536599 and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status?
0✓
❑
How Iona has your 50 1(c) organization been in existence? 41 years
Number of Employees working for organization:
2 Number of Volunteers working for organization:
200+
Is a current City Council Member on your board?
❑
How many Yucaipa residents does your organization currently serve? 115
Does the organization charge admission, membership fees, dues, etc.? ❑
❑✓
If yes. please describe:
'`Tames and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Peter Brierty, President Frank Schnetz, Vice President
Terry Lundy, Secretary
Armida Kersey, Board Member
Name of the progran>levent
Datc(s) of progrant,'evcnt:

Wayne 'Williams, Board Member
Spring Egg Hunt
March 25, 2023
Describe the prograttl/event that organization is seeking support for:
(Attach any event/program promotional materials associated with prograni'event) Receiving non-profit status in September of 1981, Childhood Cancer Foundation is now more than 800 families strong committed to serving children with cancer and their families throughout Southern California emotionally, financially, educationally and with emergency assistance. The Spring Egg Hunt is an opportunity for families to interact in a relaxed setting and enjoy an activity with other patents and families experiencing childhood cancer.

The event has an average attendance of 150 patients, siblings and parents. Through this program we serve as an integral support service for families facing the challenges that cancer can manifest in their lives daily.

City of Yucaipa Community Activity Grants Application. Rev. 03:_()22 page 2 -172-

DocuSign Envelope ID: F1CC95EF-209D-43FB-A20E-75AACOFB2EID Describe how the programfevent benefits the residents and'or community of Yucaipa:

Childhood Cancer Foundation of Southern California serves 115 individuals from the city of Yucaipa. Our program is geared to offer emotional. social, educational and emergency assistance for the entire family - not only the patient.

When a child is diagnosed with cancer, the entire family is impacted by this life threatening disease.

We can measure the impact and success of our individual programs through family and community participation.

Widening participation from members of the community and patient families is a strong indicator of a successful program. It is difficult to measure "support" and the impact it might have, but families and members of the community would not continue to participate in our events if they did not realize a benefit in participating.

Program Event Primary Target Population (check all that apply):
no
Children or Youth
❑
Seniors
❑Q
Low Ittcorne
❑
Victims
❑
n
Persons with Disabilities
❑
Welfare Recipients
❑
Number of Residents Projected to Serve: 50
Please identify what your organization is seeking:

Financial Support: ❑ Yes ✓D No �
SI6.25 SEP Fee
Waiver: ® Yes ❑ No
Public
In -kind Support: Police S Fire S Works S
Reassigned
Z7
Staff SOther S Explain
S16.25 SEP
In -Find Financial Support Fee Waiver
Total Amount of Request: S S 16.25
r
err L�
Provide a detailed description of how the financial support will be used:

City of Yucaipa Coimnunity Activity Grants Application, Rev. 03i2022 Women
Homeless
Entire Community*
CS/Rental S str,
Total Overall
Request

Page 3 ends

-173-

DocuSign Envelope ID: F1CC95EF-209D-43FB-A20E-75AAACOFB2E1D What other in-kind/financial contributions has your organization received to fund this event/program (separate from City funding)?
In -Kind
Amount
Jersey Mike's Subs [PROJECTED]
1,250
S
S
Filled reti;rrnm» ly Giveaway-, trxO.trC rt=Dt
3,500
S
S
S
S
S
S
S
S
Total Funds Received To Date:

S
S
526.26
Total Funds Requested Via Grant Application:

S
S
Remaining Balance That Will Be Funded By
S
S
Organization:

Financial
Support Antonnt
Provide City funding received by organization in the past three years (required):

Progratn In -Kind Financial $16.25 SEP Date
Support Fee Waiver Received
Spring Egg Hunt 2022
Spring Egg Hunt 2021
Spring Egg Hunt 2020
❑
❑
M
o
❑
a
o
❑
a
Total Received
5/27/2021 S 684
7/14/19
6/11/2019
S O40.L5
f 525
SECTION 7 —CERTIFICATION
I, the undersigned, do hereby attest that the above information is true and correct to the best of my knowledge, and understand that the awarded financial grant amount needs to be spent prior to submitting another ;rant request.

DocuSigned by;
D� igne n • n Executive Director May 10, 2022
it�lF�°FSs7•.• Title Date
Date Received: rJ
: mmint Funded: S
Type of Grant: A In -Kind
Date City Council received follow///up report:

Date Reviewed:

City Council Meeting:
❑ Financial Support
5-tom ,a-_
❑ Fee Waiver
City or Yucaipa Community Acti%ity Grants Application, Reis. 03/2022 Page 4 -174-

—� CHIL CAN-01 TWA
T£ (MhVDOtYYYY)
CERTIFICATE 4F LIABILITY INSURANCE DATE

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS

CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.

If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), PRODUCER License # OC36861 CONTACT
AME CT Diana Barrios
San Diego-Alliant Insurance Services, Inc. PHONE FAX
701 B St 6th FI (AIC, No, Ext): (AIC, No):

E-MAIL Diana.Barrios
San Diego, CA 92101 ADDREssalliant.COTTI_ _ �_

INSURED
Childhood Cancer Foundation of Southern California
PO Box 1663
Loma Linda, CA 92354

INSURER(S) AFFORDING COVERAGE
NAIC K
INSURER A: Nonprofits Insurance Alliance Of California
dl)�fld
INSURER B:State Compensation Insurance Fund Of California -35076
INSURERC:
-
INSURER D :
-
INSURER E :
-
INSURER F :
-
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD

INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO

WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED

HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUS ONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOAIN MAY HAVE BEEN REDUCED BY PAID CLAI(JS.

INSR' _._ _ ................_ _. ADDL SUBR-. _ _.... _POLICY EFF POLICY EXP L R ' TYPE OF INSURANCE INS WYD POLICY NUMBER r i
LIMBS
} A X - COMMERCIAL GENERAL LIABILITY -
' EACH OCCURRENCE S
1,000,000
CLAIMS -MADE X OCCUR 202210610 3/14/2022 3/14/2023
X

DAMAGE TO RENTED
PREMISES (Ea ccaurence) , S
500,000
_.
20,000
MEDEXP(Aneneperson)S .._........
1,000,000

PERSONAL & ADV INJURY S
_.__.. _.. ......
...... ._....
....._..... .................. ............_
__.._
2,000,000
GENT AGGREGATE LIMIT APPLIES PEP.

GENERAL AGGREGATE 5
X POLICY? %CT LOB
PRODUCTS .COIAPiOPAGG S
2,000,000�

LIQUOR LIABILIT
1,000,000i
OTHER.
s
A

COMBINED SINGLE LWIT
1,000,000

AUTOMOBILE LIABILITY
! (Ea accident)_ ; S
X : ANY AUTO 202210610 3114/2022 3I1412023
HoDILy INJURY (per person) $ ..........
��
� ��
OWNED _ -
.SCHEDULED
. AUTOS ONLY AUTOS
BODILY INJURY (Per accident)S . _,..._
I HIRED tJON-Ot^NED

PROPEPTY DAMAGE
c ate_ $
} ........_.: AUTOS ONLY AUTOS ONLY,i=era
.....
- UMBRELLA LIAS OCCUR
EACH OCCURRENCE 5
EXCESS LIAR CLAIMS -MADE. -
AGGREGATE_ S

DED RETENTION S
- S

B WORKES MPNSATION
PEOT_
X.' STATUTE.,_ .... EIRH
' AND EMPLOYORSELIABILI Y
YIN 16466192021 8118/2021 8/1812022
_
1,000,000
ANY PROFRIETORIPARTNERiEX.ECUTP/E
1OFFICERAIM,11,BER EXCLUDED? NIA
EI,, EACH. ACCIDENT ..__...._ S
1,000,000
(Mandatory In NH)

EL DISEASE - FA EMPLOYEE S
If yes, :escribe under
1,000,000
DESCRIPTION OF OPERATIONS below
-- E_L. DISEASE - POLICY LIMIT 5
I
I
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) I
t
j
Childhood Cancer Foundation of Southern California, Inc. 11166 Mountain View Ave., Suite 105
Loma Linda, CA 92354

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE
ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION, All rights reserved.

The ACORD name and logo are registered marks of ACORD
-175-

1t IRj� Department of the Treagnry
J."e nAl Revenue Service
In reply refer to: 0441861293
002488
OGDEN UT 84201-0038 Mar. 12, 200.9 LTR 4168C EO
33--0536599 000000 00 D00
90029688
BODC: TE

CHILDHOOD CANCER FOUNDATION OF

SOUTHERN CALIFORNIA INC
PO BOX 1663
LOMA LINDA CA 92354-1663
Employer Identification Number: 33-0536599
Person to Contact: Erin. Johnson
Tall Free Telephone Number: 1-877-829-5500
Dear Taxpayer:

This is in response to your request of Mar. 03, 2009, regarding your tax—exempt status.

Our records indicate that a determination letter was issued in September 1981, that recognized you as exempt from Federal income tax, and discloses 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(s) 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 yours,
Debcrah Bingham
Accounts Management I
Monday April 20 2009.max
-176-

5i9122, 9120 Ahi
Permit
Ci y oI Yucaipa Commurmy PHONE:1909) 790-7460
Services FAX:(939) 790.2589
4272 Yucaipa Blvd EhIAIL:consrnunityservices '}=ucaipr,.

Yucaipa, CA 92399
Organization Name Chiidhood Cancer Foundation 0; Soulkern Calif. - 371
Customer Type DNU Norr?ro +i-NR (It 1
Organization Address 11155 Mloun.tain Vies, Ave. Sty:. 105 Loma Linda. CA 92354
Agent Name Stephanie Avila
System User Tish Christian
_....._...1 1. 1 ..................

PermitContract
COMIOU14ITY
/b SERVICES
Permit # R4370
Status Tentative
Date May 9, 2022 9:19 AIA
Expiration Date May 9, 2023
Organization Phone 1 (709) 55S-3 419
Number
tdork Phone Number (909) 5583419
Home Phone Number (909) 558 341n
Email Address savita?cctsocal.org
Rental Fee
S294.00
Discounts
$0.00
Subtotal
$294.00
Deposits
S216.00
Deposit Discounts

50.00 Total Permit Fee
$510.00
Total Payment
S0.00
Refunds
$0.00
Balance
S510.00
Childhood Cancer rOI-Indcation-Egg Hunt lresource(s) lbooking(s) Subtotat:S510.00 Booking Summary
• u r r r: •.. • -
START DXlEni ME END DATUTIME ATTENDEE AMT IAI/O TAX
Mar 25, 2023 8:00 AM
Rental Fee
Resource level fees
Facility Deposit
Depos
Mar 25, 2023 2:00 PM
$49.00 / Hour x 6 $294.00
$216.00 / Each x 1 S216.00
150 $294.00
S216.00
EVENT RESOURCE I DEPOSIT FEE ( CHARGE 1 TAX ( AMOUNT PAID , REFUNDS I BALANCE Childhood :,n2phitheate Facility S216.00 S0.00 S0.00 $0.00 S216.00 Cancer 11 Deposit
https:flarlprod.actii c.com'yucaipalui.do?method=show•PermitContract&permit_id=C 1 B208860936 1/2 -177-

:, 9122, 9:23 AM; PermitContract
Foundation -Egg
Hunt
...

Paymeni SdIedules Dr€gi^st Balance: 5510.00 Current Balance: S5E0.O0 DUE DATE AMOUNT DUE AMOUNT PAID YdlTHDRAWAL ADJUSTIAENT I BALANCE liar 11, 2023 S510.00 S0.00 S0.00 55i0.�I0
- ........ .... ......... _....

X: X:

Date:

City of Yucaipa Community Services
Hailing Address: 34272 Yucaipa -Blvd, Yucaipa, CA
92399
Phone Nuaiber. (9091 790-7460
Fax Number: (903) 790-2559
EmagAddress:commur..ityservices. yucaipa.org
Date:

Childhood Cancer Foundation Of Southern Calif.

Customer Type: DNU Non-Profit-NR (N,
Customer 1D: 10795
hailing Address: i1t55 Mountain View Ave. Ste. 105, Loma Linda. CA 923541
Organization Phone 1 Number: (909) 558-3419
Authorized Agent Name: Stephanie Avila
;Mork Phone Number. (909) 558-3419
Home Phone Number: (909) 556-3419
'Email Address: saviloaccisocal.org
https:lianprod.active romdyucaipalui.do?method=stiov, PerinitContraci'�permit_id=C 1 B208860936 -178-
2r'2

Attachment C
Fiscal Year:

Date Application submitted:

COMMUNITY ACTIVITY GRANT

FINANCIAL / IN -KIND I FEE WAIVER

APPLICATION
2022/2023
Submit to:

City of Yucaipa
General Services/City Clerk Department
34272 Yucaipa Blvd.

Yucaipa, CA 92399
Attn: Kimberly Everts
02 1_°: 1-022
Received
City of Yucaipa
MAR 2 2 2022
General Services/
City Clerk's Department
Name of ApplicantlOrganization: Family Promise of Yucaipa - Calimesa Applicant/Organization Mailing Address: PO Box 72 Yucaipa CA 92399 `jt.f Applicant/Organization Phone Number: ( 909 ) 7I2-8430
L I C Ct i t�< bl 0X
Contact (1) ?Martha Amistadi
Name Phone Number
martha.faini lyprotnise(a gmail.coin
E-mail address
Contact (2) F. Glory Garcia (909 ) 528-9798
Name Phone Number
f [email protected]
E-mail address
Yes
No
Is your organization located in another community?
❑
Will the program/event take place in another community? ❑
❑✓
Are you aware of any other Cite program providing this service? ❑
(�
If so, which one?
If you answered "Yes" to a n v of the questions listed above, tour request is not eligibie for the Cofucnanity activity Grant. city orYucnipa Community Activity Grants Appiicatitm, Rev. 03i202I -179-
Page I

Your organization must be an established 501(c) to be considered for Community Activity Grant funding.

Please submit documentation verifying organization 501(c) status along Fvith this application.

Yes No
Is your organization a 501(c)? 0 ❑
If yes. please provide Tax ID + 82-5498565 and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? ❑ How Iona has your 501(c) organization been in existence? 4 years Number of Employees working for organization: I
Number of Volunteers working for organization: 15
Is a current City Council Member on your board? ❑ ✓❑
How many Yucaipa residents does your organization currently serve? 50 families Does the organization charge admission. membership fees, dues, etc.? ❑ ❑Q If yes, please describe:

Names and Titles of Officers and Board of Directors: (Please attach an organization chart. if available) Chris Hallenbeck, President
Johanne Dyerly, CFO/Treasurer
Valarie Peterson
Kathy Dexter
Lance Bradley
Glory Garcia
Name of the program/event:

Date(s) of programievent:

Cali Binks, Secretary/Support Church Liaison
Matha Amistadi, Ways and Means
Frankie Daub
Tyson Lingenfelter
Sandy Castilla- Executive Director
Family Promise Fundraising Gala of Yucaipa Calimesa
C4u-ne�-I-Ith-;2-022, - _. QC`-p b e-r-
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) Our mission is to help families who are experiencing homelessness achieve housing stability through short-term emergency and transitional housing, financial literacy, individualized case management and employment counseling. Family Promise helps local communities coordinate their compassion to address the root causes of family homelessness. We plan to start coordinating with our local service groups, churches, city officials and community members by throwing a Fundraiser Gala to pay for the secured location to fulfill the "short -tern emergency housing" portion of our mission.

City of Yucaipa Community Actix it-, Grants Application, Rey. 03 /2021t :�
Pace 2

Describe how the program/event benefits the residents and/or community of Yucaipa:

When our small group gathered in 2017 we leaned that over 400 students suffered some kind of homelessness .

Those number have grown since then, to over 500. We plan on informing and addressing the homelessness issue in our school district holistically, providing prevention services before families reach crisis, shelter and case management when they become homeless, and stabilization programs once they have secured housing to ensure they remain independent. The event will help us gather the funds needed to have a permanent location and network to be able to tap into existing local resources. So we can empower our needy families towards economic stability.

Program/Event Primary Target Population (check all that apply):
© Children or Youth
1=1 Low Income
❑ Persons with Disabilities
Number of Residents Projected to Serve:
❑ Seniors
❑ Victims
❑• Welfare Recipients
Please identify what your organization is seeking:

Financial Support: ❑ Yes Q✓ No S
S16.25 SEP Fee
Waiver: ❑ Yes W1 No
In -kind Support: Police S Fire S_
Reassigned
Staff S Other S
Public
Works S
a Women
Homeless
❑ Entire Community
Explain ChairsandTables
-- $16.25 SEP
In- Ind Financial Support Fee Waiver
Total Amount of Request: S1 0 C) S $
CS/Rental S w,,c
Total Overall
RS ut
Provide a detailed description of how the financial support will be used:

Co M to t i r. l Ce +c r fir, u ct RN © ' c}-ch e n t` �' 1 R4 O r�, � By allowing us to use the YP.A. along with the chairs and Yables for our Gala event, we will keep the money our donors have given us towards the location we wish to lease to have a permanent Family Promise of Yucaipa Calimesa to call our own.

City of Yucaipa Community Activity Grants Application. Rev. 03/2021 -181-

Page 3 ends

What other in-kind/financial contributions has your organization received to fund this event/program (separate from City funding)?
In -Kind
Amount
Total Funds Received To Date:

Total Funds Requested Via Grant Application:

Remaining balance That Will Be Funded By
Organization:

Financial
Support Amount
Provide City funding received by organization in the past three years (required):

Program In -Kind
Financial
S16.25 SEP Date
Support
Fee Waiver Received
❑
❑
❑
❑
❑
❑
❑
❑
❑
Total Received
$
$
$
I, the undersigned, do hereby attest that the above information is true and correct to the best of my knowledge, and understand that the awarded fin cial grant amount needs to be spent prior to submitting another grant request. 4WD
Gala Coordinator 02t28/2022
Title Date
Date Received:

Amount Funded: $
Type of Grant: %in -Kind
Date City Council received follow up report:

Date Reviewed:

City Council Meeting:
❑ Financial Support
�-/ -").t:> j Z�- ----
❑ Fee Waiver
City of Yucaipa Community Activity Grants Application, Rea. 03/2021 Page d -182-

617122. 9:24 AM
PermitContract
Permit
City of Yucaipa Community
Services
34272 Yucaipa Blvd
Yucaipa, CA 92399
PHON E:(909) 790-7460
FAX:(909) 790-2589
EMAIL:communityservicesayucai pa.org
Organization Name
Family Promise Of Yucaipaicalimesa - 413
Customer Type
Non -Profit (R)
Organization Address
P. O. Box 72
Yucaipa: CA 92399
Agent Name
tJlartha Amistadi
System User
Tish Christian
- COMMUNITY

SERVICES
Permit # R4197
Status Tentative
Date Mar 22, 2022 11.45 AM
Expiration Date Mar 22, 2023
Organization Phone 1 (909) 446-2557
Number
Organization Phone 2 (909) 528-9798
Number
Home Phone Number (909) 445-2557
Payer Family Promise Of Yucaipa`Calimesa
Rental Fee
$940.50
Discounts
$0.00
Subtotal
$940.50
Deposits
$648.00
Deposit Discounts
$0.00
Total Permit Fee
S1,588.50
Total Payment
$866.50
Refunds
$0.00
Balance
$722.00
Family Promise of Yucaipa Calimesa Fundraising
Gala
1 resource(s) 1 booking(s) Subtotal: $1,588.50
Booking Summary
Banquet RoomtKitch/Mt6 RM' On&6r Reservations)
Center. Yu i
hiunity Center
START DATEfTIME

END DATE/TIME

ATTENDEE

AMT W/O TAX
Oct 15, 2022 12:15 AM
Oct 15, 2022 10:00 AM
160
8940.50
Liability Insurance $115.00 / Each x 1
$115.00
Rental - Hourly $76.00 / Each x 9.5
$722.00
Rental - Saturday Event Assistant (8P-12A) $17.25
/ Each x 6 $103.50
Resource level fees
$648.00
Alcohol Deposit $216.00 / Each x 1
S216.00
Deposit $432.00 / Each x 1
$432.00
Waivers and Information

INFORMATION DESCRIPTION

SIGNING STATUS
Alcohol Sales Lic
Checked
https:llanprod.active.comlyucaipalui.do?method=showPermitContract&permit_id=C6SE08890E35 113 -183-

6t7122, 9:24 AM PermitContract
Proof of Liability Insurance Checked
Security Guard Contract Checked
Proof of Non Profit Status Checked

WAIVER NAME DUE DATE FOR I SIGNING STATUS
Facility Usage Waiver Jun 17, 2022 Waiver Signed
Facility user hereby agrees to indemnify, defend and hold harmless CRY of Yucaipa, its officers, officials, employees and volunteers from and against all claims, damages, losses and expenses that may arise during or be caused in any way by such occupancy or use of facilities, but the facility user shall not be liable for any claims, damages, losses and expenses caused by the sole negligence or wilifui misconduct of the City of Yucaipa. Permittee shall have received any and all permission or license(s) as may be required to perform or use any protected materials in its use of the Premises. Permittee agrees to protect and save harmless the City, its elected officials, employees and agents from and against any and all claims, penalties, and.'or damages which may accrue as a result of Permittee's failure to comply with this requirement.

I have read the rules and regulations relating to use of facilities and accept responsibility fo€ meeting the requirements stated herein Signature
Deposit
EVENT

RESOURCE
I DEPOSIT FEE I CHARGE 1 TAX I AMOUNT PAID I REFUNDS I BALANCE Family Promise
Banquet
Alcohol $216.00 $0.00 $216.00 S0.00 $0.00
of Yucaipa
Room/Vitch!
Deposit
Calimesa
Mtg Rm
Fundraising
Gala
Family Promise
Banquet
Deposit $432.00 $0.00 $432.00 $0.00 $0.00
of Yucaipa
Room/Kitch!
Calimesa
Mtg Rm
Fundraising
Gala
Payment and Refund
RECEIPT #
DATE

FEE DESCRIPTION
EVENT

RESOURCE (

PAYMENT / REFUND
1134005.002
Apr 13, 2022
Deposit
Family Promise of
Banquet
$432.00
Yucaipa Calimesa
Room!Kitch!Mtg Rm
Fundraising Gala
1134005.002
Apr 13. 2022
Alcohol Deposit
Family Promise of
Banquet
S216.00
Yucaipa Calimesa
Room!Kitch/Mtg Pm
Fundraising Gala
1134005.002
Apr 13, 2022
Rental - Hourly
Family Promise of
Banquet
$218.50
Yucaipa Calimesa
Room/Kitch!Mtg Rm
Fundraising Gala
'2013453.002
Jun 2, 2022
Alcohol Deposit
Family Promise of
Banquet
S0.00
Yucaipa Calimesa
Room,KitchlMtg Rm
Fundraising Gala
3013453.002
Jun 2, 2022
Rental - Hourly
Family Promise of
Banquet
$0.00
Yucaipa Calimesa
Room!Kitch!Mtg Rm
Fundraising Gala
hops:/: anprod.active.comlyucaipatui.do?method=showPermitContract&permitid=C6BE08890E35 -1784-
213

617/22, 9:24 AM
PermitContract
3013455.002 Jun 2, 2022
Rental . Hourly
Family Promise of
Banquet
-$103.50
Yucaipa Calimesa
RoomlKitchlMtg Rm
Fundraising Gala
3013455.002 Jun: 2, 2022
Rental - Saturday Event
Family Promise of
Banquet
$103,50
Assistant (8P-12A)
Yucaipa Calimesa
Room!KitchiMtg Rm
Fundraising Gala
Payment Schedules
Original Balance:
$1,588.50
Current Balance: $722.00

DUE DATE

AMOUNT DUE

AMOUNT PAID

WITHDRAWAL ADJUSTMENT I

BALANCE
Mar 22, 2022
5738.50
S738.50
$0.00

50.00 Jun 2, 2022
$69.00
$69.00
$0.00
$0.00
Jun 3, 2022
S78100
$59.00
SO.00
S722.00
X:

Date
City of Yucaipa Community Services
Mailing Address: 34272 Yucaipa Blvd, Yucaipa, CA
92399
Phone Number: (909) 790-7460
Fax Number: (909) 790-2589
Email Address: communityservices4:yucaipa.org
X:

Date:

Family Promise Of YuceipalCalimesa
Customer Type: Non -Profit (R)
Customer ID: 30816
Mailing Address: P. 0. Box 72, Yucaipa, CA
92399
Organization Phone 1 Number: (909) 446-2557
Organization Phone 2 Number: (909) 528-9798
Authorized Agent Name: Martha Amistadi
Home Phone Number: (909) 446-2557
https:llanprod.active.com/yucaipa/ui,do?method=showPermitContract&permit_id=C6BE0889OE35 313 -185-

Attachment D
Fiscal Year:

Date Application submitted:

Submit to:

City of Yucaipa
General Services/City Clerk Department
34272 Yucaipa Blvd.

Yucaipa, CA 92399
Attn: Kimberly Everts

COMMUNITY ATIVITY GRANT

FINANCIAL / IN -KIND / FEE WAIVER

APPLICATION
2022-2023
5-25-22
City of Yucaipa
MAY 312022
General Services/
City Clerk's Department
All sections of the application tttust lie returned complete and all stipporting documentation provided prior to City Council review. Incomplete applications received will be returned to the applicant.

Name of Applicant/Organization: inland Leaders Charter School Applicant/Organization Mailing Address: 12375 California St, Yucaipa, CA 92399 Applicant/Organization Phone Number: (909 )446-1100
Contact (1) Jeremy Hoch (909 ) 705-9507
Name Phone Number
[email protected]
E-mail address
Mike Gordon
Contact (2) (909 ) 446-1100
Name Phone Number
[email protected]
E-mail address
iN 2 - ELIGIBELITY REQUIREMENTS:

Yes NTo
Is your organization located in another community? ❑ z
Will the program/event take place in another community? ❑ (�✓ Are you aware of any other City program providing this service? ❑ (� II - so, which one?
*If you answered "Yes" to any of the questions listed above, your request is not eligible for the Community Activity Grant.

City oi'Yucaipa Community Activity Grants Apipiication, Rev. 03/2022 Page 1 -186-

Your organization must be an established 501(c) to be considered for Community Activity Grant funding.

Please submit documentation verifi ing organization 501(c) status along with this application.

Yes No
Is Your organization a 501(c)? ✓❑ ❑
20-8343 378
If yes, please provide Tax ID.; and attach all supporting documents.

Does 11iis application include submittal ofdocutnentation verifying 501(c) status? Q ❑ 1 -5 years
How long has your 501(c) organization been in existence? 120
'.Number of Employees %vorking for organization:
100
.Number of Volunteers working for organization:

Is a current City Council Member on your board? ❑
650
How many Yucaipa residents does your organization currently serve? Does the organization charge admission, membership fees, dues, etc.? ❑ 0 If yes, please describe:
;Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Dr. Jay Jiminez Member
Michael Casavan
Aron Wolfe
Bonnie Mitchell
Eli Gillespi
Mike Gordon
Name of the program event:

Volleyball Games
Member
Member
Secretary
Member
Director
9- Date(s) of program event: 9-27. 10-4. 10-6. 10-1 I. I L— I g -- 2,� Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) Our sports program is in need of a gym to host our home volleyball games. \1le have six home volleyball games.

Our games are on the above dates.

City of Yucaipa Community Activity Grants Application. Rev. 0372022 -187-
Pagc 2

Describe how the program/event benefits the residents and/or community of Yucaipa:
\Ve believe that athletics are an important part of the educational experiance at inland Leaders Charter School, Our students benifit from learning, how to handle success and disappointment. Athletics help build good leadership qualities in students that will help them be leaders in our community.

Program>Event Primacy Target Population (check all that apply):

Children or Youth
❑ Loly Income
Persons with Disabilities
Number of Residents Projected to Serve: 20
❑ Seniors
❑ Victims
❑ Welfare Recipients

GIUNIT FUNDING REQLTST
Please identify what your organization is seeking:

Financial Support: ❑ Yes ❑✓ No S
S16 25 SEP Fee
Waiver: ❑ Yes IVI No
In -kind Support: Police $
Reassigned
Staff $
In -Kind
Total Amount of Request: $
❑
Women
❑
Homeless
❑
Entire Community
t
Public '4 �Z.,$
Dire $ Works $ CS/Rental Sl}-}�-;f}
Other $ Explain
$16.25 SEP
Financial Support .Fee Waiver
S $
Total Overall
Request
_-$-M tom%.. j
� 2 �3��-
Provide a detailed description of how the financial support will be used:

Our sports program is in need of a gym to host our volleyball games. We have six home volleyball games for the 2022 season. The total cost of using the gym in 2021 was 3118.50.

City of ocai-pa C'ornmonity ;• etiviiy Grants Application, Rev. 03.12022 Page

1N 6 — FINANCIAL CAPABILINUSIBUDGET:

What other in-kind/financial contributions has your organization received to fund this event/program (separate from City funding)?
NA
Total Funds Received To Date:

Total Funds Requested Via Grant Application:

Remaining Balance That Will Be Funded By
Organization:

In -Kind
Amount
$
$
Financial
Support Amount
SECTTONi ! t ♦ t
Provide City funding received by organization in the past three years (required):

Program In -Kind Financial 516.25 SFP Date Total Received Support Fee Waiver Received
Community Center Gym Fall 2019 2500
Community Center Gym
❑
❑
Fall 2021 3118.50
61 1, the undersigned, do JiQ►ed�v kt t that the above information is true and correct to the best of my knowledge, and understand that thct\y.aQeci fIn ff ial Ti amount needs to be spent prior to submitting another grant request.

