Yucaipa City Council
June 26, 2023

Agenda Item No. 17

CITY OF YUCAIPA

AGENDA REPORT
TO: Honorable Mayor and City Council
FROM: Jennifer Crawford, Assistant City Manag
Kimberly Metzler, Deputy City Cle
FOR: City Council Meeting of June 26, 2023
SUBJECT: Review and Consider Fiscal Year 2023/2024 Community Activity Grant Applications
RECOMMENDATION:

That the City Council:

1. Review and consider the Fiscal Year 2023/2024 Community Activity Grant applications submitted by local non -profits 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 13, 2023, City Council reviewed the Community Activity Grant (CAG) program guidelines and funding levels for Fiscal Year (F'Y) 2023/2024 and approved the following:

Allocate the current funding levels of $40,000 for in-kind/fee waiver grants and $17,500 for financial grants.

All other program guidelines remain unchanged.

On April 5, 2023, the City issued notices to past applicants and new contacts, announcing the FY 2023/2024 CAG program, the firm deadline of May 11, 2023, 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, and social media platforms.

A total of twenty-two applications requesting in -kind and/or financial support were received and processed for Council review and consideration. The table on the following page 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, Attachment 25 highlights financial grant awards from 2010-2023 and Attachment 26 outlines CAG's awarded to the organizations over the past three years and a section for Council to assist in the award process. 171

Community Activity Grant
FY 2023/2024 Applications
Attachment 1 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 2024. Total residents projected to serve: 15+. i Requested In -kind Amount 1 $2,862 1
Attachment 2
Childhood Cancer Foundation of Southern California — 2024 Spring Eggstravaganza
Scope
Applicant is seeking in -kind support to cover the costs associated with the use of the Yucaipa Community Park Amphitheater and to waive the special event permit fee to host a Spring Eggstravaganza on March 16, 2024, for families experiencing childhood cancer. Total residents projected to serve: 250+.

Requested In -kind Amount
1 $1000
Attachment 3 Calicai a Nooners Lions Club — 2023 Veterans Day Ceremony Scope Applicant is seeking in -kind support to cover the costs associated with the use of the Yucaipa Community Park Amphitheater and Shelter #1 to host the 2023 Veterans Day Ceremony on November 11, 2023. Total residents projected to serve: 200+.
l Requested In -kind Amount 1 $974 1
Attachment 4
Inland Leaders Charter School — Volleyball Gaines
Scope
Applicant is seeking in -kind support to cover the costs associated with the use of the Yucaipa Community Center Gymnasium to hold volleyball games for the 2023 season. Total residents projected to serve: community -wide.

Requested In -kind Amount
1 $1,800
Attachment 5
Redlands Bicycle Classic Inc. — 2024 Yucaipa Road Race
Scope
Applicant is seeking in -kind support to cover the costs associated with police support for traffic control at key intersections, fire support to address medical response, and public works support for the placement of signage prior to the event in April 2024. Total residents projected to serve: 800.

Requested In -kind Amount
$10,875
Attachment 6 Rotary Club of Yucaipa — Weekly Club Meetings Scope Applicant is seeking in -kind support to cover the costs associated with the use of the Senior Nutrition Center to hold weekly Club meetings through June 2024. Total residents nroiected to serve: 30 weekly.
_ Requested In -kind Amount 1 $10,155 1
172

Community Activity Grant
FY 2023/2024 Applications
Attachmcnt 7 Rotary Club of Yucaipa — 68" Annual Christmas Parade Scope Applicant is seeking in -kind support to cover the costs associated with conducting the 2023 Christmas Parade on December 9, 2023. Total residents projected to serve: 5,000.

Additional financial support in the amount of SI, 000 is included in the FY 2023124 Non -Department Not- ar-Pro rt Approved Budget (Attachment 23 Requested In -kind Amount 1 $12,334
Attachment S 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 2024. Meetings are held for planning, artwork take -in, setup of displays, fundraising, etc. Meeting are open to the public. Total residents rjected to serve: 80+.

Requested In -kind Amount $2,958
Attachment 9
Yucai a Valley Art Association YVAA — Weekly Art 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 weekly art meetings through rune 2024, to encourage local artists to collaborate in painting sessions. This event is open to the public. Total residents projected to serve:
80+.

Requested In -kind Amount
$5 733
Attachment 10 Yucai a Valley Lions Club — Monthly Club Meetings Scope Applicant is seeking in -kind support to cover the costs associated with the use of the Community Center Meeting Room to hold monthly meetings through November 2023. Total residents projected to serve: 10-15.

Requested In -kind Amount $540
Attachment 11
Yucaipa Youth Basketball — 2023-24 Basketball Season
Scope
Applicant is seeking in -kind support to cover the costs associated with the use of the Community Center Meeting Room and Gymnasium and financial support to purchase uniforms and cover costs related to the utilization of volunteer coaches and referees. Total residents projected to serve: 450.

Requested In -kind Amount
$4 080
Requested Financial Amount
$2 000
Attachment 1.2 The Church of Jesus Christ of Latter -Day Saints — Yucaipa Freedom Run — 5 K Fun Run and Walk
Scope Applicant is seeking financial support to purchase t-shirts and medals for participants of the Yucaipa Freedom Run on Memorial Day 2024. Total residents projected to serve: 250.

Requested Financial Amount $1,000
173

Community Activity Grant
FY 2023/2024 Applications
Attachment 13
Family Promise of Yucai a/Calimesa — Operational Expenses Scope
Applicant is seeking financial support to subsidize operational expenses that assist at risk and/or homeless families.

Requested Financial Amount
$17 500
Attachment 14
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). Total residents projected to serve: 50.

Additional financial support in the amount of $5, 000 is included in the FY 202312024 Non -Department Not -For -Profit Approved Budget (Attachment 23).

Requested Financial Amount
$5 000
Attachment 15
Gardenworksforkids — Autism Patio Cover
Scope
Applicant is seeking financial support to cover the costs associated with purchasing a shade cover for the recently constructed sensory patio learning garden for autistic and special needs children. Total residents projected to serve: 1 400/m.

Requested Financial Amount
$1,700
Attachment 16
Smiles for Seniors Foundation — Assist 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. Total residents projected to serve: 30-50.

Requested Financial Amount
$3,000
Attachment 17
Valle Elementary School — Leadership Da
Scope
Applicant is seeking financial support to cover the costs associated with holding a Leadership Day event (April 26 and May 23, 2024) in order to showcase the hard work and accomplishments of students. Total residents ro'ected to serve: 400.

Requested Financial Amount
1 $1500
Attachment 18
The Well Outreach Center — Provide Clothing Needs to At -risk Students Scope
Applicant is seeking financial support to cover the costs associated with providing basic clothing needs to at -risk students living in the area. `fatal residents projected to serve: 350,
Requested Financial Amount
$3 000
174

Community Activity Grant
FY 2023/2024 Applications
Attachment 19 Yucai a/Calimesa Family Assistance — Purchase and Install Security Cameras Scope Applicant is seeking financial support to cover the costs associated with the purchase and installation of security cameras for the interior and exterior remises. Total residents projected to serve: 285.

Requested Financial Amount $4,557
Attachment 20 Yucaipa Elks 02389 — AnnuaI Hoop Shoot and Soccer Shoot Scope Applicant is seeking financial support to purchase basketballs, soccer balls, trophies, t-shirts, and administrative materials. Total residents projected to serve: community -wide.

Requested Financial Amount $1,000
Attachment 21
Yucaipa Piekleball Inc. — Clinics and Open Play Opportunities Scope
Applicant is seeking financial support to offer year-round clinics and open play opportunities at local facilities. Total residents projected to serve: 1000.

Reguested Financial Amount
1 $14,450
Attachment 22 Yucaipa Womans Club — On -going Maintenance of Building Scope Applicant is seeking financial support to cover the costs associated with on- going repairs to the Clubhouse. Total residents projected to serve: community - wide.

Requested Financial Amount 1 $4,000 1
Total In -Kind Assistance Requested: $53,311.00
Total Financial Assistance Requested: $58,707.00
FISCAL IMPACT:

Upon adoption of the FY 2023/2024 Budget, the fund for in-Kind/fee waiver requests will have a balance of $40,000.00. The total amount requested for in -kind assistance from the CAG applications submitted with this staff report is $53,311.00, exceeding the total funds available by the amount of $13,311.00 if all eleven in -kind grant applications are approved.

Upon adoption of the FY 2023/2024 Budget, the fund for financial requests will have a balance of $17,500.00. The total amount requested for financial assistance from the CAG applications submitted with this staff report is $58,707.00, exceeding the total funds available by the amount of $41,207.00 if all twelve financial grant applications are approved.

Attachments:

1. Al -Anon Family Groups Application

2. Childhood Cancer Foundation of Southern California Application

3. Caficaipa Nooners Lions Club Application

4. Inland Leaders Charter School Application

5. Redlands Bicycle Classic, Inc. Application

6. Rotary Club of Yucaipa Application
175

7. Rotary Club of Yucaipa Application
S. Yucaipa Valley Art Association Application

9. Yucaipa Valley Art Association Application

10. Yucaipa Valley Lions Club Application

11. Yucaipa 'Youth Basketball Application
12, The Church of Jesus Christ of Latter -Day Saints Application

13. Family Promise of Yucaipa/Calimesa Application
14, Family Service Association of Redlands Application

15. Gardenworksforkids Application

16. Smiles for Seniors Foundation Application

17. Valley Elementary School Application

18. The Well Outreach Center Application,

19. Yucaipa/Calimesa Family Assistance Application

20. Yucaipa Elks Club #2389 Application

21. Yucaipa Pickleball, Inc. Application

22. The Womans Club Application

23. FY 2023/24 Non -Department Not -for -Profit Approved Budget Sheet

24. FY 2023/24 CAG Guidelines

25. Financial Award Grant Tracker Fiscal years 2010/11 through 2022/23

26. Prioritization Worksheet
Approved by:�
176

ATTACHMENT I
177

Fiscal Year_

COMMUNITY ACTIVITY GRANT
2023-2024
Date Application submitted: 5/9/2023
Submit to:

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

Yucaipa, CA 92399
Attn: Kimberly Metzler
FINANCIAL IIN-KINiD f FEE WAIVER

APPLICATION
Received
City Of Yucaipa
MAY 10 20B
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. incomplete applications received will be returned to the applicant.

Name of Applicant/Organization:

Applicant/Organization Mailing Address:

Applicant/Organization Phone Number:

Contact (1)
Contact (2)
Al -Anon Family Groups
1012 E. Cooley Dr., Ste .1-2, Colton CA 92324
(909 )924=1516
John Muller
Name
[email protected] 34745
Elmwood Lane, Yucaipa CA 92399
E-mail address
Kathleen Gerome
Name
kitkageromeimsn.com
(714 )290-7341
Phone Number
909 335-6245
Phone Number
E-mail address
SECTIONREQUIREMENTS:

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 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. 17R -
City of Yucaipa Community Activity Grants Application, Rev. 03/2023 Page

SECTION 3 —ORGANIZATION INFORMATION/APPLICANT BACKGROUND Your organization trust 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 ID#" '� and attach all supporting documents.

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

Is a current City Council Member on your board?
❑
❑✓
l5+
How many Yucaipa residents does your organization currently serve? Does the organization charge admission, membership fees, clues, etc,? ❑
►'❑
If yes, please describe:

Naives and Titles of Officers and Board of Directors: (please attach an organization chart, if available) John Muller, Business Chair
Kathleen Gerome, Ad Hoc
Kristina Pamias. Intergroup Rep
Name of the program/event:

Date(s) of program/event:
1 112 hour weekly Al -Anon meeting
Saturdav 1 Dam.-11:3Dam
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with programlevent) City of Yucaipa Community Activity Grants Application, Rev, 03/2023 page 2

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

Al -Anon family group meetings provide support for friends and relatives of alcohoilics. This is a 12 step program of recovery open to anyone seeking ways to deal with the effects of family alcoholism.

Program/Event Primary Target Population (check all that apply):
❑ Children or Youth
❑ Low Income
❑ Persons with Disabilities
Number of Residents Projected to Serve: 1 5+
Please identify what your organization is seeking:

Financial Support: ❑ Yes Q No
$200 SEP Fee
Waiver: ❑ Yes ® No
In -kind Support: Police $
Reassigned
Staff $
In -Kind
Total Amount of Request: $2862
❑
Seniors
❑
Victims
❑
Welfare Recipients
Fire $
Other $
Financial Support
Public
Works $
❑
Women
❑
Homeless
■❑
Entire Community
CS/Rental $2862
Explain 53 meeting bookings, community room
$200 SEP Total Overall
Fee Waiver Request
$ = $ 2862
Provide a detailed description of how the financial support will be used:

One and a half hour meeting every Saturday morning, l0arn - 11-30 am. (53 total meetings) in the Community Room (holds up to 20 people).

Note: we will provide insurance and pay the $100 room deposit ourselves. 190
City of Yucaipa Community Activity Grants Application, Rev. 03/2023 Page 3

What other in-kind/financial contributions has your organization received to fund this event/program (separate from City funding)?
In -Rind
Financial
Amount
Support Amount
None
$
$
$
Total Funds Received To Date:
$
Total Funds Requested Via Grant Application: $
$
Remaining Balance That Will Be Funded By
$
Organization:

SECTION'Ar
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
3/9/2000
❑ ❑ ❑
$496.50'*
AI -Anon Family Croup
4/25/2022
w
❑ ❑ ❑
$879.00
L1 ©
$

CERTIFICATION
I, the undersigned, do by attest that the above information is true and correct to the best of my knowledge, and understand
that the aw cial gra_V am eeds to be spent prior to submitting another grant request.

Business Chairman
5/9/2023
SiJnat4e Title
Date
Date Received: D — �
Amount Funded: $
Type of Grant: D ;-Kind
Date City Council received follow up report:

Date Reviewed.

City Council Meeting:
❑ Financial Support ❑ Fee Waiver
City of Yucaipa Community Activity Grants Application, Rev. OM023 Page 4

Permit
City of Yucaipa Community
PHONE:{909j 790-7460
Services
FAX:(909) 790.2589
34272 Yucaipa Blvd
EMAIL:communityservlces,e Vucaipa.org
Yucaipa, CA 92399
Customer Name
John Muller - 29740
Customer Type
General Public
MaE[tng Address
34745 Elmwood Ln
Yucaipa, CA 92399
System War
Julia l
Al Anon Family Group Meeting
Booking SuninlEry

START DATE/TIME

END DATE/TIME
Jul 1, 202310:00 AM
Jun 29, 202411:30 AM
OCCUeS @very 5ett,rdey* facuve Jrrt 1, 202.7 until Jun 29, 2024 from 10:00 AM to IL30AM Jul 1, 202310,00 AM
Jul 1, 202311:30 AM
Rental - Hourly (R)
$40.00 / Hour x 1.5
$60.00
Residenl Discount - 10%
-10%x 1
-$6.00
Jul S. 2023 1000 AM
Jul S, 2023 11:30 AM
Rental - Hourly IR)
$40.00; Hour x 1.5
$60.00
Regidenl Discount - 10%
-10%x 1
-$6,00 ,
Jul 15. 202310:00 AM
Jul 15. 202311:30 AM
Rentui - Hourly (R)
$40.00 / Hour x 1.5
$60,00
Resident Discount -10%
-10% x 1
-$6.00
Jul 22. 202310:00 AM
Jul 22, 202311:30 AM
Rental - Hourly (R)
$40.00 / Hour x 1.5
560.00
Resident Drscount - logo
-10% x 1
-S13.00
Jul 29, 202,310:00 AM
Jul 29, 202311:30 AM
Rental • Hourly (R)
$40.001 Hour x 1.5
$50.00
Res+denl Discount -10%
-10% x 1
•$6.00
•-„,:'.'fr

COMMUNITY
y

SERVICES
� f
r?
bLi-i'M Wt Li'.
settre
Permit # R5305
Stratus Tentative
Date Apr 28. 2023 &46 AM
Expiration Date Apr 27, 2024
Home Phone Number 7141 290.7341
Email Address JancIKmulier03Agmail,com
Rental Fee
$3,190.00
Discounts
-$318.00
Subtotal
$2,862.00
Deposits
$100,00
Deposit Discounts
$0.00
Total Permit Fee $2.962-00
Total Payment $0.00
Refunds $0.00
Balance $2.962.00
1 resource(s) 53 bookingls) 5ublotal: $2,962.00

ATTENDEE AMT W/O TAX
$2,862.00
15 $54.�0
15 S[i�.uu
is $54.00
15 $54.00
15 $54.00
# R5305 Status Tentative 182 page 1 of 6

Aug 5, 202310:00 AM
Aug 5, 202311:30 AM
Rental - Hourly (R)
$40.00 1 Hour x 1.5
$60.00
Resident DiSCOLlnt • tD%
•1c°; x 1
-$6100
Aug 12, 202310:01) AM
Aug 12, 202311:30 AM
Rental - Hburly (R)
$40.001 Hour x 1.5
$60.00
Resident DlgeaunL - 10%
-10%x 1
-$6.00
Aug 19, 202310:00 AM
Aug 19.202311:30 AM
Rental - Hourly (R)
$40.00 / Hour x 1.5
$60.00
Resident Discount • 10`xd
-10%x 1
-S6.00
Aug 26, 202310:00 AM
Aug 26, 202311:30 AM
Rental - Hourly (R)
$40.00 / Hour x 1.5
$60.00
Resident Discount • 10%
-1018 x 1
-se.00
Sep 2, 202310:00 AM
Sep 2, 202311:30 AM
Rental - Hourly (R)
$40.00 / Hour x 1.5
$60.00
Resident Discount • 10%
10 £. x 1
413,00
Sep 9, 202310:00 AM
Sep 9, 202311;30 AM
Rental - Hourly (R)
$40.001 Hour x 1.5
$60.00
Resident DlscounL - in,
-10°f x 1
-S(i.00
Sep 16, 202310:00 AM
Sep 16, 20231U0 AM
Rental - Hourly (R)
$40.00 / Hour x 1.5
$60.00
Resident DkGCount - 10".,
-low. x 1
-$5.00
5cp 23, 202310:00 AM
Sep 23, 202311:30 AM
Rental - Hourly (R)
$40.001 Hour x 1.5
$50.00
Resident Discount • 101L
-10% x 1
-$6100
Sep 30.202310:00 AM
Sep 30, 202311:30 AM
Rental - Hourly (R)
$40,001 Hour x 1 5
$60.00
ResldenL DlscOunL • 10%
-1016 x 1
-$6,0C
Oct 7, 202310:00 AM
Ocl7, 202311:30 AM
Rental • Hourly (R)
$40.00 1 Hour x 1.5
$60.00
Resident Discount -10%
•1096 x 1
-S6.00
Oct 14, 202310:00 AM
Oct 14, 2023 t1:30 AM
Rental - Hourly P)
$40 001 Hour x 1.5
$60.00
ResidBnl Discount - t0",
-10%x 1
-$("00
Oct 21, 2023 10:00 AM
Oct 21, 2023 11:30 AM
Rental • Hourly iR)
540.00 / Hour x 1.5
n60.00
Resident Discount - 10%
•10% x 1
-$6.00
Oct 28, 202310:00 AM
Oct 28, 2023 11,30 AM
Rental - Hourly (R)
$40.00 / Hour x 1.5
$60.00
Resident Discount • 10%
-10% x 1
-S6,00
Nov 4, 202310:00 AM
Nov 4, 202311:30 AM
Rental - Hourly (R)
$40.001 Hour x 1.5
560 00
Resident Discount -10 %
•10% x 1
•$6.00
Nov 11, 202310:00 AM
Nov 11, 2023 11:30 AM
# R5305 Status Tentative
183
15 $54.00
15 $54.00
15 $54,00
15 $54.00
15 554.00
15 $54.00
15 $54,00
t5 $54,00
15 $54-00
15 $54.00
15 $54,00
15 $54.00
15 $54.00
15 $54-00
15 $54,00