Athletic Director 5-24-22
Title Date

COMPLETEDRYCITY
Date Received: 6 —3 1 — Date Reviewed:

Amount Funded: $
Type of Grant: In -Kind
Date City Council received follow up report:

City Council Meeting:
❑ Financial Support ❑ Fee Waiver
City o►'Yucaipa Community Activity Grants A
Rev, 0312022
1 Pane 4

Permit
City of Yucaipa Community PHONE:(909) 790-7460
Services FAX:(909) 790-2589
34272 Yucaipa Blvd EMAIL:con,nu, ntyse:vicc•s:s:yucaipa.org Yucaipa, CA 92399
Organization Name Inland Leaders Charter School - 170
Customer Type Non -Profit (R)
Organization Address 12375 California St
Yucaipa, CA 92399
Agent Name Jeremy Hoch
System User Karen Ruiz
a-, COMMUNITY FaSake x
'� SERVICES
Permit # R4454
Status Tentative
Date Jun 2, 2022 2:56 PM
Expiration Date Jun 2, 2023
Home Phone Number (909) 705-9507
Email Address P:e +; inla:dlLadGss.carn
Rental Fee
$2.835.00
Discounts
$0.00
Subtotal
$2,835.00
Deposits
$323.00
Deposit Discounts
$0.00
Inland Leaders Charter School
Total Permit Fee $3,158.00
Total Payment $0.00
Refunds SO.00
Balance $3,158.00
1 resource(s) 6 booking(s) Subtotal: $3,158.00
GJuking Swrwic rye

START DATE/TIME

END DATE/TIME

ATTENDEE

AMT W/O TAX
Sep 27, 2022 2.45 PM
Oct 18, 2022 5:15 PM
—
$2,835.00
Occurs on selected dates- Sep 27.
2022, Sep 29, 2022, Oct 4. 2022, Oct 5. 2022. Oct 11, 2022, Oct 18, 2022 Sep 27, 2022 2:45 PIA
Sep 27, 2022 5:15 PIA
1 $472,50
Rental - Hourly
$189.00! Hour Y. 2.5
:s472.50
Sep 29, 2022 2:45 PIA
Sep 29, 2022 5:15 PM
1 $472.50
Rerital - Hourly
S189.00; l Eour x 2.5
$472.50
Oct 4, 2022 2:45 PM
Oct 4, 2022 5:15 PM
1 $472.50
Rema! - Hourly
S189,0011 lour r 2.5
$472.50
Oct 6, 2022 2:45 PM
Oct 6, 2022 5:15 PM
1 $472.50
Ren.ta' - Hourl.,
5189.00 I lour Y 2. ;
$472.50
Oct 11, 2022 2:45 PM
Oct 11, 2022 5:15 PM
1 $472.50
€?crnta - How!v
515�€ 00 f Hour x 2.5
772.50
Oct 18, 2022 2:45 PM
Oct 18, 2022 5:15 PM
1 $472.50
Rental- Hourly
S189,00 Hour x 2.5
S472.50
l

Resource level fees
S''323.00 , Each x "I S32::.00
$323.00
Waivers al -id inforniation

INFORMATION DESCRIPTION SIGNING STATUS
Alcohol Sales Lic Checked
Proof of Liabi;ity Insurance Checked
Security Guard Contract Checked
Proof of Non Profit Status Checked

WAIVER NAME DUE DATE FOR SIGNING STATUS
Facility Usage Waiver Sep 27, 2022 Waiver Signed
Facility user hereby agrees to indemnify, defend and hold harmless City of Yucaipa, its officers, officials, employees and volunteers from and against all claims. damages, losses and expenses that may arise during or be caused in any way by such Occupancy or use of facilities, but the facility user shall not be liable for any claims, damages, losses and expenses caused by the sole negligence or willful misconduct of the City of Yucaipa.

Permittee shall have received any and all permission or license(s) as may be required to perform or use any protected materials in its use Of the Premises. Permittee agrees to protect and save harmless the City, its elected officials, employees and agents from and against any and all claims, penalties, and/or damages which may accrue as a result Of Permittee's failure to comply with this requirement.

I have read the rules and regulations relating to use of facilities and accept responsibility for meeting the requirements stated herein.

Deposit
EVENT
Island
Leaders
Charter
School

RESOURCE DEPOSIT FEE CHARGE
Gymnasium Deposit S323.00
Payment Schedules

DUE DATE
Sep 13, 2022
Signature

TAX AMOUNT PAID REFUNDS BALANCE
S0.00 $0.00 SO.00 $323.00
Original Balance: $3,158.00 Current Balance: $3,158.00

AMOUNT DUE AMOUNT PAID WITHDRAWAL ADJUSTMENT BALANCE
S3,158.00 $0.00 $0.00 $3.158.00
-191-

Date:

City of Yucaipa Community Services Inland Leaders Charter School Mailing Address: 34272 Yucaipa Blvd, Yucaipa. CA Customer Type: Rion -Profit (R) 92399 Customer ID: 11233
Phone Number: (909) 790-7460 Mailing Address: 12375 California St, Yucaipa. CA Fax 'number: (909) 790-2589 92399
Email Address: comrnunityservices t'yucaipa.org Authorized Agent Name: Jeremy Hoch Home Phone Number: (909) 705-9507
Email Address: jhoch d iniandleaders.com
-192-

Attachment E
CITY O�,

COMMUNITY ACTIVITY Y RANT

FINANCIAL / IN -KIND / FEE WAIVER

APPLICATION
Fiscal Year: 2022-2023 "cLc' V `"
Date Application submitted: 06''-
City of Yucaipa
c7''
Submit to: JUN 14 2022
City of Yucaipa
General Services/City Clerk Department General Services/ 34272 Yucaipa Blvd. City Clerk's Department
Yucaipa, CA 92399
Attn: Kimberly Everts
All sections of the application must be returned complete and all supporting documentation provided prior to City Council review. Incomplete applications received will be returned to the applicant.

SECTION 1 — GENERAL INFORAIIATION
Nor
Name of Applicant/Organization: Rotary Club of Yucaipa
Applicant/Organization Mailing Address:

Applicant/Organization Phone Number:

Contact (1)
Contact (2)
PO Box 661 Yucaipa, CA 92399
Todd Gutjahr (909 ) Roo G537
Name Phone Number
tgutjahr a,,hotmail.com
E-mail address
Name Phone Number
E-mail address
SECTION 2 - ELIGIBILITY REQUIREMENTS:

Is your organization located in another community? ❑ 0
Will the program/event take place in another community? ❑ ❑✓ Are you aware of any other City program providing this service? ❑ ✓❑ If so, which one?
*If you answered "Yes" to any of the questions listed above, your request is not eligible for the Community Activity Grant.

City of Yucaipa Community Activity Grants Application, Rev. 03/2022 -193-
Page I

SECTION 3 — ORGANIZATION INFORAUTION/APPLICANT BACKGROUND 1 Your organization must be an established 501(c) to be considered for Community Activity Grant funding.

Please submit documentation verifying organization 501(c) status along -with this application.

Yes No
Is your organization a 501(c)? ❑
If yes, please provide Tax ID445-514930$ and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? ❑✓ ❑ How long has your 501(c) organization been in existence? 1956 Number of Employees working for organization: 0
Number of Volunteers working for organization: 40
Is a current City Council Member on Your board? ❑
FIT
How many Yucaipa residents does your organization currently serve? 51,000 Does the organization charge admission, membership fees, dues, etc.? ✓❑ ❑ If yes, please describe: $140/yr
Dames and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Chris Markarian, President
Donnakaye Ostrander, President Elect
Joan Dendinger, Treasurer
SECTION 4 - PROGRAA1 DESCRIPTION/SCOPE: (PLEASE USE ADDITIONAL PAGES IF NECESSARY) Name of the program/event:

Date(s) of program/event:

Julyl, 2022-June 30, 2023
Tuesdays
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) Weekly Club Meetings
City of Yucaipa Community Activity Grants Application, Rey. 0312022 52 Pave 3

Describe how the program/event benefits the residents and/or community of Yucaipa:

The weekly club meetings allot Rotarians to plan and discuss community events.

Program/Event Primary Target Population (check all that apply):

Fol Children or Youth
0 Low Income
Persons with Disabilities
Number of Residents Projected to Serve: 51,000
❑°
Seniors
0 Victims
©
Welfare Recipients
SECTION' 1 REQUEST
Please identify what your organization is seeking:

Financial Support: ❑ Yes ✓❑ No S
S16.25 SEP Fee
Waiver: ❑ Yes ® No
In -kind Support: Police S o
Reassigned
Staff $ 0
In -Kind
Total Amount of Request: $ 9s96
Public
Fire S o Works S 0
Other $ o Explain
$16.25 SEP
Financial Support Fee Waiver
$Q $0
Provide a detailed description of hog}- the financial support will be used:
0 Women
❑=
Homeless
❑
Entire Community
CS/Rental $ 93196
Total Overall
Request
Funding will cover the rental costs of the Nutrition Center that will be used for weekly club meetings.

City of Yucaipa Community Activity Grants Application. Rev. 0312022 -195-
Paee i

SECTION 1 — FINANCIAL CAPABILITIES/BUDGET:

What other in-kind/financial contributions has your organization received to fund this event/program (separate from City funding)?
In -Kind
.Amount
None
Total Funds Received To Date:

Total Funds Requested Via Grant Application:

Remaining Balance That Will Be Funded By
Orsanization:

Financial
Support Amount
SECTION1FLN.-TANCIALCAPABILITIES/BUDGET
Provide City funding received by organization in the past three years (required):

Program In -Kind Financial S16.25 SEP Date Total Received Support Fee Waiver Received
2021 I
❑
$ 5,851.37
2019 0
0 $ 4,831
2018 ❑
I
$ 3,477
SECTION 7 — CERTIFICATION
I, the undersigned, do hereby attest that the above information is true and correct to the best of my knowledge, and understand that the awarded rancial grant amount needs to be spent prior to submitting another grant request. 6/14/22
Signature Title Date
TO BE 1 i BY CITY
c
Date Received: �` _ IL[ — Date Reviewed: t-i
Amount Funded: $
Type of Grant: ❑ In -Kind
Date City Council received follow up report:

City Council Meeting:
❑ Financial Support
❑ Fee Waiver
Cite of Yucaipa Community Activity Grants Application. Rev. 03/2022 Yaae 4 M•

6!6/22, 5:50 PM
PermitContract
Permit
City Of Yucaipa Community
Services
34272 Yucaipa Blvd
Yucaipa. CA 92399
PHONE:(909) 7907460
FAK(909) 790-2589
Ef.e,AIL:com-,iiu*,i!4,seR,ices�-d,yucaipa.org
C0110MUNiTY Palrt, s

SERVICES
Permit # R4464
status Tentative
Date Jun 6, 2022 5:31 PIA
Expiration Date Jun 6, 2023
Organization Name Rotary Club Of Yucaipa - 336 Organization Phone 1 (909) 900-9537 Customer Type Non -Profit (R) Number
Organization Address PO Box 661
Yucaipa, CA 92399
Agent Name Todd GuIjahr Home Phone Number (909) 900-9537 System User Tish Chrisian
Rental Fee
$9126.00
Discounts
$0.00
Subtotal
$9126.00
Deposits
$270.00
Deposit Discounts
$0.00
Total Permit Fee
$9,396.00
Total Payment
$0.00
Refunds
$0.00
Balance
S9,396.00
Rotary weekly Club Meetings I resource(s) 52 booking(s) Subtotal: $9,396.00 Booking Summary
SrC Nutrition Center Undoor
Reservations)
END DA7FE(TV,/-=- j
Center- Yucaipa

AT T N D E
Senior Center
AMT %11/0 TAX
S E) -
Jul 5, 2022 6:00 AM
Jun 27,2023 9:15 AM
Occurs every Tuesday
effective Jul 5, 2022 until Jun 27 2023 from 6.00 AM to 9:15 AM Jul 5, 2022 6:00 AM
Jul 5, 2022 9:15 AM
50 $175.50
Rental - Hourly
$54.00 Hour x 3.25 $175.50
Jul 12,2022 6:00 AM
Jul 12, 2022 9:15 AM
50 $175.50
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Jul 19,2022 6:00 AM
Jul 19,2022 9:15 AM
50 $175.50
Rental - Hourly
$54.00 Hour x 3.25 $175.50
Jul 26,2022 6:00 AM
Jul 26,2022 9:15 AM
50 $175.50
Rental - Hourly
$54.00 Hour x 3.25 $175.50
Aug 2,2022 6:00 AM
Aug2,20229:15AM
50 $175.50
littps:/Ianprod.acU,ve,com,lyucaipalui.do?method=showPerm!tContract&permit id=C1 B508870930 -r97-

616/22, 5:50 PM
PermitContract
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Aug 9, 2022 6:00 AM
Aug 9, 2022 9:15 AM
Rental - Hourly
S54.00 / Hour x 3.25 $175.50
Aug 16, 2022 6:00 AM
Aug 16, 2022 9:15 AM
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Aug 23, 2022 6:00 AM
Aug 23, 2022 9:15 AM
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Aug 30, 2022 6:00 AM
Aug 30, 2022 9:15 AM
Rental - Hourly
$54.001 Hour x 3.25 $175.50
Sep 6, 2022 6:00 AM
Sep 6, 2022 9:15 AM
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Sep 13, 2022 6:00 AM
Sep 13, 2022 9:15 AM
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Sep 20, 2022 6:00 AM
Sep 20, 2022 9:15 AM
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Sep 27, 2022 6:00 AM
Sep 27, 2022 9:15 AM
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Oct 4, 2022 6:00 AM
Oct 4, 2022 9:15 AM
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Oct 11, 2022 6:00 AM
Oct 11, 2022 9:15 AM
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Oct 18, 2022 6:00 AM
Oct 18, 2022 9:15 AM
Rental - Hourly
$54.00 J Hour x 3.25 $175.50
Oct 25, 2022 6:00 AM
Oct 25, 2022 9:15 AM
Rental - Hourly
$54.00 ! Hour x 3.25 $175.50
Nov 1, 2022 6:00 AM
Nov 1, 2022 9:15 AM
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Nov 8, 2022 6:00 AM
Nov 8, 2022 9:15 AM
Rental - Hourly
$54.00 / Hour x 3,25 $175.50
Nov 15, 2022 6:00 AM
Nov 15, 2022 9:15 AM
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Nov 22, 2022 6:00 AM
Nov 22, 2022 9:15 AM
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Nov 29, 2022 6:00 AM
Nov 29, 2022 9:15 AM
Rental - Hourly
$54.001 Hour x 3.25 $175.50
Dec 6, 2022 6:00 AM
Dec 6, 2022 9:15 AM
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
https:/tanprod.active.com,yucaipa/ui.do?method=showPermitContract&permit id=CiB508870930 -198-
50 $175.50
50 $175.50
50 $175.50
50 $175.50
50 $175.50
50 $175.50
50 $175.50
50 $175.50
50 $175.50
50 $175.50
50 $175.50
50 $175.50
50 $175.50
50 $175.50
50 $175.50
50 $175.50
50 $175.50
50 $175.50 i
2t5

6/6/22, 5:50 PM
PermitContract
Dec 13, 2022 6:00 AM
Dec 13, 2022 9:15 AM
50 $175.50
Rental - Hourly
$54.0O / Hour x 3.25 $175.50
Dec 20, 2022 6:00 AM
Dec 20, 2022 9:15 AM
50 $175.50
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Dec 27, 2022 6:00 AM
Dec 27, 2022 9:15 AM
50 S175.50
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Jan 3, 2023 6:00 AM
Jan 3, 2023 9:15 AM
50 $175.50
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Jan 10, 2023 6:00 AM
Jan 10, 2023 9:15 AM
50 $175.50
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Jan 17, 2023 6:00 AM
Jan 17, 2023 9:15 AM
50 $175.50
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Jan 24, 2023 6:00 AM
Jan 24, 2023 9:15 AM
50 5175.5O
Rental - Hourly
$54.00 I Hour x 3.25 $175.50
Jan 31, 2023 6:00 AM
Jan 31, 2023 9:15 AM
50 $175.50
Rental - Hourly
554.00 / Hour x 3.25 $175.50
Feb 7, 2023 6:00 AM
Feb 7, 2023 9:15 AM
50 $175.50
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Feb 14, 2023 6:00 AM
Feb 14, 2023 9:15 AM
50 $175.50
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Feb 21, 2023 6:00 AM
Feb 21, 2023 9:15 AM
50 $175.50
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Feb 28, 2023 6:00 AM
Feb 28, 2023 9:15 AM
50 $175.50
Rental - Hourly
554.00 / Hour x 3.25 $175.50
Mar 7, 2023 6:00 AM
Mar 7, 2023 9:15 AM
50 $175.50
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Mar 14, 2023 6:00 AM
Mar 14, 2023 9:15 AM
50 $175.50
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Mar 21; 2023 6:00 AM
Mar 21, 2023 9:15 AM
50 $175.50
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Mar 28, 2023 6:00 AM
Mar 28, 2023 9:15 AM
50 $175.50
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Apr 4, 2023 6:00 AM
Apr 4, 2023 9:15 AM
50 $175.50
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Apr 11, 2023 6:00 AM
Apr 11, 2023 9:15 AM
50 $175.50
Rental - Hourly
$54.00 I Hour x 3.25 $175.50
t
hitps:;lanprod.active.comfyucaipalui.do?method=showParmitContract&permit id=C1 B508870930 3!5
-1-99-

616122, 5:50 PIJi
PermitConfract
Apr 18, 2023 6:00 AM
Apr 18 2023 9:15 AM
50 - $175.50
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Apr 25, 2023 6:00 AM
Apr 25, 2023 9:15 AM
50 $175.50
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
May 2, 2023 6:00 AM
May 2, 2023 9:15 AM
50 $175.50
Rental - Hourly
$54.001 Hour x 3.25 $175.50
May 9, 2023 6:00 AM
May 9, 2023 9:15 AM
50 $175.50
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
May 16, 2023 6:00 AIA
May 16, 2023 9:15 Aid{
50 $175.50
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
May 23, 2023 6:00 AM
IN4ay 23, 2023 9:15 AM
50 $175.50
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
May 30, 2023 6:00 AIA
May 30, 2023 9:15 AM
50 $175.50
Rental - Hourly
$54.001 Hour x 3.25 $175.50
Jun 6, 2023 6:00 AM
Jun 6, 2023 9:15 AM
50 $175.50
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Jun 13, 2023 6:00 AM
Jun 13, 2023 9:15 AM
50 $175.50
Rental - Hourly
$54.00 / Hour x 3.25 $175.50
Jun 20, 2023 6:00 AM
Jun 20, 2023 9:15 AM
50 $175.50
Rental - Hourly
$54.001 Hour x 3.25 $175.50
Jun 27, 2023 6:00 AM
Jun 27, 2023 9:15 AM
50 $175.50
Rental - Hourly
S54.00 i Hour x 3.25 $175.50
Resource level :_es
S270.00
Deposit
$270.00 / Each x 1 $270.00
Waivers and Information
1 lFORh4ATlOi 1 DESC:�IPTIGN

SIGNING STATUS
Alcohol Sales Lic
Checked
Proof of Liability Insurance
Checked
Security Guard Contract
Checked
Proof of Non Profit Status
Checked

VYAIVER NAME

DUE DATE FOR
SIGNI14G STATUS
Facility Usage Waiver
Jul 5, 2022
Waiver Signed
Facility user hereby agrees
to indemnify, defend and hold harmless City of Yucaipa, its officers, officials, employees and volunteers from and against all claims, damages,
losses and expenses that may arise during or be caused in any way by such occupancy or use of facilities, but the facility user shall not be liable for any claims, damages, losses and expenses caused by the sole negligence or willful misconduct of the City of
Yucaipa. Permittee shall have received any and all permission or license(s) as may be required to perform or use any protected materials in its
use of the Premises. Per,mittee agrees to protect and save harmless the City, its elected officials, employees and agents from and against any
hitps:llanprod.active.comflvcaipa/ui.do?method=showPermitContract&permit id=C76508870930 -200-
415

616122, 5:50 PM PermitContract
and all claims, penalties, and/or damages which may accrue as a result of Permittee's failure to comply with this requirement. have read the rules and regulations ielating to use of facilities and accept responsibility for meeting the requirements stated herein.

Signature
Deposit
EXTENT RESOURCE DEPOSIT FEE ( CHARGE; TAX I AIAOUNT PAID PErUNQS ( BALANCE Rotary weekly SrC Nutrition Deposit S270.00 S0.00 $0.00 $0.00 $270.00 Club heetincs Center
Payment Schedules

DUE DATE AMOUNT DUE
Jun 21, 2022 S9,396.00
X:

Date
City of Yucaipa Community Services
hailing Address: 34272 Yucaipa Blvd, Yucaipa, CA
92399
Phone Number. (909) 790-7460
Fax Number: (909) 790-2589
Email Address: communityservicesi?yucaipa.org
Original Balance: $9,396.00 Current Balance: $9,396.00
AMOUNT PAID { W1 T HDRAVVAL ADJUSTMENT BALANCE
$0.00 $0.00 $9.396.00
X:

Date:

Rotary Club Of Yucaipa
Customer Type: Non -Profit (R)
Customer ID: 27557
Mailing Address: PO Box 661, Yucaipa, CA
92399
Oroanization Phone 1 Number. (909) 900-9537
Authorized Agent Name: Todd Gutiahr
Home Phone Number: (909) 900-9537
https:ifanprod.active.com?yucaipafui.do?method=showPermitContract&permit ij1C1B508870930 515

Attachment F
Fiscal Year:

Date Application submitted:

Submit to:

City of Yucaipa
General Services/City Clerk Department
34272 Yucaipa Blvd.

Yucaipa, CA 92399
Attn: Kimberly Everts

COMMUNITY ACTIVITY GRANT

FINANCIAL / IN -KIND I FEE WAIVER

APPLICATION
2022-2023
Received
City of Yucaipa
MAY 0 2 2022
('eme:ral Services/
Cit , Cle; Ws'Department
All sections of the application must he returned complete and all supporting documentation provided prior to City Council review. Incomplete applications received Nvill be returned to the applicant.

SECTIONINFORMATION
Name of Applicant/Organization: Yucaipa Valley Art Association Applicant/Organization Mailing Address:

P.O. Box 404, Yucaipa, CA 92399
Applicant/Organization Phone Number: ( )'`'A
Contact (1) Alan Remele (909 ) 556-3645
Name Phone Number
[email protected]
E-mail address
Contact (2) Zully Martinez ( 909 ) 797.7741
Name Phone Number
[email protected]
gmail.com
E-mail address
•
ELIGIBILITY ! Yes No
Is your organization located in another community? ❑ 0
Will the program/event take place in another community? ❑ ❑✓ Are you aware of any other City program providing this service? ❑ ❑✓ If so, which one?
*If you answered "Yes" to any of the questions listed above, your request is not eligible for the Community Activity Grant.

City of Yucaipa Community Activity Grants Application, Rev. 012Q-102- Page t

Your organization must be an established 501(c) to be considered for Community Activity Grant funding.

Please submit documentation verifying organization 501(e) status along with this application.

Yes No
Is your organization a 501(c)? 0 ❑
If yes, please provide Tax I1)4495-3701090 and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? ❑✓ ❑ How long has your 501(c) organization been in existence? 41 years Number of Employees working for organization: 0
Number of Volunteers working for organization: 16+
Is a current City Council Member on your board? ❑
How many Yucaipa residents does your organization currently serve? 70+ Does the organization charge admission, membership fees, dues; etc.? ❑ If yes, please describe: 525.00 annual membership dues
Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Alan Remele - President
Zully Martinez - Shows & Events
Lenore Will - Ways & Means/Secretary
Cindy Kanakriyeh- Membership Newsletter
Enrique Lima - Treasurer/Exhibits
Carolyn Bonnano - Welcoming
Bob Norris - Parlimentarian
Judy Remele - Hospitality
SECTION 4 - PROGRAM DESCRIPTION/SCOPE: (PLEASE USE ADDITIONAL PAGES IF NECESSARY) Name of the programlevent:

Date(s) of program/event:

YVAA Art Meeting, twice a month on a Tuesday & Thursday Sept 2022 through May 2023, see dates below
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with programfevent) The Yucaipa Valley Association's monthly art meetings encourage members to exhibit artwork and photography for peer enjoyment. At the meeting, artists are peer approved and awarded a ribbon for their artwork. Members and guests also benefit from demonstrations on art techniques and methods. The public is able to attend meetings as guests and encouraged to become members of our organization. YVAA will hold a monthly Tuesday planning - meeting
from 10:00 am to 12:00 pm and the Thursday art show from 6:00 pm to 9:15 pm at the Scherer Center.

Requested dates are: 9/13/22, 9/15/22, 10/18/22, 10/20/22, 11/15/22, 11/17/22, 12/6/22, 12/8/22, 1/17/23,1/19/23 2/14/23, 2/16/23, 3/14/23, 3/16/23, 4/18/23, 4/20/23, 4/25,123, 5/16/23, 5/18/23. Permits R4301 & R4320.

City of Yucaipa Community Activity Grants Application, Rev. 03r2(2N3_ Page

Describe ho\N? the program/event benefits the residents and/or community of Yucaipa:

The Yucaipa Valley Art Association meetings give our members and guests an opportunity to to visually appreciate local artistic talent. The meetings also help us in planning and our fundraising activities to promote art in our community. Throughout the year, we coordinate with local businesses and other organizations such as Vision Quest and the City of Yucaipa on art related events and displays. Futhennore, YVAA cooperates with YHS ail dept. in helping promote art, lending art displays or awarding two student scholarships in our community. Our community contributions and activities significantly increase awareness and appreciation for the artistic talent of our members and local students.

Prograin/Event Primary Target Population (check all that apply):
❑
Children or Youth
❑
Seniors
❑
Women
❑
Low Income
❑
Victims
❑
Homeless
❑
Persons with Disabilities
❑
Welfare Recipients
on
Entire Community
Number of Residents Projected to Scn c: ao-
SECTION 5 — GRXNT FUNDING REQUEST
Please identify what your organization is seeking:

Financial Support: ❑ Yes Q No S
$16.25 SEP Fee
Waiver: ❑ %'es 0 No
In -kind Support: Police S Fire S
Reassigned
Staff S Other S
In -Kind
Total Amount of Request:

Public
Works S CS/Rental S
Explain
516.25 SEP Total Overall
Financial Support Fee Waiver Request
S $ = $2.62a.oa
Provide a detailed description of how the financial support will be used:

The in -kind CAGrant support will be used to cover the cost to reserve rooms monthly at the Scherer Center twice a month Tuesday morning planning meeting (1 hr) in room B or the back cabinet storage room and a Thursday night art show/meeting (3.25 hrs) in room A & B and from September 2022 through May 2023.

The CAGrant covers rental costs for two monthly meetings. Activities include planning, artwork take -in, setup of displays, peer review of artwork for ribbon award, fundraising, demonstration of art techniques.

This event is open to our members and guests.

City of Yucaipa Comnu nity Activity Grants Application, Rev. 03.'20 4- Noe 3

What other in-kind/financial contributions has your organization received to fund this event/program (separate from City funding)?
In -Kind
Amount
None
Total Funds Received To Date:

Total Funds Requested Via Grant Application:

S
S
S
S
S
S 0
S
Retraining Balance That Will Be Funded By S
Organization:

Financial
Support Amount
S
S
S
S
S
S 0
S
S
SECTION 6 — FINANCIAL CAPABILITIES/BUDGET J
Provide City funding received by organization in the past three years (required):

Program In -Kind Financial $16.25 SEP Date Total Received Support Fee V17aiver Received
YVAA Spring Art Show 2022
YVAA Monthly Meetings 2021
YVAA Monthly Meetings 2022
0 ❑
❑
7 ❑
❑
El
❑
❑
6/2/21 S 1483.63
6/2i21 S 687.00
6/2/21 S 926.24
SECTION 7 —CERTIFICATION
1, the undersigned, do hereby attest that the above information is true and correct to the best of my knowledge, and understand that the awarded financial grant amount needs to be spent prior to submitting another grant request. zti- �� President 4/18/22
Signature Title Date
TO
1 '

E COMPLETEY CITY
•
Date Received: `' � � %' � Date Reviewed:

Amount Funded: S
Type of Grant: 9—In-Kind
Date City Council received follow up report:

City Council Meeting:
❑ Financial Support
❑ Fee Waiver
City of Yucaipa Community Activity Grants Application, Rev. 03-20405- Page 4

4'25 22, :?.42 AM
PermitContract
Permit
City of Yucaipa Community
Services
34272 Yu:aE?a Bwd
Yucaipa, CA 92399
PHONE:(9091790-7460
FAX:1909) 790- 589
ES �At� :cemm;;rityservices�yucaipa.arg
Organization Name Yucaipa Valley Art Association - 49
Customer Type Non-Noiii (R)
Organization Address PO Pox 404
Yucaipa, CA 92399
Agent Name tufty Maninez
System User Tish Cixistian
..............._....._.. .