Rental - Hourly (R)
$40,00 / Hour x 1.5
$60.00
Resident Discount - 109%
-10%x 1
-y15.00
Nov 18, 2023 10:00 AM
Nov 18. 2023 11:30 AM
15 $54.00
Rental - Hourly (R)
$40.00 / Hour x 1.5
S60.00
Resident Discount-10`.'%
-10% x 1
-S6.00
Nov 25, 202310,00 AM
Nov 25. 202311:30 AM
i5
$54.00
Rental • Hourly (R)
$40.00 / Hour x 1.5
$60.00
Resident Discount - 10`Ye
-10% x 1
-$6 00
Dee 2, 2023 10,00 AM
Doc 2, 2023 11:30 AM
i5
$54.00
Rental - Hourly (R)
$40.00 / Hour x 1.5
$60.00
Resident Discount -10%
-10'% x 1
-$G,00
Dec 9, 2023 10:00 AM
Dec 9, 2023 11:30 AM
15 554.00
Rental - Hourly (R)
$40-00 / Hour x 1.5
$60,00
Resident Discount, 10%,
-10%x 1
-SG.00
Dec 16, 2023 10:00 AM
Dec 16. 2023 11:30 AM
15 $54 04
Rental - Hourly (R)
S40.00 I [-lour x 1.5
$60.00
Rewlent Discount -10%
-101- x 1
-S6.00
Dec 23.2023 10 00 AM
Dec 23. 2023 11:30 AM
15 $54,00
Rentnl - Hourly (R)
$40.00 / Hour x 15
$0.00
Resident Discount-10%
-10`Yn x 1
•$6.00
Dec 30, 202310:00 AM
Dec 30, 2023 11:30 AM
15 $54.00
Rental - Hourly (R)
$40.001 Hour x 1.5
$130.00
Resident DiSCOUnt -10°j,
-10`u x 1
-$6.00
Jon 6, 202410:00 AM
Jan 6, 202411:30 AM
15 $S4.00
Rental • Hourly {R)
$40,00 / Hour x 1,5
$60.00
Resident Discount -10%
-10% x 1
-$6 00
Jon 13, 202410:00 AM
Jan 13. 2024 11:30 AM
15 $54.00
Rental - Hourly (R)
$40.00 / Hour s: 1,5
560.00
Re5ident DisCaunt - 10%
•10%x 1
•$6.00
Jan 20, 2024 10:00 AM
Jan 20, 2024 11,30 AM
15 $54.00
Rental - Hourly (R)
$40.001 Hour x 15
$60.00
Re5ldent DISca11111 -10%
-10`so x 1
-$G.00
,ton 27.202410:00 AM
Jan 27, 202411:30 AM
15 S54.00
Rental - Hourly (RI
S40.00 / Hour x 15
$60.00
Resident Discount - 10%
-10% x 1
•$6.00
Feb 3, 2024 10:00 AM
Feb 3, 2024 11:30 AM
15 $54.00
Reot2ll - Hourly IR)
$40.00 1 Hour x 1.5
$150.00
Re$ldont Discount - 10%
-10% x 1
SG.00
Feb 10, 2024 f0:00 AM
Feb 10, 202411:30 AM
15 $54.00
Rental - Hourly (R)
$40,001 Hour x 15
$60.00
Resident DisCount-10N
•10%x1
-$6,00
Feb 17, 2024 10:00 AM
Feb 17, 2024 11:30 AM
15 $54.00
Rental - Hourly (R)
$40,001 Hour x 1.5
$60.00
# R5305 StMUS Tentative

184

Resicent Dincounl - 10°<,
-10% x 1
-56.00
Feb 24, 202410:00 AM
Feb 24, 202411:30 AM
15 $54.00
Rental - Hourly (R)
$40.001 Flour x 1.5
$60,00
Resident Discount - 10%
-10% x 1
-$6.00
Mar 2, 202410:00 AM
Mar 2, 202411:30 AM
15 S54.00
Renttrl - Hourly (R)
$40,00 1 Hour s 1.5
$60A0
Resifk-nt Discount -10%
,10°% x 1
-$G 00
Mar 9, 2024 *00 AM
Mar 9, 202411:30 AM
1$
$54,00
Rental - Hourly (R)
$40.00 / Hour x IS
SG0.00
Resident Discount -10%
-101; x 1
$6 00
Mar iG, 202410:00 AM
Mar 16. 202411:30 AM
15 $54,00
Rental • Hourly (R)
$40.001 Hour x 1.5
S60-00
Resident Discount -10'v
-10%x 1
•$6.00
Mar 23, 202410:00 AM
Mar 23, 202411:30 AM
15 $54,00
Rental - Hourly (R)
$40,00 / Hotrr x 1.5
$G0.00
Resident Discount - 10%
-10% x 1
S6.00
Mar 30, 202410:00 AM
Mar 30, 2 024 11:30 AM
15 S54.00
Rental - Hourly (R)
$40.00 / i x 1.5
$60,00
Resident Discount -10"
-10°% x 1
-$G,00
Apr 6, 202410:00 AM
Apr 6, 2024 1130 AM
15 554.00
Rental - Hourly (R)
S40,001 Hour x 1.5
$G0.00
Resident Discount - 107;,
-10% x 1
-$6.00
Apr 13, 202410:00 AM
Apr 13, 202411:30 AM
i5
$54.00
Rental • Hourly (R)
$40.001 Hour x 1.5
SGO.00
Resident Discount - 10%
-105. x 1
•$G.00
Apr 20, 202410:00 AM
Apr 20, 2024 M30 AM
15 $54.00
Rental - Hourly (R)
$40.00 / Hour x 1.5
560.00
Res dent DISCOunt • 10'.
-10%x 1
-$G oo
Apr 27, 2024 10:00 AM
Apr 27, 2024 11:30 AM
15 $54.00
Rental • Hourly (R)
$40.001 Hour x 1.5
$150.00
Residents Discount -10%
-10%x 1
-5G.00
May 4, 202410:00 AM
May 4, 202411:30 AM
15 $54.00
Rental - Hourly (R)
$40.001 Hour x i,5
560 00
Resident Discount - 10%
-10%x 1
SG.00
May 11, 202410:00 AM
May 11, 2024 11,30 AM
15 $54-00
Rental • Hourly (R)
$40.00 / Hour x 1.5
$60.00
Resident Discount - 10,36
-1046 x 1
-S6.00
May 18, 202410:00 AM
May 18. 202411:30 AM
15 $54.00
Rental • Hourly (R)
$40,00 / Hour x 1.6
$60.00
Resident Discount - 10%
-10% x 1
-$6.00
May 25, 202410:00 AM
May 25, 202411:30 AM
15 $54.00
Rental- Hourly (R)
$40.00 / Hour x 1.5
$60 00
Resident Discount -10",
-10°% x 1
-$6.00
# R5305 Stratus Tentative

185

Jun 1, 202410:00 AM
Rental - Hourly (R)
Resident Discount • 10%
Jun S. 202410;00 AM
RerttAl - Hourly (Rj
$40.00 / Maur x 1.5
$60,00
Waivers and information
15 $54.00
15 $54.00
15 $54.00
1s $54.00
15 $54,00
$100.00

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

WAIVER NAME DUE PATE FOR SIGNING STATUS
Facility Usage Waiver Jul 1, 2023 Waiver Signed
Facility user hereby agrees to Indemnify, defend and hold harmless City of Yuculpa, 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 faclllties, 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 Yuculpa.

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 t4 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 regulatlons relating to use of facilities and accept responsibility for meeting the requirements stated herein.

Deposit

EVENT RESOURCE DEPOSIT FEE CHARGE
Al Anon Community Deposit $100.00
Family Meeting
Group Room
Meeting
Signature

TAX AMOUNT PAID
$O,aa 50.00

REFUNDS BALANCE
$0.00 $1000C
# R5305 Status Tentative 186 Page 5 of 5

Payment Schedules Original Balance: $2.962.00 Current Balance: $2.962.00

DUE DATE AMOUNT OUE AMOUNT PAID WITHDRAWAL ADJUSTMENT BALANCE Jun 17, 2023 $2,962.00 $0.00 $0 00 $2.962.00
x, X
Date; Date:

City of Yucaipa Community Services John Muller
Moiling Address: 34272 Yucaipa Blvd, Yucaipa, CA Customer ID: 29740 92399 Home Phone Number: (714) 290-7341
Phone Number: (909) 790-7460 Email Address: JandKmul1er03kbgmail.com Fax Number: (909) 790-2589
Email Address: communityservices0yucaipa.org
# P5305 Status Tentative Page 6 of 6
187

ATTACHMENT 2

Qocu5ign Envelope ID, 0695188B-E8G1-4089-81D1-5EBAIEOAA529 cirror COMMUNITY ACTIVITY GRANT
Woe of 14'
Fiscal Year:
2023-2024
Date Application submitted: .118/2023
Submit to:

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

Yucaipa, CA 92399
Attn: Kimberly Metzler

FINANCIAL / IN -KIND / FFF WAIVER

A PPL I A TI ON
Received
City of Yucaipa
MAY 0 S 208
General S -ervices/
City Clerk's Department
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.

SECTIONINFORMATION
Name of Applicant/Organization: Childhood Cancer Foundation of Southern California Applicant/Organization Mailing Address: 11155 Mountain View Ave Suite 105, Loma Linda CA 92354 Applicant/Organization Phone Number; (909 ) 558-3419
Contact (1) Stephanie Avila (909 ) 558-3419
Name Phone Number
[email protected]
E-mail address
Contact (2) Angelica Tapia gig 558-3419
Name Phone Number
[email protected]
E-mail address
ELIGIBILITYit
Yes
No
Is your organization located in another community? ❑✓
❑
Will the program/event take place in another community? ❑ ❑J
Are you aware of any other City program providing this service? [f Q
If so, which one?
*jr you answered "Yes" to any of the questions listed alcove, your request is not eligible for the Community Activity Grant.

City of Yucaipa Community Activity Grants Application, Rev. 03/2023 189

Docu5iyn Envelope ID: OB951$BB-E8C1-4489.81D1.5EBAIEOAA529 1 . VIFTAMAMON/APPLICANT 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)?
❑
If yes, please provide Tax ID# 33-0536599 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? 42 years Number of Employees working for organization: 2
Number of Volunteers working for organization: 500+
is a current City Council Member on your hoard?
❑
❑
How many Yucaipa residents does your organization CUITendy serve? 115 Does the organization charge admission, membership fees, dues, etc.? ❑
0 If yes, please desct-ibe:

Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Peter Brierty, President
Wayne Williams, Treasurer
Sara Romero, Member
Rebecca Hoggarth, Member
Frank Schnetz, Vice President
Terry Lundy, Secretary
Ryan Stelzner, Member
SECTION 4 -- PROGRAM DESCRIPTION/SCOPE: (PLEASE USE ADDITIONAL PAGES IF NECESSARY) Name of the program/event
Date(s) of prograirdcvcnt:

Spring EGGstravaganza
March 16, 2024
Describe the progratrt/event that organization is seeking support for; (Attach any event/program promotional materials associated with progratn/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 EGGstravaganza is an opportunity for families to interact in a relaxed setting and enjoy an activity with other parents 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 a cancer diagnosis can, manifest in their lives.

City of Yucaipa Community Activity Grants Application, Rvv, 03/2023 190 Page. 2

DocuSign Envelope ID: OB9515BB-E8C1-4089-81[71-5EHA1EOAA529 Describe how the programlevent 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):

R1 Children or Youth
Q Low Income
Persons with Disabilities
Number of Residents Projected to Sctve�_5
Please identify what your organization is seeking:

Financial Support: ❑ Yes E] No
$200 SEP Fee
Waiver: FO Yes ❑ No
In -kind Support: Police $
Reassigned
Staff $
In -Kind
Total Amount of Request: $ saca
❑ Seniors
❑ Victims
❑ Welfare Recipients
Fire $
S
Other $
Financial Support
$
Public
Works $
Explain
$200 SEP
Fee Waiver
$ 200
Provide a detailed description of how the financial support will be used:

Q
Women
❑
Homeless
❑
Entire Community
CS/Rental $
Total Overall
Request
= $ 100
City of Yucaipa Community Activity Grants Application, Rcv, 03/2023 191 Page 3

4ocuSlgn Envelope ID: 0B95168B-E8C1-4089-89D1-5EBA1EOAA529 What other ilia -kind financial contributions hits your organization received to fund this event/program (separate from City funding)?
In -Kind
Amount
Jersey Mike's Subs (Projected)
$
1,500
Donations to event
$
3,500
$
$
$
Total Funds Received To Date:
$
$
Total Funds Requested Via Grant Application:
$
800
$
Remaining Balance That Will Be Funded
By $
$
Organization:

CAPABILITIES/BUDGETSECTION 6 — FINANCIAL
i
Provide City funding received by organization in the past three years (required):

Program In -bind
Financial
$16.25 SEP
Date
Support
Fee Waiver
Received
Spring Egg Hum 2023
Spring Egg Hunt 2022
Spring Egg Hunt 2021
El
❑
0 0
❑��
f❑
❑
IZI
Financial
Support Amount
Total Received
7/6/2022 $ 310.25
5/27/2021 $ 684
7/ 14/2020 $ 646.25
I, the undersigned, do hereby attest that the above information is true and correct to the best of my knowlcdge, and understand that the awarded financial grant arnount needs to be spent prior to submitting another grant request.

DccuSlpnad by:

Executive Director 5/8/2023
Signature 9=5706FEDFa67... Title Date
Date Received:

Amount Funded: $
5 . — , 3 Date Reviewed:

Type of Grant: Mn-Kind
Date City Council received follow up report:

City of Yucaipa Community Activity Grants Application, Rev. 03/2023 192 City Council Meeting
❑ Financial Support
� 1
❑ Fee Waiver

CHILDHOOD CANCER FOUNDATION
OF SOUTHE-RN CAUPORNIA, TING.

NON-PROFIT CORPORATION
May 8, 2023
Dear friends at The City of Yucaipa,
I'd like to first offer a generous THANK YOU for your continued support of our program and the many families we serve.

On behalf of Childhood Cancer Foundation of Southern California, I wish to respectfully request your support of the Annual Spring Egg Hunt to be held an March 16, 2024.

Receiving non- profit status in September of 1981,ChildhoodCancerFoundation of Southern California, Inc. (CCFSC) is now more than SOOfamilies strong committed to serving children with cancer and their families throughout Southern CaIiforniaemotionally, fir ancially, educationally and with emergency assistance. The Spring Egg Hunt is an excellent opportunity forth e families to interact in a relaxed setting and enjoy an activity with other parents and families experiencing childhood cancer. The Egg Hunt has an average attendance of 150 patients, siblings and parents.

Everytwo minutesa parent hearsthe devastating news, "Yourchild has cancer." With thesewords, normal life stops and a difficult new journey begins, a journey that will test families physically, emotionally, socially, and financially, Families dealing with cancer use every last resource to fight the disease in an effortto keep their child alive.

More children die of cancer than of any other disease, including asthma, diabetes, cysticfibrosis, congenital anomalies and AIDS, COMBINED.

Through this event, Childhood Cancer Foundation of Southern California will serve as an integral support service forchildren and their families facing the challenges that cancer can manifest in their lives on a daily basis and throughout the year. We greatly appreciate your continued support of our children and their families throughout the years. It is donors like you that help us spread smiles and hope.

We would like to respectfully request yourconsideration of a n In -Kind donation of the use of Community Park Facilities in order to help make this event possible. We recognize that our organization is located outside of the community and also request an exception to that requirement as part of the application.

Thank you for your consideration of our request. Should you have any questions or require additional information, please feel free to contact me at (909) 558-3419.

Childhood Cancer Foundation is a 501c3 Registered Non -Profit Organization, 33-0536599.

Respectfully,
W
_A4`
Stephanie Avila
Executive Director
"Where there is li� t� there is hope."
P.O. BOX 1663 LOMA LINDA, CA 92354 (909) 558-3419 1 www.ccfsocal.org

FAI IRS
Dapartmont ormo'Trreaury
i I�tternai Revonuo 9orvlea
In reply refer to: 044186IR93
DGDEN LIT 84201-0038 Mar. 1.21 200.9 LTR 4168C rao
33-0536599 000000 00 000
00029688
DODC: TE

CHILDHOOD CANCER FOUNDATION OF

SOUTHERN CALIFORNIA INC
PO BOX 1663
I'M CODA L INDA CA 97554-- 1663
aa��ea
EMPloyer Identification Number: 33-0536599
per-s-on• to C.or%tact.:, Er -in.. J,n..hnsa,n
Toll Free Telephone Number: 1-877-829-5500
Deep 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)l3) 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 sectlan(s) 509(a)(1) and 170(b)(1)(A)(vi).

Donors may deduct contributions to you as provided in section 170 of the Code. RaquestS, 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 gingham
Accounts Management I
T Monday Apri20'2009.max

5/1123, 3:53 PM
PermitC4ntraCt
Perm it
City of Yucaipa Community
Services
34272 Yucaipa Blvd
Yucaipa, CA 92399
PHONE;(909) 790-7460
FAK:(909) 790-2589
EMAIL;comm unityservlces*yucaipa.org
COMMUNITY�t'

SERVICES ('
Permit # R5309
Status Tentative
Date May 1, 2023 3:53 PM
Expiration Date Apr 30, 2024
Organization Name Childhood Cancer Foundation Of Southern Organization Phone 1 (909) 559-2419 Calif. - 371 Number
Customer Type l flan-Profit-NR (M
organization Andress 11155 Mountain View Ave. Ste. 105
Lama Linda, CA 92354
Agent Name Stephanie Avila Work Phone Number (909) 558-3419 Home Phone Number (909) 558-3419
Email Address [email protected]
System user Tlsh Cl
Rental Fee
$1,000.00
Discounts
$0.00
Subtotal
$1.000,00
Deposits
$100.00
Deposit Discounts
$0.00
Total Permit Fee
$1.100.00
Totai Payment
$0.00
Refunds
$0.00
Balance
$1,100,00
Childhood Cancer Foundation Egg Hunt
3 resource(t:) a booking(s)
cull $1.100.00
Booking Summary

START DATE/TIME

END DATE/TIME

ATTENDEE

I AMT W/O TAX
Mar 16, 2024 7:00 AM
Mar 16, 2024 8-00 PM
150
$500.00
Rental - Da11y
$ 500.00 ! Day x 1
$500.00
Resource level fees
Maw
Facility Deposit
Sl #2 Large
$100.00 / Each x 1
Facilitics)
$100.00
Center! Yucaipa
Community Center
l

START DATEITIME
I

END DATEITIME

I ATTENDEE
1 AMT W/O TAX
Mar 16, 2024 7:00 AM
Mar 16, 2024 8:00 PM
40 $300.00
Rental - Daily
$300.001 Day x 1
$300.00
Special Il Pprmlt5
START DATE/TIMI;
l Event Application)
j

END DATE/TIME
Center-. Community Scrvices

ATTENDEE
Department

I AMT W/O TAX
htlps:llanprod,active,comlyucaipalui.do?method;�showPermitContraci&permiLg-5�8B307860F37 112

511/23, 3:53 PM ParmitContract
Mar 16, 2024 8:00 AM Mar 16, 2024 4:00 PM
Special Event Fee (NIA-V) $200,001 Each x 1 $200.00
X:
150 $200,00
Deposit
EVENT I RESOURCE I bEPQStT FEE I CHARGE 1 TAX I AMOUNT PAID I REFUNDS BALANCE Childhood Amphltheate Facility $100.00 $0.00 $0.00 $0.00 $100.OD Cancer r Deposit
Foundation Egg
Hunt
Payment Schedules Original Balance: $1,100.00 Current Balance: $1,100,00 DUE DATE: i AMOUNT DUE AMOUNT PAID I WITHDRAWAL ADJUSTMENT i BALANCE Mar 2. 2C24 $1,100.00 $0.00 $0.00 $1,100.00
Date:

City of Yucaipa Corr munity Services
Mailing Address: 34272 Yucaipa Blvd, Yucaipa, CA
92399
Ph❑nE Number: (9091790-7460
Fax Number: (909) 790-2589
Email Address: cammunityservices0yucaipe.org
X:

Date:

Childhood Cancer Foundation Qf Southern Calif.

Customer Type: DNU Non-Profit-NR (IV)
Customer ID: 10796
Mailing Address:11155 Mountain View Ave, Ste.105. Loma Linda, CA 92354
Organization Phone 1 Number: (909) 558-3419
Authorized Agent Name: Stephanie Avila
Work Phone Number: (909) 558-3419
Horne Phone Number: (909) $58.3419
Email Address: [email protected]
https:llanprod,active.comlyucaipalui.do?method=showPermitContract$,permiF %C8B307860F37 212

ATTACHMENT 3
197

Fiscal Year:

Date Application submitted:

Submit to:

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

Yucaipa, CA 92399
Attu: Kimberly Metzler

COMMUNITY ACTIVITY GRANT

FINANCIAL / IN -KIND / FEE WAIVER

A PPL I A TI ON
2023-2024
Received
City Of YUcaipa
JUN U 7 2023
General Services/
City Clerk's Department
All sections of the application must he returned coniplc-te and all supporting documentation provided prior to City Council review. Incomplete 11pplicatioins received will ho returned to the applicant.

Name of Applicant/Organization:

Applicant/Organization Mailing Address:

Applicant/Organization Phone Number:
contact (1)
Contact (2)
Ivan-uaipa Nooners Lions Club
12692 5th St. Yucaipa, CA 92399
( 909 ) 2-24-6086
Linda Molina
Name
aresslady0umail.com
Email address
Kachael Ci118tu8011
Name
editorCa)newsmirror.net
Email 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?
(626 )731-2335
Phone Number _
(9U9 ) 915-7311
Phone Number
Yes
No
❑
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, 03/2023 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)? r❑ ❑
47-57 I J;i7li
If yes, please provide Tax ID# and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? © ❑✓ :i-15-15
How long has your 501(c) organization been in existence? Number of Employees working for organization:
a
Number of Volunteers working for organization:

IS a current City Council Member on your board? ❑ Q
51 y000+
How many Yucaipa residents does your organization currently serve? Does the organization charge admission, membership fees, dues, etc.? ✓❑ ❑ $108 per year
If yes, please describe:

Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Lucy Manning, President
Linda Amerault, Secretary
SI?f-r[ON 4 - I'l;`OG14AM DESCRIPTION/SCOPE: (PLEASE USE ADDITIONAL PAGES II' NECESSARY) r. -
Name of the
�.
11-11-23
Date(s) of program/event:

Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) Every year the Yucai pa/Cal i mesa Veterans/Memorial Day committee holds a program to honor Veterans.

City of Yucaipa Community Activity Grants Application, Rev. 03/2023 - - - Page 2

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

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 Number of Residents Projected to Serve: ZVV+
Please identify what your organization is seeking:

Financial Support: Yes 21 No $
$200 SEP Fee
Waiver: j' Yes ❑ No
In,kind Support: Policy $_ _
Fire $�
public
Works $
CS/Dental $ 974
Reassigned
Staff S
Other $ _
Explain
In
$200 SEP
Total Overall
-Kin
Total .Amount of Request: $ 2Dt_
Financial Support
$
Fee Waiver
$
Reques)
�
_ $ t
Provide a detailed description of how the financial support will be used:

Use of the Community YarkAmphitheater and Shelter #1 on Veterans llay (i 1-I 1-zj) trom 1tla1n-1pm City of Yucaipa Community Activity Grants Application. Rev. 03/2023 200 Page 3

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
Total Funds Received To Date:
$
$
Total Funds Requested Via Grant Application:
$
$
Remaining Balance That Will Be Funded
By $
$
Organization:

SECTION 6 — FINANCIAL CAPABILITIES/BUDGET
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
Veteran,; Day
2UM
421.25
Veterans Day
'❑❑
d
$
Veterans Day
2022
_
❑✓
0 $_
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 grant reqquest. ��9' Interim Chair 6-5-23
Signature Title Date
Date Received:

Amount Funded: $
LC-`?--O.,
Type of Grant: In -Kind
Date City Council received follow up report:

Date Reviewed.

City Council Meeting:
❑ Financial Support
kY'I-te n
Le r'p.te - 9,D
❑ Fee Waiver
City of Yucaipa Community Activity Grants Applicatinn, Rev. 03/2023

CIII IIN L]00LI( )I I LUITIM k011 A I EI,sac iaiton oL Ilons clltus llips.l Lipp.s.Irs.gow; tPp Qw.1GCtt1IISL'L1g'V:UIJI-41-31 ►Y,3 j L[IUIUC-- Q HELP@ MENU
'ome > -fax Exempt organization Search > international Association Of lions Clubs < Back to Search results
international Association Of Lions Clubs
EIN: 47-3719378 1 Yucaipa, CA, United States
_:�.•�n YRAxnts6a Al=:mr - ------,.���--='"�errc4an�P:s�.lar�Rss.•••••,•••••�••'^�•••�•R•••u;•••••�-•"•YILsrLwwF4nx.Fu+..�;,w j Other Names

CALIMESA YUCAI PA NOON ERS LIONS CLUB
'orm 990-N (e-Postcard) o
organizations who have filed a 990-N (e-Postcard) annual electronic notice. Most small organizations that receive less than $50,000 fall into this category.
} Tax Year 2018 Form 990-N (e-Postcard)
Tax Period.
2018 (07/01/2018 - 06/30/2019)
FIN:
47-3719378
Legal Name (Doing Business as):

International Association Of Lions Clubs
Mailing.Address:
13491. La Paz Ct
Yucaipa, CA 92399
United States
Principal Officer's Name and Address:

Linda Arnerault
248
i uC?
13491. La Paz Ct 202 51212021. 8:51 At

City of Yucaipa
communtiy Services Rental Fees
Picnic Shelters
Deposit Daily Fee
Small
(Community Park #3,4,5,6,7,8) (Wildwood #1) (7th St. #1) --- $ 187.00 Medium
(Community Park #3&4 & 5&6) (7th St. #213) --- $ 287.00 Large
(Community Park #2 includes electricity) (7th St. #4) - $ 387.00 Amphitheater
(Community Park) $ 100.00 $ 587.00
Resident Discount ._ I lo%
Shelter fees include daily fee and insurance fee.

Athletic Fields
Per Field - Hourly Fees

DEPOSIT
Youth Sports $ 100.00 $ 10.00
Adult Sports $ 100.00 $ 30.00
Lights — 10.00
All athletic field reservations require insurance. Prices may vary. 7th Street Pool
Deposit
*7th Street Pool
Resident Discount
$ 100.00
$ 200.00
—
10%
I *Two (2) hour minimum
Date modified: 5111/2023
203

ATTACHMENT 4
204

Fiscal Year:
2023-2024
Date Application submitted: 6-1-2023
Submit to:

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

Yucaipa, CA 92399
Attn: Kimberly Metzler

FINANCIAL / IN -KIND /,FEE WAILER

APPLIA TION
Received
City of ` LICcilp-1
JUN 0 5 29B
Gener,ai Services/
City Clerk's DePartl11ent
All sections of the application must be returned complete and all sul)porting cloctllnentation provided lyrior to City C:oitneil reviciv. Incomplete applications received will he returned to the applicant.

Inland Leaders Charter School
Name of Applicant/Organization:
_
12375 California St. Yucaipa, CA 92399
Applicant/Organization1Vlailing Address;
Applicant/Organization Phone Nuiribcr: 909 446-1100
Jeremy Hoch
Contact (1) (909 ) 705-9507
Name Phone Number
jhoch(Pinlandleaders.com
E-mail address
Mike Gordon
Contact (2) (909 ) 446-1100
Name Phone Number
[email protected]
E-maiI address
Yes
No
IS your organization located in another community?
❑
0 Wi 11 the programlevent take place in another community? ❑
❑✓
Are you aware of any other City program providing this service`? ❑
❑✓
If so, which one?
,iryou answered "Yes" to any of the questions listed above, your request is not eligible for the Community Activity Grant.

City of Yuc:aip.r Conmitmhy Aclivily Gcanls Applic,11 1. RCV, 031?U33 Pt�gc 1

SEU.1'10N 3 — ORGANIZA'rION INFORMATION/APPLICANT 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
1s your organization a 501(c)?
20-8343378
If yes, please provide Tax iD# and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? 0 E]
How long has your 501(c) organization been in existence? IS years Number of Employees working for organization: 120
Number of Volunteers working for organization; 100
Is a current City Council Member on your board?✓
I -low many Yucaipa residents does your organization currently serve? 650 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 Jimenez President
Michael Casavan
Jacob Rosario
Bonnie Mitchell
Eli Gillespi
Mike Gordon
Treasurer
Member
Secretary
Member
Director
SECTION 4 - PROGRAM DESCRIPTIONlSCOPE; (PLEASE USE ADDITIONAL, PAGES IF NECESSARY) Name of the programlevent- Volleyball Games
Date(s) of programlevent:

Aug 29, 31 September 5, 7, 14, 19, 21, 26, 28 October 5, 10, 17 Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) Cite of Yucaipsr Community Activity Grants Application. Rev. 03/2023 206 110gc 2

Describc haw the program/event benefits the residents and/or community of Yucaipa:

We believe that athletics are an important part of the educational experience at Inland Leaders Charter School.

Our students benefit 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/1lvent Primary Target Population (check all that apply):
0 Children or Youth
❑
Seniors
❑
Women
❑
Low Income
❑
Victims
❑
Homeless
❑ Persons with Disabilities ❑ Welfare Recipients ❑ Entire Community Number of Residents Projected to Serve: C- D'� r'? " n i SECTION 5 CRANT FUNDING REQUEST
Please identify what your organization is seeking:

Financial Support: ❑ Yes 0 No S
$200 SEP Fee
Waiver: ❑ Yes Q No
Public
In -kind Support: Police $ Fire $... Works $ CS/Rental $ 1 ROQ Reassigned
Staff $ Other $� T Explain
$200 SEP Total Overall
In -Kind Financial Support Fee Waiver Request
Total Amount ol'Request: $ 1800 $_ — $ - $18QQ
Provide a detailed description of how the financial StIppatl will be used:

Our sports program is in need of a gym to host our home volleyball games. We have 12 home volleyball games. The dates of the games can be moved to help the community center out with scheduling.

City ul'Yucaipa Community Aetiviry Grants Applicatis}n. E;ev. I?3!2 0 207 Wage 3

SECTIONC i
What other in-kind/financial contributions has your organization received to fund this even tlprogratn (separate from City funding)?
In -Kind
Amount
NA
S
Total Funds Received To Date: S
Financial
Support Amount
"Total Funds Requested Via Grant Application: $ $
Remaining Balance That Will Be Funded By $ $
Organization:
i M
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
Community Center Gym Sprine, 2018 2500
0 El El $_
Community Center Gym El ❑ © Spring 2019 3000
Community Center Gym ❑ ❑ ❑ Spring 2022 _ $2835
SECTION 7 — CERTIFICATION i
I, the undersigned, do hcreb at lest that the above information is true and correct to the best of my knowledge, and understand that t'he nwa • 1 1 it ,111� or, i »ount needs to be spent prior to submitting another grant request.

Athletic Director 6-1-2023
Sign Title Date
COMPLETEDF0 RE BY CITY
Datc Rcccivcd: Le — , Dale Reviewed: Le — Yo - 9 1
Atnount Funded: _ City Council Meeting:

Type of Grant: [/ln-Kind ❑ Financial Support ❑ Fee Waiver Date City Council received follow up report'
City of Yucaipa Cornmuni[y Activiiy GrunRs Applicution, Rev. 03/2023 208 Page 4

Permit
City of Yucaipa Community PHONE:(909) 790.7450
Services PAX;(909) 790-2589
34272 Yucaipa 91vd EMAIL;tammurlitys ervrces(2yu€ntpn,crrt Yucaipa, CA 92399
Organization Name Inland Leaders Charter School -170
Customer Type Non -Profit iIR)
Organizatlon Address 12375 California St
Yucaipa, CA 92399
Agent Name Jeremy Hoch
System User Julia case
ILC.S Volleyball
COMMUNITY pllakc

SERVICES
%I IiC?t:.tl
Permit # R5405
Status Tentative
Pate Jun 1, 2023 10:54 AM
Expiration Date May 31, 2024
Home Phone Number (909) 705.9507
Email Address jhocllyriniandlonders,com
Rental Fae
$1,800.00
Discounts
$0.00
$umotal
$1,800,00
Deposits
$100.00
Deposit Discounts
$0.00
Total Permit Foo $1.900.00
Total Payment $0.00
Refunds $0,00
Balance $1,9C)0.00
1 resouree(s) 12 bookitiy(s) Subtatol: $1,900.00
Booking Sumrn,ry
North
I
r r r
START DATCiTIME

END DATEITIME

ATTENDEE
AMT W10 TAX
Aug 29, 2023 2:45 PM
Oct 17r 2023 5:15 PM
--
$1,300.00
Occurs on selected dates: Aug 29,
2023, Aug 5+, 2023, Sep S. 2023- Sep 7, 2023, Sep 14. 2027. Sep 19, 2023. Sep 2r. 2023. Sep 26. 2020, Sep 29 2022. Oct 5, 2023. Oct 10. 2023, Oct 17, 2023
Aug 29, 2023 2:45 PM
Aug 29, 2023 5:15 PM
25 $150.00
Rental - Hourly
$60.00 11 x 2.4
$150 00
Aug 31, 2023 2:45 PM
Aug 21, 2023 5:1S PM
25 $150,00
Rental - Hourly
SEO.00 I Hour x 2.5
$150.00
Sep 5, 2023 2A5 PM
Sep 5, 2023 5:15 PM
25 $150,00
Rental • Hourly
$60.00 1 Hour x 2.5
$150.00
Sep 7, 2023 2AS PM
Sap 7, 2023 5:15 pM
25 $150.00
Rcnlal- Hourly
$60 00 1 Hour x 2.5
$150.00
Sep 14. 2023 2AS PM
Sap 14, 2023 515 PM
25 $150.00
Pon int -Hourly
$60 00 1 Horn x 7 5
$150.00
Sep 19, 2023 2:45 PM
Sep 19. 2073 5:15 PM
25 $150.00
t (munt -HOW ly
560.00 , Hour x 2 5
$750 Da
Ji R5405 Status Tentative

209

$gip 21, W23 2:45 PM
Rcnml - Ha l
Sep 25. 2023 2:45 PM
RC'Iltai • hltufiv
S�o.oa � Hour x 2.5
$1

50.40 Waivers and lnformgtlen
25 $150.00
25 25
25 25
25 $150.00
$150.00
$150.00
$150.00
$150.00
$='00

INFORMATION DESCRIPTION SIGNING STATUS
Alcohol Sales Lic Ch"ked
Proof of Liability tnsurance Chotked
Securely Guard Conlrflct Checked
Proof Qf NQn Profit Status Checked

WAIVER NAME DUE DAIS FOR SIGNING STATUS
Facility Usage WBrver Aug 29. 2023 Waiver Signed
Facility user hereby agrees to indemnify, defend and hold harmless City of Yucaipa. Its officers. officials, 2mployoes and volunteers from and against ell claims. Damages, losses and expenses that may arise during or be caused in any way by suchility u otcupency or use of facilities, but the i ser
shall not be liable for any claims• damages, lasses and expenses caused by the sale negligence or willful misconduct of the City of Yucaipa.

Permittee shall have received any and all permisalQn or dcense(s) as may be reCtUired to parform or use any protected materials in its use or the Premises. Permlttoo agrees to prptect and save harmless the C11y, its elected officials, employees and agents from and against any and all claims, penalties• andlor damages which may accrue as o result of Parmittea's failure to comply with this requirement_ I have read the rules and regulations relating to use of facilities and accept responsibllity for meeting the requirements stoted herein. ♦:WENT RESOURCE f1F.P051T FEE
ILCS Gymnasium, Dcposlt
Volleyball North
P lynlUfll 5c:l+r;w�uiva..

DUE DATE AMOUNT DuE
# R5405 Status Tentat}ve
Signature
CHARGE TAX AMOUNT PAID REFUNOs BALANCE
$100.00 $0.00 $0.00 $0,00 $100 00
Original Salancre: $1,g00.00 Current Balance: $1.900.00

AMOUNT PAID WITHDRAWAL ADJUSTM ENT BALANCE

210

Aug 15, 2023
K
Date: I f�
$1,900.00
City of Yucaipa Community Services
Mailing Address: 34272 Yutaip3 Blvd, Yucaipa. CA
92399
Phone Number: (909) 790.7460
Fax Number: (90gi 790.2589
Email Address: commLin ityservices0yucaipa.arg
$0.00
x:

Dere:
$0.00 $1.300.00
inland Leaders Charter School
Customer Type: Non-Profli (R)
Customer ID: 11233
Mailing Address: 12375 California St, Yucoipa, CA
92399
Authorized Agent Name: Jeremy Hach
Hama Phone Number; (909) 705-9507
Email Address: [email protected]
# R5405 Status Tentative Page 3 of 3
211

ATTACHMENT 5
212

Fiscal Year:

Date Application submitted:

Submit to:

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

Yucaipa, CA 92399
Attn: Kimberly Metzler

COMMUNITY ACTIVITY GRANT

FINANCIAL / IN -KIND / FEE WAIVER

APPLICATION
2023-2024
6M2023
Received
City of Yucaipa
JUN 0 6 2023
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. Incomplete applications received will be returned to the applicant.

Name of Applicant/Organization:

Applicant/Organization Mailing Address:

Applicant/Organization Phone Number:

Contact (1)
Contact (2)
Redlands Bicycle Classic, Inc.