YVAA Thurs. Meetings
y7
C0�ti1tiFUNITi`� �`
„ri SERVICES `*eitC
Permit # R4320
status Tentative
Date Apr 25, 2022 9:42 AM
Expiration Date Apr 25, 2023
Home Phone Number t939) 797-77,41
Rental Fee
S2.034.04
D;srounlS
so.00
Subtotal
52,084.0 4
Deposits
$0.00
Deposit Discounts
$0.00
Total Permit Fee S2,084.04
Total Payment
$0.00
Refunds
SO.00
Balance
S2.0084.04
1 re-sourcets) 9 booking(s) Subtotal: 52,084.04
Soaking Summary
STC Banquet •-a(Indoor- - ta Centerr, a.. Senior Center START DATUTIME END DATEITIME ' ATTENDEE I AMT V410 TAX
Sep 15, 2022 6:00 PM May 18, 2023 9:15 PM --
Occurs on selected dotes: Sep 15, 2022. Oct 20, 2022, Nov 17, 2022, Dec 8, 2022. Jon 19, 2023, Feb 16, 2023, /tor 16, 2023, Apr 20, 2023, Ivloy 18, 2023
Sep 15, 2022 6:00 P14 Sep 15, 2022 9:15 PM 40 $231.56
Rental - Hourly $54.00 / Hour x 3.25 $175.50
Rental -Weekday Event Assistant (4P-12A) $17.25 / Hour x 3.25 $56.06 Oct 20, 2022 6:00 PM Oct 20, 2022 9:15 PM 40 $231.56
Rental - Hourly $54.001 Hour x 3.25 $175.50
Rental - Weekday Event Assistant (4P-12A) $17.25 / Hour x 3.25 $56.06 Nov 17, 2022 6:00 PM Nov 17, 2022 9:15 PM 40 $231.56
Rental - Hourly $54.00 ! H0LJr x 3.25 $175.50
Rental - Weekday Event Assistant (4P-12A) $17.25 / Hour x 3.25 $56.06 h tips :t'anprod.active.com./yucaipatu i.do?rnethod=showPermitContract&permit_id=C4B 208860C36 1/3
-206-

4`25t22, 9 2A10
PermitConlract
Dec 8. 2022 6:00 MAI
Dec 8, 2022 9:15 PIA
Rental - Hourly 554.031 Hour x 3.25 5175.50
Rei:tai - kl4reekclay Ever5t Assistant i4P-12A1
S 17.251 Hour x 3.25 S56.06
Jan 19, 2023 6:00 PIA
Jars 19, 2023 9:15 PIA
Rental - Hourly 554.:10 ! Hour x 3.25 $175.50
Rental -Weekday Event Assistant OP-12A)
517.251 Hour x 3.25 S56.06
-c-316, 2023 6:00 PIA
Feb 16, 2023 9:15 PIA
Rental - Hourly S5 4.00 i Hour x 3.25 5175.50
Rental -Weekday Event Assistant 4P-12A1
517.25 f Hour x 3.25 S56.06
Mar 16, 2023 6:00 PIA
I' tar 16, 2023 9:15 PIA
Rental - Hourly S5 4.00 !Hour x 3.25 $175.50
Rental - khteekday Event Assistant (4P-12A)
517.25 i Hour x 3.25 S56.06
Apr 20, 2023 6:00 PM
Apr 20. 2023 9:15 PfA
Rental - Hourly 554.00 f Hour x

3.25 $175.50
Rental - kA!eekday Event Assistant 14P-12A)
$17.251 Hour x 3.25 556.06
May 18, 2023 6:00 Pft
May 18, 2023 9:15 PM
Rental - Hourly $54.00 ! Hour x

3.25 $175.50
Rental -Weekday Event Assistant (41P-12A)
517.25 t Hour x 3.25 $56.06
Waivers and Information
40 $231,56
40 5231.56
40 $231.56
40 $231.56
40 $231.56
40 $231.56

INFOWATION DESCRIPTION SIGNING STATUS
Alcohol Sales Lic Checked
Proof of Liability Insurance Checked
Security Guard Contract Checked
Proof of Non Profit Sta'us Checked
WAIVER NAlriE DUE DATE j FOR ; SIGNING STATUS
Facility Usage Vlaiver Sep 15, 2022 Waiver Signed
Facility user hereby agrees to indemnify, defend and hold harmless City of Yucaipa, its officers, officials, employees and volunteers from and against ail claims, damages, losses and expenses that may arise during or be caused in any v:ay by such occupancy or use of facilities, but the facility user shall not be liable for any claims, damages, losses and expenses caused by the sole negligence or .vilifut misconduct of the City of Yucaipa. Permittee shall have received any and all permission or license(s) as may be required to perform or use any protected materials In Its use of the Premises. Permittee agrees to protect and save harmless the City, its elected officials, employees and agents from and against any and all claims, penalties, and/or damages which may accrue as a result of Permittee's failure to comply with this requirement.

I have read the rules and regulations relating to use of facilities and accept responsibility for meeting the requirements stated herein.

Payment Schedules
Signature
Original Balance: S2,084.04 Current Balance: 52,084.04
I I I
0 ps:ltanprod.aetiVe.eom!yucaipalui.do 7 method=sho;:•PermitContraet&permit_id=C4B23886OC36 2;'3
-207-

41,2122, 142 MO PermitContract

DUE DATE AMOUNT DUE AMOUNT PAID WITHDRAWAL ADJUS T HENT I BALANCE Sep 1.1022 52,0=4.04 50.00 50.OD 52.084.04
X-
Date:

City of Yucaipa Community Services
Mailing Address: 34272 Yucaipa Blvd, Yucaipa, CA
9235-g
Phone Nu, ber: {909) 790-7460
Fax NLimber. (909) 790-2589
Email Address:
can;murrityseraices yucs(pa_org
X:

Date:

Yucaipa Valley Art Association
Customer Type: Non -Profit IP.}
Customer ID: 12551
Hailing Address: PO Box 404. Yucaipa. CA
92399
Authorized Argent Name: Zully Martinez
Home Phone Number_ (903) 797.7741
https:ftanprad.active.com'yucaipalui.do?met(Sr;dTsnovvPermitContract8permii id=C B2L8863C36 -208-
3%3

4r'25122, 9:47 AM
PermitContract
Pe,r !
city of Yucaipa Community
PHONE:(909) 790-74,60
Services
FA.Y.:(909) 790-2589
34272 Yucaipa Blvd
Et SAIL:comziunityservicesyucaipa.arg
Yucaipa, CA 92399
Organization Name
Yucaipa Valley An Association. - 49
Customer Type
Non -Profit (R)
Organization Address
r
PO Box 404
Yucaipa, CA 92399
Agent Narne
Zuliy !Martinez
System User
Tish Christian
Tues. Monthly Art Meetings

COIAMUNITY

J ' SERVICES
Permit -# R4301
Status Tentative
Date Apr 19. 2022 5:00 PfA
Expiration Date Apr 19, 2023
Home Phone Number (909) 797.7741
Rental Fee
$540.00
Discounts
SO.00
Subtotal
$540.00
Deposits
$0.00
Deposit Discounts
$0,00
Total Permit Fee
$540.00
Total Payment
$0.00
Refunds
$0.00
Balance
$540.00
i resource(s) 10 booking(s) subtotal: S540.00
Booking Summary

START DATE/TIME END DATEITIME ATTENDEE AIAT W/O TAX
Sep 13, 2022 10:00 AM
May 16, 202312:00 PM
--
Occurs on selected dates: Sep 13, 2022, Oct 18, 2022, blov 15, 2022, Dec 6, 2022, Jan 17, 2023, Feb 14. 2023, filar 14, 2023,
Apr 18, 2023, Apr 25, 2023. Moy 16, 2023
Sep 13, 2022 10:00 AM
Sep 13, 2022 12:00 PM
30 $54.00
Rental - Hourly $27.00 / Hour x 2
$54.00
Oct 18, 2022 10:00 AM
Oct 18, 2022 12:00 PM
30 S54.00
Rental - Hourly $27.00 / Hour x 2
$54.00
Nov 15, 2022 10:00 AM
Nov 15, 2022 12:00 PM
20 S54.00
Rental - Hourly $27.00 / Hour x 2
$54,00
Dec 6, 2022 10:00 AM
Dec 6, 2022 12:00 PM
30 S54.00
Rental - Hourly $27.00 / HOUr x 2
$54,00
httos:I,anprod.active.com/yuceipalui.do?method=sltowPermitContre.ct&permit_id=C6BD0886OE39 i 3 -209-

4125I22, 9.47 Atvt
PermitContract
Jan 17, 2023 10:00 AIA
Jan 17. 2023 12:00 Ptvt
Rental - Hourly
S27.00 I Hour x 2
S54.00
Fe`) 14, 202310:00 AIJr
Feb 14, 2023 12:00 Ptl
Renal - Hourly
S27.001 Flour x 2
S54.00
Mar 14, 2023 10:00 AM
Mar 14, 2023 12:00 PM
Rental - Hourly
527.001 Hour x 2
S54.00
Apr 18, 2023 10:00 A!A
Apr 18, 2023 12:00 PM
Pental - Hourly
S27.00 r' Hour x 2
S54.00
Afar 25, 2023 10:00 AMI
Apr 25, 2023 12:00 PISS
Rental - Hourly
S27.00 f Hour x 2
S54.00
May 16, 2023 10:00 Af-f
Mlay 16, 2023 12:00 PM
C,ental - Hourly
S27.00 t Hour x 2
S54.00
Waivers and Information

INFORMATION DESCRIPTION
Aicohot Sales Lic
Proof of Liability Insurance
Security Guard Contract
Proof of Non Profit Status

WAIVER NAME
( DUE DATE
{ FOR
30 $54.00
30 S54.00
30 S54.00
30 $54,00
30 S54.00
30 S54.00
{ SIGNING STATUS
Checked
Checked
Checked
Checked
{ SIGNING STATUS
Faculty Usage Waiver Sep 13, 2022 Waiver Signed
Facility user hereby agrees to Indemnify, defend and hold harmless City of Yucaipa, its officers, officials, employees and volunteers from and against all claims, damages, losses and expenses that may arise during or be caused in anyway by such occupancy or use of facilities, but the facility user shall not be liable for any claims, damages, losses and expenses caused by the sole negligence or wiiifui misconduct of the City of Yucaipa. Perinittee shall have received any and all permission or license(s) as may be required to perform or use any protected materials in its use of the premises. Permittee agrees to protect and save harmless the City, its elected officials, employees and agents from and against any and all claims. penalties, andfor damages which may accrue as a result of Perm€ttee's failure to comply with this requirement.

I have read the rules and regulations relating to use of facilities and accept responsibility for meeting the requirements stated 'herein hitps:ir'anprod_active.com=yucaipar`ui.do?method=shovrPermitContract&perm€t id=C68D08860E39 2i3 -210-

4,'25 22, 9 1 AM
PermitContract
X:

Date:

City of Yucaipa Community Services
Mailinc Address: 34272 Yucaipa Blvd, Yucaipa, CA
92399
Phone Number: (909) 790-7 460
Fax Number: (9091 790-2539
En nail Addre5s: cornmutiityservic=sn yucaipa.crg
X:

Data:

Yucaipa Valley Art Association
Customer Type: Non -Profit JP)
Customer 10: 12551
Mailing Address: PO Box 404. Yucaipa, CA
92399
Authorized Agent Naztz: Zuily 19a1ineZ
Home Phone Slumber: (909) 797-7741
https:lfunprod.active. eumtyucaipalui.do?method=shajvPermitContact&pe.Imit_id=CGBD0886©E39 3?3
-211-

Attachment G
VTM°F COMMUNITY ACTIVITY GRANT
FINANCIAL I IN -KIND l FEE WAIVER

APPLICATION

CONINIUNITYACTIVITY GRANT APPLICATION
Fiscal Year: 2022-2023
Date Application submitted: 41"18/22 Received
y of Yucaipa
Submit to:

City of Yucaipa MAY 02 2022
General Services/City Clerk Department
34272 Yucaipa Blvd.

Yucaipa, CA 92399 :. >; c°.; 'ePartment
Attn: Kimberly Everts
All sections of the application must he returned complete and all supporting documentation provided prior to City Council review. Incomplete applications received will be returned to the applicant.

SECTION' i' !
Name of Applicant/Organization: Yucaipa Valley Art Association Applicant/Organization Mailing Address:

Applicant/Organization Phone Number:

Contact (1)
Contact (2)
P.O. Box 404, Yucaipa, CA 92399
?A
Alan Remele
(909 ) 556-364>
Name
Phone Number
[email protected]
E-mail address
Zully Martinez
l 909 ) 797-7741
Name
Phone Number
yvaamail.92(a?gmail.com
address
SECTION 2 - ELIGIBILITY REQUIREMENTS:

Is your organization located in another community? ❑
Will the progranilevent take place in another community? ❑ Are you aware of any other City program providing this service? ❑ 21 If so, which one?
*If you answered "Yes" to any of the questions listed above, your request is not eligible for the Community Activity Grant.

City of Yucaipa Community Activity Grants Application. Rev. 03i2a-212- Page I

It
SECTION 3 — ORGANIZATION INFOR.NIATIO\ APPLICAIT BACKGROUND Your organization must be an established 501(c) to be considered for Community Activity Grant funding.

Please submit documentation verifying organization 501(c) status along with this application.

Yes No
Is your organization a 501(c)? 0 ❑
If yes, please provide Tax lD# 95-3701090 and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? ❑ ❑ How long has your 501(c) organization been in existence? 41 years Number of Employees working for organization: 0
Number of Volunteers working for organization: 16+
Is a current City Council Member on your board? ❑
How many Yucaipa residents does your organization currently serve? 70+ Does the organization charge admission, (membership fees, dues, etc.? 0 ❑ If yes, please describe: S25.00 annual membership dues
Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Alan Remele - President
Zully Martinez - Shows & Events
Lenore Will - Ways & Means/Secretary
Cindy Kanakriyeh- Membership Newsletter
Enrique Lima - Treasurer/Exhibits
Carolyn Bonnano - Welcoming
Bob Norris - Parlimentarian
Judy Remele - Hospitality
SECTION 4 - PROGRaNI DESCRIPTION/SCOPE: (PLEASE USEADDITIONAL PAGES IT= \ECESSARY) Name of the program.!event:

Date(s) of programlevent:

YVAA Spring Art Show, 4/29/2023, Permit R4300
Spring Art Show Setup 4/28/2023, Show on 4/29/2023
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program'event) The Yucaipa Valley Art Association Spring Art show gives the public an opportunity to acknowledge the artist community in Yucaipa and to visually appreciate local artistic talent. The inclusion of high school art students has significantly increased community awareness and attendance and has encouraged students to display their art in a public art show that invites attendees of all ages to view their works.

Page 2 ends

City of Yucaipa Community Activity Grants Application, Rey. 03 2(I'M3-

Describe how the programlevent benefits the residents and/or community of Yucaipa:

The Yucaipa Valley Art Association meetings give our members and guests an opportunity to to visually appreciate local artistic talent. The meetings also help us in our fundraising activities to promote art in our community. Throughout the year, we coordinate with local businesses and other organizations such as Vision Quest and the City of Yucaipa on art related events and displays. Futhermore, YVAA cooperates with YHS art dept. in helping promote art, lending art displays or awarding two student scholarships in our community. Our community contributions and activities significantly increase awareness and appreciation for the artistic talent of our members and local students.

Program/Event Primary Target Population (check all that apply):
❑ Children or Youth
❑ Low Income
❑ Persons with Disabilities
Number of Residents Projected to Serve: 250
❑ Seniors
❑ Victims
❑ Welfare Recipients
❑ Women
❑ Homeless
Entire Community
SECTION' — GW-XNT FUNDING REQUEST I
Please identify what your organization is seeking:

Financial Support: ❑ Yes Q No
$16.25 SEP Fee
Waiver: ❑ Yes
In -kind Support: Police S
Reassigned
Staff S
© No
In -Kind
Total Amount of Request: S °-F
S
Public
Fire S forks S
Other S Explain
CS/Rental S —1
S 16.25 SEP Total Overall
Financial Support Fee Waiver Request
$ S = S 1,999 s i
Provide a detailed description of how the financial support will be used:

The in -kind CAGrant support will be used to cover the cost to reserve rooms and the kitchen at the Yucaipa Community Center on Oak Glen Road for the annual Spring Art and Photography Show. The CAGrant covers rental costs for the day on Friday in which YVAA takes -in artwork, setup of displays and art space and hires outside judges to pick winning artwork. It also includes the next day, Saturday for the art show to open to the public, culminating with the awards ceremony. Usually, a city official is invited to participate in the final award ceremony.

City of Yucaipa Community Activity Grants Application, Rev. 03=2Q-_!l4- I'a�e-c 3

What other in-kind/financial contributions has your organization received to fund this event/program (separate from City funding)?
Done
Total Funds Received To Date:

Total Funds Requested Via Grant Application:

Remaining Balance That Will Be Funded By
Organization:

In -Kind Financial
Amount Support AmouIIt
S S
S S
S S
S S
S S
S 0 S 0
S $
S S

SECTIONCAPABILITIES/BUDGET
Provide City funding received by organization in the past three years (required):

Program In -Kind Financial $16.25 SEP .Date Total Received Support Fee Waiver Received
YVAA Spring Art Show 2022 El El 6/2/21 S I483.63
YVAA Monthly Meetings 2021
YVAA Monthly Meetings 2022
®
❑
❑
❑
❑
❑
6/2/21 $687.00
612/21 S 926.24
SECTION —CERTIFICATION
1, the undersigned, do hereby attest that the above information is true and correct to the best of my knowledge, and understand that the awarded financial grant amount needs to be spent prior to submitting another grant request.

President 4/18/22
Signature Title Date

TO BE COMPLETED BY CITY
Date Received: Date Reviewed: -.

Amount Funded: S
Type of Grant: ❑ In -Kind
Date City Council received follow up report:

City Council Meeting:
❑ Financial Support
❑ Fee Waiver
City oi' Yucaipa Contntunity Activit%, Grants Application, Rev. 03 20-215- Page 4

4119122. 4.46 P41
PermitContract
Permit
City of Yucaipa Community
Services
34272 Yucaipa Blvd
Yucaipa, CA 92399
PHONE:(909) 790-7460
FAX:1,909) 790.2569
ElYiAlt.:communityservicest4yucalpa.org
Organization Name Yucaipa Valley Art Association - 49
Customer Type Non -Profit (R)
Organization Address PO Box 404
Yucaipa, CA 92399
Agent Name Zully Martinez
System User Tish Christian
YVP,,% Spring Art Show
COhfFFlUtdiiY ` r�

SERVICES
�atce
Y
Permit # R4300
Status Tentative
Date Apr 19, 2022 4:34 PIA
Expiration Date Apr 19.2023
Home Phone Number (909) 797-7741
Rental Fee
$1,999.51
Discounts
$0.00
Subtotal
$1,999.51
Deposits
$512.00
Deposit Discounts
$0.00
Total Permit Fee 52,511.51
Total Payment $0.00
Refunds $0.00
Balance $2.511.51
2 resourcets) 3 booking(s) Subtotal: $2,511.51
Booking Summary
SrC Banquet Roorn Fufl (indoor Reser-ratiom) Center Yucaipa SerAw Centler START DATE/TIME ` END DATE/TIME ATTENDEE I AMT W10 TAX
Apr 28. 2023 8:30 AM
Apr 28, 2023 4:00 PM
10 $736.88
Rental - Hourly $81.00 / Hour x 7.5
$607.50
Rental - Weekend Event Assistant (FRI-SUN)
$17.25 / Hour x 7,5 $129.36
A;.r 29. 2023 8:00 AM
Apr 29, 2023 6:30 PM
100 $1,031.63
Rental - Hourly $81.00 / Hour x 10.5 $850,50
Rental -Weekend Event Assistant (FRI-SUN)
$17.25 I Hour x 10.5 $181.13
Resource level fees
$404.00
Deposit $404.001 Each x 1
Reservations',
$404.00
Center Senior
YucaipaSrC
lCitchen (Indoor

START DATEMME

END DATE/TIME
ATTENDEE } AMT W/O TAX
Aw 9, 2023 8:00 AM Apr 29, 2023 6,30 PM 4 $231.00
Rental - Hourly $22,00 / Hour x 10.5 $231.00
ltttps://anprod.aciive.comlyucaipalui.do2method=shoo,PermitCon1 ract&permit_id=C6B208860 E36 -216-
113

4119122, 4:a6 PM
Resou'ce I-evel Tees
Dep_ s't
Waivers and Information
S108.00 Each x 1 $108.00
PermitContract
iNFORttIATION DESCRIPTION I SIGN114G STATUS
Alcohol Sales Lic Checked
Proof of Liability Insurance Checked
Security Guard Contract Checked
Proof of Non Profit Status Checked
$102,00
WAIVER NAt+IE , DUE DATE FOR SIGN114G STATUS
Facility Usage Waiver Apr 28, 2023 Waiver Signed
Facility user hereby agrees to indemnify, defend and hold harmless City of Yucaipa, its officers, officials, employees and volunteers from and against all claims, damages, tosses and expenses that may arise during or be caused in anyway by such occupancy or use of facilities, but the facility user shah not be liable for any claims, damages, losses and expenses caused by the sole negligence or willful misconduct of the City of Yucaipa. Permittee shalt have received any and all permission or license(s) as may be required to perform or use any protected materials in its use of the Premises. Permittee agrees to protect and save harmless the City, its elected officials, employees and agents from and against any and all claims, penalties, and/or damages which may accrue as a resuit of Peimittee's failure to comply with this requirement.

I have read the rules and regulations relating to use of facilities and accept responsibility for meeting the requirements stated herein.

Signature
Deposit
EVENT j
RESOURCE i DEPOSIT FEE
CHARGE 1
TAX 1

AMOUNT PAID

REFUNDS ( BALANCE
YVAA Spring Art
SrC Banquet Deposit
$404.00
$0.00
$0.00
SOM 5404.00
Show
Room Full
YVAA Spring Art
SrC Kitchen Deposit
S108.00
$0.00
$0.00
S0.00 S108.00
Showy
Payment Schedules
DUE DATE + }AMOUNT DUE f
Apr 19, 2022 S411.00
Apr 14, 2023 $2,100.51.

Original Balance: $2,511.51 Current Balance: $2,511.51
AMOUNT PAID XvITHDRAWAL ADJUSTMENT I BALANCE
$0.00 $0.00 $411.00
$0.00 $0.00 S2100.51
hlips:/Ianprod.active.comlyucaipalui.do?method=sho:.,PermilContract&permit_id=C6B20886OE36 213 -217-

4119122. 4 : 6 PIA
PermitContract
X:

Date:

City of Yucaipa Community Services
Mailing Address: 34272 Yucaipa Blvd, Yucaipa, CA
92399
Phone Number: (909) 790-7460
Fax Number: (909) 790-2539
Email Address: communityserviceszayucaipa.crg
Y.:

Date:

Yucaipa Valley Art Association
Customer Type: Non -Profit IR)
Customer ID: 12551
hilailing Address PO Box 404, Yucaipa, CA
92399
Authorized Agent Name: Zully Martinez
Home Phone Number: 1909) 797-7741
https:r!a nprod.active.cotnfyuca(patui.do?meiiiod=showPermitContract& permit_id=C6B208860E36 -218-
313

Attachment H
Fiscal Year:

Date Application submitted:

Submit to:

City of Yucaipa
General Services/City Clerk Department
34272 Yucaipa Blvd.

Yucaipa, CA 92399
Attn: Kimberly Everts

COMMUNITY ACTIVITY GRANT
FINANCIAL I IN -KIND f FEE WAIVER

APPLICATION
2022_2023
Heceivea
City of Yucaipa
MAY 0 9 2022
General Services/
City Clerk's Department
All sections of the a;)p'sication most he returned complete and all supporting documentation provided prior• to City Council review, Incomplete applications received will be returned to the applicant.

Name or Applicant/Organization: Family Service Association of RedlandsNueaipa Outreach Project Applicant/Organization Mailing Address: 612 Lawton Street Redlands CA 92374 Applicant/Organization Phone Number: (909
Contact
Kyra Stewart 909 M3-2673 ext 134
(1) _
Name Phone Number
kvrarn?redlandsfamilyservice.org
E-mail address
Contact (2) Samantha Morgan (909 ) 793-2673
Name Phone Number
samantharredlandsfamilyservice.org
E-mail address
Yes No
is your organization located in another community? ❑ M
Will the program/event take place in another community? Are you aware of any other City program providing this service? If so, which one?
*if you answered "Yes" to any of the questions listed obove, your request is not eligible for the Community Activity Grant.

City of Yucaipa Community Activity Grants Application. Rev. 0312022 Pegs t -219-

i iBACKGROUND
Your organization trust be an established 501(e) to be considered for Community Activity Grant funding.

Please submit documentation verifying organization 501(e) status along with this application.

Yes No
Is your organization a 501(c)? L7 ❑
if yes, please provide Tax 1Q# 95-1655614and attach all supporting documents.

Does this application include submittal of documentation verifying 50l(c) status? ❑ Flow long has your 501(c) organization been in existence? 1848
Number of Employees working for organization: 16
Number of Volunteers working for organization: 500
Is a current City Council Member on your board? ❑ 0
How many Yucaipa residents does your organization currently serve? 100
Does the organization charge admission, membership fees, dues, etc.? ❑ If yes, please describe:

Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Board President, Lori Hatfield Board member - Pam Allen Coleman Vice President, Personnel, Gary Fagan
Vice President, Resource, Matt Miller
Vice President, Housing, Carol Snodgress
Treasurer, Diane Remy
Secretary, Christina Rivera
Board member- Pam Allen
Board member- Marilyn Bean
Board member- Ann Bryan
Board member - Char Burgess
Board member - Yolanda Contreras
Board member - Deb Crowley
(see attached for full listing)
Name of the programlevent: Housing Assistance Program/Yucaipa Outreach Project Date(s) of program/event: 07/01 /2022-06/3 0/2023
Describe the programfevent that organization is seeking support for:
(Attach any eventtprogram promotional materials associated with program/event) Family Service Association of Redlands' is requesting $5,000 from the City of Yucaipa's Community Activity grant initiative in support of our Housing Assistance Program at the Yucaipa outreach Project located at 11985 4th Street Suite 9216 Yucaipa Ca 92399. I f funded, the support shall be utilized for emergency rental assistance, motel vouchers, food, case management, transportation assistance and resources and referrals for low income, at risk homeless and homeless families of the City of Yucaipa.

With the funding, we will provide safety net services for the City of Yucaipa residents who are in a housing crisis. The goal of the project is to prevent and remedy homelessness. (Please see attached for service counts) City of Yucaipa Community Activity Grants Application, Rcv. 0312022 Page 2 -220-

Describe how the programlevent benefits the residents andior community of Yucaipa:

This program benefits the City of Yucaipa residents by providing safety net, housing stabilization, basic support and emergency financial assistance for families who are facing eviction, already homeless or in financial crisis.

Strengthening this program creates safety and stabilization for individuals for residents who are facing the imminent dangers of homelessness or already homeless. It shall also provide food resources for clients who are battling food insecurity/hunger.

Program?Event Primary Target Population (check all that apply}:

Q Children or Youth
0 Low Income
® Persons with Disabilities
® Seniors
® Victims
® Welfare Recipients
Number of Residents Projected to Serve:.50_ .--
SECTION 5%—GR.1NT FUNDING REQUEST
Please identify what your organization is seeking:

Financial Support: 2 Yes © No S55000
S16.25 SEP Fee
Waiver: ❑ Yes ❑ No
Public
In -hind Support: Police S__ Fire $� Works $
Reassigned
Staff So Other$.— Explain
S 16.25 SEP
In -Kind Financial Support Fee Waiver
Total Amount of Request: S $5000 S _
Provide a detailed description of how the financial support will be used:
® Women
® Homeless
❑ Entire Community
CSFRental $
Total Overall
Request
= S 5000
If funding is received, the entire amount shall go towards direct client services which include motel vouchers, emergency rental assistance, move in deposits, food and transportation assitance, We are grateful for your past, present and hopefully future support as we continue to serve and deal with growing inflation and housing costs which is greatly impacting low income and low waged workers in our communities.

City orYucnipa Community Activity Grants Application, Rev. 0312022 Page 3 -221-

What other in-kind/financial contributions has your organization received to fund this event/program (separate from City funding)?
In -Kind
Financial
Amount
Support Amount
Emergency Food and Shelter Program
$
$
$25,000 (ail cities)
ARPA Funding
S
$
50,000 (all cities)
Private Donations
$
S
$25,000
ESG County
$
S
$8,500.00
EventlFundraising
S
S
10,000,
Total Funds Received To Date:
$
$
Total Funds Requested Via Grant Application:

S
S
5000.00
Remaining Balance That Will Be Funded By
S 1 13,500
$
118,500
Organization:

Provide City funding received by organization in the past three years (required):

Program
to -Kind
Financial
516.25 SEP
Date
Total Received
Support
Fee Waiver
Received
Community Activity Grant
❑
❑
❑
08/01/2021
S 3867.00
CDBG funding
❑
❑
❑
07/01/2022
$7500.00
CDBG- Yucaipa Grant and City Funding
❑
❑
®
07/01 /2021
$ 5000.00
undersigned, do hereby attest that the above information is true and correct to the best of my knowledge, and understand Weard financial grant amount needs to be spent prior to submitting another grant request. 5,
Title Date
Date Received:

Amount Funded: $
Type of Grant: ❑ In -Kind
Date City Council received follow up report:

Date Reviewed:

City Council Meeting:
❑ Financial Support
7 Fee Waiver
City of Yucaipa Community Activity Grants Appiication, Rev. 031 022 -222-

_UC FHE Y MPA OUTREACH PROJECT
A PROGRAM OF FAI-AILY SERVICE ASSOCiATION OF REDIANDS
2021 Service Counts
Total Families 104 Total Individuals 209
Food Distribution:

Emergency Food — number of families 54
Emergency Food — bags of food 185
Housing Assistance:

Emergency Rental Assistance — number of families 20
Months of Rent Paid 37
Rapid Re -Housing — homeless families moved into stable housing 13 Motel Vouchers Issued 47
Clothing Distribution:

Families
Support Services:
36 Transportation — gas vouchers or bus passes 13
Hygiene ICts 29
Holiday Distribution:

Christmas Adopt -A -Family 7
Yucaipa Case Summary
In early 2021, an elderly disabled couple whose wife was in the early stages of dementia, visited the Yucaipa office to apply for emergency rental assistance. Both the husband and wife were on social security and limited income, they fe
ll behind on their rent and bills due to familial and health challenges they were facing. The couple, guided by a local social worker, requested financial assistance and after meeting with a Family Service case manager, we were able to pay their rent, provide food and gas cards and stabilize their crisis. (edited for content)
-223-

Internal Revenue Service
P.O. Box 2509
Cincinnati, OH 45201
Date: August 22, 2014

FAMILY SERVICE ASSOCIATION OF REDLANDS
612 LAWTON ST
REDLANDS. CA 92374
Dear Sir or Madam:

Department of the Treasury
Person to Contact
Ms. Wiles
Toll Free Telephone Number:
877-829-5500
Employer Identification Number;
95-1655614
This is in response to your March 13, 2014 request for information regarding your tax-exempt status Our records indicate you were recognized as exempt under section 501(c)(3) of the Internal Revenue Code in a determination letter issued in September 1953.

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 section509(a)(2).

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.

Please refer to our website wviw.irs.gov/charities for information regarding filing requirements. Specifically. note that section 60330) of the Code automatically revokes the tax -exemption of any organization that fails to satisfy its filing requirement for three consecutive years. The automatic revocation of exemption is effective as of the due date of the third required annual filing or notice. The IRS maintains a list of organizations whose tax- exempt status was automatically revoked at IRS.gov.