P.O. Box 7880 Redlands, CA 92375
(909 ) 963-9099
MarC Shave ( 909 ) 963-9099
Name Phone Number
mshaw@redlandsclassic,com
E-mail address
Ed Purves { 909 ) 208-5352
Name Phone Number
[email protected]
E-mail address
Yes No
Is your organization located in another community? ❑ 0
Will the program/event take place in another community? ❑ 0 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. 03/2023 213 Page t

SECTION 3 — ORGANIZATION INFORMATION/APPLICANT 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)?
✓❑
❑
If yes, please provide Tax ID# 33-0231753 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? 30 Number of Employees working for organization: 0
Number of Volunteers working for organization: 350+
Is a current City Council Member on your board?
C]
0 How many Yucaipa residents does your organization currently serve? All Does the organization charge admission, membership fees, dues, etc.? ❑
J❑
If yes, please describe:

Names and Titles of Officers and Board of Directors: (please attach an organization chart, if available) Marc Shaw Executive Director / President
Eric Reiser Vice President
Craig Kundlg Vice President
Ed Purves Vice President
Colleen Gamboa Vice President
Melissa Valdez Treasurer
Andrea Jo:rgensen. Secretary
SE rPROGRAM IreE: (PLEASE USE ADDITIONAL
Name of the program/event: Redlands Bicycle Classic
Date(s) of program/event: April I 0-14, 2024
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with programlevent) The Redlands Bicycle Classic, Yucaipa Road Race, will occur as part of the 2024 Redlands Bicycle Classic. The event is a five day professional bicycle race, which has been held for the past 37 years. It is known as one of the top cycling events in the country. In addition, the race includes youth events for local children. Leading up to the event, professional cyclists visit local schools to promote healthy lifestyle habits and encourage kids to be active and practice safe bicycle riding habits. Each year, cyclists visit approximately 35 schools and see over 10,000 students.

City of Yucaipa Community Activity Grants Application, Rev. 0312023 214 Page 2

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

The Redlands Bicycle Classic is an all -volunteer organization, managed by the Redlands Bicycle Classic Organizing Committee, comprised of active community members that seek to promote cycling and its benefits in Redlands and the surrounding communities. The event was founded in 1985 by a community group, chaired by Then -Mayor Carole Beswick, to promote awareness of downtown Redlands. Since that time, professional cyclists from around the world have been racing the event, which is centered in the city of Redlands, California, The event has expanded to several surrounding communities to expand the original scope of the organization, including the City of Yucaipa.

The event continues today invigorated by the RBC Organizing Committee's adoption of, and commitment to, the events' core virtues of Health, Diversity, and the Environment. As a part of that effort a school visit program has been expanded. This program involves the professional cyclists who participate in the race and help promote the benefits of a healthy and active lifestyle, The Redlands Bicycle Classic is on the USA Cycling (USAC) Pro Road Tour national calendar of events, As such it brings national attention to local communities.

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

FRI Children or Youth
❑ Low Income
❑ Persons with Disabilities
Number of Residents Projected to Serve; Soo
Please identify what your organization is seeking:

Financial Support: ❑ Yes Z No
$200 STEP Fee
Waiver: 0 Yes ❑ No
❑ Seniors
❑ Victims
❑ Welfare Recipients
❑ Women
❑ Homeless
❑ Entire Community
Public
In -kind Support: Police $ 10,000 Fire $ 250. Works $ 250 CS/Rental $ Reassigned
Staff $ Other $ 175. Explain
$200 SEP Total Overall
In -Kind Financial Support Fee Waiver Request 1 CAr r�
Total Amount of Request: $ 10,575 $ $ 200. = $ 10,875
Provide a detailed description of how the financial support will be used:

Police support will be used to control traffic at various key intersections on the course (see attached maps) and officers who will provide escort for the rolling enclosure of the professional races, Public works support will be for the placement of warning signs prior to event.

City of Yucaipa Community Activity Grants Application, Rev. 03/2023 215 Page 3

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

Total Funds Requested Via Grant Application:

Remaining Balance That Will Be Funded By
Organization:

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

Program In -Kind Financial $16.25 SEP Date
Support Fee Waiver Received
2023 Event
2022 Event
2019 Event
Financial
Support Amount
Total Received
❑ 0 $ 9691.25
❑ Q $ 9691.25
❑ ❑ 0 $ 9687
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 grant request. -2- Execrative Director- 6i7i2024
Signature Title Date
Date Received:

Amount Funded: $
V —k — 9''5
Type of Grant: In -Kind
Date City Council received rollow up report:

Date Reviewed:

City Council Meeting:
❑ Financial Support
❑ Fee Waiver
City of Yucaipa Community Activity Grants Application, Rev. 03/2023 216 Page 4

Yucaipa Fire Request Form (Exhibit B)
Attachment to the Community Activity Grant Application/SEP Process Name of Applicant / Organization
Mailing Address:

Fiscal Year: 2023-2024
Date Application submitted: 6/6/2023
Redlands Bicycle Classic, Inc.

P.O. Box 7880 Redlands, CA 92375
Phone Number: (909) 963-9099
Contact: Marc Shaw (909) 963-9099
Name Phone Number
[email protected]
E-mail address
Applicant Signature: W0410Ems- Title: Executive Director SECTION 2 — EVENT INFORMATION
Event Name: Redlands Bicycle Classic
Event Location: Yucaipa (and surrounding areas)
Event Date: 4/11 /2024 Event Time: 0600-1600
Estimated Event Attendance Number: 800
Number of Fire/r,MS Requested;
,Bates Requested:

Additional Information:
4/11 /2024 Times Requested: TBD
Ongoing discussions with Fire Department and related
fire personnel in preparation for the event and on race day.

Reviewed by:

Signature:

Title:

Total Cost forin-Kind Requesl.

Date
City of Yucaipa Community Activity Grants Application, Rev. 03/2023 217 Page I

Yucaipa Police Request Form (Exhibit A)
Attachment to the Community Activity Grant Application/SEla Process Name of Applicant / Organization
Mailing Address:

Fiscal Year: 2023-2024
Date Application submitted: 61712023
Redlands Bicycle Classic, Inc.

P.O. Box 7880 Redlands, CA 92374
Phone Number: (909) 963-9099
Contact: Marc Shaw (909) 963-9099
Name Phone Number
[email protected]
E-mail address
Applicant Signature: c G— Title: Executive Director
Event Name: Redlands Bicycle Classic
Event Location: Yucaipa (and surrounding areas)
Event Date: 4/11 /2024 Event Time: 0600-1600
Estimated Event Attendance Number: 800
Number of Officers Requested: Sworn Officers:

Dates Officers/COPS Requested: 4/11 /2024
Citizen Patrol (COPS):

Times Officers/COPS Requested: 0600-1600
Equipment Requested Patrol Car: ■❑ Motorcycle: ❑ Other: ❑ Additional Information: Total number of personnel to be determined during meetings with Yucaipa PD, CHP and RBC staff. The number of fixed post officers will likely be six, with two lead vehicles and Citizen Volunteers.

Reviewed by:

Signature:

Title:

Total Cost far In -Kind Request:

Date
City of Yucaipa Community Activity Grants Application, Rev, 03/2023 218 Page i

Public Works Department bequest Form (Exhibit C)
Attachment to the Community Activity Grant Application/SEP Process Name of Applicant / Organization
Mailing Address:

Fiscal Year: 2023-2024
Date Application submitted:

Redlands Bicycle Classic, Inc.

P.O. Box 7880 Redlands, CA 92374
Phone Number: (909) 963-9099
Contact: Marc Shaw (909) 963-9099
Name Phone Number
[email protected]
E-mail address
Applicant Signature: V— Title: Executive Director
Event Name: Redlands Bicycle Classic
Event Location: Yucaipa (and surrounding areas)
Event Date: 4/11 /2024 Event Time: 0600_1 600
Estimated Event Attendance Number: 800
Number of Public Works Staff Requested:

Equipment Rentals and Quantity Requested:
❑ Cones
Dates Requested:
❑ Delineators
4/11 /2024
❑ Street Closures
times Requested:
❑ Signage
0600-1600
Projected Staff Time Expense: $ Equipment Expense: $
Additional Information: The City of Yucaipa normally has Public Works staff available on the day of the event, however, all cones, barricades, and signage will be provided by BBC's contracted traffic management company.

Reviewed by:

Signature:

Title:

Total Cost forin-Kind Request.

Date
Cily of Yucaipa Coinrnunity Activity Grants Application, Rev. 03/2023 219 Page t

SICYCLC CLASSIC
City of Yucaipa
34272 Yucaipa Boulevard
Yucaipa, CA 92399
Dear Elected Officials and City Staff:

On behalf of the Redlands Bicycle Classic Committee, we are excited to approach the City of Yucaipa with our intent to conduct the Redlands Bicycle CIassic in your city on April 11, 2024, and throughout the region from April 10-14, 2024.

As promised during the 2023 event approval process, the Redlands Bicycle Classic staff worked diligently with city staff to improve traffic flow and overall logistics for this year's race, and we are very pleased with the progress we achieved. We certainly could not have done it without the help of city staff, and we look forward to continually improving as we embark upon planning for 2024.

We remain committed to hosting this nationally renowned cycling competition and community event in a safe and responsible manner, while bringing recognition and revenue to the city. In exchange, we are soliciting the support of the City's leadership through their waiver of the costs and fees associated with our event. We fully understand and support the City Council's focus on fiscal responsibility. With that, we remain confident that you will continue to see that the value of the Classic far exceeds the costs incurred. In terms of value, we realize it is very difficult to quantify a specific dollar amount associated with many of the benefits this event provides. However, I would like to take a moment to share the following perspective on what the Classic means to our communities.

Value to the City
The positive exposure to the city is extensive and difficult to measure. Marketing the Classic translates into marketing the City of Yucaipa. Our in -kind media sponsor partnerships include a large cross section of all media capacities, and our message reaches hundreds of thousands of viewers, with total media impressions in the millions. Our partnerships with twelve inland area radio stations and local mews groups, including the Redlands Community News, Yucaipa News Mirror, San Bernardino Sun and Redlands Magazine focus on inviting spectators to come to the region to enjoy our famous hospitality, while watching an exciting world -class event and inviting them to patronize our local hotels, restaurants and stores.

Additionally, the Classic is covered by Every local news organization in an editorial capacity with stories and images from each day's events. It is well known throughout the media circles, and it is a "must cover" event. We have worked diligently to increase the exposure for the City of Yucaipa through the Classic.

P.Q. Box 78BO Redlands, CA 92375 www.redlandsclassic.com 220

Value to local businesses
Many Yucaipa businesses benefit from the participants, their families and spectators who travel here from out of the area. Whether they are staying with local host families, dining in restaurants, purchasing fuel, or shopping in local stores, 'Yucaipa businesses enjoy an uptick in business when the Classic comes to town.

Value to the community
In addition to providing the United States with a top-notch professional cycling event, the Classic provides so much more. We offer the opportunity for people of all ages to experience the thrill of an exceptionally organized event. Our school visit program allowed professional cycling teams to visit 35 schools and see nearly 12,000 children in 2023.

Our partnership with the city of Yucaipa has been tremendous over the years and we sincerely appreciate the relationship we have developed. We have worked diligently with each of the city departments to minimize the impact the event has on their operations. We provide Race Marshals to reduce traffic control expenses by the Police Department. We provide doctors from Loma Linda Medical Center to lessen the impact on the Fire Department. Lastly, we coordinate with Public Works in order to have signs, barricades and traffic control at key locations.

As we embark upon planning for the 3$th edition of this event, your support and investment are key in the continued success of the Classic. We feel strongly that the Classic is a part of what makes our communities special, and we are very proud to have a small part of making this community a wonderful place to call home. In closing, on behalf of the 500 community volunteers that make up our team, I thank you for your continued support in 2024.

Sincerely,
441C19-
Marc Shaw, Executive Director
Redlands Bicycle Classic, Inc.
221

WELCOME TO THE CITY OF YUCAIPA
Thank you for your interest in hosting a Special Event in the City of Yucaipa. The Community Services Department
created this application to help you host a successful and exciting event here in Yucaipa. Please review and complete the following application in accordance with the provided information. A special event in the City of Yucaipa is
defined as a "Carnival„, "Community Celebration", or
"Outdoor Festival" which includes the use of amplified
sound and/or estimated attendance equal to or exceeding 300 people on City or private property. Except as otherwise provided by state law, no person or entity shall operate, maintain, conduct, advertise, or provide admission for any temporary special event within the City of Yucaipa without possessing a permit for each such temporary special event (Ord. No. 384).

CITY OF

PROCEDURES
A complete permit application may be filed as early as one (1) year before the event, but it must be received no later than three (3) months before the actual event date. Any organized activity involving the use of, or having impact upon, public property, facilities, public parks, sidewalks or street areas requires a permit. Applicants requesting a waiver of fees or services must submit their application a minimum ofsix (6) months in advance.

The permit application process begins when you submit a complete Special Event Permit application. Keep in mind that acceptance of your application should in no way be construed as final approval or confirmation of your request. Upon receipt of your application, the Special Events Supervisor will help guide you through the permit process. Copies of the application are forwarded and reviewed by all affected departments and/or agencies. During the review process, you will be notified if your event requires any additional information, permits, licenses or certificates. During our initial application screening process, you will be allowed time to provide us with all pending documents, We must receive these items before issuing a Special Event permit (i.e,, certificates of insurance, secondary permits, etc.). Delays in providing these items often delay our ability to finish our review and approve your application in a timely manner. Special Event Permits can be approved administratively by City management under specific limited criteria. Events that exceed those criteria will require the approval of City Council:

City Management/Administrative Approval
• Estimated attendance 300-999 persons
• Amplified Sound (excluding Special Event Facilities)
City Council Approval
• Estimated attendance 1000+ persons
• Alcohol Service (excluding Community Centers and YPAC) • Street Closure -- traffic management
• Fee Waiver/Co-Sponsorship/In-Kind (Community .Activity Grant Application required)

APPLICATION
11Page
222

Organization and Applicant Information
El Commercial (For -profit) 9Noncommercial (Non-profit) Tax I.D. #: -� � 753 Organization
Name
Redlands Bicycle Classic, Inc.

Applicant Name
Marc Shaw
Address
P.O. Box 7880 Redlands, CA 92375
Email
[email protected]
Phone Number
(909) 96 -9099
On -Site Contact
Ed Purves
Phone number
(909) 208-5352
Event Information
Type of Event: © Athletic/Recreation ❑ Festival/Celebration ❑ Outdoor Market ❑ Circus/Carnival
❑Concert/Performance ❑ Parade/Processidn/March ❑Other (specify):

Event Title
Redlands Bicycle Classic
Event Location
Yucaipa (see attached map)
Event
This is a multi -day professional bicycle stage race that occurs throughout the region. On this Description
particular day, professional cyclists will race In the City of Yucaipa, as well as the unincorporated areas of Mentone and Oak Glen. The men's field is normally 200 riders and the women's field is close to 125 participants, The Redlands Bicycle Classic is the longest continually running professional stage race in the country and 2024 will mark the 38th year of the event. Yucaipa has hosted a stage for many years and it is a highlight of the race.

Please complete a daily breakdown of event -related activities. Use multiple lines to distinguish between different daily activities. Please attach additional sheets if necessary.

Date(s)
Daily Activity
Start Time
End Time
4/11/2024
■ Set-up ■ Event Day ■ Clean-up
0600
1600
❑ Set-up ❑ Event Day ❑ Clean-up
❑ Set-up ❑ Event Day ❑ Clean-up
❑ Set-up ❑ Event Day ❑ Clean-up
Set-up Event Day ❑ Clean-up
❑ Set-up ❑ Event Day ❑ Clean-up
Has this event taken place before? ❑■ Yes ❑ No How many years? 37 Total anticipated attendance: 800 Participants: 325 Spectators: 475 2 1 P a g e
223

Site Plan
Attach a diagram showing the overall layout and setup locations using the letters below.

Indicate the site for these on your diagram.

A. Alcoholic and nonalcoholic concession and/or beer garden, areas B. First -aid facilities and ambulance locations
C. Tables and chairs
D. Fencing, barriers and/or barricades
F. Generator locations and/or source of electricity
F. Canopies or tent locations
G. Booths, exhibits, displays or ,. ,..
enclosures
H. Scaffolding, bleachers,
platforms, stages,
grandstands and related
structures
I. Vehicles and/or trailers
J. Other related event
components not covered
above (describe
separately)
K. Trash containers and
dumpsters
L. Non-food vendor locations
M. Food concession and/or
food preparation areas
N. Potable toilet locations)
Sample Site Plan:
' • 9[T
cl x
ti M
�u 84'x40'
..11... _ 3
fM ri[ST G. Yf, aa3Y tend}y ia6afi
' r F ,. 10-� ta.. C. NNW
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Y
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iYJ.n..,.ma axa.l L9 91
' •W.brl.u..l
When planning a moving route, the Yucaipa Police Department is available to assist you in planning your route. Consider the following in your planning:

Impedance of emergency fire, police or paramedic vehicles.

Conflict with public transportation, such as buses.

Interference with people trying to reach their own residences, businesses, places of worship and public facilities.

If your event involves street closures, you may be required to obtain traffic safety equipment, and a certified traffic control plan. Depending on the type of event, barricades, traffic cones, signs, etc., may be required. Depending on the type of event and after evaluating roadway conditions, you may be required to properly place this equipment prior to commencing the event. If the closure creates a potential hazard, your organization will be required to contract traffic service from the Yucaipa Police Department and/or Street Division. 3 1 P a g e
224

List street(s) requiring closure as a result of this event. Include street name(s), day, date, and time of closing and time of reopening:

See attached information. RBC contracts with a traffic management company to provide traffic control devices and installation. Additionally, RBC works with the City of Yucaipa and Yucaipa Police Department to plan road closure and detour routes. Yucaipa Police Department staff and volunteers will assist in staffing designated routes in order to ensure safe traffic flow. Additionally, RBC volunteer race marshals will provide assistance staffing road closures and detours. Finally, RBG moto staff will provide escorts to motorists who need to reach restricted areas of the course during the event.

Indicate how this closing/reopening of streets will be handled. ❑■ City of Yucaipa to handle (cost to be specified) Al Event to handle per CalTrans standards
List street(s) requiring the posting of "No Parking" signs. Indicate days, dates, and times needed and an explanation of necessity of "No Parking" zone:

The only "no parking" signs that need to be posted are on Sunnyside, north of Oak Glen Road. Those will be posted and removed by our contractor, TMI. They handle all road closure signage and traffic control devices for the course, pursuant to specifications provided.

Note; "No Parking" signs will be posted forty-eight (48) hours in advance of required days, dates and times. cost for the postingaf "No Parking"signs will bespecified upon reviewafthe application byCitystaff.

Food and Beverage
Please describe how food will be served at the event:

None
Will food be cooked in the event area? ❑ Yes [W No
Method: ❑ Gas ❑ Electric ❑ Charcoal ❑ Other (specify):

Does the event involve the sale or use of alcoholic beverages? LJ Yes I■J No If alcohol is to be sold, how will the alcohol sales be regulated? Who will be handling the alcohol sales?
Restrooms
Portable restrooms are required when estimated attendance exceeds what the host facility's restrooms can accommodate. One portable restroom is required for every SO patrons attending over the minimal site accommodations.

Will Event Organizer provide portable restroom facilities? 9 Yes ❑ No 4 1 P a g e
225

Company
Warne
White House Sanitation
Contact Name
Ryan Blackburn
Phone Number
(951) 943-1550
Lighting
If this is an evening event, please state how the event and surrounding areas will be illuminated to ensure the safety of the participants and spectators. (If required, show a separate site may which details streetlights, vartable lights, and other illuminating devices.I None
Waste Removal
Event Organizer is responsible for arranging for the removal of all waste related to the event.

This includes but is not limited to emptying of trash bins and the removal of waste from the event site and other affected areas. If hiring a professional sanitation company, please rovide the tono ing information.

Company
Name
Contact Name
Phone Number
If nc�t hiring a professional sanitation company, please provide the following information for heperson(s) responsible for waste removal.

Contact Name Ed Purves
Phone Number- (909) 208-5352
Cal Fire/Medical
In case of an emergency, the on -site contact will call 9-1-1. If event requires an ambulance comnanv to be on�site. nlease nrovide the followinr3 information:

Company
Name
AM
Contact Name
TBo
Phone Number
(909) 793-7676
91Page

Please describe your medical plan including your communications plan, the number, certification levels (MD, RN, Paramedic, EMT) and types of resources that will be at your event and the manner in which they will be managed and deployed. Your plan should include hours of setup and dismantle of medical aid areas. You may attach the plan to this application if necessary:

RBC utilizes a team of physicians from Loma Linda University Medical Center to provide medical care for race participants. This includes a first aid tent at the start/finish area, as well as physicians in vehicles as part of the race caravan.

Additionally, Cal Fire and AMR will have units staged in strategic locations to assist with any incidents that arise.

Police Services/Securiity
In the event that a carnival/street fair and/or alcohol service will be included in the event, an
alcohol garden and security plan will need to be submitted as well as a security contract and/or public safety staffing plan for review by the Police Department.

Is there a professional securiV organization hired for this event? [-]Yes ■❑ No Company
Name
Contact Name
Phone Number
Please describe your security plan including crowd control, internal security or venue safety, Dx attach the plan to this application:

Yucaipa Police Department will be on site during the event and available to assist with any security -related needs, should they arise.

Entertainment
Will sound amplification be used? 0 Yes ❑ No Start time: 0900 End time: 1500 Are there any musical entertainment features for this event? [—]Yes K No Name ofAct Public Address Announcer only
Contact Name
Phone
Number
How many stages? Number of bands? Genre of music:

Will fireworks, rockets, or other pyrotechnics be used? ❑ Yes © No Company
Name
6 1 P a g e
227

Contact Name
Phone Number
Describe (indicate dates, times and Iocations for launching and fallout areas):

N/A
Has a permit been issued: U Yes U No
(Note; Additional permits maybe required as indicated by staff. These include, but are not limited to, Conditional Use Z4 Permit, Land Use Permit, and Fire Department permits.) Insurance
Before a Special Event Permit is issued, a certificate of insurance must be submitted.

Insurance certificate must be issued by insurance underwriters "admitted" by the California Insurance Commission and rated 'A' or better by AM Best. Requirements are:

Minimum $1,000,000 General Liability Limit
• Minimum $1,000,000 General Automobile Liability
• Minimum $1,000,000 Worker's Compensation
• On an additional insured endorsement, the City, its elected officials, officers, and agents are to be named as additional insured
• Minimum limits of coverage may change depending on event 0 Insurance certificate attached ❑ Insurance certificate on file ❑ Insurance certificate not available
Filing Fees
Special Event Permit Application Fee: $200.00
* Other Fees may apply (e.g. street closures, Fire Permit/Inspections, utilities, facility rental, etc.)
7 1 P a g e
228

Application Checklist
1■❑ Completed Application
■❑ Certificate of liability insurance
❑M Site Plan (location of structures, lighting, restrooms, parking, etc.) ❑ Copy of Security Contract (if applicable)
❑ Copy of Potable Restroom purchase order (if applicable) ❑ Facility or Shelter reservation Application (if applicable) ❑ Copy of ARC license (if applicable)
❑ Copy of County Health Permit (if applicable)
By signing below, I agree to indemnify, hold harmless, and defend the City and its officials, employees, and agents, against all claims, liabilities, and losses arising from activities connected with or undertaken pursuant to the Permit. The City is not liable for any business loss, property loss, or other damage that may result from the use of the Permit, or suspension or revocation of the Permit.

Name: Marc Shaw
Signature: Date:6l712424. _
8 1 P a g e
229

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CERTIFICATE OF LIABILITY INSURANCE
GATEon'Yrrl
1r13/2anoz3
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS

CERTIFICATE DOES NOT AFFIRMATIVEI-Y 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 INSURERS), 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 policles may require an endorsement. A statement on this certificate does not confor rights to the certificato holder in lieu of such andorsement(s).

PRODUCER
C NTADT Fairly Group Certificates
Fairly Consulting Group, LLC
1800 S. Washington, Suite 400
Amarillo, TX 79102

PHONE FAX
AIC. No, Extl: {AiC, N.I:

E , certs fairs roU .com
INSURERS AFFORDING COVE rap
KAtC N
imaugskAjaxas Insurance Company
16543

INSURED
INSURER B:

INSURER C ,
USA Cycling, Inc.

INSURER D
210 USA Cycling Point, Suite 100
Colorado Springs. CO $0919
INSURER :

INSURER F r
r0VFRAC;FS C r-PTIFIC:ATF NUMFIFR' 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 CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS

CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,

INSR LTRTYPE

OF INSURANCE
ADDL
SUBR

POLICY NUMBER

POLIOD EFF
POLICY E%P

LIMIT'S
A
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EACH OCCURRENCE
S I,000,000
CLAIMS -MADE [k] OCCUR
X
BESGLPTC0011201_17002B�01
1213112022
1213112023

DAMAGE TO RENTEDISES
1,000,000
MEDEXP (Any oneperson)
S Excluded
_

R NA & A V INJURY
1,000,
C.EN'LAGGR ATE LWITAPPLIE$ PER:

POLICY jp� LOC

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5 3,000,000

P T MP PA
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AUTOMOBILE

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COMBINED SINGLE LIMIT
§
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ANY AUTO

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E.L. DISEASE -EA EMPLOYEE
IT yes, tleecr9be antler
DE RIPTION OF OPERATIONS ISelbx
E.L. DISEASE • POLICY LIMIT
S
DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD 101. Addlliondl ReWarks 5011e00e, may Be gttaelled If more apace is requlredl Job 2023-679B
ES401OZA-NAC (10122) - SCHFDULE OF NAMI7D INSUREDS; Event Organizers and/or Promoters are Named Insureds. It shall be a condition of coverage that all organizers/promoters forwhom coverage is afforded under this policy execute a USAC Event Permit Application and coverage will be afforded only for the specific event and date(sp on the permit.

The General Liability policy includes a blanket automatic additional insured endorsement that provides additional insured status to any person or organization if required by a written contract or agreement provided such contract or agreement was executed prior to the occurrence or offense. Please see SEE ATTACHED ACORD 101
City of Yucaipa
34272 Yucaipa Boulevard
Yucaipa, CA 92389

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEI-IVFREp IN ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE
0_&�
ACORD 25 (2016/03) (D1988-2015 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD
232

AGENCY CUSTOMER ID: USACYCL-23
KHAYES
LOC #:

ADDITIONAL REMARKS SCHEDULE

AGENCY
FairlyConsulting Group, LLC
p�
NAMEDiNSURED
USA Cyycling, Inc.
210 U5A Cycling Point, Suite ifl4
Colorado Springs, CO 00919

POLICY NUMBER
SEE PAGE 1

CARRIER

NAIC CODE
EE PAGE 1
SEE P 1
EF9FGME DATE: SEE PAGE 1

ADDITIONAL REMARKS

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORN FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liahitity Insurance Description of OperationslLocationslVehicles:
attached endorsement CG 20 26 (412013).

Event Number: 2023.6798
Event Name: Redlands Bicycle Classic
Event Location: Yucaipa, CA
Event Date(s): 0411312023, 0411212023, 0411412023, 04115/2023, 0411612023 Setup Dates 0411112023
ACORD 101 (2008191) Q 2008 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD
233

POLICY NUMBER: BESGLPTC0011201 170028 01

COMMERCIAL GENERAL LIABILITY
CG 20 26 0413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED - DESIGNATED

PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the Following,

COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE
me Of Additional Insured Person(s) Or Organization(s):
person or organization if required by an insured contract provided such contract was executed r to the occurrence or offense.

Information required to compL_ this Schedule, if not shown above, will be shown in the Declarations.

A. Section II — Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property damage" or "personal and advertising injury"
caused, in whole or in part, by your acts or
omissions or the acts or omissions of those acting
on your behalf:

1. In the performance of your ongoing operations;
or

2. In connection with your premises owned by or
rented to you.

However-
1 . The insurance afforded to such additional
insured only applies to the extent permitted by
law; and

2. If coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.

B. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III — Limits Of Insurance:

If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:

1. Required by the contract or agreement; or

2. Available under the applicable Limits of
Insurance shown in the Declarations;
whichever is less.

This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.

CG 20 26 0413 O Insurance Services Office, Inc., 2012 Page 1 of 1 234

JLL-20-2�12 10 55 LPGLA NIM EL
INIrMUML RRVEN X SERVICE
P. 0. BOX 2508
CINCI=hTI, OJi 45201
Date: J U L 15 2012
Rih3I,j Me BICYCLE CL'kB67C INC
PO BOX 7240
PED1.RMS, CA 92375
949 389 5032 P.02
DOPARTMKMT OF iHK TREAEFU Y
Employer Identification Number:
33-0231753
OW
17457004307407.

Contact Pereaa:

PAM r CAPPRI, 11 IAN 31663
Contact Tblephonc Number:
(0771 B29-5500
Ticcounting Period Ending:

JWM 3a
Form 950 Required:

Yes
Effective D&te of itcamption:

December 10, 2011
Contribution Deductibility.

No
Addendum AppiiGr,
yen
Dear Applicant:
we are plea$84 SO inform you that upon review of your application for tax- , j =cxpt statue re have datermiried that you arc exempt from Federal ,income tax under eeetion 502(c)(4) of the Internal Revenue code. Because this letter could help resolve away ques.tiona raga;ding your exempt atat.i5, you obould kelp .. it in your permanent rmcordt.
}. P1mare utt tncloVea Publication d231-NC, Compliance Guide f(Ir That-Exgt:pt Organizations (ocher than 501(c)(3) public C1uLrities ate, private FoundaticaGI '.: for sow helpful inform slon about your respoasilsili,tiec as an exempt organrxation.

Contributionar to you $ro not deductible by donors under section 1-y0(c)12f of the Code.
r we 'live gent a copy of thlc latter to your representative as indicntnd in your power of attorney.

ZnCiorure� PubliCation 4221-YiC
&incermly.

W6% `P
Holly a. Paz
iiircr-t0r, Pxcrvpt Organizationc
nulirga and AwgrawantEo
99�:

Letter 948 (DOICG)
P.03

c
ARTICtX Of INCOR70RATION
or
"DGAWS BICYCLE CLASSIC, INC.

I
P A Y C�
pI1.RD L
t �
OCT 3 0
W"
MAU 0% W.b040,$:--
Tho oame of this Corporation Is REDL NDA BICYCLE
, Inc.

II
This Corporation is a nonprofit public benefit
porativn and Is not organized for the private 4nin of any son. xt is organized under the Nonprofit Public behefit poratLon Law for public purposes.

The specific purposes fox which the CorporAtion to
anized tncludes to faster national and international
teur bicycle racing competition and to conduct national international bicycle racing competitions, races and
ibItions, with participation by both amateur and
."fensionel athletes.

f+'
AGl!'
III
The name and address in this State of the 00rp990-
ti�on's initial agent for service -of process is John 8almes, 34 Cajon. Street, Redlands, California 92373.

IV
This Corporation is organized and operated exclu-
vely for fostering nartionai and international *port$
titian purpoven within the cleaning of Sections
(c)(3) and 901 0) of the Internal Revenu! Code of l954, a► *nded .

Ro substantial part Of the activities Of this
rporation Shall consist of the carrying on of propaganda, e otherwige #ttwxpting to influence legislation, nor shall t Us Corporation participate or intervene in any political epaign on behalf of any candidate for public office
(neluding the publishing or distributing of statements).

V
I ;
The property of this CorgaratioR is irrevocably :
dicated to the purposes set forth on Article iI hereof, nd PO pert of the net income or &sasts of this Corporation hail ever inure to the benefit of any director, trustee, �l�' �•�::i..:Ia.'~••.w�. roti x� ..1itS��..iS..w'f; �'r�A•_.,... )TA?{7c; PrYgmm :"1nn 237 R FF i7Fq rFi T T :RT PAR7.lFT AP

facer or member of this Carporationj or to the benefit of other individual.

Upon the winding tap and dissolution of this Corpo-
trion, and after paying and adequately providing for the bts ana liabilities of the Carporatian, the assetm of this rporation shall be distributed to the City of Redlands, litornia, a political subdivision of the State of
lifornia, or to any successor organisation which is
ganiaed and operated exclusively for public o: charitable rposes, or for the fostering of national and international ateur sports, and which has eetabli.shed itn tax-exempt atus under Section 501(0 0) of the Internal Revenue Code 19541, as amended.
r October 29, 1986
C"D1Sd
ae o s, incofPciator
�..� � .d�•��• ter--.

ML F. Her of , 1ACOVOr4tOr
-3-
r•�nrw�r�r �n�.�rrr r.r..-,
Lu
0 ATTACHMENT 6
239

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 / FEE WAIVER
2023-2024
1/24l23

APPLICATION
}deceived
City Of YLIcalpa
MAY 3 0 2023
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.

Name of Applicant/Organization: Rotary Club of Yucaipa
Applicant/Organization Mailing Address; PC) Box 661 Yucaipa, CA 92399 Applicant/Organization Phone Number: ( )
Contact (1) Todd Gutjahr (909 ) 900-9537
Name Phone Number
Contact (2)
[email protected]
E-mail address
Name Phone Number
E-mail address
Yes No
Is your organization located in another community? ❑ ❑,� Will the program/event take place in another community? ❑ 0 Are you aware of any other City program providing this service? ❑ ❑2 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 Page 1 240

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 1D# 45-5149308 and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? 0 ❑ 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? ❑ ,/❑
How many Yucaipa residents does your organization currently serve? 51,000 Does the organization charge admission, membership fees, dues, etc.? 0 ❑ If yes, please describe: $140/yr
Names and Titles of Officers and Board of Directors; (Please attach an organization chart, if available) Donnakaye Ostrander, President
Henry Markcwicz, 'resident Elect
Joan Dendinger, Treasurer
Name of the program/event:

Tnlvl l ?.O?.'A_Timi-. ?S
Date(s) of program/event: 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, Rev. 03/2022 Page 2 241

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

The weekly club meetings allow Rotarians to Flan and discuss community events.

Program/Event Primary Target Population (check all that apply):
❑■ Children or Youth 0 seniors
❑■ Low Income ❑■ Victims
'0 Persons with Disabilities Welfare Recipients
Number of Residents Projected to Serve: Zo
Please identify what your organization is seeking:

Financial Support: Yes J❑ No $
$200 SEP Fee
Waiver: ❑ Yes m No
In -kind Support: Police $ Fire $ u
Reassigned
Staff $ o Other $ �}
Public
Works $ o
Explain
❑■
Women
❑■
Homeless
❑
Entire Community
CS/Rentaf���
$200 SEP Total Overall
In -Kind Financial Support Fee Waiver Re crest
Total Amount of Request: $ o $ o
J
�0 Is �
Provide a detailed description of how the financial support will be used; 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 Page 3 242

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
Organization:

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

Program In -Kind Financial $16.25 SEP Date
Support Fee Waiver Received
2022
a
0 ❑,�
2021
0 ❑✓
0 2019
0 0
F
Financial
Support Amount
Total; Received
$19,109
$ 5,851.37
$ 4,831
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 aunt needs to be spent prior to submitting another grant request. 5/24/23
Signature Title Date
Date Received:
5-"3LD --:), -_s
Amount Funded: $
Type of Grant: In -Kind
Date City Council received follow up report:

Date Reviewed:

City Council Meeting:
❑ Financial Support
❑ Fee Waiver
City of Yucaipa Community Activity Grants Application, Rev. 03/2022 Page 4 243

5130123, 2:43 PM PermitContract
COMMUNITY f'�s rs�s
Permit SERVICES Uf e
Bet j.