If you have any questions, please call the phone number in the heading of this letter. - Sincerely,
Tamers Rip erda
Director; Exempt Organizations
-224-

a
is
Serving the Community
Since 1898
Family Sej ice Association of Redlands
2022 Board of Directors
6121-awo-7.5avet, Redl:w(ls, Calilonnia 9237-1
Ohm 909 71V 2G73 Ray. .90.9 793-7321 ice. or;
_-,Ilfe i9ate pol ei- fi cuc-ouP7ge self-5ulliclel7c)' au7d pt-c)j77ote the d7_-rlu�v of all cLellts

EXECUTIVE COMMITTEE
President
Vice President, Personnel
Vice President, Resource
Vice President, Housing
Treasurer
Secre
BOARD MEMBERS:

Pam Allen (Tema ist- 2025)
Director ofEme7gency Services RCH
Cell 760 445-5675
Email [email protected]
1624 Alesandro Rd
Redlands CA 92373-6945
Lori Hatfield
Gary Fagan
Malt. Miller
Carol Snodgress
Diane Remy
Cluistina Rivera
Pamela Allen Coleman (Terra 1s:- -)25)
Senior Associate Drector LWR
Cell 909-6857-0693
Email [email protected]
5032 Spruce Ct
Fontana, CA' 92336-4743
Marihm Bean (Term Ist- 2024)
Retired Teacher
Home 909 793-4454
Email [email protected]
1320 Drake Ridge Crest
Redlands CA 92373-6519
Ann Bryan (Term Ist-2024)
Business O vnerlRealtor
Cell 909-938-7725
Email [email protected]
1900 Country Club Dr
Redlands CA 92373-7408
all. 909 754-6497
Cell 909 771-8423
Cell 909 645-0802
Cell 909 732-9989
Cell 909 556-7760
Cell 714 40.3-9305
Charlotte Burgess (Tema 2°d - 2024)
Retired U of R Vice President
Cell 909 709-6607
Email Char Burgess ct, edlands.edu
923 W Fern. Ave
Redlands, CA 92373-5877
Yolanda Contreras (Term end - 2024)
Retired Educator
Cell 951 809-1450
Email [email protected]
1455 Sierra Crest Ct
Redlands, CA 92374-2775
Deborah Crowley (Term 211 -2024)
CPA
Home 909 792-0202
Cell 909 953-1596
Email derowley511 @gmail.com
1419 E Highland Ave
Redlands, CA 92374-5421
George DeLanQe (Term I" - 2024)
Retired Healthcare fanagen:ent
Cell 909 553-1605
Email [email protected]
1210 Fulbright Ave
Redlands, CA 92373-1605
-225- 05/10/22

BOARD MEMBERS CONTINUED:

Sam Edison (Ten. )lid _ 2023)
Retired Colpol-ate Executive
Cell 720 341-9901
Email sne1406 rnsiixom
1405 Sterling Rd
Redlands. CA 92373-6675
Debbie Evans (Tenn 1' - 2023)
Director of Social Se vices 1tCH
Cell 909 815-2324
Email devans LredlandshospitaLorg
7912 Santa Paula St
Highland, CA 92346-6308
Gary Fagan (Tenn 1'` - 2024)
Retired Prosecutor
Houle 909 389-9166
Cell 909 771-8423
Email �aangat�0��2��_nnail.corn
1573 Pala Bells Ct
Redlands. CA 92374-2707
Lori Hatfield (Extended 2nd Tern, �CF23)
Business Ow-ner
Cell 909 754-6497
Email buickl9l3)@nsn.coni
340 Franklin Ave
Redlands, CA 92373-2800
Robert Heinze (Tenn 2nd - 2025)
CFP
Cell 909 307-8478
Horne 909 798-8138
email heinzerr stiieLcom
30370 Copper Hill Ct
Redlands, CA 92373-7373
Al Hernandez (Terse 2nd - 2024)
Business Oii-ner
Mork 909 792-3901
Email [email protected].
113 E State St V
Redlands, CA 92373-4755
Janine Ledoux (Tenn 1" - 2024)
PrO fessor
Cell 909 838-7813
Email jledoux@�scraftonhills.edu
219 Grant St
Redlands, CA 9237-5116
Robin Maupin (Tern,, 21d - 2023)
Business Ownei-
Horne 909 792-1766
Email r robinCastar ",izz.net
310 E` Citrus Ave
Redlands, CA 92373-5217
Matt Miller (Tenn 2nd -'025)
Dircclar ofDevelopr=teat L.L. U Health
Cell 90.9; 645-0802
Email rnjniiller20�,gniail.com
6913 Clear Spring Ct
Highland, CA 92346-6203
Sue Alorasco (Tenn 2nd - 2023)
Se7fiOT" JUbtion Graphics Artistl
Producer at esri
Horne 909 794-9617
Cell 909 253-3487
Email sumoandjim0me.com
304 La Colina Dr
Redlands, CA 92374-8247
Diane Remy (Tenn 1" - 2023)
Retired CPA
Cell 909 556-7760
E--mail dremy ahotmail.com
515 E - Mariposa Dr
Redlands, CA 92373-7351
Christina Rivera (Term 2nd _ ?023)
Retired RHS Principal
Cell 714 403-9305
Email christina_rivera:c Ca,
16744 Colonial Dr
Fontana, CA 92336-5128
2 226-
05/ 10/2 2

BOARD MEMBERS CONTINUED:

Barbara Rozema (Tenn 1" - 2025)
Event PlannerlRealtor
Cell 909 322-5739
Email [email protected]
6412 Seavey Ct
Highland, CA 92346-7758
Joseph Shaw (Tenn ISM - 2025)
Business Owner/Realtor
Cell
Email joseph@ritasha,�v.net
1107 N Orange St
Redlands, CA 92374-3218
Karah Shaw (Tenn I` - 2024)
Business Owner/Realtor
Cell 951-544-2146
Email karahshaw&w.com
1092 Tangerine Dr
Redlands, CA 92374-1833
Lori Shelffo (Term 1" - 2025)
Administrative Assistant
Cell 909-239-8199
Email [email protected]
glnail.com
338 Sherwood St
Redlands, CA 92373-4964
Carol Snod r; ess (Tenn 11- 2024)
Retired Bank Officer
Cell 909 732-9989
Email [email protected]
464 W'Mariposa Dr
Redlands, CA 92373-7436
STAFF
Terry Vines (Term V - 2025)
Business OwnerlDenist
Cell 951 217-0962
Email [email protected]
PO Box 1125
Redlands, CA 92373-0366
Christopher Walker (Term 1" - 2023)
Professor Emeritus U or R
Home 909 792-7715
Email Christopher_a-alker a:redlands.edu
616 Valley View Dr
Redlands, CA 92373-7358
Waner, T rler
Financial Advisor
Cell
Email [email protected]
300 E State St Ste 530
Redlands, CA 92373 =5253
Ellen Weisser (2°d -2025)
Retired Tice President
Home 909 792-0688
Cell 909 633-3616
email [email protected]
PO Box 7595
Redlands, CA 92375-0595
Kyra Stewart
Executive Director
Jill Prendergast
Fund Development Manager
Mandy Carlson
Program Director
Samantha Morgan
Office Manager
Donna Olson Jones
Office Assistant
Crystal Lau
Marketing Et Volunteer Coordinator
Adela Brown
Accounting Clerk
Paula Petty
Case Manager
Vanessa Jasso
Case Manager
Abi Pote
Temporary Case Manager
Maranda Jites
Case Manager YOP
Loretta Villarreal
Program Assistant/Receptionist
Mary -Ellen King
Program Assistant
Stephanie Villana
Program Assistant YOP Et FSA
Jennyfer Metgoza
Program Assistant
Tiana McBride
Donation Center Lead
3-227-
kyra@ redlandsfamilyservice.org
[email protected]
mandy@redlandsfami lyservice. org
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
05/10/22

:-4 • s

A Message from the President, Ellen Weisser
As the pandemic raged on, Family Service came to the rescue of over 1800 families in need of food, emergency shelter, rental assistance and other vital goods and services. Many of our newer clients had become homeless or were at risk of homelessness due to job loss, caregiving or health issues. School was not in session, businesses were closed and families had needs like never before seen.

In June we launched a one day per week food box drive -through distribution program with an average of 100 cars each Tuesday. The boxes were available to all county residents who were in need. The boxes included fresh fruit and vegetables, bread, and milk when available.The Redlands Unified School District gladly partnered with us for our food efforts. The Redlands Charitable Resource Coalition, led by Pastor Craig Turley, also began distributing bagged lunches every day of the week and Redlands Family Service became the host site. All services that staff provided were executed in a safe mannerto lessen the risk of our staff and volunteers becoming exposed to the virus and for the safety of our clients. We never closed our doors.

Our generous donors, supporters, and valued partners contributed mightily to help us accomplish the important work we do - serving families in crisis with basic safety -net services.

Our staff and volunteers embraced our clients with ingenuity and all the heart and soul needed at this most vulnerable time, even when their own family issues and fears persisted.

In partnership with San Manuel Band of Mission Indians, the cities of Redlands and Yucaipa, Bank of America, and more, the Housing Assistance and Advocacy Program paid 195 months of rent toward the fight against homelessness. Families facing eviction or already homeless sought help through our agency and our case managers worked tirelessly to partner with landlords and property managers to secure housing. The affordability issues wrapped around housing costs and the pandemic causing job loss and health issues - for many became a looming recipe for disaster. Family Service stepped in for 136 families, 35 of which were already without shelter.

We hope to become a bigger part of the solution with a new Housing Village of 10-12 affordable housing units right here on our own campus in Redlands.

We commenced a Diversity, Equity, and Inclusion committee to address social issues that are plaguing our community and our world today. Promoting human dignity will always be the cornerstone of our mission.

We began 2021 with optimism that so much heartache would be behind us, but as the ramifications of the pandemic and social unrest continue to surface - we recognize that there is plenty of need ahead and we are up to the task.

Respectfully submitted,
Ellen Weisser
2020 Fomily5ervice President
LU
-229-

123 Years of Building
Stro Families
Family Service and Housing Advocacy Points of Contact
2020
Total Families
1,861
Total Individuals
6,503
Emergency Food - number of families
1,013
Drive Thru Food Bags (May through December)
23,314
Meals Served (January through March only)
1,440
Donated Food- weight by pounds
148,287
a.. •,. r,.1i7111-77711111111
Families
556
Total Individuals
2,093
Emergency Rental Assistance - number of families
123
Months of Rent Paid
195
Homeless families moved into stable housing
36 Motel Vouchers Issued 309 individuals representing 133 children of the street 688
Motel Vouchers - number of bed nights
1,127
Transportation -gas vouchers or bus passes
56 Training Contacts - individuals (January through March) 23 Volunteers
435
Volunteer hours
4,192
Children's Easter Baskets
255
Easter Food Boxes
86 Thanksgiving Food Boxes
95 Christmas Food Boxes
84 Adopt A Family
139
-230-

■ � _ r r
Fig(}6Yng Homelessness!
As the pandemic raged on and households were affected by job loss, school closures and caregiving, Family Service continued on in the fight against homelessness.

Executive Director, Kyra Stewart, describes emergency rental assistance, move in deposits and motel voucher services that were provided - as the "organizations proudest achievement from year to year."
As homelessness numbers continue to grow, the case management, wrap around support and crisis intervention is crucial to stabilizing families.

In 2020, we provided 123 families with 195 months of emergency rental assistance. Of those 36 were homeless. We worked diligently with landlords, motels and other agencies to get the homeless families housed and to stop the threat of homelessness with other families served.

Stories of Stabilization -
Every number has a story, every story is a life.

A recently unemployed mother who is also a domestic violence victim applied for housing assistance with Family Service. After interviewing with a case manager, Family Service assisted her with a move -in deposit to a safe location away from the danger that she was previously experiencing. She also received food, clothing, hygiene kits, transportation assistance and case management support.

A single unemployed mother with three children was screened for emergency rental assistance in the summer of 2020. Prior to the screening, her 18 year old daughter was helping with bills but due to COVID-19, her employment ended. The mother, who was a waitress also lost her job and the family was suddenly facing homelessness.

Family Service intervened for the client and paid for one months rent while they waited on unemployment benefits. The family also received food and later holiday support to help them get through their crisis.
-231-

- 1 i
Trita ky€ u's From Clients .W
iedited for content)
In may time of need as all my household and eXtended fama- ily had t,GVIP and may husband was in the W Family
Service stepped in with food and things needed toget back Oki our feet. W hen I first entered the door, Lori greeted mae with a wo rma smaile and kind words. What better place to comae to when you need a hel ping hand. I give props and my hat off to Paula, she listened, didn't rush calls and checked to maal e sure all the paper work was in. She offered food each times whether I needed it or not. This agency is 100 /- the best. I appreciate everything each and everyone did whether a kind word or a smile. May Ood bless you and heaven smaile upon you.
- the F Famar'ty
//ta,,,k you � wt" (�r till ttGt,P a"o( f rppor�- nad,
u Pr5VIkai
Me-, c ue Gte�e tiros Gaowie�fess Coet- way
i tope LI, pe6pCc, f G o{s f= r� y Sc,- t �c� Gta� sGto z rat was S-a to"cdwapa��,'rrn a o(. rr-j� f-eo(. kovy/ tt "af you
dr ys are of f l��re �s a a 9. rGa l� you �sr' eve-"y�K�, — CG
/Pf Vam//y and i would love to thank you for your hey /n our very hard fine oi' need. You will always be remembered in hearlL szoz9 has been o eom�olete history /a /tseW. you are al/ #EROS " in th/s tme o,L need. find standing on the Front //ne ready to lep. Thank you so much. iliay God bless you and keep dong what you o0 are dowg w/th a warm lean and open hands, - ET
iour,generosity he/Ps yne keep working without worryin3 about nay basic - needs. to keep focused at; work. I feel so blessed to have People on `ny side and caring about: roe. It's been really tough this year but with your help togs have turned around. - I
-232-

Manning a Deeper Solution to Homelessness vi l
the hers of the Faith Based Community
In 2018, seeing the increased homeless counts published by our County, Family Service decided to launch a Housing Committee to explore deeper solutions that Family Service could administer. We wanted the solutions to be aligned with our mission and practical for the resources, land ownership and clients we serve.

Led by Past President, Carol Snodgress and with the
talents of real estate agents, business professionals,
architects and investors, discussions about the
possibility of creating a 10-12 unit tiny home village
on the Redlands campus started to take light.

The perceived project finally got its legs when a grant from the First Baptist Church of Redlands known as
the Gregory Legacy Grant was facilitated by Board member, Deborah Crowley. She is a long standing member of both the church and the organization. A total of $35,000 was received to start the conditional permit process and gave us the resources to firm up our housing plan in order to submit to the City for approval in the near future.

We are excited for the new partnership with the First Baptist Church of Redlands and grateful for the talent of the committee which is continuing to work diligently on this exciting project. We hope to become a deeper more meaningful part of the housing solution with stabilization and options for families and elderly in crisis. ........... zj:i3x',Y.
a
-233-

.-ood Box Dwis-tribution
When the COVID-19 pandemic hit in early 2020, we quickly realized that there was an enormous need for food in our community. Grocery store shelves were bare, school was cancelled, and jobs were lost. It was then that we launched our weekly food box program with the help of two grants from The Will J. Reid foundation and various other donors. Our contactless drive through food box program is held every Tuesday and open to all residents of San Bernardino County.

In 2020, we served over 700 (unduplicated) families with food boxes and distributed more than 3,100 boxes of food. The primary recipients of the program include people who are in crisis due to job loss, school closures, loss of income, caregiving or suffering from illness.

In a commitment to the safety of staff and others, the distribution is done in an organized system in which staff members and volunteers ask to see identification through the vehicle window and then place food in the trunk of the vehicle. Typically each vehicle that comes through gets a box of nonperishable food, fresh fruits and vegetables, dairy products and bread.

In the fight against hunger we continue to help approximately 100 families each week with food. For more details please visit our website at rediandsfamilyservice.org. -234-

ry � E 1 f
Our volunteers add incredible value to our organization. They assist us in achieving our mission and in a twofold purposeful manner, Family Service helps to provide opportunities for volunteers to learn new job skills, complete school/intern hours and build community.

In 2020, even through a global pandemic, Family Service provided opportunities for volunteers to get involved in various ways and we celebrate 435 volunteers who tracked 4,192 hours. Family Service recognizes the efforts of these giving volunteers through orientation, training, motivation and appreciation.

Volunteering brings people together, helps build socialization and friendship skills and broaden ties to the community.

Our hats are off to you wonderful volunteers! Thank you for your dedication to serving others!'` Rollie Mare Receives Aran McMahon Service Award
At the Annual Meeting in early 2021; Rollie Moore received the prestigious Volunteer of theYear Award for his years of service and leadership on the Finance and Facilities team. Rollie oversees major capital projects related to security, campus maintenance and other complex projects. Whatever the crisis or emergency, Rollie is always there to lead the team and create a solution to strengthen the community he loves.

Since 2016, each year, we honor a special Volunteer of the Year with the Ann McMahon Service Award. Ann is a long standing, hard working Rollie Moore - volunteer who served as a President for Family Service Association twice. Volunteerofthe Her community minded spirit and dedication is remembered every year YearAward with this name sake award in 2020.
-235-

t t t
F Fooc Drive -'
Dest Practice Partnershios!
Faith Based, Business and Nonprofit working together for the common good.

On a beautiful, sunny fall Saturday in November, we all place marked time on our calendars, masked up, socially distanced and excitedly looked forward to a productive day of collecting food at the Redlands campus. The day was organized in partnership with the Church of Jesus Christ of Latter-day Saints in order to keep our food pantry stocked for the anticipated need in the year to come. Tables were set up, music played, registrations were organized and volunteers were oriented all preparing for a busy day of incoming food.

Not knowing what to expect either from volunteers or food donors, (everyone needed to be aware of their own food stock and safety with the crisis we were in) - we all waited as the Church of Jesus Christ of Latter-day Saints volunteers started to bring their Stater Bros. bags filled to the brim with non-perishable food. Empty bags were donated by Stater Bros. and distributed to Redlands residents.

Slowly but surely as the day progressed, the incoming donated food piles grew and grew and the generosity of the residents as well as the concern for those in need became more and
more evident.

With the leadership of Bob and Judy Cannon Family Service counted pound after pound and to our surprise we collected over 32,000 pounds of food in ONE day! The most we have ever collected and yes - in the middle of a pandemic.

The day was so amazing and hard working volunteer groups, board members and Family Service staff worked diligently to sort and accept the food we received!
Faith Based - Church aflesus Christ
ofLatter-daySaints- Provided Business -StaterBros.Charities - leadership, direction, drivers for Provided 15,000 bags which were pick up and drop off and distributed to the community.
volunteers on th�av of.

Family Service - Administered
weekly food boxes, received
the food, responsible for
receiving and set up.

V
-236-

r
� M—F
mi �, e.mce rt: er I ', it e ands I�. rater st
Charitable Coaiition
Following the Center for Disease Control recommendations regarding communal dining, Family Service decided to shut down our daily meal services. We collaborated with the Redlands Charitable Resource Coalition as a partner site to allow them to start distributing daily bagged lunches to the homeless, at risk homeless and low income individuals and families of the region. Since the partnership started in mid 2020, thousands of lunches have been served.

Other ways you can support FSA
I\/
• Pick FSA as your Amazon Smile recipient
• Host a Facebook Fundraiser for us for your birthday
• Donate your time as a volunteer
• Donate food to our food pantry
• Host a food drive or hygiene drive on our behalf
• Donate monetary gifts
i
I • Choose to leave a gift to FSA as a bequest (car, property, E
money,
stocks and bonds).
1 • Donate your car to FSA (must be up to date on registration and in good running condition)
0 -237-

Family Service Team
Vvorkinci Together `or the Good
Operations were drastically changed during 2020 and our staff remained steady, flexible and resilient through the changes. Operational hours were adjusted, meals were cancelled and replaced with a weekly food box drive -through, classes were moved to a virtual forum, housing orientations were assessed through a survey link, sneeze guards were installed at every desk, mandated temperature checks and mask wearing were enforced and staff meetings were turned into Zoom meetings.

Through all of their own fears, childcare issues and safety protocols, our team worked diligently to continue to serve. We honor our team and appreciate all that they do to keep Family Service productive, relevant and with the continued capacity to serve in a safe environment,
THANK YOU EAMIL.Y SERVICE TEAM!
(Backrow,left to right): Cornell Fuqua, Josie Rawlinson, Samantha Morgan, Paula Petty, Jill Prendergast, Stacy Heredia, Crystal Lau,Vanesa Cantu, Adela Brawn
(Frontrow,leR to right): Liza Mejia, Mary -Ellen King, Kyra Stewart, Lori Villarreal, Mandy Carlson d
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- g-
_ �...E_
Than You 2020 Donors
For providing a hand up, not just a handout, to local children and their families.

We couldn't have done it without you!
Ambassador;$25,000+)
Esri
Hovey Tile Art
Lindsey, Bill & Barbara
McLaughlin, David & Diana
San Manuel Tribal Administration
The Will J. Reid Foundation
Founder $15,000 - 524,999)
Bean, Gerald & Marilyn
Majestic Realty Foundation
Maupin, David & Robin
Benefactor ($10,000 - $14,9991,
Anonymous
Beaver Medical Group, LP
Breakfast Club Of Redlands Inc
J & L Day Care Centers
Marvin, David &Tami
Mission Pediatrics
Myron F. Ratcliffe Foundation
Raymond Pryke Foundation
Riordan, Barbara
Spencer, Tilden & Nancy
Weisser, Stan & Ellen
The Annette M. Williams Charitable Foundation
Varner, Bruce
Zdunowski, Gene & Donna
Guardian ($5,000 - $9,999`,
Adams, Scott & Diane
Buster Family Foundation
Cutler, Tom & Julie
Diversified Pacific
Fass, Joseph & Dianne
First Baptist Church Of Redlands
First Congregational Church
Hamilton, Sharalyn & Edison, Sam
Hansberger, Karen
Hatfield, Bill & Lori
Morasco, Sue &TenBrink, James
Nance, Richard & Barbara
Redlands Day Nursery
Rosen, Elaine
Sandel, Anne
Snodgress, James & Carol
Sunrise Rotary
The Community Foundation
Zdrojewski, John & Donna
-239-

2020
Steward ($2,500 - $4,999)
Abushanab, Daniel & Heather
Ally Financial Inc.

Banken, Stephanie
Belote, Jim & Patti
Bryan, Vaughn & Ann
Bunnell, Bill & Marilyn
Burgess, Larry & Charlotte
Crowley, Keith & Deborah
Emmerson, Bill & Nan
Engel, Patricia
Estelle, Lorraine
First Lutheran Church
Gerrards Market
Gill, Carolyn
Gomez, Ed
Heinze, Robert
Heppenstail, June
Hone, Philip
Jones, Landy
Kiwanis Club Noon
Loma Linda University Health
Lossett, Cheryl
Martin, Faydell Pressly
Maupin Financial Advisors
Milloy, Wayne & Doris
Munz, Larry & Cindy
Optimist Club Of Redlands
Osborne, Sarah &
Adomshick, Chris
Humanitarian ($1,000- $2,499)
Ahern, Thomas&Alice
Epic Management LP
Albrektson & Shumate, LLP
Eppehimer, Ryan & Sarah
Andrews, Dick &Cindy
Farley, John
Angelides, Dean & Laura
Fellenz, Kathy
Anonymous
First Presbyterian Church
Arthur, Cheryl
First United Methodist Church -Greenleaf
Bacca, James &ColeJaney
Bangsund,Luann
Barich &Associates Insurance
Beasley Craig
Becker, Steve & Vickie
Bell, Robert & Janet
Bennett, Diane
Blaney, Carol & Sun, John
Braxton, David
Brubacher, Elaine
Cantwell, Tim & Marie
Chandler, Evelyn
Connolly, Sean & Lynn
Corley, Mildred
Corneille, Richard & Colleen
Cosgrove, Donna
Date,Marilyn
Daily, Robert & Ern
Davis, Marty & Jane
Delta Kappa Psi
DiBiase, David &Valerie
East Valley Association Of Realtors
Elks Lodge 9583
Fletcher, Janet
Foster, Paul & Juli
Frazier,James D. & Betty
Fuller, Debbie
Granilio Orthodontics
Griffith, Karen
Guiles, Norman & Sharon
Heyming, Frank
Hiebert, Magorie
Hoffs, Mr. & Mrs. Vernon
Holcomb, Michele
Holy Name Of Jesus Catholic Church
Inland Empire Disc Golf Club
Inland Empire Four Wheelers
Jacobson, Lloyd &Janice
Johansen, Lawrence &Judy
Jones, Greg & Silvia
Kaiser, Pat
Kallander, Ron & Kay
Kane, Christopher & Lisa
Kaney,Tom & Karen
Kiwanis Club Evening
rT�
Phillips, Jon & Sabine
Portney, Jamie
Power, Alexander & Heloise
Redlands Community Foundation
Redlands Community Hospital
Rotary Club Of Redlands Noon
Schindler, Gary
Schumann, Lee & Louise
Stephany, Ron & Winifred
Thalmayer, Matt & Jennifer
Tolsma, Ryan & Miriam
Watson, Jim & Vicky
Yurkosky, Pete & Brandy
Knight, Jane
Knudsen, Jim & Olivia
Koss, Peter& Melissa
Krause, Richard
Larry Jacinto Construction, Inc.

Long, Larry
Longan, Marty
Lopez, Sherry
Macias, Christine
Macomber, Douglas
Magedanz, Joseph & Stacy
Mayhew, Diane
McCall, Allan
McCurdy, Michael & Rebecca
McMahon, David & Ann
Meals, Robert
Mera, Steve & Mary Ann
Miles, Duncan & Vicki
Miller, Bettye
Miller, Mary
Mirau, John & Reische, Susan
Moore, Rollie&Sally
Morris,Teresa
Mullooly, Bill & Wynell
Murphy, Daniel & Linda
P & R Paper Supply
Pacific Western Bank
Parker, Ben & Stafford, Dawn
Patel, Jayesh & Rekha
-240-

;Ko
;.;
Humanitarian ;$1,00£1- $2,4991 _,u
Price, Wayne & Millicent
Shah, Praful & Radha
Underwood, Donna
Ramsay, John & Susan
Shelffo, Rod & Lori
United Church Of Christ
Regalado, Sharon
Sherman, Jan
University United Methodist Church
Remy, Mike &Diane
Shimoff Law Corporation
Vines, Terry& Geneil
Ritchie, Alen &Carolyn
Shook, James &Brenda
Walker,Chris
Rivera, Christina
Softer, Marilyn
Wanchoo, Maharaj & Ranjana
Roche, Brian
StGeorge, Donna
White Horse Vapor
Rohrer, Charles & DeTreville, Sarah
Stindt,Jeralyn
Wiens, Marion
Rold, Kerry & Vicki
Suk, Andrew & Kay
Wilder, David & Lynn
Rougeau, Paul & Judy
TalleyTerry& Janise
Williams, John & Mary
Saba, Khalil & Mary
Thibedeau, Richard & Kristin
Williamson, Valerie
Sanbom'sWestcoastMechanical
Thielemann, David
Wilson, Richard&Nancy
Sada, Brigitte
Tilden -Coil Constructors
WISE Healthcare
Save Redlands! No On G
Tincher, John & Karen
Yegge, Steve & Sandi
Schneider, Roger&Aida
Tolerico, Frank& Ann
Zeiner, Bruce & Peggy
Seiberling, Monroe & Pat
Tri-City Acoustics, Inc
Sellas, James & Annie
Trinity Church
Patron t$500 - $999?
Albert, Robert D.

Davis, Peter & Serena
Guillen, Rita
Alpha Delta Kappa
Debra C. Meade Family Fund
Harris, Mark & Monica
Associates OfThe Redlands Bowl
of Foundation
Hodges, Robert & Patty
Bannister, Steve
Denham, Robert & Stephanie
Holland, Joe & Nancy
Barton, Kathryn
Dewey, Michael
Homes 2 Suites, Hotel By Hilton
Sates, Jerry & Barbara
DeWitt, Daniel & Janice
Honeycutt, Dale &Jane
Blatchley, Cindy
Disc Golf Values
Hurlbut, Susan K.

BNI Mason's Of San Bernardino &
Doolittle, Phillip
Jordan, Matt & Jill
Redlands
Dora P.Wlaters Investment
Kaney, Heidi
Bray Jeri
Dreher, Kent & Jane
Kasarjian, Julie
Brier, Wes & Peggy
Driessnack, Bob & Paula
Knudson, Gary & Joy
Brown, Charleen
Earney, Gary & Nancy
Knypstra, Melanie & Tilden, Carey
Burch, Russell & Jan
Egan, John & Ellen
Krogstad, Kim
Burgess, Ron & Molly
Ellinor, Chris & Paula
Kuhn, Michael & Mindy
Burke, Suzanne
Estes, Alice
Kusko, Vaughan
Busek, Joseph & Annette
Fagan, Gary & Marcia
Larry Jacinto Farming, Inc.

Butler, Bette
Farlander, Leann
Leonard, Larry & Ann
Cameron, lames
Fong, David
LeRoy, Christina
Cavagnaro, Rosemary
Ford, Pamela & Alford, Ken
Levern!er, Katherine
Christopherson, Richard & Christina
Frykman, Gary & Annette
Lewis, Roger & Marjorie
Clark, Kim
Fuller, Samuel & Margaret
Loo, Larry & Patty
Clark, Robert & Norma
Gallant, lay &Valerie
Markos, Gregory & Joyce
Clark, Tom & Pam
Garcia, William
Martinez, Jeff & Susan
Cobb, James & Allison
Geissinger, James & Patricia
McAllister, Caroline
Cohoe, Garry & Elaine
Gifford, Don & Marge
McCue, Donald & Susan
Comfort Suites Hotel
Glaze, Jim & Alexis
McMunn, John & Kay
Contreras, Yolanda
Godon, Judy
Melcher, Eugene
Costa, Nicholas & Amber
Gomez, Mary Frances
Miles, Germaine
Curti, Larry & Jannette
Guidry, Kenneth &Yvette
Miner, Norman & Mary Jane
Davis, Ann
Moon, Kathy
-241-

Patron (S500 - $999)
Morgenthaler, Doug & Michele
Mounzer, Maroun & Gisele
Murphy, Ed & Karen
Ne.% Life Foursquare Church
Nist, Laura
Noiset, Phillippe
O'Prey, Bernie & Evelyn
Orr, Norma
Oster, Linda
Owens, Jeff & Suzanne
Park, Stephen
Pesavento, Richard & Lucian
Pitsaros, Ted & Judy
Pleiss, Greg & Christie
Prickett, Norman & Sherry
Reade, Daniel
Redden, Charles & Velma
Redlands Decorating Center
Reid, Bryan & Susan
Reinsch, Carin
Rettig, Franz & Susan
Supporter #$250 - $499
Adams, Jennifer
Adams, Patricia
Agee, James & Kristy
Albrektson, Ray & Kathleen
Alpha Theta Phi
Anderson, David & Lowa
Areffi, Patrick & Carolyn
Arrowhead Valley Chapter DAR
Arzaga, Laurie
Ashton, Patricia
Balderrama, Larry & Ann
Barbo-Partain, Judy
Barnes, Dave & Virginia
Bathgate, Kenneth
Bealer, Sheron
Bell, Karen
Bellinder, Michael & Marilyn
Bodine, Heather
Broyde, Jeffrey & Kathleen
Burgess, Jerry & Jan
Burke, Jack
Burke, Robert
Bussell, Mark & Rachelle
Cadkin, Jennifer
Rice, Ann
Rowland, Bruce & Linda
Rud rich, Horst & Aleta
Ruml,Treadwell & Laura
Rylett, Rick & Linda
Saline, Christiana
Salvesen, Kathleen
Sandos, Jim &Tish
Satzger, Bruce & Susan
Scarpace, Robert & Kathi
Schmidt, Edith
Seccombe, Scott & Melodee
Serros, Edward & Linda
Shira, Scott &Teri
Silva, Richard
Simmons, Barbara
Smith -Collins, Sandra
Somers, Dorothy
Sommer, James & Diana
Stewart, Steven & Dona
Stifel Nicolaus & Co., Inc.

Stockton, Shelli
Szukaiski, Bernie & Sandy
Terhorst, Philip & Lynda
The Home Depot Foundation
Theodorou, Anthony & Georgia
Thiesse, Judith
Thole, John & Roberta
Thomas, George & Betty
Thomas, Griffith
Tolar, Ken & Claudia
Trost, Sally
Tschann, Judith
Tuff, James & Carolyn
Van Engelen, Debra
Waldron, Jeffrey &Trudy
Wesson, Craig & Carole
Wick, Debra
Williams, Gregory & Georgia
Wolfe, Brenda
Zook, Shawnda
Carolyn's Cafe
Carskaddan, Phillip & Joan
Cervantes, Carlos & Cynthia
Chandra, Frederick
Chavez, Eugene & Patricia
Conley, Jamie
Constant, Linda
Cosand, Tom &Caroleen
Couperus, James & Cheryl
Cranfil I, Tracy
Daly, Lydia
Dangermond, Joyce
Dawes, Robert & Cheri
DeBold, Raymond & Mabel
Dehart Construction Services Inc.

Dieterich, Gail
Dieterich, Greg & Geri
Dill, Monty & Carol
Dr. Hyman Forensic Pediatrics
Drake, Carol
Dresner, Donald & Gladys
Dunn, Thomas & Roslyn
Einhorn, Mason
Ekema, Larry
r.T.a
Ekstrom, Marie
Elder, Eric
Elder,Todd &Judy
Elliott, Megan
Evans, Debbie
Feller, Ralph
Ferguson, Scotty & Barbara
Flater, Drew & Elizabeth
Floyd, Wilber
Frivold, Geir & Berit
Girl Scout Troop 1854
Gomez & Associates
Gonzales, Anna
Goodrich, Beth
Goral, William &Jan
Griffing, Gary
Gullon, Ron
Guzkowski, Conrad & Gifford
Katherine
Hamden, Emi & Castillo, Manuel
Harshbarger Law
Hartzell, Andrew
Hatfield-Odero, Kailey &
Odero, Nevin
-242-

Supporter f$2S0 - $4991
Hatfield, Crista
Heaney, Kevin &Yvonne
Henry, Jane
Herries, Jim & Nicole
Herzberger, Kathy
Holder, Debra
Hylkema, Mary C.

Investment Counselors
Of Redlands, LLC
Jacinto, Gary & Debbie
Jacob, Sally
Jensen, Paul & Kathi
Jones, Carol
Jury, William & Constance
Kattus, Sarah
Kennedy & Kennedy CPAs
Kille, Natalie
Kolpien, Barry & Beth
Kong, Les & Ong, Pamela
Krebs, Monika
Kronberg, Ben & Bethany
L. Curti Truck & Equipment
Lambson, Julia
Larson, Sherry
Lauer, James
Lavine, Karen
Lechuga, Paul & Lisa
Lemon, Lewis
Lessard, Annie
Lessard, George & 10
Lewis, Jerry & Arlene
Lions Club - Evening
Magro, Joe & Jane
Mahoney, Paul & Vivien
Mastin-Schepps, Margene
McCarville, Brian & Ellen
McClung,Thomas
Provider ($100 - $249)
Albertao, Felipe
Alford, Michelle
Alldredge, Brad
Anapolsky, Alan & Clemencia
Andriese, Lynn
Angell, Sue
Arellano-Jackson, Raquel
McEwen, Paul & Wendy
McIntosh, Donna
Mclvor, Owen & Deborah
Mckechnie, Roger
Mitchell, George & Margaret
Moloney, Pat & Emer
Morris, Phillip & Judy
Mote, Gordon & Raylene
Newton, Colleen
Nickerson, Daniel
Nies, Boyd
Nomura, Cory & Laura
Olson, Lisa
Ontiveros, Helen
Oppenheim, Patsy
Parkinson, Joanne
Patricia Hicks & Associates
Realtors
Pawooskar-Almeida, Sachi
Pierce, Kristin
Purvis, June J.

Ramos, Richard & Penny
Rendler, Dan & Michele
Rettig, Robert & Christi
Rezendes-Herrick, John &
Kathleen
Roberts, Julian & Jane
Robles, Juan & Anna
Rogers, Nancy
Romo, Dawn
Sanders, Elizabeth
Schadwinkel, Andrew & Mandie
Scharer, Jon & Juley
Seed Leaf
Serrao, Fran
Shaffer, Megan
Shaner Tammy
Shaw, Jeff & Irene
Arnett, Regina
Artist In The Garden
Bailey, Rod & Mary
Baker Steven & Chris
Baker, Thomas & Janet
Balderrama, Maria
Barr, Kenneth & Sharkey, Kathy
&2020�
Shotts, Mike &Tami
Sierra Summit - Surety
Sisterhood Congregational
Emanu El
Snyder, Paula
Sorenson, Dave & Callene
Spafford & Landry, Inc.

Spieske, Douglas
Stadelmann, Mirjam
State Street Management Co
Steele -Mixon, Ann
Steinke, Andrew & Yang
Stout &Waner
Stowitts, Mark & Joanne
Struna, James
Stuck, Monte & Nelda
Templeton, Julie A.

Totzke, Bob & Sue
Tsushima, Paul & Carol
United Health Group
United Methodist Women
Upshaw, Claude & Annie
Van Cleve, Lois
Van Esch, Steven & Beata
Vienneau, Aleta
Villa, Steve
Wagner,Todd
Wallis, Charles
Walsh, Brian & Sherry
Waner, Neal &Joyce
Wells, Suzy
Westerfield, David & Patricia
Whitmer, Gary & Lynn
Williams, Ruthanne
Williams, Susan
Wong, Dennis & Susan
Zureick, Aaron & Andrea
Battey, Judith
Baty, Jonathon & Michelle
Baty, Roger & Phebe
Beck, Darwin & Shari
Becker, Sylvia
Benson, John & Joan
Bernstein, Erica
-243-

Provider ($ ; 00 - $249 s
Beswick, Carole
Dodson, Thomas & Brynn
Betancourt, Rodolfo & Carol
Dunn, Kerry & Pam
Bill Solberg's State Farm Insurance
Dutton, Charles & Linda
Bird, Cynthia
E.J. Meyer Company
Bitterlich, Nidia
Eldridge, Pamela
Blackbaud Giving Fund
Elkins, Robert
Blaney, Laura
Emrick, Marge
Bodnar, Shelley
Endsley, Janice
Bogh, Margaret
Ervast, Roger
Borkowski, Eleanor
Evans, Lorraine
Both-Gragg, Janee
Fails,Terence
Bounds, Jeffrey & Venita
Farhar, Dennis & Pauline
Bowman, Judy
Farmer, Laura
Brainerd, Jennifer
Fay, Liz
Breyer, Cecelia
Flanigan Construction
Brigman, Kristina
Flood, Kelly
Brigman,Terese
Fowler, Albert & Jan
Brown, Gil & Carol
Franke, Elizabeth A.

Brown, Kathryn J. & Hendon, Jim
Freitag, Adelheid
Burt'sJewelry
Fujimoto, Rosemary
Bushnell, Judith
Fujiwara, Tom
Capella, Ann
Gage, Greg &Janis
Carnes, Shelley
Gaylord, Jeannie
Carpenter, Matthew & Amy
Gill, Kacey
Carter, Londa
Golden, Bruce
Catton, Jack & Kehr, Peggy
Goldstein, Cynthia
Cawthon, Thomas& Janet
Goodrich, Diane
Chang, William & Elizabeth
Graybill, Richard & Cheryl
Chapman, Bonnie
Grcich, Kennith
Chappell, Suzanne
Greaves, Thelda
Chavez, Annie
Green, Dolores
Chonkich, George & Nanette
Greene, Stacey
Choudhry, Catrina
Greenfield, Norma
Clark, Mike & loan
Greg's Garage
Clark, Robin
Grenda, Donn & Janet
Clements, Mike & Sherrie
Griesemer, Allan & Nancy
Cobb, Terri
Grimm, Kathryn
Connor, Kellie
Gruenler, Eric & Pauline
Coonradt, Peter & Suzanne
Hadley -Scofield, Merrilee
Cooper, Noel
Hahn, Robert & Shirley
Cox, Richard E
Hamilton, Milan
Crittenden,Jean
Hanchett, Chelsea
Dahlgren, Karen
Hansler, Holly
Dangermond, Jeffrey
Hanson, Cynthia
Davis, Sylvia
Hardy, Bill & Sue
Dawson, Clifford & Diane
Harkness, Brian & Mary
De La Ossa, Elizabeth
Harry, Shirley
DeBlauw,Walter &Joyce
Hauser, Minnie
Dickson, April
Haverty, John & Suk Cha
Dixon,Varonica
Hayden, Patty
Djanbatian, Hratch &Tricia
Heitritter, Mitchell
!_ r ! 1
Helbron, Ron & Nikki
Helzer, Kimberly
Hemme, Karen
Henshaw, Katharine
Hill, Erica
Hinkleman, Lorrie
Hisada, Paul & Goldstein, Susan
Hoghaug, Jon & Cindy
Holden, Mike & Pam
Hollis, Patsy
Holmes, J.E. & Mary 10
Houck, Evan & Laura
Houston, Carolee
Hubbell, Lisa
Hutchinson, Doug & Linda
Hyman, Clete & Merrilee
ICCBBA
Ideker, Paul
Inglis, William
Jack Elite, Inc.- Wingstop
Jacobs, Toni
Jervis, Chuck & Betty
Jimenez, Betti
Johnson, Duane
Johnson, George & Amy
Johnson, Spence & Darlene
Juby, Dawn
Kasinski, Jerry & Helenruth
Kean, Susan
Kelverin Inc.

Kennedy, Martha
Kensok, Orville & Liv
Kerr, John & Barbara
King-Shamp, Heather
Kleinhaus, Nonie
Knox -Allen, Marlene
Koepp, Holger
Kohlmeier, Jack & Patricia
Koonce, Alexander & Armstrong,
Dana
Koss, Valerie
Krause, Ward & Barbara
Kuhn, Irvin & Doreen
Labbe, Pamela
Lambert, Jo & Larrance, Michael
Lambson, Marge
Lantier, Ward
Lazar Commercial Real Estate
LDM Commercial
Leavitt, Pamela
Leonard, Sherli
-244-

OroVider l $ f 00 - $2491
Lesh, Craig
Lewis, Janet
Lewis, Josh & Lisa
Lindemer, Curt & Charmane
Maas, Carol
MacLean, Marsha
MacMurray, Anne & Pedersen,
Robert
Mariano -Denning, Patricia &
Denning, Jeff
Mario, Lena
Markovitch, Lee
Marnell, Matthew & Kristi
Mast, Helen
MatcoTools
McAlearney, John & Patricia
McDermott, Kathleen
McKinnon, Mary
McLane, Ray & Amber
McLoughlin, Mary
McNerney, Leona
McPeck, Ron & Suzanne
Mead, Jim & Annemarie
Messner, Laurie
Miller, Miles & Deborah
Miller,Thomas & Jayne
Mills, Erin S
Mishak, lane
Mitchell, James & Debra
Monk, Bobbe
Montgomery, Jennifer
Moore, Steve & Mary
Morales, Tomas & Evy
Monts, Andrea
Morrill, Ken & Roberta
Muise, Allison
Multani, Harbans & Renu
Mundy, Perrie
Munson, Laurel
Musser, Patrick
Napoli, Anna Marie
Nelson, Anne
Nelson, Jennifer
Nichols, Jules
Nicoloff, Fred & Christine
O'Brien-Abshire, Ellie
O'Connor, Nancy
O'Donnell, Rich & Carolann
O'Neill, Michael &Colleen
Osborne, Thomas & Rita
Palumbo, Linda
Perez, Beverly
Peske, Jonathan &Wendy
Petite, Steve & Mary Frances
Petrasek, Joseph & Carol
Poole, Sharon
Pope, Colleen L.

Potts, Claude & Carol
Preston, Kay
Prutsman, Debbie
Rabinowitz, Janet
Racine, Judy
Raynes, Jeanne
Razzouk, Teresa
Redlands Christian Center
Reese, Helga
Reeves, Suzie
Rehome, Daniel & Dee
Reinert, Beverly
Rentschler, Bob & Judy
Ribotto, Joe & Nancy
Richardson, Mary Beth
Richman, Rebecca
Riesz, David & Karen
Rita Shaw Broker &
Associates Inc.

Robertson, John & Sally
Robins, John
Rogers, Tom & Jan
Ross, Valerie
Rostberg-Bettini, Halie
Rozema, Randy & Barb
Rubio, Alexander
Ruiz, Alice
Sakaguchi, Tom& Ellen
San Bernardino County Medical
Society
Sander, Renee
Sanders, Jerry & Beth
Sanderson, Beverly
Savacool-Barkley, Donna
Scanlan, Daniel & Jenny
Schmidt, Ann
Schreiber, Peter & Catherine
Schroeder, Gregg
Schultehenrich, Joe & Ruth
Schumacher, Philipp
Sells, Allen & Cheryl
Serrao, Bonnie
Severo, Deborah
Shelbourne, Richard & Laurie
Shuler, Tor & Julie
Siddiqui, Ali & Doris
Sidhu, Dip & Nancy
Only contributionsreceivedlanuary 1 to ALAIk
December3l, 2020 are listed here.

Siever, John
Skousen, Nancy
Smith, David
Smith, Hugh & Donna
Smith, John & Laura
Smith, Walter
Snowden, Paul &Joanne
Soria, Mark
Soto, Catherine
Spilsbury, Ned & Lauren
Stanfield, Gerald & Janet
Stellar, Jim
Stimson, Nancy
Sullivan, Jim & Leslea
Surdzial, Chris
Surdzial, Jillian
Swinson, Becky
Tetley, Mickey
Tiernan, Tom & Joanne
Trinity Kids LINK Class
Trujillo, Raquel
Tubbs, Duane & Cheryl
Tucker, Zach & Berangere
Two Guys Pasta and Pizza
Valdez, David
Van Mouwerik, Clemmie
Vaughan,Randy
Vela, Ruth
Vitt, Irene
Von Hatten, Ruth
VSR Incorporated
Waitz, Fred & Helen
Warier, Al & Joanne
Warnell, Ronald & Kathy
Warren, Kathy
Webb, Robert & Helen
Webber, George & Heima
Weir, David
Weis, Annette
Weisberg, Benjamin & Chelsea
Wells, Charles & Joan
West, Richard
Williams-Reade, Jacqueline
Williams, Marilyn
Williams, Mark & Kathryn
Williams, Mike (Ken) & Barbara
Wilson,Jasmine
Winters, Judith
Wise, Donna
Woolverton, Buel & Beverly
Zappia, Marc
-245-

Gifts in Hlon rf rvlemory ut¢.B
In Honor of Daniel & Heather
In Memory of Covid Victims
Abushanab
Brijesh Shrivastav
Darwin & Shari Beck
In Memory of David Dangermond
In Honor of Alexander
Joyce Dangermond
Brenda De Amaya
In Memory of Gail Ebert
In Memory of John Ray Allen
Craig Beasley
Tony & Darlene Jacinto
In Honor of Emergency
in Honor of Clemencia Anapolsky
Essential Workers
Alan Clemencia
Mary McLoughlin
in Honor of the Marriage of
In Honor of Family Services
Jerry & Marilyn Bean
Volunteers
Ray & Kathleen Albrektson
Charles & Linda Dutton
Pamela Eldridge
In Honor of the Flater Family
Allan & Nancy Griesemer
Drew & Elizabeth Flater
Marilyn Solter
to Honor of lames P Frazier
in Memory ofTonio Birabent
James & Betty Frazier
Susan Williams
In Honor of the Front Line Team
In Memory of Bill & Mary
Lee Markovitch
Bottenberg
Frank &Lucy Heyming
In Honor of Robert Garcia
Carolyn & James Tuff
In Honor of Char Burgess
In Honor of Rose M Garcia
Phillip Doolittle
William Garcia
In Honor of Larry & Char Burgess
In Honor of Susan Goldstein
Paul &Paula Burgess
& Paul Hisada
In Honor of Debbie Burgner
Cynthia Goldstein
Amy Gaudette
In Memory of Cornelia Grant
In Memory of Deborah Carlson
Phillip Doolittle
Jim & Olivia Knudsen
David & Ann McMahon
In Honor of Christ Jesus
In Memory of Jack Griffith
Richard Worden
Karen Griffith
in Honor of John B. Clark
In Honor of Milan & Linda Hamilton
Terri Cobb
Jim & Leslea Sullivan
For our community
in Memory of Dennis Hansberger
Debbie Evans
Steve Davila
In Honor of all the lives lost
Dolores Green
from Covid
John Reza
Christina Kristoffersen
San Bernardino County Medical Society
-246-

L 1 1
In Honor of John & Kathy Hansler
Holly Hansler
In Honor of Emi Harnden
Erin Mills
In Memory of Christy Rae
Heimerman
Cynthia Bird
Ruth Heimerman
Mike & Pam Holden
Ken Munoz
Suzie Reeves
In Memory of Roxanne Hubbling
Debra Van Engelen
In Honor of Sally Inglis
William Inglis
In Honor of Larry Jacinto
William & J.J. Jacinto
In Honor of Jack & Charlotte
Colleen Newton
In Honor of Diane Johnson's
Birthday
Becky Swinson
In Honor of Trish & Sean Johnson
Spence & Darlene Johnson
In Memory of Harriet King
Heather King-Shamp
In Honor of Lisa LaSalle
Janine LaSalle
In Honor of Bruce Laycock
Catherine Laycock
In Honor of Chris LeRoy
Mike Buyak
Mary Deissler
In Memory of Ann Marie Long
Dominick DeLuca
Diane Goodrich
Minnie Hauser
Kathleen McDermott
Norman & Sherry Prickett
Alexander Rubio
Walter Smith
Griffith Thomas
In Honor of Jeanne Ludikhuize
Marty Longan
In the Memory of Margaret Ann
Matich-Kaney
Heidi Kaney
In Honor of John Maus
Linda Constant
In Honor of the Michaels Family
Greg & Janis Gage
In Memory of Mom
Patricia Ashton
In Memory of Mom & Dad
Sarah Kattus
In Memory of Mother
Rachel Wall
In Memory of Helen Nies
David & Ann McMahon
In Honor of Sofia Nist
Laura Nist
In Memory of Grace Pope
Colleen Pope
In Honor of the Ramsay Family
Sheron Bealer
In Memory of Mr. & Mrs.

Myron F. Ratcliffe
Betsy & Bob Heinze
-247-

® t tory of
In honor of the Redlands Elks
Joseph & Dianne Fass
Gary Schindler
In Honor of Lori Rhodes
Stan & Ellen Weisser
In Honor of Mother Nacha Robles
Rachel Wall
On behalf of James R Rodgers
Suzanne Burke
In Honor of Dawn Romo
Grace Monsma
In Honor of Gary Schindler
William & J.J. Jacinto
In Honor of Barbara S. Schroeder
Gregg Schroeder
In Honor of MarkTexter
Philipp Schumacher
!r- -ZF-$-
In Memory of Ty Shelton
Kent & Jane Dreher
Lorrie Hinkleman
Jim & Olivia Knuds
Bill & Lori Hatfield
In Honor Isabel Sun
Carol Blaney & John Sun
In Honor of John Sun
Jim & Olivia Knudsen
In Honor of Team100K
Maureen Clark
Julie Crandall
Rosemary Fujimoto
Betty Lou Gill
Kacey Gill
Andrew Steenhausen
Sarah Steenhausen
In Honor of Ruthanne Williams
Fionnuala Williams
WIWI
�`��:

In -Kind Gifu...

AAA Alarm Systems
Dan & Heather Abushanab
Tom & Alice Ahern
Albertson's
Arnold's Backflow
Boy Scouts of America
Mark Campbell
Julie Cauthron
Cemex
Citograph Printing Co.

Janey Cole
Community Home Health
Eadie & Payne, LLP
Ronald Edwards
Judy Elder
Esri
First Baptist Church of Redlands
First Lutheran Church
First Presbyterian Church of Redlands
Barbara Ford
Freemasons of California
Gerrards Market
Dennis & Karen Hansberger
Bequest
:�0:2]0
Mrs. M.L. Harmelink
Bill & Lori Hatfield
Hatfield Buick GMC
Highlands Giving Garden
Inland Harvest
Zan Jafry
Kennedy & Kennedy
Kimberly Juniors
Kiwanis Club of Redlands Noon
Larry Jacinto Farming
Diane & Randy Lincoln
Rollie Moore
New Origins
Optimist Club of Redlands
Pacific Wealth Strategists
Paradox Church
Romberg Tree & Landscape Business
Rotary Club of Redlands Noon
The River Church
Debbie Underwood
Stan & Ellen Weisser
Zoom Mailing
A bequest is an easy way to remember and carry on your belief in the work Family Service Association of Redlands after your death. A bequest can be made through your will or trust and does not come into being until your passing. You continue to use the asset throughout your lifetime, but upon your death the gift is made and will be used as you request. Bequest can be made for a specific amount or a percentage of your estate. Thank you to all our friends who believe in our mission and want to see our work continue in the future.

If you would like more information on including Family Service Association of Redlands in your will, please con tact Jill Prendergast or Kyra Stewart at Family Service- 909-793-2673. a
►' 2

iozo
LeadersThe
Board of Directors 2020
Board Members 2020
Ellen Weisser- President
William Bunnell
Olivia Knudsen
Rod Shelffo -
Charlotte Burgess
Susan Martinez
1stVice President
Janey Cole
Robin Maupin
Lori Hatfield -
Yolanda Contreras
Matt Miller
2nd Vice President
Deborah Crowley
Rollie Moore
Judy Godon -
Jane Dreher
Sue Morasco
3rd Vice President
Sam Edison
Diane Remy
Sam Edison -Treasurer
Debbie Evans
Joe Richardson
Christina Rivera -
Judy Godon
Christina Rivera
Secretary
Kayla Granillo
Rod Shelffo
Lori Hatfield
Shelli Stockton
Robert Heinze
Victoria Watson
Al Hernandez
Ellen Weisser
Sta"
Kyra Stewart -Executive Director
Vanessa Cantu -Case Manager
Mandy Carlson- Program Director/Site Director
Donna Olson Jones - Office Assistant
Jill Prendergast- Fund Development Manager
Paula Petty- Case Manager
Samantha Morgan- Administrative Office Manager
Lori Villarreal - Program Assistant
Liza Mejia - Donation Center Coordinator
Adela Brown- Accounting Clerk
Cornell Fuqua - Donation Center Assistant
Stacy Heredia - Program Assistant/Yucaipa
Mary -Ellen King - Program Assistant
Josie Rowlinson- Case Manager
Crystal Lau-Volunteer/Program Coordinator
-250-

Farnily Service dissociation of Redlands
612 Lawton Street ( Redlands, CA 92374-3013
909.793.2673 1 Fax:909.793.7324
; www.redlandsfamilyservice.org
NON-PROFIT ORG.

US. POSTAGE
PAID

SAN BERNARDINO, CA
PERMIT No.1217
-251-

CITY 0
Attachment I

COMMUNITY ACTIVITY GRANT

FINANCIAL / IN -KIND / FEE WAIVER

APPLICATION
Fiscal Year: 2022-2023
Date Application submitted:

Submit to:

City of Yucaipa
General Sen-iceslCity Clerk Department
34272 Yucaipa Blvd. _
Yucaipa, CA 92399
Attn: Kimberly Everts
Received
City of Yucaipa
MAY fl 3 2022
General Services/
City C,erk's Department
Ail sections of the applicarion must be returned complete and all €upportinn documentation provided priUr to City Council rovien. incomplete'applieatic ns received i+ill be returned to the applicant.

Name of ApplicantjQrganization:

ApplicantiOrganiiation Mailing Address:
i','` 7C . 0�7.......

Applicantl0ranzation Phone Number: (q) 13Q 1 5J U�3 -�^3 Ck
Contact (1) __ 3)CM;nc,: domon( fOq 3,0
Name Phone Number
�,lvJy t o or net2.,rno%-n mCt "VY)
CL, f coyyl E-niail address
Contact (2) �A \"Y-)\ e (9 51) S `3 2 --14 o ci
Frame Phone Number
E-mail address
SECTION 2 - ELIGIBILITY REQUIREMENTS:
ides No
Is y6ur organization located in another community ? ❑
Will the:progratnlevent take place in another community? ❑ �] Are you aware of any other City program providing this service? ❑ If Soy which one?
*If you answered "Yes" to any of the questions listed above, your request is not eligible for the Community Activity Grant. ty of Yucaipa Community Activity Grants Application, Rev. 0312022 Page I - -252-

SECTION ORG.AMZATION INFORMATION/APPLICANTBACKGROUND
Your organization must be an established 501(c) to be considered for Community Activity Grant funding.

Please submit documentation verlfying organization 501(c) status along with this application.

Yes No
Is your organization a 501 c)?
If yes, please provide Tax ID# q(ri'aq 2-vktD9 and attach al! supporting documents.

Does this application include submittal of documentation veti,fying 501(c) status? ❑ How long has your 501(c l organization been in existence? Number of Employees wor_kin, for organization:

Number of Volunteers working for organization:

Is a current City Council member on your board? ED
T
How many Yucaipa residents does your organization currentiv serve? Does the orcanization chars_=e admission. membership fees, dues, etc.? !� If yes. pease describe:

Names and Titles of Officers and Board of Directors: (?lease attach an organization chart. it`available) Decr��
J
SECTION P.t DESCRIPTION t•E: (PLENSEUSEADDITIONAL
n
Name of the program/event:

Date(s) of program,`event:

Describe the pro= anv`e<<ent that organization is seeking support for: `�"� tO1 C� �'; ti' Gtl acf -.etl Qc2G. 47or- �h�idt t� t►'1
(attach any evenu'prograrn promotional materials assoc ec with proQrarnfeventi 1Ja1�k C he CS A
C ity «f Yucaipa Conmtun-sra Activity Grants Application. Rev. (s_ 2022 Pace 2
-253-

Describe how the programfevent benefits the residents and:/or conununity of Yucaipa:
1 k- vJ �� se��1e 5��ct ` gg
Provide a detailed description of how the financial support will be used:

Cs� �c��io eC�r�ni�nJ
#c4chcG,_
'C-C?C? Y-) 1 t�
City of Yucaipa Community Activity Grants Application, Rev- 03 2022 PaL,e 3
-254-

SECTION 6— FINANCIAL i
What other in-kind/financial contributions has your organization received to fund this event/program (separate from City funding)?
In -Kind
Amount
i Y- ec� e L N u� N)c s
�—
S
S
S.

Total Funds Received To Date: �
Total Funds Requested Via Grant Application: S!3
Remaining Balance That Will Be Funded By S
Organization:: -�
Financial
Support Amount
S 7G
S -J -, CEO r
R , ©%G -'
Provide Citv funding received by organization in the past three years (required):

Program In -Kind Financial $1615 SEP. Date
Support Fee Waiver Received
C-- x �-�i� inrQnt ❑ C
❑ ❑
Total Received
L the undersigned, do hereby attest that the above information is true and correct to the best of my knowledge, and understand that the awarded financial Erant amount needs to be spent prior to submitting another ;grant.request_ CC 0Po rtrPC#fir I 'r�C�a� r�,
Sienature Title Date
Date Received: Date Reviewed:-- ��
Amount Funded: S City Council Meeting:

Type of Grant: ❑ in-K�nd [Financial Support El Fee Waiver Date City Council received follow up report:

City of Yucaipa Community Activity Grants Application, Rev. 0312022 Page 4 -255-

UNT OF THE TRE:'�..5[3Fd.`z''
T -`-• R l '�I}E SERVICEDEFP.R'P1'
1:tai
?. O. BCn 230S
CINCTINnIil, CE 15205
Enploaer identification Number:

AC- Z428869
Date,
DUl :
17053243328033
C=ZDENs au F4R^1S
Contact Person:

Ste' RY O :xP»�-. :�3'r 31752
C/o In= SaLoX-O
Contact Telephone Number;
36159 sjUR g IM& DR
(8771 8Z9-550()
3Sti? Div"`=. C 92223
i g period Fn i
+.GCrJ�iLi- � 57,E g'
December 3=
public Charity ut'`t_ zus:

Form 990 Reauxrec:
yes
_weative Date of Exawptioi:

February 13, 201?
Contribution D&Kotobility:

Yes
Addendum Applies:

No
Dear Ap'.p i Cant.:
e are pleased to inform you that upon r&'vlaw Of your anylication for tax exempt Status We have determined that You are s:.iCcmpt from :ederal income tax i2Lf33.e5' section 501(G)3i OZ the LY'+te=`"a1 RevenueL'O.Clc. Contributions tO you are 0� = e 4u=. You are also auai_= ed to receive
deductible i eer sect" 370
tax deductible bequests,devises' -=ans= rs or gilts ,-da, s - ion esti 2106 or 2522 of he Code. Benat;se this ;'letter could help resolve' -yy questions regarding your exempt status, You should Keep it in Z'ou pe.''"i:'.-ne0t records. echo_ S€11ic) !3) of the Code are further classified
Organizations exempt under
as either Z?Lblic charities or private fouDdations- i7t determined hheading that 'v+7t3 are
a Public chawztjt rider the code. Sections! listed Z�1 the r=a'L~.,".�C� Ai t�3tS otter.
please see ssnclosea publication 4221--RC, COM-Pliance "de f- or501(c) (3) ;ublic
Charities, ror some belpiU3 '4:TOT_m"tioa about yo"s; -- _exempt OrSenizat"a- Let.4e r 007(DO/ CG)
-256-

Attachment J
Fiscal Year:

Date Application submitted:

Submit to:

City of Yucaipa
General Services"City Clerk Department
34272 Yucaipa Blvd.