City of Yucaipa Community PHONE:(909) 790-7460 Permit # R5351 Services FAK(90917904589
Status Tentative
34272 Yucaipa Blvd EMAIL:[email protected] Date May 11, 202310:08 AM Yucalpe, CA 92899 Explratlon Date May 10, 2024
Organl:ration Name Rotary Club Of Yucaipa - 336 Organlxatfon Phone 1 (909) 900.9537 Customer Type Nan-Proftt (R) Number
Organization Address PO Box 661
Yucaipa, CA 92399
Agent Name Todd Gut ahr Home Phone Number (909) 900-9537 System User Fish Christian
Rental Fee $11,282,79
olscounts-$1,128.32
f }} Subtotal $10.154.47
lf�%� �30, .w Deposits $250.00
Q
r ! Af L>-po-5 Deposit Discounts $0.00
Yucaipa Rotary - Wkly. Meetings
Booking Summary
Total Permit Fee $10.404.47
Total Payment $0.00
Refunds $0.00
Balance $10,404.47
1 resource(s) 41 taooking(s) Subtotal: $10,404.47
START DATEfTIME
I END DATE/T1ME
Jul 11. 2023 6.30 AM
Jun 18, 2024 B-15 AM
Occurs every Tuesday effective
Jul 71, 2023 until Jury 18, 2024 from 6:30 AM to 8:15 AM Jul 11, 2023 6:30 AM
Jul 11. 2023 8:15 AM
Rental - Hourly
$140.00 / Hour 0.75 $245-00
Rental -Weekday Event Assistant (12A-830A) $17.251 Hour x 1.75 $30.19 Resident Discount -10%
-10% x 1-$27.52
Jul 18. 2023 6:30 AM
Jul 18, 2023 8:15 AM
Rental - Hourly
$140-00 / Hour x 1.75 $245.00
Rental -Weekday Event Assistant (12A-830A) $17.251 Hour x 1,75 $3019 Resident Discount -10%
-10% x 1-$27.52
Jul 25, 2023 6:30 AM
Jul 2S. 2023 8:15 AM

ATTENDEE I AMT W/O TAX
50 $247.67
50 $247.67
50 $247.67
https:ilanprod.active.C4mlyucaipelui_do7method=showPermitContract&parmi"—&CBD07860639 1/7

51,
10123, 2'43 PM
PermltContract
Rental - Hourly $140.001 Hour x 1.75 $245.00
Rental - Weekday Event Assistant (12A-830A)
$17.25 / Hour x 1.75
$30.19
Resident Discount -10% -10% x 1
-$27.52
Aug 1, 2023 6:30 AM
Aug 1, 2023 8:15 AM
Rental . Hourly $140.00 / Hour x 1,75 $245.00
Rental -Weekday Event Assistant (12A-830A)
$17.251 Hour x 1.75
$30.19
Resident Discount -10% -10% x 1
-$27.52
Aug 8, 2023 6:30 AM
Aug 8, 2023 8:15 AM
Rental - Hourly $140.001 Hour x 1.75 $245.00
Rental - Weekday Event Assistant (12A-830A)
$17.25 / Haut x 1.75
$30.19
Resident discount -10% -10% x 1
427.52
Aug 15, 2023 6:30 AM
Aug 15, 2023 8:15 AM
Rental - Hourly $140.00 / Hour x 1.75 $245.00
Rental -Weekday Event Assistant (12A-830A)
$17.25 / Hour x 1.75
$30,19
Resident Miscount -10% -10% x 1
-$27.52
Aug 22, 2023 6.30 AM
Aug 22, 2023 8:15 AM
Rental - Hourly $140.00 1 Hour x 1.75 $245.00
Rental - Weekday Event Assistant (12A-830A)
$17.251 Hour x 1.75
$30.19
Resident Discount -10% -10% x 1
-$27,52
Sep 5, 2023 6:30 AM
Sep 5, 2023 8:15 AM
Rental • Hourly $140.001 Hour x 1.75 $245.00
Rental -Weekday Event Assistant (12A-830A)
$17.25 / Hour x 175
$30,19
Resident Discount -10% -10% x 1
427.52
Sep 12, 2023 6:30 AM
Sep 12, 2023 8:16 AM
Rental - Hourly $140.00 / Hour x 1.75 $245.00
Rental -Weekday Event Assistant (12A-830A)
$17.25 / Hour x 1.75
$30.19
Resident Discount -10% -10% x 1
-$27.52
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Sep 19. 2023 8:15 AM
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Rental -Weekday Event Assistant (12A-830A)
$17.251 Hour x 1.75
$30.19
Resident Discount -10% -10% x 1
-$27.52
Oct 3, 2023 6:30 AM
Oct 3, 2023 8:15 AM
Rental - Hourly $140.00 / Hour x 1.75
$245.00
Rental -Weekday Event Assistant (12A-830A)
$17.25 / Hour x 1,75
$30.19
Resident Discount- 10% -10% x 1
-$27.52
Oct 10, 2023 6:30 AM
Oct 10, 2023 8:15 AM
Rental - Hourly $140.001 Hour x 1.75
$245.00
Rental -Weekday Event Assistant (12A-830A)
$17.25 / Haur x 1,75
$30.19
Resident Discount- 10% -10% x 1
-$27.52
50 $24767
50 $247.67
50 $247.67
SO $24767
50 $247.67
50 $247.67
Fit I $247,67
50 $247.67
so $241.6;
htlps:llanprod.active.cornlyucaipalui.d0method=showPermitContract&permit2g5CBt707860839 111

51�
httr
0123, 2:43 PM
PermitContract
Oct 17, 2023 6-30 AM
Oct 17, 2023 8:15 AM
Rental - Hourly $140.00 / Maur x 1.75 $245.00
Rental -Weekday Event Assistant (12A-830A)
$1725 / Hour x 1.75
$30.19
Resident Discount -10% -10% x 1
-$27.52
Oct 24, 2023 6:30 AM
Oct 24, 2023 8:15 AM
Rental - Hourly $140.00 / Hour x 1.75 $245.00
Rental -Weekday Event Assistant (12A-830A)
$17.251 Hour x 1.75
$30-19
Resident Discount -10% 10% x 1
-$27.52
Nov 7, 2023 6:30 AM
Nov 7, 2023 8:15 AM
Rental - Hourly $140.00 / Hour x 1.75 $245.00
Rental - Weekday Event Assistant (12A-830A)
$17.25 / Hour x 1,75
$30.19
Resident Discount -10% -10% x 1
-$27.52
Nov 14. 2023 6:30 AM
Nov 14, 2023 8:15 AM
Rental - Hourly $140.00 / Hour x 1.75 $245.00
Rental -Weekday Event Assistant (12A-830A)
$17.25 1 Hour x 1.75
$30.19
Resident Discount -10% -10% x 1
-$27.52
Nov 21, 2023 5:30 AM
Nov 21. 2023 8:15 AM
Rental - Hourly $140,00 / Hour x 1.75 $245.00
Rental -Weekday Event Assistant (12A-830A)
$17.25 / Hour x 1.75
$30.19
Resident Discount - 10% -10% x 1
-$27.52
Nov 28. 2023 6:30 AM Nov 28, 2023 8:15 AM
Rental - Hourly $140.00 / Hour x 1.75 $245,00
Rental -Weekday Event Assistant (12A-830A) $17.25 / Hour x 175 $30:9 Resident Discount -10% -10% x 1427.52
Dec 5, 2023 6:30 AM
Dec 5, 2023 8:15 AM
Rental - Hourly $140.00 / Hour x 175 $245.00
Rental -Weekday Event Assistant (12A-830A)
$17.25 / Hour x 1.75
$30.19
Resident Discount -10% -10% x 1
-$27.52
Dec 12, 2023 6:30 AM
Dec: 12, 2023 8.15 AM
Rental - Hourly $140.00 / Maur x 1.75 $245,00
Rental -Weekday Event Assistant (12A-830A)
$17.25 / Hour x 1.75
$30,19
Resident 01scount-10% -10%x 1
-$27.52
Dec 19, 2023 6:30 AM
Dec 19. 2023 8:15 AM
Rental - Hourly $140.00 / Hour x 1.75 $245.00
Rental - Weekday Event Assistant (12A-830A)
$17.25 / Hour x 1.75
$30.19
Resident Discount -10% -10% x 1
-$27.52
Jan 9, 2024 6:30 AM
Jan 9, 2024 8.15 AM
Rental - Hourly $140.00 / Hour x 1.75 $245.00
Rental - Weekday Event Assistant (12A-830A)
$17.25 / Hour x 1.75
$30.19
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50 $247.67
50 $247.67
50 $247.67
50 $247.67
50 $247,67
50 $247.67
50 $247.67
117

5/30/23, 2:43 PM PermltContraQI
Resident Discount - 10% -JC)% x 1-$27.52
Jan 16, 2024 6:30 AM Jan 16, 2024 8:15 AM
50 $247.67
Rental - Hourly $140.00/ Hour x 1.75 $245.00
Rental -Weekday Event Assistant (12A-830A) $17,25/ Hour x 1.75 $30,19 Resident Discount -10% -10% x 1 -$2752
Jan 23, 2024 6:30 AM Jan 23, 2024 8:15 AM
50 $247.67
Rental - Hourly $140.00 / Hour x 1.75 $245.00
Rental -Weekday Event Assistant (12A-830A) $1725 / Hour x 1.75 $30,19 Resident Discount -10% -10% x 1-$27.52
Feb 6, 2024 6:30 AM Feb 6, 2024 8:15 AM
50 $247.67
Rental - Hourly $140.00 / Hour x 1.75 $245,00
Rental -Weekday Event Assistant (12A-830A) $17.25 / Hour x 1.75 $30.19 Resident Discount -10% -10% x 1-$27.52
Feb 13, 2024 6:30 AM Feb 13, 2024 8:15 AM
50 $247.67
Rental - Hourly $140.00 / Hour x 1.75 $245.00
Rental - Weekday Event Assistant (12A-830A) $17.25 / Hour x 1.75 $30.19 Resident Discount -10% -10% x 1-$27.52
Feb 20, 2024 6:30 AM Feb 20, 2024 8:15 AM
50 $247.67
Rental - Hourly $140.00 / Hour x 1.75 $245.00
Rental -Weekday Event Assistant (12A-830A) $17.25 / Hour x 1.75 $30.19 Resident Discount -10% -10% x 1-$27.52
Mar 5, 2024 6:30 AM Mar 5, 2024 8:15 AM
50 $247,67
Rental - Hourly $140.00 / Hour x 1,75 $245.00
Rental - Weekday Event Assistant (12A-830A) $17.251 Hour 0.75 $3019 Resident Discount -10% -10% x 1-$27.52
Mar 12, 2024 6:30 AM Mar 12, 2024 8:15 AM
SO $24767
Rental - Hourly $140.00 / Hour x 1.75 $245.00
Rental -Weekday Event Assistant (12A-830A) $17.25 / Hour x 1,75 $30.19 Resident discount -10% -10% x 1 42752
Mar 19, 2024 6:30 AM Mar 19, 2024 8:15 AM
50 $247.67
Rental - Hourly $140.00 / Hour x 1.75 $2455,00
Rental - Weekday Event Assistant (12A-8.30A) $17,25 / Hour x 1.75 $30.19 Resident Discount -10% -10% x 1-$27.52
Apr 2, 2024 6:30 AM Apr 2, 2024 8:15 AM
50 $247.67
Rental - Hourly $140.00 / Hour x 1.75 $245.00
Rental - Weekday Event Assistant (12A-830A) $17.25 / Hour x 1,75 $30.19 Resident Discount -10% -10% x 1-$27,52
Apr 9, 2024 6:30 AM Apr 9, 2024 8:15 AM
50 $247.67
Rental - Hourly $140.00 / Hour x 175 $245.00
https:llanprod.active,comlyuCaipalui.do?method=showPermitContract&permit_id 00786OB39 A17

512
http
0/23, 2143 PM PermitContract
Rental - Weekday Event Assistant (12A-830A) $17.25 / Hour x 1.75 $30.19 Resident Discount -10% -10% x 1-$27,52
Apr 16, 2024 6:30 AM Apr 16. 2024 8:15 AM
Rental - Hourly $140.00 / Hour x 1.75 $245.00
Rental - Weekday Event Assistant (12A-830A) $17,25 / Hour x 1.75 $30,19 Resident Discount -10% -10% x 1 -$2752
Apr 23, 2024 6:30 AM Apr 23, 2024 8:15 AM
Rental - Hourly $140.00 / Haur x 1,75 $245.00
Rental -Weekday Event Assistant (12A-830A) $1725 / Hour x 1.75 $30.19 Resident Discount -10% -10% x 1-$27.52
May 7, 2024 6:30 AM
May 7, 2024 8:15 AM
Rental - Hourly $140.00 / Hour x 1.75 $245-00
Rental -Weekday Event Assistant (12A-830A)
$17.251 Hour x 1.75 $30.19
Resident Discount -10% -10% x 1
427.52
May 14, 2024 6:30 AM
May 14, 2024 8,15 AM
Rental - Hourly $140.00 / Hour x 1.75 $245.00
Rental -Weekday Event Assistant (12A-830A)
$17.25/ Hour x 1.75 $30.19
Resident Discount-10% -10% x 1
-$27.52
May 21, 2024 6:30 AM
May 21. 2024 8.15 AM
Rental - Hourly $140,00 / Hour x 1.75 $245.00
Rental -Weekday Event Assistant 02A-830A)
$17.25 / Hour x 1.75 $30.19
Resident Discount -10% -10% x 1
-$27.52
May 28, 2024 6.30 AM
May 28, 2024 8:15 AM
Rental - Hourly $140.00 / Hour x 1.75 $245.00
Rental - Weekday Event Assistant (12A-830A)
$17.251 Hour x 1.75 $30.19
Resident Discount -10% -10% x 1
-$27.52
Jun 4, 2024 6:30 AM Jun 4, 2024 8:15 AM
Rental - Hourly $140-00 / Hour x 1.75 $245,00
Rental - Weekday Event Assistant (12A-830A) $17.25 / Hour x 1.75 $30.19 Resident Discount -10% -10% x 1 -$7752
Jun 11, 2024 6:30 AM Jun 11. 2024 8:15 AM
Rental - Hourly $140.00 / Hour x 1.75 $245.00
Rental -Weekday Event Assistant (17A-830A) $17,25 / Hour x 1.75 $30,19 Resident Discount -10% -10% x 1-$27.52
Jun 18, 2024 6:30 AM Jun 18, 2024 3:15 AM
Rental - Hourly $140.00 / Hour x 1,i5 $245.00
Rental -Weekday Event Assistant (12A-830A) $17.251 Haur x 1.75 $30.19 Resident Discount -10% -10% x 1-$27.52
Resource level fees
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50 $247.67
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50 $247.67
50 $247.67
50 $247.67
50 $247.67
50 $247.67
$250.00
S/7

5130123. 2:43 PM PermilContract
Deposit $250.00 / Each x 1 $250.00
Waivers and Information

INFORMATION DESCRIPTION I SIGNING STATUS
Alcohol Sates Llc Checked
Proof of Liability insurance Checked
Security Guard Contract Checked
Prof of Non Profit Status Checked

WAIVER NAME DUE DATE I FOR , SIGNING STATUS
Facility Usage Waiver Jul 11. 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, losses and expenses that may arlse during or be caused in any way by such occupancy or use of facllltles, but the facility user shall not be Ilable for any claims, damages, losses and expenses caused by the sole negligence or willful misconduct of the City or Yucaipa. Permittee shall have received any and all permission or license(s) as may be required to perform or use any protected materials in ils 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 et facilities and accept responsibility for meeting the requirements stated herein.

Signature
Deposit
EVENT I RESOURCE ` DEPOSIT FEE I CHARGE I TAX I AMOUNT PAID REFUNDS BALANCE Yucaipa Rotary - $rC Nutrition Deposit $250,00 $0.00 $0.00 $0.00 $250.00 Wkly. Meetings Center
Payment Schedules
Original Balance: $10,404.47 Current Balance: $10,404.47

DUE DATE I

AMOUNT DUE I

AMOUNT PAID

WITHDRAWAL ADJUSTMENT I

BALANCE
May 30, 2p23
Jun 27, 2023
$37.29
$111,367.18
$0.00
$0.00
$0.00
$0.00
$37.29
$10,367.18
hops:!lanprod.active.comlyucaipolui.do7method=showPermitContract&permitrgi4:9CBD078B0B39 617

6130/23, 2:43 PM
PermitContract
X:

Date:

City of Yucaipa Community Services
Mailing Address: 34272 Yucaipa Bivd, Yucaipa, CA
92399
Phone Number; (Dog) 790-7460
Fax Number, (909) 790-2589
Email Address: [email protected]
a
Date:

Rotary Club Of Yucaipa
Customer Type: Non-Profit(R)
Customer ID: 27557
Mailing Address: PO Box 551. Yucaipa. CA
92399
Organlxatlon Phone t Wrnbet: (909) 900-9537
Authorized Agent Name: Todd Gutjahr
Home Phone Number: (909) 900-9537
https:llanprod.active.corrlyucaipalui.do7 method =showPermi tContract&perrn2ggC(3D07860839 717

ATTACHMENT 7
251

CITY OF
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 / FEE WAIVER

APPLICATION
2023-2024
5124123
Heceivea
City of Yucaipa
MAY 3 0 2023
General Services/
City Clerk's Department
All sections of the 2pplic200nl 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:

Rotary Club of Yucaipa
Applicant/Organization Mailing Address: PO Box 661 Yucaipa, CA 92399 Applicant/Organization phone Number:

Contact (1) Todd Gutjahr (909 ) 900-9537
Name Phone Number
[email protected]
E-mail address
Contact (2) N/A ( }
Name Phone Number
NIA
E-mail address
Yes
No
Is your organization located in another community?
❑
❑f
Will the program/event take place in another community? ❑
Q
Are you aware of any other City program providing this service? ©
❑✓
If so, which one? NIA
*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 Page 1 252

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 IN 45-5149308 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? ❑ Q
How many Yucaipa residents does your organization currently serve? 51,000 Does the organization charge admission, membership fees, dues, etc.? 0 ❑ If yes, please describe: $140/year
Names and Titles of Officers and Board of Directors; (Please attach an organization chart, if available) Donnakaye Ostrander, President
Henry Markowitz, President Elect
Joan Dendinger, Treasurer
Name of the program/event:

Date(s) of program/event:
68th Annual Christmas Parade
Saturday, December 9, 2023
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with programlevent) The 68th Annual Christmas Parade will be held on Saturday, December 9, 2023. This year will mark the fourth year that the parade will be organized by the rotary Club of Yucaipa.

The Parade will start on the comer of A venue D and California Street. The route proceeds north on A venue D to California Street, where it will then travel west onto Yucaipa Boulevard. The route will travel west on Yucaipa Boulevard and then will turn south onto 6th Street and end at the Oak Valley Educational Center campus,
City of Yucaipa Community Activity Grants Application, Rev. 03/2022 Page 2 253

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

The 68th Annual Christmas Parade rings in the holiday season for Yucaipa residents. The parade is estimated to bring out over 5,000 residents to watch the parade and to then stroll around the Historic Uptown.

Program/Event Primary Target Population (check all that apply):
0 Children or Youth ❑■ Seniors ❑■ Women
❑■ Low Income ❑ Victims 0■ Homeless
❑� Persons with Disabilities Welfare Recipients Entire Community Number of Residents Projected to Serve: s,000
Please identify what your organization is seeking -
Financial Support: ✓❑ Yes ❑ No $ l,cuxo
$200 SEP Fee
Waiver:] Yes ® No
Public
In -kind Support: Police $ 9,034 Fire $ o Works $ 3,100 CS/Rental $ Reassigned
Staff $ Other $
In -Kind Financial Support
Total Amount of Request: $ 12,134 $
Explain
$200 SEP Total Overall
Vcc Waiver Request
$ 200 = $ 12,334
Provide a detailed description of how the financial support will be used:

The In -Kind Support received from the Community Activity Grant program will cover the costs of police and fire personnel presence and provide Public Works support for street closures (personnel and equipment).

The Financial Support received from the Community Activity Grant will assist with covering the costs of the portable restrooms that are placed throughout the Parade route.

City of Yucaipa Community Activity Grants Application, Rev. 03l2022 Page 3 254

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
None
$
$
Total Funds Received To Date:
$
$
Total Funds Requested Via Grant
Application:
$
12,334
$
1,000
Remaining Balance That
Will Be Funded
By $
$
Organization:

SECTION 6 — FINANCIAL

CAPABILITIES/BUD
r
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
2022
❑✓
0 $19,109
2021
0 0
0 $ 5,851.37
2019
_ a
o
o
$_, 831
1, the undersigned, do hereby attest that the above information is true and correct to the best of my knowledge, and understand thvw7 e awa d ancial grant amount needs to be spent prior to submitting another grant request. 5/24/23
Signature Title Date

COMPLETED BY
Date Received: Date Reviewed: _
Amount Funded: $ City Council Meeting:

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

City of Yucaipa Community Activity Grants Application, Rev. 03/2022 Page 4 255

DocuSign Envelope Id: B33D7772•CE38-4954-AE5C-34BA46CBC262 ..._}._ Yucaipa Police Request Form Exhibit A
R � Attachment to the Community Activity Grant ApplicationlSFP Process U Y OR 2 11_( -5— 7- C'Z V
Fiscal Year: 2y�2� 1
514123
_ Date Application submitted:
r
1 Name of Applicant / Organization Rotary Club of Yucaipa Mailing Address: PO Box 661 Yucaipa, CA 92399
Phone Number:

Contact:

Applicant Signature:

Event Name:

Event Location:

Event Date:

Todd Gutjahr 909-900-9537
Name Phone Number
tgutjahrhotmail.com
Estimated Event Attendance Number:

Number of Officers Requested
Dates Officers/COPS Requested:

Equipment Requested
Additional Information:

E-mail address
Title:
68th Annual Christmas Parade
Yucaipa Blvd (CA. St. to 6th St.)
1219123
5,000
Sworn Officers:
1219I23
Patrol Car: ❑
11 Event Time: 8 a.m.-3 p.m.