Yucaipa, CA 92399
Attn: Kimberly Everts

COMMUNITY CTIVITY GRANT

FINANCIAL / IN -KIND / FEE WAIVER

APPLICATION
2022-2023
Received
City of Yucaipa
MAR 212022
General Services/
City Clerk's Department
All sections of the application must he returned complete and all supporting documentation provided prior to City Council review. Incomplete applications received will be returned to the applicant.

Smiles for Seniors Foundation
Name of ;�p}JiiCalll/i)1'E�allf"I_a(tOn:
34045 Yucaipa Blvd. Ste 104
ApplicantFOrganization MailingMailingAddress:

Applicant/Organization Phone Number: (909 )790-6671
Catherine Serianni
Contact (1) (909 ) 790-6671
Name Phone Number
siniles4seniors(ci'.yahoo.com
E-mail address
Andrew Woravka
Contact (2) (909 )790-6671
Name Phone Dumber
sell les4seniors(CG yahoo. eom
E-mail address

SECTION
Yes
\o
Is your organization located in another community?
❑
❑✓
Will the program/event take place in another community? ❑
Are you aware of any other City program providing this service? ❑
If so, which one?
xlf you answered "Yes" to any of the questions listed above, your request is not eligible for the Community Activity Grant.

City of Yucaipa Community Activity Grants Application, Rev. 0312022 Nme T
-257-

Your organization must be an established 501(c) to be considered for Community Activity Grant funding.

Please submit documentation verifying organization 501(c) status along with this application.

Yes No
Is your or.,anizatton a 501(c)? ❑✓ ❑
26-0373b02
If yes, please provide Tax ID jY.________. - ---- att}d attach all supporting documents.

Does this application include submittal of documentation verifying 1501(c) status? ❑ ❑ 2007
flow long has your 501(c) organization been in existence? 2 Number of Employees working for organization: -
35 lumber of Volunteers working for or«anization:

IS a current City Council lViember on your board"? ❑ ❑✓ Flow many Yucaipa residents does your organization currently serve? Does the organization charge admission, membership fees, dues, etc.? ❑ I f ycs, please describe:

Names and Titles of Officers and Board of Directors (Please attach an organization chart, if available) Kathy Dexter. President
George Macias- Vice President
Lisa Cobeen - Treasurer
Jennette Sullivan- Secretary
__ ._.._...._ _ -.— --- ------ _ ---------...

Angelina elina -
_..___—..___._-- ._._._.____----_-------_—_--
Glory Garcia, Member
Brandy Gomez, Member
Peggy Murphy, Member
Melinda Ross, Member
SECTION 4 - PROGRAM DESCRIPTION/SCOPE: (PLEASE USE ADDITIONAL PAGES IF NECESSARY) Name of the progratn'event:

Date(s) of program event:

Low Income Senior Assistance
01/01 /2022
Describe the programlevent that organization is seeking support for:
(Attach any event=progrant promotional materials associated with programlevent) We are kindly asking for fundinc, for our low income senior assistance program.. This is an ongoing program which provides access to basic needs for struggling low income seniors in the city of Yucaipa.

Please sec enclosed
City of Yucaipa Community Activity Grants Application. Rev, 03<?_0221 -258-
Paae 2

Describe hoes the program/event benefits the residents and.?or community of Yucaipa:

We provideknv income seniors food. rental Lind utility assisatnce and help with life saving medications and medical etluipment just to name it fet+. We have many letters of recognition and appreciation given to us from various agencies throughout the community who value and share in our mission alon`t, cyith many Thank you notes from the seniors who have been through our program. Our seniors are struu_ling now more than ever with the rising cost of food and gas: inflation has gripped the social security check of our elderly and has ict't them with less stoney to survive and vulernable to falling through the cracks. Our seniors are struggling everyday to put food on the table and to make the rent. They just need a chance to catch up. Thais where we come in. there is a dire need to be filled and we are lillino it. We have many success stories to testify to the fact that our program is changing and saving lives.

Proaranv"Event Primary 'farget Population (check all that apply):
❑
Children Or Youth
❑Q
Seniors
FRI
®
Low Income
❑
victims
9 Persons with Disabilities
0 Welfare Recipients
❑
Number of Residents Projected to Serve: 300
Please identify what your organization is seeking:

Financial Support: © Yes ❑ No $4.900
ti116,25 SEP Fee
NVaiver: ❑ Yes ❑ No
Public
In -kind Support: Police S Fire S \Yorks S
Women
Homeless
Entire Community
CS'Rental S
Reassigned
Staff SOther S_.-._...__._..._.___ Explain
S 16.25 SEP i'otal Overall
In -Kind Financial Support. Fee Waiver Request
Total Amount of Request: S S4,000 S = S4.000
Provide a detailed description of how the financial support will be used:

To be ,:Iigible tin' ilic pro_=Lens s tior clients inust he age ! 5 or older ,in(! lutist have sn income no greater Ilian S 17, l00 per year for single rnd S34.200 per your combined iilconle and nla) ti e the progl'aill Once every two %,cabs for emergency assistance. Please note that most of our clients only receive an average Social f Security o9*tt.00 per nlontJl
Fandint, will he used tier direct assistance to seniors Food
Hou;ine
(Rental As,islance)
Gas bills
Wai:r Bills
Electric MIN
Medication
Medical Equipment
Minor Iionic Repairs: Grabbars etc
City ol-Yucaipa Community .activity Grants application. Rev. 01202" -259-
rage ?

What other in-kind/financial contributions has your organization received to fund this event/program (separate from City funding')'?
In -Kind
Financial
Amount
Support Amount
Scan Health Plan
10000
S
5 Rite Aid Foundation

1.0000
S
Cunningham Davis Corp
10000
S
S
UPS Foundation
25000
S
S
_
Soboba 1=owulahon
10000
S
S
75000
"Dotal Funds Received To Date:

S _
S
4000
"Total Funds Requested Via Grant Application:

S
S
Remaining Balance That Will Be Funded By
S
S
71,000
Organization:

SECTION: : 1 i
Provide City funding received by organization in the past three years (required):

Program In -Kind Financial S16.25SEP Date Total Receked Support Fee Waiver Received.

1.ovv Income Senior Assistance
Covid Assistance
Low Income Senior Assistance
❑
❑ 08/26/2021 S3,587
❑
17 09/02/2020 S 5,000
❑
❑
❑ 07/ 10/2019 S 4000

SECTIONCERTIFICATION
1, the undersigned. do hereby attest that the above inlin-mation is true and cotzect to the best of my knowledge, and understand that th warded financialin-ant amount needs to be spent prior to submitting another grant request. i Executive Director 03/17/2022
Signature Title Date

TO BE COMPLETED BY CITY
Date Received: % i/ `^- Date Reviewed:

Amount Funded: S _ _ City• Council Meeting:

Type of Grant: ❑ In -Kind Iq Financial Support
Date City Council received follow up report:
❑ Fee Waiver
City of Yucaipa Community _ ak ity Grants Application. Rev- 03/2022 Page 4 -260-

Smiles for Seniors Foundation Tax ID 26-0373602
P.O, BON 1113 Yucaipa Ca 92399 Pli-909-790-6671
www.smiles4semors.org smiles4seniors yahoo.coni
Funding Request for Smiles for Seniors Foundation
Name of Organization Smiles for Seniors Foundation
Federal Tax ID # 26-0373602
Year Founded 2007
Ruling year 2007
Contact Name Catherine Serianni,Founder/Director
Address: Mailing Address: P.O. Box 1113 Yucaipa Ca. 92399 Physical Address: 34045 Yucaipa Blvd Ste 104 Yucaipa Ca 92399 Phone Number t9091790-6671 Fax (909) 790-7112
Website Address: www.smiles4seniors.org
Email Address: [email protected]
Purpose of Program
The purpose of Smiles for Seniors Low Income Senior Emergency Assistance Program is to provide low income seniors access to basic necessities needed to survive such as food, housing, utility assistance, minor home and auto repairs, lifesaving medications and medical equipment along with providing valuable resource and referrals for our vulnerable low income seniors in need. Each year our program provides emergency assistance and safety net services to struggling low income seniors who have nowhere to else to turn when basic necessities and everyday emergency situations arise and do not fit in to their fixed income budget.

We also work closely with various government and non -government agencies, law enforcement, social workers, senior centers and others in collaboration for the good of our seniors.

Funding Request $ OPEN
Purpose of Funding Senior Emergency Assistance Fund
Population Helped 100% Low income seniors 65 and over
Geographic Areas Served All of the Inland Empire San Bernardino and Riverside Counties -261-

Smiles for Seniors Foundation Tax ID 26-0373602
P.O. Box 1113 Yucaipa Ca 92399 Ph-909-790-6671
\v%vw.smiies4seniors.oro snliies4seniorsn`\rahoo.coiii
Program for which funds are being requested
Smiles for Seniors is a Non Profit 501 c (3) organization proudly serving our low income seniors in the Inland Empire and surrounding areas since 2007 We have quickly become one of the leading senior assistance agencies known for providing emergency assistance for foot!, housing, utility payments such as water; gas, electricity, minor home and auto repair and help pery for life saving prescriptions and medical equipment just to name a feiv. To be eligible for the program senior clients must be age 65 or older and must have an income no greater than S17,100 per• year forsingle and .S34,200 peryear combined income and may use the program once every tiwoyeors f rr emergency assistance. Please note that most of out- clients only receive an average Social Security oj,950.00 per month
Each year our agency provides emergency assistance and safety net services to hundreds of struggling low income seniors who have nowhere to else to turn when everyday necessities and emergency situations arise and do not fit in to their fixed income budget. We also work closely with various government and non -government (gencies, law enforcement, social workers, senior centers and others in collaboration for• the good of out -seniors and provide valuable resources and referrals.

HEALTH. We provide direct health services for seniors in need and provide emergency funding for Co -pays, not covered by Medi-CaIlMedi-Care or private insurance. Our program assists lout income seniors with lifesaving medications and medical supplies, Cochlear implants, hearing aids, glasses and eye exams, dental procedures, pr•ostheticlinibs, cancer treatments, nutritional supplements, diabetes supplies, incontinence supplies, oxygen and blood pressure nionitors, just to name a few. We are often the last resort far seniors who cannot afford to pay their co -pays at- who have no means to get the lifesaving medications or niedical equipment their doctors have prescribed.

FOOD, We providegr•ocery store gift cards that out -seniors can use to get fresh meat, vegetables and dairy.

These items are not usually provided by church, missions or fi)od pantries. We also hold free food drives and deliver food and meals to home bound seniors along with providing valuable resources to local food programs HOUSING, Smiles for Seniors assists with locating and procuring affordable senior housing, deposit assistance and rental assistance along with minor home repairs. We are proud of the fact that we have placed many homeless seniors in affordable housing and off of the streets.

UTILITY ASSISTANCE, Smiles forseniors provides emergency assistance for those who are having difficulty paying their utility bill. We, have close relationships with many utility companies who refer to ouragency and are often able to get fees and late charges waived or reduced.

HOME REPAIRS, Smiles forSeniors provides financial assistance with handicap accessibility equipment ramps, grab bars, specialty niedical equipment and minor home repairs that are needed to ensure the safety of our clients and allow them to remain in their own homes.

ADVOCACY, Smiles becomes the voice for those who can not or are not able to speak for themselves. We have a network of referrals and programs and work closely with various groups for the betterment of ourseniors in need
ECONOMIC DEVELOPMENT, We provide our senior clients access to voluable programs that offer financial stability and guidance in monetary matters and provide access to social services Why funding is needed
We are seeking funding for our Senior Assistance Prograrn which is an ongoing program. From this program we directly assist qualifying low income seniors with safety netservices and basic necessities needed to survive. With the state budget acid economy being what it is along with the various cuts to senior assistance programs, we have seen the needfor our services increase awhile the jimding has decreased. Out- low income seniors are really struggling to make ends meet.
-262-

Smiles for Szniors foundation 'Fax ID 26-0373602
P.U. Box I 113 Yucaipa Ca 92399 Ph-909-790-6671
wxNA-j.smiles4seniors.oro smiles4seniors6gDyahoo.com
How the project will be carried out
With highly qualified volunteers, staff and board members whom all have had previous experience in their particular field, we are able to assist hundreds of struggling seniors each year. We receive most of our referrals directly from local ,governmental and non -governmental agencies throughout the Inland Empire, such as Adult Protective Services, United Way, Social Services 211, Dept. of Aging, Office on Aging, Salvation Army, Law Enforcement Agencies, Catholic Charities, churches, senior service organizations hospitals and senior centers (wound the Inland Empire
These agencies refer low income seniors to our program because they know thatSmiles forSeniors is one of the only agencies that are able to help. We do iwhatever it takes to get vital resources that are so desperately needed to the elderly and because we reach out to low income seniors in two of the largest counties In California we have a better- opportunity to get vital services to those who need it most.

There are always seniors in need and not many organizations that are fully capable to do what we dofor seniors, We are very proud of the fact that we are able to help quickly within minutes of a shut off notice for utilities and have been known to drive for hours to bring a needy senior food or medication.

What we expect to achieve through this program
We realize that there will always be poverty among the senior population; however we intend to stop the downward spiral that tends to happen when you are on a very fixed income. Even a grocery bill that is a few dollars higher can start this effect, leaving our elderly to choose between medication and food. Many seniors do not eat 3 meals a day and some even have to split their medication in half or skip doses all together.

This does not have to happen... Our vision is a world where not one senior will go without the basic necessities needed to survive. INe want to hell) to alleviate some of the pressures and fears that many seniors have of not having enough.

How we will secure funding to continue the project
We will continue to apply diligently forgrants and firrnding from individuals, small business, foundations and corporate grants along with funding from our three successful fundraising events held each year. We feel it is important not to rely on one particular source for funding; knowing this we make every effort to continue to share our program mission and goals with as many organizations and companies as possible whose mission aligns with our own.

Organizational structure, hoard and staff responsibilities including volunteers.

VVe have a governing board that oversees all program and project matters and sound fiscal management with an outside accountant and bookkeeper. We review and evaluate our program at quarterly board meetings and record all minutes.

Our volunteers are the life blood of out- organization. We utilize tine senior workforce volunteers who enjoy helping our community. We appreciate their knowledge, insight and dedication. Our program is much needed in the community and our volunteers are happily involved, knowing that they are making a difference in the lives of seniors. We are so proud of our volunteers and we really appreciate their wonderful acts of kindness that help to achieve tine goals of the organization. We also have many childrenJteen representatives that volunteer and share their time with our local seniors residing in nursing homes. They visit with them and bring cards and goodies and the residents really enjoy the cornnparry.

How the program effects change in the community and touches the lives of those we serve We have many letters of recognition and appreciation given to us from various agencies throughout the community who value and share in our mission along with many Thankyou notes from the seniors who have been through our program. Ourgreatest qualification is the fact that there is a dire need to be filled and we are filling it. We have many success stories to testify to the fact that out, program is changing and saving lives. -263-

Smiles for Seniors Foundation Tax ID 26-0373602
P.O. Box 1113 Yucaipa Ca 92399 Ph--909-790-6671
a t-ww.snAes4seniors.oig smiles4seniors czyahoo.com
Ilow Nre track and measure impact
We are able to secure inipor•tant data in the form of surveys and questionnaires from low income senior clients to leverage our capacity and obtain useful information on where the most need is. the use the data revealed to ensure our program is utilizing the fondling in the best capacity possible.

Below you will find a few real life testimonials frown our newsletter file (How your donation dollars are helping the lives of low income seniors)
A very sweet lady in her late 80s called our office just before the New Year. She was beginning to tell me what kind of assistance she needed when she broke down in to tears. Site stated that she had never had to ask anyone for help in the past and was feeling ashamed and embarrassed and was very distraught. We comforted her by letting her know that we care for her and are here for her and quietly listened as she spoke in a timid, frightened and almost defeated voice.

You see her husband had just passed away after being ill and hospitalized for several man ths.

She explained; he would come home for a couple days only to return to the emergency room within a few days. He was notgetting any better in fact he was getting worse. From the hospital Ire went to a board and care from there he went to a nursing have and from there he entered hospice and sadly he passed away after 8 months of being hospitalized.

Site was in dire need of assistance after her late husbands medical bills exhausted both of their income and savings and she was now close to losing her home and was behind on many utilities, some were just days away from being shut off. 14,e were able to give her the assistance she needed for the utility bills and referred her to various agencies that can assist her with her home and also referred her to a supportgroup that help her through her loss.

We met an 82 year old lady who was in need of a utility payment of $296.00. Her water had been shut off for weeks and her bill had not been paid for close to 6 months. She stated that the bill was higher than usual because there was a leak in a pipe on her property. She was able to get her neighbor who is a plumber to help fix the leak for -free but there was still the issue of the bill. Because her water had been shut off she could not bathe, drink, cook, or use the restroonn. Site did not drive so she would walk a 1 mile every day to the water machine at the local grocety store and fill up two large gallon bottles of water which she would have to carry all the way home. She had to do this ritual every day in order to use the restroom. She poured the jug of water into the back of her toiletso that she would be able to flush. Can you imagine not being able to flush your toilet and having to walk a mile each day to get water? Because ofyourgenerous donations we were able to pay her water bill and get her service turned back on. 1 am happy to report that she is now caught up thanks to your donations and the kindness of her neighbors.

A woman called our hotlinefor her 86year old grandfather who had been in the hospital after taking a bad fall in his home. The reason he fell was because his electricity had been cut off for nonpayment and lie couldn't see where he was going. Apparently he had been without electricity for quite a while and one night he got up to use the rest room in the pitch dark; cracked his head open on a table and laid therefor 2 days before his granddaughterfound hire. He was rushed to the emergency room where Ire was treated for his head wound, given 1.V. fluids and held overnight far observation. 141hile in the hospital the social worker•gave him a list of safety net organizations that can help with his utility payment. Smiles for Seniors was on that list.
-264-

Smiles for Seniors Foundation Tax ID 26-0373602
P.O. Box 1113 Yucaipa Ca 92399 Ph-909-790-6671
x ;NNrxN,-.smiles4seniors.oro smiles4seniors@,y�ahoo.com Thankfully he was released in good health. His granddaughter stated that he had just lost his wife 6 months earlier and that he was struggling with depression. He had let his home and finances spin out of control and hadn't paid any recent bills. She said "He is a tough old guy, a veteran of the Korean Wor and he f elt that he could get through anything,"so when they shut off his electricity he would use flashlights to see, read books instead of watch TV and to keep busy he would play solitaire by candle light. Because of friends like you in the community Smiles for Seniors was able to pay his electric bill get his services back on and also give him and hisgronddaughter referrals to agencies that could assist him with his depression. She called recently to let us know that he is doing much better and has enrolled in bereavement classes where he is learning to cope with his loss.

A gentleman called our office looking for a help to purchase a blood pressure monitor as requested by his doctor, but ire could not afford it and Medi-Cal would not pay for it. He called a local agency for help and was referred directly to Smiles for Seniors foundation. There are not many agencies that can do what we do for seniors. 14re were able to give him a gift card to his local pharmacy so he could get the medical equipment lie needed.

Recently we received a call from a gentleman whom we'll call Sam. He was calling to see if Smiles for Seniors would be able to help hire pay for his diabetes medication. He had gone without it for a few weeks because he could not afford to get it out from the pharmacy. He was feeling very sick the day Ire called, he needed his medication immediately or lie was going to die. Because he was so ill an ambulance was immediately called and he was taken to the emergency room for treatment and overnight observation. He was given the medication he needed while in the hospital but after his release he was still in need of his insulin. We were able to meet him at his pharmacy to payfor the lifesaving medication he could not afford. We were shocked to find out the price of his prescriptions. /t was ($3.20)
Three dollars and twenty cents justsaved a man's life —yet three dollars and twenty cents also could have killed him.
141hat a shame it is that this man almost lost his life over what would amount to pocket change for most of us.

The pharmacist informed its that per his insurance we ivere only able to bav him a 3 month supply so we did. Mire vvere also able to pay far• his eye exam and glasses, and a blood glucose monitor. 1Ne also gave him o few grocery store gift cards so that he could get the healthy food that he needs. This is happening all overArnerica. Many seniors are finding it difficult to pay for their medications and often cut their medication in half orskip doses all together: Sam was so very grateful to Smiles for Seniors for the support we gave him, we let him know that we are only able to help thanks to the local businesses in the community. He asked if we would thank the Community for- hire (of course we will Sam) On behalf of our new friend Sam, we than kyoit foryour support and friendship towards out- loin income seniors.
-265-

Smiles for Seniors Foundation Tax ID 26-0373602
P.O. Box 1113 Yucaipa Ca 92399 Ph-909-790-6671
«1vw.smiles4seniors.org smiles4seniors�c vahoo.com
(Mission Statement
Our motto is...
"Helping the lives of seniors through acts of kindness." Our mission is...
...To alleviate some of the pressure and fear many seniors have of not having enough to survive or having to choose between medication and food.

Our goal is...
...To continue to help seniors by providing access to safety net services and basic necessities needed to survive. We will do this with dignity, compassion and respect.

HISTORY
Smiles for Seniors was established in 2007. The founder noticed a lack in services for the low income senior population while trying to find assistance for her own mother who at the time was going through a financially difficult situation trying to pay for cancer treatments and other emergencies.

Seeing firsthand the struggles that her mother and her mother's peers were having trying to make ends meet. she soon realized the sad fact that the assistance for seniors was hard to come by and decided to take action.

The program reaches out to low income seniors throughout the entire Inland Empire areas of Southern California and focus is on basic needs and safety net services.

Today the program boast helping over 300 seniors each year by assisting them with basic necessities needed to survive along with providing valuable resources for hundreds of others in our senior community.

Financially it is very hard for seniors to survive each month on a fixed income; even an electric bill that is a fey dollars higher can send their budget on a downward spiral; leaving them to choose between medication and rent.

All they need is a chance to catch up. Sadly instead, they go without the basic necessities in life, rood. warmth. electricity and lifesaving medicine. This does not have to happen. This is where vve come in: smiles for Seniors will put a smile on the faces of those who need it most. Smiles for Seniors has become a beacon of light to the elderly in our community who have nowhere else to turn. y
-266-

Smiles I' t- SCnior's 10LIIId' I �l a ' 11) 26-0 37 602 P.O. Flo-\ I I 1 Yucaipa Ca 92 399 1311-909-790-6671
1��.smiles 4sc-niors.ort� smiles4sciiiorslci:,�'alioo.com Smiles for Seniors Foundation Board Members
Kathy Dexter- President
Veterans Administration Community Service Specialist/Paralegal Assistant George Macias- Vice President
Personnel Manager for Senior Home Care Company/ Community Volunteer Lisa Cobeen - Treasurer
Legal Secretary
Jennette Sullivan- Secretary
Business Owner/ Community Volunteer
Angelina Chassman, Member
Senior Services Coordinator/ Administrator at
Assisted Living and Memory Care
Glory Garcia, Member
Senior Housing Manager and Community Liaison
Brandy Gomez, Member
Ret. Navy/ Financial Advisor and Fiduciary
Peggy Murphy, Member
Satellite Radio Dee Jay/ Senior Housing Manager
Melinda Ross, Member
Sales Representative /Community Volunteer
Cathy Serianni-Founder/Director
Smiles for Seniors Foundation
Teen Representatives
Catherine Ross
Hope Macias
Madelyn Lawrence
Sasha Kronbeck
Tara Marquez
-267-

Smiles for Seniors Foundation'Tax ID 2G-0373602
P.O. Box 11 13 Yucaipa Ca 92399 Ph-909-790-6671
�� .smiles 4seniars.or`�. smiles4seniors5.' yahoo.com 2022 Pra ram/Project Budget 01/01/2022 to 12/31/2022

FUNDRAISING EVENTS

TOTAL PROJECTED INCOME
30,000
155,000
Expense i Description Ir Expenses

DIRECT ASSISTANCE TO SENIORS
._...._.. .._ .... _. _...___..
_ SENIOR ASSISTANCE
-_
75,460

PAYROLL
2 FULL TIME EMPLOYEES
_._...

PAYROLL40 hrs 14.00 per hr

ED WORAVKA
29,120
PAYROLL 40 hrs 14 00 per hr
MARY SERIA. _...... ......
_ ..

PAYROLL T
- --... --- . ...
.. _ _ _ _. .......

PAYROLL and TAX SERVICE
-

ADP PAYROLL SERVICE
840
END of YEAR TAX SERVICE
-YUCAIPA T AX SERVICE
400
AUTO ... ..
......._.......... _.............. ....-_......... ............. ........... .........

PAYMENT

WELLS FARGO AUTO
2,049
MAINTENANCE _ .. . _.... -- - _.._...---
..........
300 _...------- -rc
...... ...._... _.... _..._ .-_......._

INSURANCE

PROGRESSIVE INSURANCE
960

REGISTRATION
DMV _._........ -......_._..........---
160
GAS
480

NON PROFIT INSURANCE
....... - .... _- ---- - -..__ _ .... ------

NON PROFIT ALLIANCE-AMS
--- --- --- --
980

RENTS AND UTILITIES
s

RENT/WATER/TRASH/SEWER

ICC PROPERTY MANAGEMENT
.--- _
5,400
.------- -- - -

ELECTRICITY
EDISON
960
.

TELEPHONE/INTERNET SERVICE
. -- ---- - .- ...------- --

FRONTIER COMMUNICATIONS
---- - -
i 2,409 .....

POST OFFICE BOX RENTAL

PALM SPRINGS-YUCAIPA POST OFFICE
260

POSTAGE/STAMPS

YUCAIPA POST OFFICE
372
OFFICE SUPPLIES- MISC.
.........
180
--
_
WEBSITE HOSTING X2
REGISTER.COM
_ _ ..._ _ _ _...... .__ ._.....
240
--_- — -
- -
DOMAINE NAMES X2
.__....

FUNDRAISING EVENTS
155,000 BUDGET TOTAL
UMBRELLA AWARDS —

TO HONOR GOOD SAMARITANS
2,000

BOWL-A-THON

BOWLING FUNDRAISER
.......... ......._ .-...... - ---- . _ .... -
1,000
---- -- -- ---. ......_... _..._..._.._-_:
-- _ . _ .... _
S1 OCKINGS 4 SENIORS HOLIDAY

GIFTS TO SENIORS IN NURSING HOMES
2,000
�.
(IF ABLE TO HOLD EVENTS IN 2022)
•:

Smiles for Seniors Foundation Tax ID 26-0373602
P.O. Box I 1 13 Yucaipa Ca 92399 Ph-909-790-6671
wwN,.smiles4seniors.org smiles4seniors(((iDyalioo.com
..F... _CE
_. 1y.OX 25C8
=.---1h`NATi, OF 45201
mate: OCT 2 3 2007
TMILES FOR SAtiSORS
L--u_ applicant:

DCPA','MMEN--� OF TEE T E.;Su&Y
identification Number:
-_ 02
_5's2c1361037
1W, 31309
Ti�.ephone. SJsst bc-r:
a29-5500
Period Ending:

Duce 3-
Public c-arity Status:
(A) (yi)
Fozn 990 Recn:iredt
Yes -
�ffective Bate cf Exemn7-inr.

Tune 5, 2007
Contribution Deductibility:

Yes
Advance Ruling Ending Date:

Bece-;er 31, 2011
Addendum Applies:
lid
We are pleased to inform you t.-,., upon review of your application for tax exempt we have aeterMired chat you are exe.t:pt from Federal income tax under section 501(c)t's) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. You are also qualified to receive_• tax deductible heduents, devises, tran3fers or gifts under section 2055, 210G or 2522 of the ,,.ode, Because this letter could help resolve auy quest_ons requ:d .::z your exempt status, you shou:d :._ep it i_. your permanent records. oryan4znt,--ins exeitpz under sFct.ion 501(c)(3) of the Code are further classified aither public c?:aritie :-,r private foundatio:;s. Burma your advance n:3it:g _.r-ou, you will be treated as a p,.blic charity. Your advance ruling period iegins w;i h the effective date of your exemption and ends with advance ruling ending date --shown in the headiry- of the letter.
hortl.y hefare the e:=_d r_,f your advance ruling period, we ••ill send = Form 2"34. .support Schedule for Advance Ruling Period. You will have 90 days after t:^.e end of your advance ruling period to return the completed form. We' will then notify you, in a:ri.t.ing, about your public charity status. please see enclosed Publication 4221-pC Comnliance Guide for 591(c)(3) Public Charities, for come helpful infornation about ye;tr responsibilities as an ex�-^pt organi zat lL.i.
if y"t: 01 st 1 il:.Vx funds tv .tier rganlzitions, veer __ocrus riust showx•I :et..._ they are under seen --a _n cases -w?te- the recipient
Letter 1045 (BC/cc)
M2

Smiles for Seniors Foundation Tax ID 26-0373602
P.O. Box 1 I I' Yucaipa Ca 92399 Ph-909-790-6671
wNk,x�,.sniiles4seniors.org sinites4seniors;cz..yahoo.com Dear Members of the Board of Directors,
On behalf of all of us at Smiles for Seniors we would like thank you for taking the time to review our proposal for grant funding. We realize that you get many funding requests each year and appreciate this opportunity to share with you our good works. Smiles for Seniors is dedicated to helping the lives of seniors through acts of kindness every day. We would not be able to do what we do for seniors without the support of our friends in the community.

We value your opinion and encourage any feedback that would help to make our funding request stand out. If you have any suggestions on how to make our proposal better; please feel free to reach out.

We appreciate your consideration and thank you once again for your time.