Citizen Patrol (COPS): 16
Times Officers/COPS Requested: 11 a.m.-3 P.M.

Motorcycle: ❑ Other: ❑
Reviewed by: LP:�
5lflnedW
Signature: �Wmt. Title: Sergeant
Total CastfarIn-kind Reque.w $9,034
Date 5/24/23
City of Yucaipa Community Activity Grants Application, Rev. 03/2022 256 Page 1

DocuSign Envelope ID: 35BA7546-919E-4ABC-A86E-21G0213B01A4 ° Yucaipa Fire Request Form (Exhibit B)
Attachment to the Community Activity Grant Applicati"onISEP Process M�
��� ��j�., Fiscal Year: i�2�3-
- " 5l24123
Date Application submitted:

Name of Applicant / Organization Rotary Club of Yucaipa Mailing Address: PO Box 661 Yucaipa, CA 92399
Phone Number:

Todd Gutjahr 909-900-9537
Contact:

Name Phone dumber
[email protected]
E-mail address
Applicant Signature: Title:

SECTION 2 — EVENT INFORMATION
68th Annual Christmas Parade
Event Name:

Yucalpa Blvd (CA ST to Bth St)
Event Location:
1219l23 8 a.m.-3 p-m.

Event Date: Event Time:
5000
Estimated Event Attendance Number:

SECTION1
TED
Number of Fire/EMS Requested:
1219l23 11 a.m.-3 p.m.

Dates Requested: Times Requested:

Additional Information:

Reviewed by:

Oacu8lpnrd by:

Signature: Title:
4A4AT2QDCA7F493...

Fire Chief
Total Cast fur In-gi►td Request:
$0.00
Date
5124/23
City of Yucaipa Community Activity Grants Application, Rev. 0312422 257 Page I

. �- -- Public Works Department Request Form (Exhibit C) Attachment to the Community Activity Grant Application/SEP Process Fiscal Year: 2022-2023
Date Application submitted: 5/25/23
Name of Applicant / Organization Rotary Club of Yucaipa Mailing Address: PO Box 661 Yucaipa, CA 92399
Phone Number:

Contact:

Applicant Signature:

Event Name:

Todd Gutjahr
Name
[email protected]
E-mail address J
909-900-9537
Phone Number
68th Annual Christmas Parade
Title:

Event Location: Yucaipa Blvd (CA. St. to 6th St.)
Event Date: 1 2/9/23 Event Time: 8 a.m.-3 p.m.

AttendanceEstimated Event i1!
SECTION 3 — PUBLIC WORKS SERVICES REQUESTED
Number of Public Works Staff Requested:

Equipment Rentals and Quantity Requested;
2 Cones 100 ❑r Delineators 40
Dates Requested; 1 219123
❑r Street Closures 13 Q Signage 13
Times Requested: 3.30 a•m.-3.30 p.m.

Projected Staff Time Expense: $ 2, 000 Equipment Expense; $ 900 Additional Information: Items to include staff time (set-up and take -down of road closures, assisting with clean up of trash boxes, use of electronic message boards, a small generator, small announcing stage/riser, and mist. traffic control equipment).

Reviewed by: oac.signed by
Sigtature; L�L*Ul , pl44ieLh Title: Director of Development Services/City Engirere Total Cost for In -Kind Request. $3,100
Date 5/24/23
City of Yucaipa Community Activity Grants Application, Rev. 0312022 page 1

ATTACHMENT 8
259

ciry aF�
yr. —
WW11,
Fiscal Year:

Date Application submitted:

Submit to:

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

Yucaipa, CA 92399
Attn: Kimberly Metzler

COMMUNITY ACTIVITY GRANT
2023-2024
5/2123

FINANCIAL / IN -KIND / FEE WAIVER

APPLICATION
Received
City of Yucaipa
MAY 0 2, Z023
General Services/
City Clerk's Dcpartrnertt
All sections of the application must be returned complete and all supporting documentation provided prior to City Council review. incomplete applications received will be rctttrned to the applicant.

Name ofApplicant/Organization: Yucaipa Valley Art Association Applicant/Organization Mailing Address: P.O. Box 404, Yucaipa CA 92399 Applicant/Organization Phone Number: . ( )
Contact (1) Zully Martinez (909 ) 797-7741
Name Phone Number
yvaarnail92 a@gmail,com
E-mail address
Contact (2) Alan Remele (909 ) 556-3645
Name Phone Number
alankernele@7a gmtlil_cam
E-mail address

ELIGIBILITY
Yes
No
Is your organization located in another community?
❑
❑✓
Will the program/event take place in another community? ❑
❑J
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. 03/2023 260 Page 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)?
❑J
If yes, please provide Tax ID# 95-3701090 and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? 0 How long has your 501(c) organization been in existence? 42 Number of Employees working for organization: 0
Number of Volunteers working for organization: 12
Is a current City Council Member on your board?
❑
❑J
How many Yucaipa residents does your organization currently serve? 70+ Does the organization charge admission, membership fees, dues, etc,? Z
❑
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 Remote - President and Board Member
Zully Martinez - Shows and Board Member
Lenore Will - Ways & Means/Secretary
Cindy Kanakriyeh- Newsletter/Social Media
Enrique Lima - Public Exhibits
Bob Norris - Parlimentarian
Judy Remele - Scholarship Liason
Carol Maidlow - Treasurer
Jo Sutt - Community Representative
SECTION 4 - PROGRAM nr SCRIPTION/SCOPE: (PLEASE USE ADDITIONAL PAGES IF NECESSARY) Name of the program/event:

Date(s) of program/event:

YVAA Art Meetings, twice a month on Tuesday & Thursday
Sept 2023 through May 2024
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) 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 mothods. 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 Community Center located at 12202 1st Street, Yucaipa. Meeting dates as detailed in Permits R5274 and R5295.

City of Yucaipa Community Activity Grants Application, RBv. 03/2073 261 Page 2

Dewribe how 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. 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: so,
Please identify what your organization is seeking:

Financial Support: ❑ Yes ❑J No
$200 SEP Fee
Waiver: ❑ Yes W1 No
In -kind Support: Police $
Reassigned
Staff $
In -Kind
Total Amount of Request: $ -
F1 Seniors
❑ Victims
❑ Welfare Recipients
Public
Fire $ Works $
Other $
Financial Support
$
Explain
$200 SEP
Fee Waiver
Provide a detailed description of how the financial support will be used:
❑ Women
❑ Homeless
❑r Entire Community
CS/Rental $
Total Overall
Request
@ , O53 i;
I C4
ee a_c I
rn it
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 (2 hr) in SrC Activity/storage room and a Thursday night art showlmeeting (3.25 hrs) in room A & B and from September 2023 through May 2024. This 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 general guests or visitors.

City of Yucaipa Community Activity Grants Application, Rev. 0312023 262 Page 3

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
None
$
$
$
Total Funds Received To Date:
$ 0
$ 0
Total Funds Requested Via Grant Application:
$
$
Remaining Balance That
Will Be Funded
By $
$
Organization:

SECTION ti - FINANCIAL

CAPABILITIES/BUDGET
(CONTINUEI
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
Deceived
YVAA Spring Art Show 2023
❑
0 ❑
6/22
$1689.00
YVAA Tues & Thursday Mtgs
L J
❑
❑
6/22
$ 2624.04
YVAA Spring Art Show 2022
✓❑
❑
❑
6/21
$ 1483.63
1, the undersigned, do hereby attest that the above information is true and correct to the best of my knowledge, and understand that tl arded f iningial grant amount needs to be spent prior to submitting another grant request. l 01610 Boai'd Member 5l2/23
Signature Title Date
Date Received:
'S _5z' — ;�" �-:5
Amount Funded: $
Type of Grant: 16In-Kind
Date City Council received follow up report:

Date reviewed. 5'( ( —
City Council Meeting: Le
❑ Financial Support ❑ Fee Waiver
City of Yucaipa Community Activity Grants Application, Rev. 03/2023 263 Page 4

4125123, 1:061
PermilContract
httF
Permit
City of Yucaipa Community
Services
34272 Yucaipa Blvd
Yucaipa, CA 923e9
PHONE:(909) 790-7460
FAX-(909) 790.2589
EMAIL7commurAyservices ayucalpa.org
Organlxation Name Yucaipa VtalleyArtAssociation -49
Customer Type Non -Profit (P)
Organization Address PO Box 404
Yucaipa, CA 92399
Agent Narne Zully Martinez
System User Tish Christian
COMMUNITY Ii
r,�:'` SERVICES ML�Ke
% 8j'I ert
Permit # R5274
Status Tentative
❑ate Apr 12. 2023 4:38 PM
Expiration Date Apr 11, 2024
Home Phone Number (90% 797-7741
r? r-rn 1i )l 2,: I 1 1• 01_ Rental Fee $2,88702
i,Vnt H5i1c?(y
—�b•t�<, x?5 pi5count5 $DD0
1 �7i'atnf (. Subtotal S2,88702

4. 0eposits $0,00
Deposit Discounts $0,00
Total Permit Fee $2,88702
Total Payment $0.DD
Refunds 54.00
Balance $2.887.02
YVAA Thurs. Monthly Mtgs. 1 resource(s) 9 booking(s) Subtotal: $2,867.D2 Booking Summary
START aATE/TiME END DATE/TIME I ATTENDEE I AMT W/O TAX
Sep 21, 2023 6:00 PM May 16, 2024 9:15 PM -
Occurs on selected dotes- Sep 21. 2023, Oct 19, 2023, Nov 16, 2023, Dec 14, 2023, 1cn 18, 2024, Feb 22, 2024, Mar 27, 2024, Apr 18, 2024, May 16, 2024
Sep 21.2023 6:00 ISM Sep 21, 2023 9:15 PM 50 $320.78
Rental - Hourly $76,50 / Hour x 3.25 $248.63
Rental - Weekday Event Assistant (41 $22.20 / Hour x 3.25 $72.15 Oct 19, 2023 6:00 PM Oct 19, 2423 9:15 PM 50 $320 18
Rental - Hourly $76.501 Hour x 3.25 $248,63
Rental -Weekday Event Assistant (4P-12AJ $22.20 / Hour x 3,25 $72.15 Nov 16, 2023 6:00 PM Nov 16. 2023 9:15 PM 51) $320.78
Rental - Hourly $76,50 / Hour x 3.25 $248,63
Rental -Weekday Event Assistant (41 $22.20 / Hour x 3.25 $72.15 s://anprod_active.comlyucaipalui.do?method=showPermitContract&permit id=C18B07890630 113 264

412Sl23, 1:06 PM
PermitContract
Dec 14, 2023 6:00 PM Dec 14, 2023 9:15 PM
Rental - Hourly $76,50 / Hour x 3.25 $248.63
Rental - Weekday Event Assistant (4P-12A) $22.20 / Hour x 3.25 $72.15 Jan 18. 2024 6.00 PM Jan 18, 2024 9:15 PM
Rental - Hourly $76,50 / Hour x 3,25 $248.63
Rental - Weekday Event Assistant (4P-12A) $22.20 / Hour x 3.25 $72,15 Feb 22, 2024 6:00 PM Feb 22, 2024 9,15 PM
Rental - Hourly $76.50 / Hour x 3.25 $248,63
Renta! - Weekday Event Assistant (4P-12A) $22.20 1 Hour x 3.25 $72-15 Mar 21, 2024 6:00 PM Mar 21, 2024 9:15 PM
Rental - Hourly $76.501 Hour x 3.25 S248.63
Rental - Weekday Event Assistant (4P-12A) $22.20 / Hour x 3,25 $72.15 Apr 18, 2024 6:00 PM Apr 18, 2024 9:15 PM
Rental - Hourly $76.50 / Hour x 325 $248.63
Rental -Weekday Event Assistant (4P-12A) $2220 / Hour x 3.25 $72,15 May 16, 2024 6:00 PM May 16, 2024 9:15 PM
Rental - Hourly $76.501 Hour x 3,25 $248.63
Rental - Weekday Event Assistant (4P-12A) $22.20 / Hour x 3.25 $72,15 50 $320.78
50 $320.78
50 $320.78
50 $320,78
50 $320.78
50 $320,78
Waivers and Information

INFORMATION DESCRIPTION SIGNING STATUS
Alcohol Sales Lid Checked
Proof of Liability Insurance Checked
Security Guard Contract Checked
Proof of Non Profit Status Checked
WAIVER NAME DUI: DATE FOR f SIGNING STATUS
Facility Usage Waiver Sep 21, 2023 Waiver Stoned
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 ar 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. Permtttee shall have received any and all permission or licenso(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 elecled 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 hereln, Signature
Payment Schedules
Original Balance: $2.887.02 Current Balance: $2,887.02
https:llanprod.active.comlyucaipalui.d❑?method=showPermitConlract&permit_id=C 1 BBO7890634 213 265

4125123, 1:06 PM PermltCanlract

DUE QATE AMOUNT DUE , AMOUNT PAID I WITHDRAWAL ADJUSTMENT I BALANCE Sep 7. 2023 $2,887.02 $0.00 $0.00 $2,88702
a
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: Comrnunityservicesuyucaipa.org
Date;
Yucaipa Valley Art Association
Customer Type' Non•Profit(R)
Customer ID, 12551
Mailing Address: PO Box A04. Yucaipa. CA
92399
Authorized Agent Nome, Zully Martlnez
Home Phone Number: (909) 797-7741
Mips:llanprod.active.comlyucaipalui.do7method=showpermitContract&permit d66C1Ba0789C630 313

4125123. 1:01 Fbl
PermltContract
Permit
Clty of Yucaipa Community
Services
34272 Yucaipa Blvd
Yucaipa. CA 92399
PHOvc:(909) 79C-7460
FAX (909) 790.2589
EMAIL:communityservices yyucaipa.org
COMlAIUMTY
�6c6? ' SERVICES
Permit ## R5295
Status Tentative
Date Apr 25, 20231:00 PM
Expiration Date Apr 24. 2024
Organization Marne Yucaipa Valley Art ASsociatibn - 49
Customer Type Non•Prolit (R)
Organization Address PO Box 404
Yucalpa, CA 92399
Agimt Name, Z iiy Martinez Flame Phone Numbor NO% 797-7741 System User Tish Christian
Rental Fee
$720.00
Discounts
$0,44
Subtotal
$720.00
Deposits
$50.00
Deposit Discounts

50.00 Total Permit Fee
$770.00
Totoi Payment
$4.00
Refunds
$0.00
Balance
S770.00
Tues. Mthly. Board Mt9s. 1 resourcels) 10 booking(s) Subtotal: $770.00 Booking Summary
START DATErrIME END DATEITIME ATTENDEE I AMT INIC TAX
Sep 19, 2023 10:00 AM
May 14, 2024 12.00 PM
--
Occurs on selected dotes., Sep 19, 2023. Oct 17
2023. Nov 14, 2023. Dec 12, 2023, Jon 16.
2024, Feb 20, 2024, Mar 19, 2024.

Apr 16, 2024. ,Apr 23, 2024, Moy 14, 2024
Sep 19, 2023 10:00 AM
Sep IS. 2025 12-00 PM
12 $72.00
Rental - Hourly $36.00 / Four x 2
$72.00
Oct 17. 2023 10;00 AM
Oct 17. 2023 12,00 PM
12 $72.00
Rental - Hourly $36,00 / Hour x 2
$72.00
Nov 14, 2023 10:00 AM
Nov 14, 2023 12:00 PM
12 $72.00
Rental - Hourly $36,001 Hour x 2
$72.00
Dec 12, 2023 10:00 AM
Dec 12, 7023 12.00 PM
12 $72.00
Rental - Hourly $36.00 / Hour x 2
$72.00
https:Hano(od.active.comiyucaipalui.do')method=showPormitContract&permit id=C98707880E33 113 167

4125/23,
1:01 PM
PermltConlract
Jan 16, 202410:00 AM
Jan 16. 202412:00 PM
12 $72.00
Rental - Hourly
$36,001 Hour x 2
$72.00
Feb 20, 2024 10.00 AM
Feb 20. 202412:00 PM
12 $72.00
Rental - Hourly
$36-00 / Hour x 2
$72,00
Mar 19. 2 024 10:00 AM
Mar 19, 2024 12.00 PM
12 $72.00
Rental - Hourly
$36.00 / Hour x 2
$72,00
Apr 16. 202410:00 AM
Apr 16, 2024 12:00 PM
12 $72.00
Rental - Hourly
$36.001 Hour x 2
$72.00
Apr 23. 202410:00 AM
Apr 23, 2024 12:00 PM
12 $72.00
Rental - dourly
$36,00 / Hour x 2
$72.00
May 14, 2024 10:00 AM
May 14, 2024 12:00 PM
12 $72.00
Rental - Hourly
$36.001 Hour x 2
$72,00
Resource level fees
$50,00
Deposit
$50.00 / Etich x 1
S50.00
Waivers and Information

INFORMATION DESCRIPTION SIGNING STATUS
Alcohol Saleg L c Checked
Pr❑or of Liability Insurance Checked
Security Guard Contract Checked
Proof of Non Profit Status Checked

WAIVER NAME DUE DATE FOR SIGNING STATUS
Facility Usage Waiver Sep 19, 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, 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 liabte for any claims, damages, losses and expenses caused by the sole negligerica or willful misconduct of the City of Yucaipa, Permlrtee shall have received any and all pormi55iOn or license(9) as may be required to perform Or use any protected materials In its use of the Premises. Permittee sprees to protect and save harmless the City, its elected officials, employees and agents from and aga#nst 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 £acilitees and accept re5pcin5ibillty for meeting the regUirement5 Stated helain.

Signature
Deposit
EVENT RESOURCE; DEPOSIT FEE j CHARGE 1 TAX f AMOUNT PAID I REFUNDS! BALANCE Tues, Mtnly, SrCActivity Deposit $50.00 $0.00 $0.00 $0,00 S50.00 Board Mtgs. Room
https:llanprod.active.comlyucaipatui.do?method=sllo%vPermitContract&perm W9R707850E33 213

A125123. 1:01 PM
PermilContrael
i
Payment Schedules Orlginal Balance- $770.00 Current Balance: $770.00 DUIE DATE AMOUNT DUE f AMOUNT PAID WITHDRAWAL ADJUSTMENT I BALANCE Sep S. 2023 $770.00 $0.00 50.00 S770,00
Date;
City of Yucaipa Community 52rvices
Marling Address: 34272 Yucaipa Blvd, Yucaipa, CA
92399
Phenp NUmboar (809) 790-7460
Fax Number: (909; 790-2 58 9
Email Address: communityservices9yucaipa.org
a
Date;
Yucaipp VaIIQy Art Association
Customer Type: Non- Profit (R)
Customer 10: 12551
Mailing Addrew PO Box 404. Yucaipa, CA
92399
Authorized Agent Name: Zully Martinez
Home Phone Number: (9p5] 797.7741
h0psJlanprod.artive.comlyucaipalui.do7method=shoavPermitContract&perLAW 70786OE33 13

ATTACHMENT 9
270

Fiscal Year:

Date Application submitted:

Submit to:

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

Yucaipa, CA 92399
Mtn. Kimberly Metzler

COMMUNITY ACTIVITY GRANT

FINANCIAL / IN -KIND / FEE WAIVER

APPLICATION
2023-2024
512/23
Received
City of Yucaipa
MAY 0 2, Z923
General Services/
City Clerk's Department:

All sections of the applicatiou must be returned complete and all supporting documentation provided prior to City Council review. Incomplete applications received will be returned to the applicant.