If you should have any further questions about our program or services or need any further information; please do not hesitate to contact me at 909-790-6671 or email us at [email protected]
Please visit our website www.smiles4seniors.org
IZespec,�;ully,
Catherine Serianni, Founder=Director
Smiles liar Seniors Foundation
-270-

Attachment K
(00'1V MUNITYACTIVITY GRANT
FINANCIAL. / IN -KIND / FEE WAIVER

APPLICATION
Fiscal Year: 2022-2023
Date Aa j:icanon sul)initted: 4-7-2022 Received
sti emit to:City of Yucaipa
City of Yucaipa APR 0 7 2022
Gk r:era `>ervices-City L. ern De 3artment
'<=--"2 YucaiDEv Blvd. Yucai„a, CA 929J General Services/ Aun: Kimberly Everts City Clerk's Department
.'.z; ?5:f:€ on-S o" tali: Ailplication i u,"A. t)e returned ctt6tif)=a't€ ti%i#% i it °5itiltnf$i%iE) €:lot;tlti:%E.i'fia.titltl } t't5l�`IC{i`i4 i)rt*er To (.141' Council rex ic'4'4". inconio! t£ applications received will he r€`tttt`ued it) the applic tits, Name o Applicant,'Organization:

Applicant/Organization Mailing Address:

A:),)'icant/Or-anization Phone umber:

Contact a i _i
Contact (2)
The Well Outreach Center
1271.7 `.2t t Street Yucaipa, CA 92 )99
i 909 1795-06)14
Vicki Wood
Nan e
in oCtwocyucaipa.com
E-mail address
Name
E-mail addr.-ss
f 9ti9 '1213-6703
Phone Number
Phone Number
Yes NO
Is your organization located in another community? ❑ Q
W lI the program!event take, p`•.ace in another eotr munitO ❑! ✓(] Are you aware of any other City program providing this service? ❑ Q 1f so, which one?
*Ifyou answered "Yes" to any of the questions listed above, your request is not eligible for the Community Activity Grant.

City of Yucaipa Community Activity Grants Ap-pEca_ion, Rev. 0312022 rage I

Your or,vanizaion must he an established 5ulm to be considered for Community Activitv Gran" fu-ndin"J.

Please submit documentation verifying organiz -atinn 50 1 e` status along with this application. ye ; N�O
s our or- il�j
-anization a '�i_ I )
2za
s. n',, a ie 3rt31 "Fax iD--aticalacl VI Sp.-porIngdo Cumeits. 7 DOCS I IS ,I ;),)ACW ._eOCU1T1CPJ�1.TiOr1 VCri- i, C' S, t i0r! inC!�Llde SUbIrAt.13! -1 a LIS') in "o�w :or;!z n'15 v0ur 0 11
\'urnher of workin- for or�!aii;zation:
',or orim.nization:
-7
current, City- Counci' Vein )er on �OLlr hoard:)
-)w inany Yuca: s e ry -,)a residen:s �-oes your orguniza-ion current;,,, -e? L) oes �te OnT3anizazioi,, charge admission. membemli.) -`ees, dues, ere.? yi s. picase descrP)e:
\ames and ifles O'e'O."'ice-s and. RowDirectors. T'-1ase attaci in or-anization c .-iart, i.`avai'abie) Ken Jones P'resii ent
Terry Kni,,- I
Me'issa Wi!';ia-.,nson
Secreunry,
�vlefnber
Naalie Bras-)er Member
Jose Banda Member
Pro-ram,'Our Nei-Abors Clothinc, Closet
Nanne cif -fie proyram/event:
. ILI
On—oino
Date(s) of` pro-ram/event-
Describe OePro�zram!evenf ia;. onlanization is see in su-)port 17or:
i Attach any maeria!sassociatee wim Progan)"event)
Ming neects or The -oal! of Our Nei2hbors Clotting Ooset (ONCC) is to provice for me basic clot.' at -risk students livin- within the Yucaima-Calhnesa coaununity. We mrger middle and hi-n school stueents in need of clothino, to Support, them t-hrough their Ilearning journey. ONCC also proviees vocational training opportunities to special education high school students who are enrolled, in the Yucaipa Cali mesa Joint Uni-iled School District (YOIUSEX?
City of Yucaipa Con muni§!e Activity Grnms Ap*)Hcation, 'Rev. 03!;_"''_22 -272-

Describe �iuw Vie pro,�,,,rami,`even, Dmoto o 7jo A:, s ONCC ishousec in a ckssroom n CV . Von 1. 1 SC VA, 0`�Cc*s volunteer cirec:or coadinates the eay-rokay n&7�o -2 1. i ��O lers, Counseiors, atlilini-strators, and youvi omtors in our conununity refer secw� F, as 6- .2 in to tC--)NC:(--.,L)nce a re.`erra� is isceive, tne director caYs the smdern's pare::'. ;wacner co. or youim ;)as*t)r an(: arracges a time 't ,-)r tzhe studenz to Asir the! closet. Ali ac i !or w accon y a s"Ildell, at 0Cc at al.- times. �'o :)ro'ec, "'le, o,n-icentiaJtv of ean stucent, c; t., 'a i -e-
e c:os,-t at a time. Students
encomaged to pick out several otOrs aril; ene Pann 4 wo n:,: iarge and return to vne closet as needeC. "-ozrx 'Event "rinial3! T
C%Ooren om-Yout,i Seniors woluen
9 Low Mom--0 VOGMs Hllon-:e�css
M Arsons wM DisL'li.izies Ewire conlnlun-t,
-\ ual-'%r o,-iesicctits PrQiectee, to seme: -?00
,'!ease ideniitv w-hat vour oraanization is seekim-,:

Financia! Support: 70 Nis 7\ o S 5
S16.25 SEP Fee
NVaiver: Yes No
PUMC
TnAnd Suppon: FT! We Me S Moos S CsMeralf S,

RCMMPWC
staws
MId
Total Amoum of ReWwo;
- I -
Odwr S nxp�lln

5.25 S "' - t-P Total Overal I
ThMnA Sin hm F= 'Aiver Request
1-1rovide a detailed d-escri,)tion of'how thefinanciai support wi: !c, -used:

Fund, Or zhis prqjc,. is essential and wH! be used to provide at-risK secondary students in our community w1h new un( ergarments, shoes, belts, and any COOK specia! clothing Tieecs they may nave. Other ty es of sighl1y wom Onhing herns can be donated, cleaned, it and disp:ayed, *,)ut we the ilerns 'aster in this para raph need to be purchased new. In order to provide these, vve am seekin W) i 9 SIUMAKin
fundina. in addition, this nnancial su-xoon will a' ow us to �)rovide our students with hole, encouraL.,,,ernent, and confidence Amly by weming c1orhingthey are proud- oF w-hen viey- go to school ,—tc ot'Yvcaipa Comnunits Acti% ity,-Jranis A)pAcation. Rcv, 103,,'2022 loge 3

SECYION 6— FINANCIAL CAPABILITIES,"BUDGET:

XN-hat other in-kindlfinane;al contribut;ons has vour orc-anization received to fund this event"pro,2ram separwe from Citv fundin-:W?
In -Kind:

Amount
C"mMin7,,
D"assro0q]
. . . . .. .......... ............ S
i,� 'e Onirc'i
P,2,4lr,e Donations
S
S 11 -5 00.00
Financial
Support Amount
S
280.07
S
S7.78CW7
S
tie(,,ues5cd Vint Gram Application: S
C',
wi" S
1,29,(
SECTION 6 — FINANCIA L CAPABILITIES/Bt DG ET waN TIM ED):

Provide City funding received by organization in the past three yeah (required):

Hnancial S 16.21 -5 S E ? Date l'otal Received
Support Fee Waiver Received
A
S
S
SECTION 7— CERTIFICATION
!,' ndersitined, do'heretie aitest that the above infomiation is true and cormato t�e -best of my knw o,edge. and understand -4c
,M, tle w-ardcd, =�inancia! cram, an-,ount needs toley qnew prior to s0mitiino anothergr,In request.

Signature
Date

TO BE COMPLETED BYCITY
Date Receivek": '7 Date Reviewed: cn,
Amount Funded: S City counci � Mleedn":

Type oF(irant: Ill -Kind inancial Support
Date Ci--\, Cvtmcil received '!`bHow up repon.:

Fee Waiver
Citv oYuc.Oa C.ommun;v, Adiviry Qmnts -Z;v, 03,202-1 Rme 4

Our Neighbors Clothing Closer.

Connmumitj ActivityGrant
S"Caternent, of Need and Measuremenz
:nour ore|�ninary research vuediscoverec, a need ex"stsfor suppunzn 'cne �)asn needsof studen.-s !V.ng in, our community.
01 Accorcin-tu��duca-iooDaza20I9'2f_'enoo|mcnz|nducec:
m enno.|ecatuoenss
p �So�zn�s�enno|ecvverefos�eryouri
� 5,074ofz1oseenro'�accua{i-�:ied Tor free and reduced lunch.

Acconz/n-,toY[!US-]Data:
w 759 scuc:en-,swere consioered1�,omeess,cane�,or�'zedinto 'our cvve!!in,;,tyoes " Teomporah|yDoub;edUp.22�..
~ Unshe�eredI2'.
ne�num��s�n��rn��e��e��oF at -risk students !Iving in our commun;ty.Our reso!ve is T'urzherstren-z.-ener- by Madow's theory o:hierarchy o:neecs. vas\zvxs-'atestneactions ofpeop|eare Drrnanynnodvatedatthe hi,,ghest!eve|abycertain basic ph\o|oo 'cal neecs.
° Ai
m vvare,
w Food
� Shelter
� S!eep
Thhs��eory gives us an understanding ofwlllat peop'e neec, how "ne needs of people differ and how tnese needs im,oac- our mot ivation. n other words,Or students to have the motivation ta acnievethe�rh�ghestacadernicpoten�ia\these basic physio|o��a|needs must bemet .
m addition, �he need for th�service ',-,,as increased substantia|(y due to tine splrbua� phys�a!, emohona|, psychoiogioal, and financial e"ects of the oovid pandemic that has been innpacdn"r our cemnmnunityover tvvo years now. Therefore, TWOC Board of Dtrectoxs and sraff are in the orocess mfon'co|mQconnrnun�tyco��a�orat>onand invo|v8rnenTvv�ch!ar8edepartment storesfor

Additiona'. y, we are sneak ngvitn service c�u,:)sto as-,,(fortneir `mancia:
asyszorce and &A host a cornawnity Wd radng even.his summer wnich; a portion of `tunes raisec. wi�! be a!�ot-ecf to zlis prolct.
nn ordezo eva!jaze ieeffectieness ns ogam anc to ceterine �ay�us- enisa!-e neede" we are ga7he3' ng Cata and zrackkg z e numaer o; studeerts vis-,-,.;ng tie cose-, me amount of c ozhilng ., given to szueens. T-)�s cL-:,; ovi oe presenteit on a bar grap� ano w.,;I a�so :)e snared viith department stores proAding theii wi-.-i a visua, snaps�iot o� now many students wo I iave Se` and how many artiVes of voNng we pmwted. Triis i.,eta'`'edirr:orrnatlon vvi':

E �nimstmze our cornrAmenz to cane success �n orov.ding flor thebas.'ic Cotlleng reecs -o- r. :ents bving in the Yucaloa-Calrnesa Community.

Dur Neighbors Clothing Closet
Cornrnunity Activity Grant
Experience in Program Area
-,Vy',,narne is V'icki an t-�e Executive Director o-71he 'Ve': Ouzrea6n Center 7,','C;C,. C'ur, emp
agen -:ra--ion, Our oyment
,, cy was esa:)!',,viec -our years ago as a KtQ,3, non -pre t corpora--ion, identification ilsimner is 823-11-,042899, %il.fe -:ocus on provid;ng service Wat supoor- sahkuai, =51ca, emobona;, anc psycho og",ca. ,�v-,oerns to in,-McLa s Iving s.%67,iln tne Yucai:)a- Ca�jrij,asa communty. Tt,,%'C)C seeks to meet the needs of people iving, in our community througi the deve1opment of three cr�"eren-, en:',zies doing business as '03A) The WeH CounseNng Center The Mosaic Center, and. Our Neignbors 0othing, Closet.

We seew funding Spec i9caNy &or Our Neign3ors Clothing Closet i"CACC). The rearn , 'far 0 NN C C' chonatea from my A years of worning Aw the YuMpa-CaI mesa �-;nifiec sc'iooDstr:ct (:YaUSD� as a Speciai Education Teacher and Program Specialist and witnessing, -Firsthand the heart -breaking reality of stucents w'nose faWks do not have tne means to provite for t; e;r fan-Mys basic cWthing neec:s. Coming face to face with this reaIty for 24 years, orompted tne deve�o,oment a nc openmg of0-%CC in August of the 21,'D1.20 sc-;ooi year. r)u,- voluMeer Diector of ONCC nos Wso a Inmr YCUUSD ernp!oyee wo workec, cirectly with Specie -ducatIoa Students for 27 years and is passion -ate a)ou-- serving, students in. need of clothing. Debby has mode!ed our CloWing Chsel a c oil'aing closet bat has been rumikg successfunv for over 3 Nmars and homed at Moorc, Viet e School in Redlands. De".)by has %%:ork,ec, C:osely -%2c-,or of dos coon to ensuz Cos sM cc', is a success-.u-i onc 'or our con.1111unity.
-277-

TESTIMONY FROM RAFAEL OGAMPO

OAK VIEW HIGH SCHOOL

COUNSELOR
"HAVING OUR NEIGHBORS CLOTHING CLOSET, RIGHT NEXT

TO OUR CAMPUS, HAS SEEN A HUGE BLESSING THIS
SCHOOL YEAR FOR OUR STUDENTS AND OUR COMMUNITY.

MULTIPLE STUDENTS HAVE BEEN BLESSED WITH SHOES
AND CLOTHES THANKS TO THIS ORGANIZATION. THE

SMILES ON THEIR FACES AS THEY WALK OUT OF THE ROOM
WITH THEIR NEW APPAREL IS PRICELESS.

THANK YOU!"
—278—

THE WELL OUTREACH CENTER

BOARD MEMBERS
'Jose Banda Member
Natalie Brasher mernber
Ken Jones MeMber
Terry Knight Member
Melissa Williamson Member
Executive Director
Vicki Wood
Contact us at
[email protected]
Visit our Website
TheWellOutreachrenter.com
wO the Well
12717 1;1111 `)t i - I
Y U C, I 11), 1, (. A , ") ; P)
-279-
L
the Well

Narrative Focused
'rri-IIIma Care Groups
I I cwidillf; ;i ,:1fI Ilf is c 1rlr II�.a,Ilirl,r I lltclris;l Wflf11"lt; �'� ',I I:�i III}�, I�i II ',t(.Illk"i it tJfrl htr�Icctllll'"]'' I'' Ill. 1':t lj)iecc, leading to7
fl r,oc I, lil l Ill I I �I:II icarl'.:,Ilill�� Will)
st.11'PORT OFFERED HY TRAINED

FACILITATORS WHO HAVE'
SIMILAR EXPERIENCES.

We Atso Offer Low Cost
Truama Informed Conferences
0 For we are 6od's masterpiece. ih, hos (rr oiro' u,,
(loew il'l chl"istf'sus So I'Aw con Chi the i';,f+;l I " plortned for us long ogo. (:F't i. 1.:1 U
909-274-9117
info@)moS'1' ictW0c.ccsm
uuww.tylosaictwoc.com
The Well Counseling Center
r�lllll'ti)rtlllh dill u)IIIIII(mity' ,llld'.Ill i r)i !fling' are,i:�, by llrclvicliIq,, 11cllw cli.ulnt; t,lylll.�� tillll �:.

M'', offc.r profcssiorlal thu.1—a ay lol ; hildl l'l1,
11"eir;,',illi;lc' ,IcllIlk, I_c.illplr-;,,uicJ i,Irliil�I ,, Indiviilital and Group
Sessions are Available
t'{ ot� have to fight
`b
,M ,�
a�� battles alone.

Call or a ll ' s Coda y
9 a
it��at+�ss�t>u��slr�i it�gt.��._1as
A

OUR NEIGHBORS
i
Illovidillj,�, for thebasic. neock or tit-rlsk
,tcldent`, liviiil; witliirt thca Yi.lcaila�l (::,llirlle�s�a community. Wc tol1"'el middle sc'hool'ind
hip,11 :ic;hool stilclrrwl in llr. ed of clotlllnl; ill ordc,r to ';t.IJ.)IMI t I barn �1 SUcc(�Y.Atll
lc:,u11111;r I'millwy,
01-11 1,lOt'llini; 11 rllM) 1lrovldr"s
voc,itional trOininl opportutliti(n to :�;pc,cial
c:ciuc 16011 hiF;h V,11001 S(Udent,, W110 "VC
r i,irollr.d in the Yucrllpa High School
I'rallscilioll F'rnti l,un.
!709-353 3264
.Suppose you see a brother or
sister who hos no food or chlthnu;,
crud you soy, "Goodbye and huvc
wood day; :stay worm and eat
swell,"but then you don'tglve thor
nerson any food or clothing, What
r,,00d does that do?
TAMES 2:15-16(N1T)
infoOneighborsmcom
www.neighborscc.com

D LN -
290532623"i5M
Contact Person:

ERW
Contact , c _ep ;.
fgi?; 325-550-
Public Charity Stacus:
o,,,,-a.y ivl'}' ea..-.N j'li1- i Re.^7ii..rad:
..es
Da--,e of a"..xemptio n:

Contribution Ded"IC7.iuiiity:

Yes
Addendum Applies:

Dear Applica_n�:-.
we're pleased to tell ..erm,,rned exempt from federa, iacome to under internal Revenue L.._.._. `ectic . Donors car. deduc�i- oontributions ttey nuke t under ZRC ect_ s. Your_ also ,ua1iz-:..ed to receive tat ee _cti.' le bequests, devises, tr_=__-_-f rs or gifts under Section 2CS5, 21v6, or 2522. his -eater could to _ ...e'sol-.,e G_,estions car. your Organizations ._ £e..px: Sec", --ion, 50!(C) > are _ur::,er L_assifien as either :pd'"lic c .arities or _ - foundations. We deter'm" .ned you're a public =rarity under t.ie ,'RC S-Lct:c _.. - .at the tol; of this. letter.

If we ._aadi:at:ed an the top of t=is letter that yowre required to fLle Form 9 ii ��l'=:L/t U-:•+r cmr records show you're required to file an annual i2?fGrmaticn return =Font, 990 or F£' nn 99"EZi or electronic notice ,For:Y1 930-N, t s ,..- x�C;Si.Ca autolaut .ca.:'.`.ly revoked.
if we .t rlt'7..+.i Ct red at the ?'op of this latter that an addendum. applies, i:he enclosed addenL-um is an i.nteS7ra,`. ,art of this letter.

For in. ,po tant information ';Doll% your .. u� s7ponsiJi1ities as a. tax-exerapt organization, go to w z'a. cvjc" rats. s. Enter 114221-PC" in the seawc.n ba:. to view Publication 422!-PC, Compliance Guide for 50? c; 1,3; Public Charities, - n?i.ch descri.'bess your ..ecordkee?.ing, re?ort.i„q, and disclosure recr4i:'eLsents, Letter 947

7-, e t t e r 9 -'- 7

1$i''?5;.:�, t___ii��j.ict.4{?S`;`�f:fS�iCitll::€is�I.�f'.">1i�GuLliS.if;ar,31"i'Sti'—%:�..'_��C�r� •._ ... _.........._... ........_.._
F-10-' i A80i:'3
.. ........ ........ ..__.. _... .. ...._._._... _. ....__...._. ......... ... _..... .,. h'EaA CN.R. _.PS R..t2, NS .f'4....v:u.:F;;CES
... ,..... ...,..._... .....

SriN'e.`t,"
Registrant Details
Entity type: Corporate Class as rEgistered with the S reta p 31 r3'..•,w cr base's *n i:Si nd,faj & 6erjj �_. %LYJuntmg Nr644l t:nd V,tt:
_ 1 _
I, RRF-1 Rc'sE..m.

F.m, ie tctit—mp,'t a RCa..,w
f RS Form 1Ml R£jcct.,1ncnmp1Oe Itrasrin:

Fro111 IZes:irr :E:vff:

Related Registrations & went Report.
relates rsccrds v+avm be€ew Le;nnv on vZ e r s{ord type Deng viewed:
+ C'.sarity i?e?xs5iC2Ci3.1S m4ale to `irw,—ssannat Furcramin€g Events w lch reiare f3 Urijfessiana` FuE dfa€ er ;Zec :_ G-s.

Pe: :Stratxvns relateto Rene Reports,
C.;,, K on t". RCT Reg€atration no to nav�ga:e to the rasated :ecore.

N'o Rt'jilied Re,nr(',S
Of ;
-283-
t{S 2 ?, j:21 1110,

2022 Budget Projections
our Neighbors Clothing Closet
Staifiiig date
y.22 J 1 .22
Roventlin
Donations 120 120 126 120 120 120 120 120 120 120 120 12CI -71. 75.5
Total Revenue U0.

CA9F1 PAID OUT
TVV0G Ex Dir Fe0S
so
5 0
so
so
so
50 50
50 50
so
50 600
Doold CA)nSwItaot
Admio Assistant
so
50 50
so
50 50
so
so
50 so
so
600
Tolal Payroll
6 6
6 6
Payeoll Than - rmployer's
. . .
- - --- --------
G
6 6
5 6
Mtkets amp Ins
0 0
0 0
0 0
0 0
0 0
--
Payroll Fees
Total Payroll EX[N)O1130
p
56 56
56 56
56 5 6
56 56
5656
671
-
Staff Training / Suiviinur6
StOt!Oflffy S(1I'j)1i0S Dusineqr. Cmds
p
Ruld ol loano
r,mfolunce rf,-,
12 12
12 12
12 12
12 12
12 12
12 11
144
Advor(iswwnt
9 9
9 9
9 9
9 Offlc.(' Suppfios
1 )
ion
7 7—
7—
7 7
7 7
7 1
84 Bookkeoping
--7.
wj-r j
13 13
13 13
1 3
13 13
13 13
13 13
156
Inventory
420
420
420.
420
?n
420

42.0 420
420
420
420
4 2()
,,On()
llow

8.333

SUBTOTAL
Ij )
2 h

TOTAL CASSIII PAID OUT
Cash on hand (and of mmith)
�)�,J-
"T
----------
-
Im

TYRE
Gr��f-t}ry Es'sx:rnt3:�Exs?z•.�'pw
.........
.........
•:��t.oc•s ` .cam
TOW for k""e-qa'zom = aL. ne
$ .$
_. »__.,
�3
,....�,
372.5'
2` 6
Co
N-afu:.:. Onna!:C-n
r ` a
su cc
322.5,
2CCZ
..,,.,.,,K. Dc�cwt
hC ,.r ss Mc '_v r,..,: e;rs=
L A S5 CnrB} Q
3 :ffg ..a.., u':eCk: ,
«.. 0.
x2.`a2
2 G-JI:'r,'20,2} Satas Rem�Vaw
Ne.a boys c)z)nat"m
Cur Neigpm3rs Cs,eek q
2C. CS

4.2.52 u'x�73'dC2? Si3S?i'Y�vr:s"".4
•' �h2t3fa :°clnr..,,..
'.i'r>44':jNu :8'.ii;ff
i.. `f :Jg.^.!:b£2tS cS3m,�-i'.o
33,
4- ✓.«Z
y; 21,21 g3?e, f?ere':.:n
NO ibors. Conat orr
IC3,00

9.375.52
52 1.27.5 52
Total (QtkWy'.r bats - ,Dona?: Cr§::

T;} ! fpr 4e; hbcrs €^c rn rr 3
Su>a t nts
},2Eu.C31
E_xpar1Sl:S
Ne"T tmars - so-,Va FS
cncic�t
CEttre.3Bus, symzets:.

Nr;ig?°.�,-,rs
`C..:.:.. ,. _ ..,_.;^
•.2
7R.12
ate::
rA,,M2Ei21 Ctwck
7 J a'axx
'ietp=;3rs5
Olzf's'»-:r ., . _
22,1)
..u.42
051},7,-02s C:Ar ,
Vvw-Mar,
Nleiq�ts
2 Gcc.;aQ
;::.yrybcfr;
%.,e
OW240,24
±;yar ?3e
SChsck,:

CI,25x2021, CzseA
Amato;
rl£ibjy'::`.VfS
;-s MsocXmi;
3'.67
;s'8.37
M.''';. zr;2} Cht K
Ar;sa. on
...
°3..E
d,:s.23
uWO+, :'2r2? Check
�sr„3,��23 C"ec:c
=?csC:vy :C�bp
�..,
�`. -., •.s Ci3;�k.•^�
.._.,..,
�vx,t"?
w <Gn•,:i21 Ch£cm
cent s.Mwe
ifxF`7':.x -1a3 ,,.a•y `V. ZL'.^,Z §5A rL .T :: -),I
"

i he ','VeN Outreach Center
Prof *, and Loss Dletal
,anuary - Dere.*ntx-,r 24021
I .... ...... .....

DATE TRANSA�
.. . . . ..... . . .........
';A �!,•v
--l— . . . . ............. -.-- .............................................................. ...................

C�As-1 4fEMaDESCMPT;CN
S?U"
. ....... . . .... ..........

Ass .ram P-ALANCZ
TYPE
..........
.............. . . . ....... . ..................... . . ...............
.. .....
2-2 C^nR
C?,
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VW Mar,
2,01 24
V. -61")
DcEi- 'URct�ASE- V6,,A ktMrl .15 C-:Y.Y, �,21 1,c
_,.Aqg T 'ef)
i CE-011 PvRQ V�SA..*,U-ARTAEE Oi,.4.Aia :f-
Ne
i2
Apsua)
DIAv T.,oe
DEB
$1,046.23
T;�,,ll far Ktj!ftm Exponsas
St'U523
Expense
T
PURCkASE TWIDRI«
Out lo -
SO
s2;2W202*, ExPflnw
Pu,,Olwv CaM
(2061
Toutz 'oi Experrses
l 146.23
Mr-, ln=na
S'23 B4
Balii :JY, Is) *,A�-, 2� ;,V M' cla:zZ"
-286-

Attachment L

COMMUNITY ACTIVITY GRANT

FINANCIAL / IN -KIND / FEE WAIVER
Fiscal Year: 2022-202 ' """
Date Application submitted: 05/02/2022 City of Yucaipa
Submit to: MAY 0 3 2022
City of Yucaipa I
General Services/City Clerk Department General Services/ 34272 Yucaipa Blvd. City Clerk's Department
Yucaipa, CA 92399
Attn: Kimberly Everts
All sections of the application must be returned complete and all supporting documentation provided prior to City Council review. Incomplete applications received will be returned to the applicant.

INFORMATIONSECTION I — GENERAL
Name of Applicant/Organization: Valley Elementary, A Leader in Me Lighthouse School Applicant/Organization Mailing Address:

Applicant/Organization Phone Number:

Contact (1)
Contact (2)
12333 Eighth Street
(909 )797-1125
Kathy Miller
Name
(760 )792-2036
Phone Number
Principal_Kathlene MillerCycjusd.us
E-mail address
Name
E-mail address
Is your organization located in another community?
Will the program/event take place in another community? Are you aware of any other City program providing this service? If so, which one?
Phone Number
❑ 0
*If you answered "Yes" to any of the questions listed above, your request is not eligible for the Community Activity Grant.

City of Yucaipa Community Activity Grants Application, Rev. 03/2022 -287-

Page 1 ends

Your organization must be an established 501(c) to be considered for Community Activity Grant funding.

Please submit documentation verifying organization 501(c) status along with this application.

Yes No
Is your organization a 501(c)? ❑
95-22541205
If yes, please provide Tax ID4 and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? ❑ [✓1 53 How• long has your 501(c) organization been in existence? 80 Number of Employees working for organization:
100
Number of Volunteers working for organization:

Is a current City Council Member on your board? ❑ 0
550 students
How many Yucaipa residents does your organization currently serve? Does the organization charge admission, membership fees, dues, etc.? ❑ ❑✓ If yes, please describe:

Names and "titles of Officers and Board of Directors: (Please attach an organization chart, if available) Leader in Me. Coordinator - Tamara Schoonover
x� 1 aiZ!):I1 `tKil i11 WAV13 IMMIJ WA a
Name of the program/event: Leadership Day
Date(s) of program/event: April 2023
Describe the prograrn/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) We are seeking additinal support for our annual Leadership Day event that takes place every spring. The purpose of Leadership Day is to showcase that hard work and accomplishments of our students, staff, and parents. This is an excellent event that allows our students to practice and devleop their leadership skills.

See attached Leadership Day Planning Guide -
City of Yucaipa Community Activity Grants Application, Rev. 03/2022 Page 2 ..I

Describe how, the program/event benefits the residents and/or community of Yucaipa:

See attached
Program/Event Primary Target Population (check all that apply):
® Children or Youth
Low Income
no Persons with Disabilities
Number of Residents Projected to Serve: 550
on
Seniors
❑o
Victims
©
Welfare Recipients

FUNDING
Please identify what your organization is seeking:

Financial Support: ED Yes ❑ No $ t.000
$16.25 SEP Fee
Waiver: ❑ Yes ❑ No
0 Women
Q
Homeless
©
Entire Community
Public
In -kind Support: Police $
fire S
Works S
CS/Rcntal S
Reassigned
Staff S
Other S
Explain
S16,25 SEP
Total Overall
In -mind
Financial Support
Fee Waiver
Request
Total .amount of Request: S
SisloO
S
= $t,000
Provide a detailed description of how the financial support will be used:

Leadership Shirts for our Greeter Action Team and/or signage for the event that is generic and can be used the following years.

City of Yucaipa Community Activity Grants Application, Rev. 03/2022 rage s -289-

BUDGET:

S
$
Remaining Balance That Will Be Funded
By S
$ 00.00
Organization:

SECTION: '
ProN-ide City funding received by organization in the past three years (required):

Program In -kind
Financial
$16.25 SEP
Date Total Received
Support
Fee Waiver
Received
❑
❑
❑
S
L.ect t{ r r� i�., ja I`��t r., ❑
® ._ �- , S
SECTION 7 — CERTIFICATION
1, the undersigned, do hereby attest that the above information is true and correct to the best of my knowledge, and understand that a awarded financial grant amount needs to be spe
submritting another grant
request.

S' nature
Title
Date
! BE COMPLETED
Date Received: """
Date Reviewed:

Amount Funded: $
City Council Meeting:

Type of Grant: ❑ In -Kind
[O"Financial Support
❑ Fee Waiver
Date City Council received follow up report:

City of Yucaipa Community Activity Grants Application, Rev. 03/2022 will

Page 4 ends

Leadership Day

A STEP-BY-STEP BACKWARD PLANNING GUIDE
Step is Define Your "Why"
Before diving into the "what," consider the "why." Review the Top io Reasons to Hold a Leadership Event. Ask students and staff members to silently select and record the reason that's most compelling to them on a sticky note. Create an Affinity Diagram labeled "Our Why for Leadership Day" and use it to collect, group, and organize sticky note reasons. Looking for like thinking will help to create a shared purpose.

Step 2: Dream and Prioritize
Reflect on the "Our Why for Leadership Day" Affinity Diagram (created in Step i). invite teachers and students to dream about what they want guests to be saying as they walk out at the end of the day. Capture thinking using a Brainstormer and use that thinking to draft possible Leadership Day agenda items. Struggling to get started? The list in the chart below includes some of the most common Leadership Day agenda items. Try using this as a guideline. After brainstorming, give each person three round stickers and ask them to identify their top three choices for the components they would definitely like to see included from the brainstorming list. Once everyone has dot voted, rank items in terms of priority.

Tours
Class Visits
Performance (opening)
Performance (during)
Performance (ending)
Student Panel Q&A
Teacher Panel Q&A
Student Speeches
Clubs Overview
Leadership Notebook Chat
Student Leadership Roles Overview
Service Projects Overview
Community and Business Leaders
Talent Showcase
Leader (t1 e..
• Components of
Leadership Day
® Frankhn Covey Co. AA rigfru reserved.
-291-

Step 3: Determine the Timeframe
Take a look at the key components identified in Step z. Work with students to consider the time you'll devote to each item and begin to outline the agenda. Remember to allow for transition time.

TIMEFRAME
Tours (45 minutes)
Once you have prioritized key components, you will
Class Visits (15 minutes, can be included in tours)
have an idea of the timeframe needed to accomplish
Performance (opening) (5-7 minutes)
the items you wanted to include. Estimated times
Performance (during) (S-7 minutes)
are listed. Remember to allow for transition time.

Performance (ending) (5-7 minutes)
Student Panel Q&A (7s-2o minutes)
Teacher Panel Q&A (15-2o minutes)
Date:

Student Speeches (2o minutes)
Clubs Overview (2o minutes)
Time:

Leadership Notebook Chat (is minutes)
Student Leadership Roles Overview (io-IS minutes)
Service Projects Overview (is-2o minutes)
Community and Business Leaders (15--20 minutes)
Talent Showcase (io-is minutes, can be included
in tours)
Step 4: Identify Possible Student Leadership Roles
Involve as many stakeholders as possible through roles or tasks for students, staff, and families. Consider tiering the roles to eliminate the barrier of time required for auditions or interviews. The table below includes a sample listing of roles that may fall under each tier You want to involve as many students as possible. Tiers also help to eliminate the same students serving in multiple roles.

AUDITIONTIER 1:

Master of Ceremonies Photographer Environment Team
Performing Arts Panelist Server
Journalist Hospitality Team
Video Team Data Chat
Greeter Club Speaker
Tour Guide Invitation Team
Marketing Team
LeaderinMeo
e Frankkn Covey Co. A4 tights ieserved-
-292-

Step 5: Create a To -Do List and Invite Contributions
Invite student, staff, and parent leaders, action teams, or clubs to claim tasks or "to-dos" from the list. The table below outlines sample tasks and contributors.

TASK WHO IS •
Compose a guest list. Student Lighthouse Team
Design and send invitations. Art Club
Create a guest feedback form. Leadership Events Team
Step 6: Make It Visible With a Backward Calendar
Once you determine your date, plan out a backward calendar. Post it schoolwide. Include all the tasks and leadership roles to be completed prior to the event. It is an excellent communication tool and visual plan for all stakeholders. Check out a sample backwards calendar below.

TIMELINE TASK (EXAMPLES) LEADERSHIP ROLES
3-4 months before... • Begin to envision the event.
• Draw up a budget (if necessary).
• Assemble action team.
• Select date and post on UM Online.
• Decide on any large-scale
entertainment acts (student
productions, performances,
keynote guest speakers).
• Contact rental companies or
district offices if you need to rent
or borrow anything (tables, chairs,
and or activity buses if guests are
parking offsite).
3-2 months before... • Design and send save -the -date cards and/or invitiations.
• Decide on dress code (order t-shirts,
build "Dress for Success" closet).
2-1 months before... • Mail invitations.
e Design evaluation or feedback form
for the event.
• Begin writing student speeches.
• Order any giveaways for guests.

Leader in Me.

Q F'raNdin Loney Ca AN righu reserved
-293-

TIMELINE TASK (EXAMPLES)

LEADERSHIP ROLES
i month before... • Post coumdown in common area.
• Call any VI Ps on your guest list.
program Y
• Create a . for the da
2 weeks before...
• Review RSVP list.
• Begin rehearsing student speeches
and performances.
i week before,,,
• Plan seating chart.
• Call any vendors and confirm
arrangements.
• Continue rehearsing student
speeches and performances.
2-3 days before„
• Continue rehearsing student
speeches and performances.
• Share day of agenda with staff
and students.

Day before...
• Hold a dress or mock rehearsal.
• Arrange giveaways and packets or
folders, sticky notes, mints, etc. at
tables for guests .
• Arrange refreshments station.

Day of...
- Add fresh foods, coffee, etc. to
refreshment station.
• Ensure student greeters are
available upon guest arrival.
• Collect guest feedback.
• Enjoy the experience!
After the event...
• Write and send thank -you
notes to guests.
• Review guest feedback.
• Reflect on the event with staff
and students.

Request for Taxpayer
Give Form to the
Form
Rev. October 2018)
Identification Number and Certification
requester. Do not
Department of the Treasury
Send to the iRS.

Internal Revenue Service
► Go to www.irs.gov1ForinW9 for instructions and the latest information. 1 Name (as shown on your income tax return). Name is required on this line; do not leave th s line blank.

Valley Elementary
2 Business name/disregarded entity name, if different irom above a,
3 Check appropriate box for federal tax classification of the person whose name is entered an line 1. Check only one of the 4 Exemptions (codes apply only to
mtollovring
seven boxes
certain entities, not individuals: see
a
instructions on page 3):
o
❑ Ind[viduallsole proprietor or ElC Corporation ElS Corporation ❑ Partnership ElTrust/estate ai C
single -member LLC
1 p
Exempt payee code (if any)
o. o
❑ Limited liability company. Enter the tax classification (C=C corporation. S=S corporation. P=Partnership) ► `p r
Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check Exemption from FATCA reporting
LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is code (if any)
CL
another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that w
is disregarded from the owner should check the appropriate box for the tax classification of its owner. m
❑ Other (see instructions) I-
MDpies to aic n4 mavta'md m&tk the U.S.)
N
5 Address (number, street, and apt. or suite no.) See instructions.

Requester's name and address (optional)
12333 Eighth Street
6 City, state, and ZIP code
Yucaipa, California 92399
7 List account number(s) here (optional)
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number
backup withholding. For individuals, this is generally your social security number (SSN). However, fora resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other FM-M-=
entities, it is your employer identification number (EIN). If you do not have a number, see Now to aet a TIN, later.

Note: if the account is in more than one name, see the instructions for line 1 Number To Give the Requester for guidelines on whose number to enter.

Under penalties of perjury, I certify that:
or
Also see What Name and I Employer identification

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and

2. 1 am not subject to backup withholding because. (a) i am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that 1 am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and

3. 1 am a U.S. citizen or other U.S. person (defined below); and

4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part 11, later. n Signature o
He e I U.S. personf�ti_.f lY aIX f 1 r MILE 1 t LE &1312 +L 2_ Date ►
General Instru6tions
Section references are to the Internal Revenue Code unless otherwise noted.

Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to wwwJrs.gov1FormW9.

Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number ([TIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099-INT (interest earned or paid)
• Form 1099-DIV (dividends, including those from stocks or mutual funds)
• Form 1099-MISO (various types of income, prizes. awards, or gross proceeds)
• Form 1099-B (stock or mutual fund sales and certain other transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TiN.
if you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later.

Cat. No. 10231X Form W-9 (Rev. 10-2018)
-295-

Fiscal Year.

Date Application submitted:

Submit to:

City of Yucaipa
General Services/City Clerk Department
34272 Yucaipa Blvd,
Yucaipa, CA 92399
Attn: Kimberly Everts
Attachment M

COMMUNITY A TIVI GRAIN

FINANCIAL / IN -KIND / FEE WAIVER

APPLICATION
2022-2023 1.

April 18, 2022 �; v � ==
NPR I'S 2�J22
OF

YUCAIPA
All sections of the application must be returned complete and all supporting documentation provided prior to Cite Council review. Incomplete applications receivedwill be returned to the applicant.

Name of Applicant/Organization: Yucaipa/Cah lesa Family ASSS1Stance, Inc.

P.O. Box 130, Yucaipa, CA 92399 r
Applicant/Organization Mailing Address:

Applicant/Organization Phone Number: ( 951 ) 797-0244
Contact Paul Kielhold (909 )$56-0954
Name Phone Number -
[email protected]
E-mail address
Contact (2)
Melissa Brunken
Name
[email protected]
E-mail address
(909 )797-0244
Phone Number
Yes No
Is your organization located in another community? ® ❑✓ Will the program/event take place in another community? ® ❑✓ Are you aware of any other City program providing this sen�ice? ❑ ❑✓ If so, which one?
*If you answered "Yes" to any of the questions listed above, your request is not eligible for the Community Acti-tzty Grant.

City of Yucaipa Community Activity Grants Application, Rev. 0312022

Page 1 ends

W•

Your organization must be an established 501(c) to be considered for Community Activity Grant funding Please submit documentation verifying organization 501(c) status along with this application.

Yes _X o
Is your organization a 501(c)? ✓� ❑
If yes, please provide Tax 1D;- 95-6102982 and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? <J ! I Hong long has your 501(c) organization been in existence? 73 }Fears Number of Employees working for or1. (1!2 FTE)
ganization:

Number of Volunteers working for organization: 15
Is a current City Council Member on your board? ❑ ❑✓
458 per month
How many Yucaipa residents does your organization currently serve? Does the organization charge admission, membership fees, dues, etc.? ❑ If yes, please describe:

Names and Titles of officers and Board of Directors: (Please attach an organization chart, if available) Richard E. Rios -President
Debra Nilson-Secretary
Margaret Vanckeleer-Treasurer
Paul Kielhold-Board Member
Melissa Brunken-Board Member
Name of the programlevent:

Date(s) of program/event:

Recondition and rejuevate 56 year old check out counters and adjacent sink assenibley.

April/ May 2022
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with programlevent) Refurbish and rearrange the check out countertop and replace adjacent sink and paint cabinetry. This rearrangement will facilitate the installation of display refrigerator for more a more efficient and streamlined client product selection process and distribution of refrigerated products.

City of Yucaipa Conununity Activity Grants Application, Rev. 0312022 'Gy / - Pane 2

Describe how the program/event benefits the residents and/or community of Yucaipa:

The refurbishment and rejuvenation of the countertops will enhance the safety and ambiance of the shopping,food selection and distribution process for a growing number of patrons. We current feed 468 individuals and children that include populations of homeless, seniors, single mothers, persons with disabilities,on a monthly basis and the numbers a
Program/Event Primary Target Population (check all that apply):
❑ Children or Youth
Q Low Income
❑ Persons with Disabilities
❑
Seniors
❑
Victims
©
Welfare Recipients
Number of Residents Projected to Serve: 468 m-thly
Please identify what your organization is seeking:

Financial Support: Q Yes ❑ No Ss4,250.00
$16.25 SEP Fee.

Waiver: ® Yes No
In -bind Support: Police S°
Reassigned
Staff S U
❑
Women
©
Homeless
❑
Entire Community
Public
Fire S 0 Works $ o CS/Rental S a
Other S 0 Explain
$I6.25.SEP Total Overall
In -Kind Financial Support Fee Waiver Request
Total Amount of Request: $a $S4,250.00. $o
Provide a detailed description of how the financial support will be used:

The financial support will be used to purchase and install new aesthetically pleasing laminate countertops and laminate siding of a counter repurposed to the following demensions; L 11'x H Tx W284'. Also to add a matching laminate counter top to an adjacient sink cabinet combination. Sink counter demensions; L 5' x H Y x WT. Paint sink cabinets and install new sink. The new demensions of the checkout countertops will facilitate the (new purchase) use. of display refrigerator for convienient sight selection by patrons of a variety refiigerated food products, fresh vegtables and fruit.

City of Yucaipa Community Activity Grants Application, Rev. 03/2022

Page 3 ends

'"'hat other in-kind/f uancial contributions has your organization received to fund this event/program (separate from City funding)?
Donations
Total Funds Received To Date:

Total Funds Requested Via Grant Application:

Remaining Balance That Will Be Funded By
Organization:

In -Kind Financial
Amount Support Amount
S
S
S S
S S
S S
0 S S
S S 4,250.00
S S difference
Provide City funding received by organization in the past three years (required):

Program In -Kind Financial $16.25 SEP
Support Fee Waiver
Refrigerator / Roof Repair
Fence Addition / Fence Repair
❑
F77
❑
❑
0 ❑
❑
❑
Date
Received
2020
2021
Total Received
2,500
s-
£ 1,875
IQ
I, the undersigned, do hereby attest that the above information is true and correct to the best of my knowledge, and understand that the awar ed financial grant at ount needs to be s ent prior to submitting another grant request.

Director
�� 19 102-
Signature Title Date
Date Received:

Amount Funded: S
Type of Grant: ❑ In -Kind
Date City Council received follow up report:

Date Reviewed:

City Council Meeting:

Financial Support
l
❑ Fee Waiver
City of Yucaipa Couununity Activity Grants Application, Rev. U2022 - - Page 4

V.r.1mzc()?wSTg2mjwm
RICHARD RUIZ C-33, B-B48354
P-0- Bax 993
Forest Falls Ca. 92339
Phone 909-213-7794
To
Kou k 1: • U z1o]•
DATE- 3/2 e12 ?--

DESCRIPTION AMOUNT
'Ice 4
le "o"
"' le
Xe
'44
J7,
j4
5 C.; r
777. va 71 c! / - 4,, &.,lAl e e 7 -
;,'
A-1 %-Ie 6e
-----------
TOTAL
5-0
-300-

-11-OW, F0l-EY;*tvc.

ONTAR;'O. CA'O- 1761
OFFICE (562) 7A3-3;435
Yucaipa Family Assistance
PO Box 130
Yucaipa. CA 921,99
E -OMIS "0% 6ovvi-1150% due when coin:)Ie-*e -
DATE 418,12022
INVOICE =± 040720222
-)HIP 10
Yucaipa Family Assistance
'-,.5075 Avenue B
Yucaipa, CA 92399
DUE DATE 411812022
DESC.RiPTION Q( PRICE ANIIOI-IiNz
Supply, Deliver & install custom laminate countertops 1 1;000.00 1,000.00 - w/rolledfront edge & 3 3/4"coved backsplash
- sink cutout, end splashes/caps included
- 28",wide double -sided barIGp inclurded
- wior --- Formica Subbia Organic 895:7-58
Relaminate front & sides of island getting new count ter' op 1 1,200m 1,200.0t0 color = Formica Dover White
v'.J= 0}. 1 UVAJIV
-301-

Attachment N
Fiscal Year:

Date Application submitted:

Submit to:

City of Yucaipa
General Scrvicesr'City Clerk Departmcnt
34272 Yucaipa Blvd.

Yucaipa, CA 92399
Attn: Kimberly Everts

COMMUNITY ACTIVITY GRANT

FINANCIAL I IN -KIND / FEE WAIVER

APPLICATION
20 22-2023
15 April 2022
Received
City of Yucaipa
APR- 2 0 2022
General Services/
City Clerk's Department
All sections of the application must be returned complete and all supporting documentation provided prior to City Council review. lncompiele applications received will he returned to the applicant.

Name of Applicant/Organization:

Applicant/Organization Mailing Address:

Applicant/Organization Phone Number:

Contact (1)
BPOE Yucaipa Elks 42389
12165 2nd St. P.O. Box 578, Yucaipa CA 92399
(909 ) 797-5268
Virginia Cosby
Name
earth I935CigmaiLcom
E-mail address
(909 ) 795-2549
Phone Number
Contact (2) ( }
Name Phone Number
F.-mail address
SECTIONREQUIREMENTS:

Yes No
Is your organization located in another community? ❑ 0
Will the progratn,evcnt take place in another community? ❑ 0 Are you aware of any other City program providing this service? ❑ F✓ If so, which one?
*lf you answered "Yes" to any of the questions listed above, your request is not eligible for the Community Activity Grant.

City of Yucaipa Community Activity Grants Application. Rev. 03/2022 Page I -302-

Your organization must be an established 501(c) to he considered for Community Activity Grant funding.

Please submit documentation verifying organization S01(c) status along with this application.

Yes
No
Is your organization a 50 1(c)?
✓❑
❑
C, q /
If yes, please provide Tax ID# I S _ 2 7 7 7 17 tL'and at al supporting documents.

Does this application include submittal of documentation verifying 501(c) status? ❑
C
55 years
Holt` long has your 501(c) organization been to existence? J
Number of Employees working for organization:
1G0+
Number of Volunteers working for organization:

Is a current City Council Member on your board?
❑
❑
Flow many Yucaipa residents does your organization currently serve? Does the organization charge admission, membership fees, dues, etc.? 0 ❑
S140 per year
I f yes, please describe:

Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Ronda Krug, Exalted Ruler
Heather Lowe, Trustee
Laura Morales, Trustee
RoyCarrozza, Trustee
Diane Snowball, Trustee
Kory Hand, Trustee
Name of the program/event:

Date(s) of program/event:

Elks National Hoop Shoot and/or Soccer Shoot
December 2022
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with progranitevent) The Elks "Hoop Shoot" Free Throw Contest is the largest and most visible of the many youth activities sponsored by Elks Lodges. The Program is open to all boys and girls, ages 8 through 13, regardless of race or creed. More than 3 million boys and girls participte each year. The Elks "Hoop Shoot" highlights the Elks cotntnittment to America's youth. From the trillions of youngesters who participate and advance through local, district and regional competition six nation champions are names. Participants qualify at their local school. One boy and one girl in each of three categories; ages 8-9, 10-11 and 12-13. The soccer shoot follows similar guidelines.

City o£Yucaipa Community Activity Grants :application, Rev. 0312022

Page 2 ends

-303-

Describe how the prograrn/event benefits the residents and/or community of Yucaipa:

The program keeps our ,Youth involved in events that are athletic and provides recognition for these age eate,ories. Shirt and backpacks or similar memorabilia are (riven to .ALL participants and trophies for places l st, 2nd and 3rd. It gives them Great confidence and support in reaching; their athletic abilities and goals.

Program/Event Primary Target Population (check all that apply):

Children or Youth ❑ Seniors ❑ Women
❑ Low Income ❑ Victims ❑ Homeless
❑ Persons with Disabilities ❑ Welfare Recipients ❑ Entire Community Dumber of Residents Projected to Serve: All
Please identify what your organization is seeking:

Financial Support: Q Yes ❑ No
S16.25 SEP Fee
Waiver: ❑ Yes ❑ No
Public
In -kind Support: Police S Fire S Works S CS/Rental S
Reassigned
Staff S Other S Explain
S16.25 SEP Total Overall
In -Kind Financial Support Fee Waiver Request
Total Amount of Request: S $ t-Uu S = S 1200
Provide a detailed description of how the financial support will be used:

Funds will be used to cover the cost of rcntin(r the =gymnasium at our preferred location, purchase of trophies, medals, back pack, T-shirts or other memorabilia for participants.

Cite o1*Yueaipa Community Activity Grants Apph ation. Rc%. 03t2022

Page 3 ends

-304-

What other in-kind/financial contributions has'your organization received to fund this event/program (separate from City funding)?
Tone
Total Funds Received To Date:

Total Funds Requested Via Grant Application:

Remaining Balance That Will Be Funded By
Organization:

In -Kind
Amount
S S
S S
S S
S S
S S
S S
S S
S S
Financial
Support Amount
Provide City funding received by organization in the past three years (required):

Program In -Kind Financial 516.25 SEP Date
Support Fee Waiver Received
Hoop Shoot 2019-2020
Hoop Shoot 2020-202.1
Hoop Shoot 2018-2019
Total Received
❑ ❑ ❑ S Returned
❑ ❑ ❑ SReturned
❑ 7 ❑ may 2018 S 1000

1. the undersigned, do hereby attest that the above information is true and correct to the best of my knowlcdgc, aid utidcrstand that the awarde financial grant amount needs to be spent prior to submitting another grant request. -lf,�c.rZ . Grant Administrator March 15, 2022
Signature Title Date
Date Received:

Amount Funded: $
Type of Grant: ❑ hi -Kind
Date City Council received follow up report:

Date Reviewed: k.-
City Council Meeting:

EFinancial Support ❑ Fee Waiver
City of Yucaipa Community Activity Grants Application. Rev. 0312022 t'age 4
-305-

Attachment O
Fiscal Year:

Date Application submitted:

Submit to:

City of Yucaipa
Ggneral ScrvicesCity Clerk Deportment
34272 Yucaipa Blvd.

Yucaipa, CA 92 399
Attn: Kimberly Everts

COMMUNITY ACTIVITY GRANT

FINANCIAL / IN -KIND / FEE WAIVER

APPLICATION
2022-2023
April 27. 2022
Received
City of Yucaipa.

APR 2 7 2022
Genera
City C`t` rk,s
All sections €tt'the application must €at= rc=ttrr•ned Complete treat! atll Nupp€ertiu" docutaaelttaticatt faro ided lariat• to €'its° Cottneil review. Incomplete ttpplicatiom received will he returned to the applicant.

Name of Applicant/Organization: GFWC Yucaipa Woman's Club Applicant/Organization Mailing Address: P. O. Box 153, Yucaipa, CA 92399 Applicant/Organization Phone Number: (909 )797 6798
Virginia Cosby
Contact (t } (909 ) 795 2549
Natne Phone Number
earth 1935 ci,gtnail.com
E-mail address
Marie Ritch
Contact (2) (95) )490 3798
Name Phone Number
grandniamarie2003@gniai l.com
E-mail address
Yes No
Is your organization located in another community? ❑ ❑✓ Will Cite prograni'event take place in another community? ❑ Are you aware of any other City program providing this sen•ice? ❑ 7 If so, which one?
*If you answered "Yes" to any of the questions listed above, your request is not eligible for the Community Activity Grant.

City ot•Yucaipa Community Activity Grants Application, Rev. 0:1I2022 3'age I -306-

Your organization must be an established 501(c) to be considered for Community Activity Grant funding.

Please submit documentation verifying organization 501(c) status along with this application.

Yes No
Is your organization a 501(c)'?
4 95-1640492
If yes, please provide Tax ID-q and attach all supporting doctunents.

Does this application include submittal of documentation verifying 50l (c) status? ❑ �✓� How long has your 501(c) organization been in existence'? 105 years_ Number of Employees working for organization:

Number of Volunteers xvorking for organization: 95
Is a current City Council Member on your board? ❑ Q
How many Yucaipa residents does your organization currently serve? Does the organization charge admission, membership fees, dues, etc.? ❑ S50 per year
If yes, please describe:

Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Marie Ritch, President
Sharon Ri1T", VP
Virginia Cosby, Treasurer
Marilyn Gower, Trustee
Letty Flores, Trustee

PROGRAM O,
Name of the programlevent: Historic buildlnor maintenance Date(s) of program/event: Ongoing
Describe the program/event that organization is seeking support for:
(Attach any eventiprogratn promotional materials associated with program?event) The 61-'WC: Yucaipa Wotnan's Club clubhouse was built in 1922. Members are cliargcd with maintaining this building which is a California Point of Historical Interest. In the past few years we have updated 3 bathrooms, added a handicap accessible bathroom, replaced old plumbing lines, installed outside security lighting and completed many other projects. The cost of these repairsr`ttparadestmaintenance has been paid for by metnber donations and rental fecs.The City of Yucaipa grants are the only outside funding we receive. Overhead costs such as tax and insurance are covered by the member dues and fundraising proceeds.

Cite W*Yucaipa Community Activity Grants, Application, Rey. 0310022 Page
-307-

Describe how the progranvevent benefits the residents and/or community of Yucaipa:

The clubhouse has been a community asset for many }sears. It is avilable for all members of the community to use as and when needed. We offer members and guests a variety of events and we are one of the few venues that will accomodate a large gathering where stage, kitchen, tables and chairs, are needed.

Proarain/Event Primary Target Population (check all that apply):
❑ Children or Youth
F Low Income
❑ Persons with Disabilities
Nutubcr of Residents Projected to Serve: all
,� Seniors
❑ Victims
❑ Welfare Recipients
SECTION 5—GRANT FUNDING REQUEST
Please identify what Four organization is seeking:

Financial Support: 2 Yes ❑ No $ 5425
SI6.25 SEP Fee
Waiver: ❑ Yes ❑ No
® Women
❑ Homeless
0 Entire Community
Public
In -kind Support: Polices Fire S Works S CS/Rental S
Reassigned
Staff'$ Other S Explain
S16.25 SEP Total Overall
In -Kind Financial Support Fee Waiver Request
Total amount of Request: S S5-i-5 S = - 2 rs
Provide a detailed description of how the financial support will be used:

1. Repair ceiling. The ctubtiouse has a small room at the northeast corner of (lie building. It is separate from the main hall and tea room, off the lobby. The ceiling+ has buckled and in danger of falling in. we believe birds entered, made nests, and compromised the structure_

2. Building u•uttiot%s. guiters and downspouis and exterior doors. Oiler the years rain and debris damaged (he existing gaiters and downspouts.

Plus one downspout teas damaged when a car ran into the buildinL. Cleaning and repairing rephicing iti needed. Several window panes are cracked or broken. Resulting from age and settling. several or the exterior doors allow drafts which increase the uri ity costs. They need weatherstripping at a minimum and replacement irneecssary. We were advised that one door is an interior door and definitely should be replaced.

3. hack extrerior wall. The broken windows at the rear of the building should be removed and the «all stuccoed.

Quote for numbers I,'_ and 3 is $4975.00

4. Paint. The utility room, which is the location of our handicap accessible bathrooni has not been painted in over 25 years. Quote is S t50 0iy of Yucaipa Community Activity Grams Application. Res. 03/2022

Page 3 ends

What other in-kind/financial contributions has your organization received to fund this event/prograin (separate from City funding)?
None
Total Funds Received To Date:

Total Funds Requested Via Grant Application:

Remainino Balance That Will Be Funded By
Or�oranization:
tit -Kind Financial
Amount Support Amount
S S
S S
S S
5 S
S S
S S
5425
S S
S S Donations
Provide City funding received by organization in the past three years (required):

Program In -Kind Financial $16.25 SEP
Support Fee Waiver
2021-2022
Li
2020-2021
2019-2022 ❑
u
Date
Received
July 2022
Total Received
_$2951
August 2021 53935
1, the and, igned, do Hereby attest that the above information is tote and correct to the best of my knowledge, and understand that the aw rded financial grant amount needs to be spent prior to submitting another grant request Treasurer _ 21 - 22`
Signature Title Date
Date Received: -4
Amount Funded: $
Type of Grant: ❑ In -Kind
Date City Council received follow up report:

Date Reviewed:

City Council Meeting:

Z"Financial Support
City of Yucaipa Community Activity Grants :Application. Rev. 03/2022 ❑ Fee Waiver
i"'me 4
511Z2

LIM CONSTRUCTION CONTRACT 1367
K.R.K. Construction
K.R.K. CONSTRUCTION 11114th Street
Calimesa, CA 92320
Owner's Name: Owner's Address: 909.725.5538
YUCAIPA WOMANS CLUB 35215 AVE A [email protected] Owner's City: Owner's Phone: Owner's Alt. Phone: CA CSLB License No. 874464 YUCAIPA 9097976788 (B) General Building Contractor
Project Name & Address:

Email:

Construction Fund Holder Name flf any).

Construction Fund Holder Address:

Construction Fund Holder City, State, Zip:

I/WE, the Owner(s) of the premises described above authorize K.R.K. Construction, hereinafter referred to as "Contractor", to furnish all materials and labor necessary to construct and/or improve these premises according to the following terms, specifications and provisions:
a. Description of the work and the materials to be used.lM-EATHER..STRIP-MUR DOORS. 2)RFGI A7F FOUR WINDOWS-
3) REPAIR TWO (;TITTER DOWN S201111
4)RFPAiR CE(t ING, MOST NORTH FAST ROOM
S)REPAIR WAI I- WITH ST ICC_� -O PATCH, ABANDONED WINDOWS BY., FAST SIDF OF SOUTH FACING FAST CORNER EXIT DOOR_ ------- ----------------------END — —--------
b. Description of any areas that will NOT be worked on: NOTH INC, OTHER THFN STATFD ABOVE

THIS LIST OF SPECIFICATIONS MAY BE CONTINUED ON SUBSEQUENT PAGES (SEE PAGE NUMBER BELOW) c. Payment: Contractor proposes to perform the above work, (subject to any additions and/or deductions pursuant to authorized change orders), for the TOTAL SUM OF $ 4975.00 DOWN PAYMENT (if any) $ 2475,00
PAYMENT DUE WHEN AMOUNT PAYMENTS TO BE MADE IN INSTALLMENTS AS FOLLOWS:

1. UPON COMPLETION OF JOB $2500.00

2. 3.

4. S.
d. Commencement and Completion of Work: Commencement of work shall mean the physical delivery of materials onto the premises and/or the performance of any labor and commencement shall be subject to permissible delays as described in provision (6) on the reverse side.

Approximate Start Date: 2022 Approximate Completion Date: 2022 e. Acceptance: This contract is approved and accepted. I (we) understand there are no oral agreements or understandings between the parties of this agreement. The written terms, provisions, plans (if any) and specifications in this contract is the entire agreement between the parties. Changes in this agreement shall be done by written change order only and with the express approval of both parties. Changes may incur additional charges.

Additional Provisions Of This Contract Are On The Reverse Side And May Be Continued On Subsequent Pages (see page number below).

OWNER/AGENT, see the "Arbitration of Disputes" provision approved and accepted (owner) date on page two (provision 14) and the NOTICE following this provision. If you agree to arbitration, initial on the line below the NOTICE where indicated. Also, initial in the same place on approved and accepted (owner) EACH COPY of this contract.

NOTE: This contract may be withdrawn or renegotiated after approved and accepted (contractor) date days from if not approved and signed by BOTH parties.

To: Yucaipa Woman's Club AprU 27, 2022
From: Eric Alison
Virginia Cosby f.47 AM P1
miFILItes ago)
me
Hi Virginia,sorry I got done at work late today,ok so for paint & labor to do walls and cabinets/shelves is going to be a total of $450.

Sent from my Phone
NOTE:

Eric Allison is the contractor who did the handicap accessible bathroom for the Woman's Club two tears ago.

We asked for a "quick" quote so the revised application could be submitted on time. -311-

Yucaipa City CouncilJune 27, 2022

Yucaipa City Council
June 27, 2022