INFORMATION
Name of Applicant/Organization: Yucaipa Valley Art Association Applicant/Organization Mailing Address: P.O. Box 404, Yucaipa CA 92399 Applicant/Organization Phone Number: ( )
Contact (1) Zully martillez (909 ) 797-7741
Name Phone Number
[email protected]
gmail.com
E-mail address
Contact (2) Alan Remele (909 ) 55G-3645
Name Phone Number
[email protected]
E-mail address
SECTIONREQUIREMENTS:

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 service? ❑ �J 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. 03/2021 271 Page I

SECTION 3 — ORGANIZATION INFORMATIONJAPPLICANT 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)? El El
If yes, please provide Tax ID# 95-3701090 and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? 1 ❑ How long has your 501(c) organization been in existence? 42 Number of Employees working for organization: 0
Number of Volunteers working for organization: 12
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.? d ❑ If yes, please describe: No Annual Membership is required Names and Titles of Officers and Board of Directors. (Please attach an organization chart, if available) Alan Remele - President and Board Member
Zully Martinez - Shows and Board Member
Lenore Will - Ways & Means/Secretary
Cindy Kanakriyeh- Newsletter/Social Media
Enrique Lima - Public Exhibits
Bob Norris - Parlimentarian
Judy Remele - Scholarship liascn
Carol Maidlow - Treasurer
Jo Sutt - Community Representative
SECTION 4 - l"110GRAM DESCRIPTION/SCOPE: (PLEASE USE ADDITIONAL PAGES IF NECESSARY) Name of the program/event: YVAA Art Meetings, Weekly on Wednesdays Date(s) of program/event:

July 5th, 2023 through ,tune 26, 2024, Permit R5292
Describe the program/event that organization is seeking support for; (Attach any event/program promotional materials associated with prograttt/event) The Yucaipa Valley Art Association's will hold weekly art meetings to encourage any adult artists to participate in a group collaborative painting session with fellow artists. Participants bring their own supplies. This event is free and open to the public and the City may wish to include this activity as part of community programs. YVAA will hold weekly painting sessions from I:00 pin to 3;00 pm on Wednesdays at the Scherer Community Center located at 12202 1 st Street, Yucaipa, Schedule is outlined in Permit R5292.

City of Yucaipa Community Activity Grants Application, Rev. 03/2023 272 Page 2

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

The Yucaipa Valley Art Association's small group painting sessions give artists in the community the opportunity to meet up in person to paint in a collaborative and peer group environment. The meetings help to promote art in our community and supports the creativity and talent of our local community member. Our community contributions and activities significantly increase awareness and appreciation for the artistic talent of our members and local community members.

Program/Event Primary Target Population (check all that apply):
❑ Children or Youth
❑ Low Income
❑ Persons with Disabilities
Number of Residents Projected to Serve: 10-15
❑ Seniors
❑ Victims
❑ Welfare Recipients
Please identify what your organization is seeking:

Financial Support: ❑ Yes ❑ No S
$200 SEP Fee
Waiver: © Yes m No
In -kind Support: Police $ Fire $_
Reassigned
Staff $ Other $
❑ Women
❑ Homeless
■❑ Entire Community
Public
Works $ CS/Rental $ 5,733.00
Explain
$200 SEP Total Overall
In -Kind Financial Support Fee Waiver Request
Total Amount of Request: $ 5,733.00 $ $ = $ 5,733.00
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 a room for two (2) hours on a weekly basis on Wednesdays for meetings at the Scherer Center in room A from July 2023 to June 2024. This CAGrant covers rental costs for the weekly meetings year round. Activities will include art painting in any medium chosen by participant. This event is open to any adult, including our members and the general public who may wish to participate in a group painting scssion.

City of Yucaipa Community Activity Grants Application, Rev. 0312023 273 Page 3

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

Total Funds Requested Via Grant Application:

Remaining Balance That Will Be Funded By
Organization:

In -Kind
Financial
Amount
Support Amount
$
$
$
$ 0
$ 0
Provide City funding received by organization in the past three years (required):

Program In -Kind Financial $16.25 SEP Date
Support Fee Waiver Received
YVAA Spring Art Show 2023
YVAA Tues & Thursday Mtgs
YVAA Spring Art Show 2022
0 ❑
❑
0 ❑
❑
❑�
❑
❑
6/22
6/22
6/21
Total Received
1689.00
$ 2624.00
$ 1483.63
1, the undersigned, do hereby attest that the above information is true and correct to the best of my knowledge, and understand that tl arded fin n ial grant amount needs to be spent prior to submitting another grant request.

U% Z!f,Af'Board Member 5/2/23
8igaaature Title Date
Date Received;
Amount Funded: $
-) "' Date Reviewed
Type of Grant: Vn-Kind
Date City Council received follow up report:

City Council Meeting:
❑ Financial Support
� - ( ( --FL,3
❑ Fee Waiver
City of Yucaipa Community Activity Grants Application, Rev. 03/2023 274 Page 4

4125. 23, 11:15 AM
Permit
City of Yural p$ Community
S2N1ce5
34272 Yucaipa Blvd
Yucaipa. CA 92399
PermitCorttract

COMMUNITY
;a' SERVICES
PHONE-(909)790-7460 Permit # R5292
FAX:(909) 790.2589 Status Tentative
EMAIL:CommLinityservices,Oyucaipe.org Date Apr 25, 2023 11;13 AM Expiration Date Apr 24. 2024
Organixatlon Name Yucaipa Valley Art Association - 49
Customer Type Non-Profi. (R)
Organization! Address PO Box 404
Yucaipa. CA 92399
Agent Name Zu11y Martinez Home Phone Numbef (909) 797.7741 System User Tisn Cnristtan
Rental Fee
$5.73300
❑i5t6ur5ts
so.00
Subtotal
$5.732 40
Deposits
S0.00
Deposit Discounts
S0.00
Total Permit Fee
$5.733.00
Total Payment

50.00 Refund'.
$0.00
Balance
55,73300
Wed. Paint Sessions- YVAA 1 resvurcep) 49 booxing(s} Subtotal: $5.733.00 Booking Summary
START DATE171ME

END DATEITIME
Jul 5, 2023 1:00 PM
Jun 26, 2024 3:00 PM
Occurs every Wednesday effective Jut 5, 2022 until Jury 26, 2024 from P00 PM to 3,00 FM Jul 5. 2023 1,00 PM
Jul 5, 2023 3:00 PM
Rental - Hourly
$58,50 / Hour x 2 $117-00
Jul 12, 2023 1:00 PM
Jul 12, 2023 3:00 PM
Rental - Hourly
$58.501 Hour x 2 5117,00
Jul 19, 2023 1:00 PM
Jul 19, 2023 100 PM
Rental - Hourly
$58.50 f Hour x 2 $117.00
Jul 26.20231:00 PM
Jul 26, 2023 3:00 PM
Rental - Hourly
$58.50 / Hour x 2 $$11700
Aug 2. 2023 1:00 PM
Aug 2. 2023 3:00 PM
https:ffanprod.aclivo.comiyucaipafui.do?method=shovvPermitContrac(,$permit id=CC6337890738
AT7ENDEE I AMT WIO TAX
15 $117.00
15 5117.00
15 Si17.00
15 $117.00
15 $117.00
U5

4125123, 1115AM
PermliContracl
Rental - Hourly
553,50 / Hour x 2
S117.00
Aug 9, 2023 1:00 PM
Aug 9, 2023 3:00 PM
15 S11700
Rental - Hourly
$58.50 / Hour x 2
S117.00
Aug 16. 2023 1:00 PM
Aug 16, 2023 3:00 PM
15 S117,00
Rental - Hourly
$58.50 / Hour x 2
$117.00
Aug 23, 2023 1:00 PM
Aug 23, 2023 3:00 PM
15 3117.00
Rental - Hourly
$58.50 I Hour x 2
$117.00
Aug 30, 2023 1:00 PM
Aug 30, 2023 3:00 PM
15 S 11700
Rental - Hourly
$58.50 I Hour x 2
$117,00
Sep S. 2023 1:00 PM
Sep 6, 2023 3:00 PM
15 $117.00
Rental - Hourly
$56.50 / Hour x 2
$117.00
Sep 13, 2023 1:00 PNI
Sep 13, 2023 3:00 PM
15 S117.00
Rental - Hourly
$58.50 / Hour x 2
$117.00
Sep 20, 2023 1:00 PM
Sep 20, 2023 3:00 PM
15 $117.00
Rental - Hourly
S58.50 / Hour x 2
$117.00
Sep 27. 2023 1:00 PM
Sep 27, 2023 3:00 PM
15 $117.00
Rental - Hourly
$58.50I Hour x 2
S117.00
Oct 4, 2023 1 00 PM
Oct 4, 2023 3:00 PM
15 1117.00
Rental - Hourly
$58.60 / Hour x 2
$117,00
Oct 11, 2023 1:00 PM
Oct 11, 2023 3:00 PM
15 $117.00
Rertal - Hourly
$58.501 Hour x 2
$117.00
Oct 18, 20231,00 PM
Oct 18, 2023 3:00 PM
15 $117.00
Rental . Hourly
$58.50 I Hour x 2
$117.00
Oct 25, 2023 1:00 PM
Oct 25, 2023 3:00 PM
15 $117,00
Rental - Hpurly
558.50 / Hour x 2
$11700
- Nov 1, 2023 1:00 PM
Nov 1, 2023 3:00 PM
15 $117.00
Rental - Hourly
$58.50 / Hour x 2
$11700
Nov 8, 2023 1:00 PM
Nov S. 2023 3:00 PM
15 S117.00
Rental - Hourly
$58,50 / Hour x 2
$117,00
Nov 15. 20231,00 PM
Nov 15, 2023 3.00 PM
15 $117.00
Rental - Hourly
$58.50 / Hour x 2
$117.00
Nov 29, 2023 1:00 PM
Nov 29, 2023 3:00 PM
15 $11700
Rental - Hourly
$58.50 / Hour x 2
$117.00
Dec 6, 2023 1:00 PM
Dec 6, 2023 3:00 PM
15 $117.00
Rentai - Hpurly
$58.50 / Hour x 2
$117.00
Dec 13, 2023 1:00 PM
Dec 13. 2023 3:00 PNI
15 S117.00
Rental - Hourly
$58,50 / Hour x 2
$117.00
htlps:/lanprod.active.comlyumpaNLdo?method=slimvPermitConiract&permit %08307n0738
2/5

4125/23, 11:15 ANI
PermaConlract
Jar} 3, 20241,00 PM
Jan 3, 2024 3:00 PM
15 $117.00
Rental - Hourly
$58.501 Hour x 2
$117.00
Jan 10, 2024 1:00 PM
Jan 10, 2024 3:00 PM
15 S117.00
Rental - Hourly
$58,50 / Hour x 2
$117.00
Jan 17, 2024 1:00 PM
Jan 17, 2024 3:00 PM
15 $117,00
Rental - Hourly
$58.50 / Hour x 2
S117.00
Jan 24, 2024 1:00 PM
Jan 24, 2024 3:00 Pivl
15 S117,00
Rental - Hourly
$58,50 1 Hour x 2
5117.00
Jan 31, 2024 1:00 PM
Jan 31. 2024 3:00 PM
15 $117,00
Rental - Hourly
$58.50 / Hour x 2
$117.00
Feb 7, 2024 1:00 PM
Feb 7, 2024 3 00 PM
15 $117.00
Rental - Hourly
$58.501 Hour x 2
$117.00
Feb 14. 2024 1:00 PM
Feb 14, 2024 3:00 PM
15 $117.00
Rental - Hourly
S58 50 / Hour x 2
5117.00
Feb 21, 2024 1:00 PM
Feb 21, 2024 3:00 PM
15 $117.00
Rental - Hourly
$58,501 Hour x 2
S117-00
Feb 28, 2024 1:00 PM
Feb 28, 2024 3:00 PM
15 $117,00
Rental - Hourly
858.50 1 Hour x 2
$117,00
Mar 5, 2024 1:00 PM
Mar 6, 2024 3:00 PM
15 $117,00
Rental - Hourly
$58.50/ Hour x 2
5117.00
Mar 13, 2024 1:00 PM
Mar 13, 2024 3:00 PM
15 $117.00
Rental - Hourly
$58.50 / Hour x 2
$117.00
Mar 20, 2024 1;00 PM
Mar 20, 2024 3:00 PM
15 $117.00
Rental - Hourly
$56-50 / Hour x 2
$117,00
Mar 27, 2024 1:00 PM
Mar 27, 2024 3:00 PM
15 $117.00
Rental - Hourly
$58.501 Hour x 2
$117.00
Apr 3, 2024 1:00 PM
Apr 3, 2024 3:00 PM
15 $117.00
Rental - Hourly
$58,501 Hour x 2
$117,00
Apr 10, 2024 1:00 PM
Apr 10, 2024 3;00 PM
15 $117.00
Rental - Hourly
$58.501 Hour x 2
$117.00
c
_ Apr 17, 2024 1:00 PM
Apr 17, 20243,00 PM
i5
S11700
Rental - Hourly
$58.501 Hour x 2
$117.00
Apr 24, 2024 1:00 PM
Apr 24, 2024 3:00 PM
15 S117.00
Rental - Hourly
$58,501 Hour x 2
$117,00
May.1, 2024 WO PM
May 1, 2024 3:00 PM
15 $117.00
Rental - Hourly
$58.50 / Hour x 2
$117.00
https:llaiiprod.active.com/yucaipalui,de7method=snowpermltContract&permiLiTi , r307890738 3;5

PermitConlract
May 8, 20241:00 PM
May 8, 2024 3:00 PM
15 S117.00
Rental - Hourly
S58.50 / Hour x 2
5117,00
ii toy 16, 2024 1:00 PM
May 15. 2024 3:00 PM
15 $111,00
-
Rental - Hourly
$5$.50 / Hour x 2
S117.00
May 22,. 20241:00 PM
May 22. 2024 3:00 PM
15 S117.00
Rental - Hourly
$58.501 Hour x 2
S117.00
May'2,�, ;024 1.00 PM
May 29, 2024 3:00 PM
15 $117.00
Rental - Hourly
$58,50 / Hour x 2
$117,00
Jun 5, 20241:00 PM
Jun 5, 2024 3:00 PM
15 5117.00
Rental - Hourly
$58.50 / Hour x 2
$117.00
Jun 12. 20241:00 PM
Jun 12, 2024 3:00 PM
15 5117.00
Rental - Hourly
$513.50 / Hour x 2
$117.00
Jun 19, 20241:00 PM
Jun 19. 2024 3:D0 P,'v1
15 $117.00
Rental - Hourly
$58,S0 / Hour x 2
$117.00
Jun 26, 20241:00 PM
Jun 26, 2024 100 PM
15 3117.00
Rental - Hourly
$58.50 / Hour x 2
$117.00
Waivers and Information

INFORMATION DESCRIPTION SIGNING STATUS
Alcohol Sales Lic Checked
Proof of Liability Insurance Checked
Security Guard Cdntratt Checked
Proof of Non Profit Status Checked

WAIVER NAME DUE DATE FOR SIGNING STATUS
Facility Usage Waiver Jul S. 2023 Waiver Signed
Facility user hereby agrees to indemnify, defend and iiold 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 snail not be liable for any c'Aims• damages, losses and expenses caused by the sole negVgence or willful misconduct of the City of Yucaipa. Permittee shall have received any and all permission or license(s) as may be requlred to perform or use any protected materlals in Its use of the Premises. Permittee agrees to protect and save harmless the City, its electad officials• employees and agents from and against any and all claims, penalties, and/or 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.

Signature
Payment Schedules Original Balance: $5,733.00 Current Balance: $5,733,00 DUE DATE + AMOUNT DUE AMOUNT PAID I WITHDRAWAL ADJUSTMENT I BALANCE Jun 21. 2023 $5,733.00 $0.00 S0.00 $5,733.00
'lanpfod.aCtiva.Comfyucaipa/ui.do?method=showPermitContract8permil_id=CCt3 7890738

412512', 11:15AM
Perm itContract
(Date:

City of Yucaipa Community Services
Mailing Address: 34272 Yucaipa Blvd, Yucaipa, CA
92399
Phone plumber: (909) 790-7460
Pax Number. (909) 790-2539
Email Addresa communaVservlces:O)yucaipa,org
X:

Date:

Yucaipa Valley Art Association
Customer?ype: Non•Profit(R)
Cuscam@r ID, 12551
Marling Address: PO Box 404, Yucaipa. CA
92399
Authorized Agent Name: Zu1y Martinez
Horne Prrone Numbef:1909) 797-7741
https:llanprod -, cOve,comlyucaipatui.do?me thod=showPermitCon tract&perms 711 p0880789073$ 515

ATTACHMENT 10
:E

Fiscal Year:

Date Application submitted:

Submit to:

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

Yucaipa, CA 92.399
Attn: Kimberly Metzler

COMMUNITY Y ACTIVITY GRANT
2023-2024

FINANCIAL / IN -KIND / FEE WAIVER

APPLICATION
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: Yucaipa Valley Lions Club Applicant/Organization Mailing Address: 10961 Desert Lawn Drive #92, Calimesa, CA 92320 Applicant/Organization Phone Number:

Contact (I)
Contact (2)
(909 )240-3491
Jane Van Norstrand
Name
[email protected]
E-mail address,
Ann Bedel
Name
ArtaReb.15 @yahoo.aorn
(909 ) 240-349 1
Phone Number
(714 ) 767-4604 _
Phone Number
E-mail address
Yes No
Is your organization located in another community? d ❑'' 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. f itv of Ynraina C'.nmmimity ,Activity reirant. Annlication. Rev, 03/20232M 1 rage 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)7 0
❑
95-6133638
If yes, please provide Tax ID#and attach all supporting documents.

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

Is a current City Council Member on your board? ❑
❑✓
all of'them
How many Yucaipa residents does your organization currently serve? Does the organization charge admission, membership tees, dues, etc,? 0 ❑
Dues for members only
If yes, please describe:

Flames and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) President - Ann Bede] Cindy Swanson
-Vice President - Richard Bedel Ron Charleston
Secretary - Jane Van Norstra.nd Michelle Beckman
Treasurer - Jim Klocek
Nita Allgower
Vita Charleston
Janene Klocek
r
Name of the programlevent: Yucaipa Valley Lions Club Meetings Date(s) of program/event: Third Monday evening of each month Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) General and Board meeting
f iFv nMirn inn Cnmmunity Activity Cratits AOoiication. Rev, o3/2A23 Z82 page 2

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

Planning service projects and various donations within the community Program/Event Primary Target Population (check all that apply):
0 Children or Youth 0 Seniors
0 Low Income #❑ Victims
❑8 Persons with Disabilities Q Welfare Recipients
Number of Residents Projected to Serve: ' ` H5
SECTION 5 —GRANT FUNDING REQUEST
Please identity what your organization is see ng:

Financial Support: ❑ Yes No $
$200 SEP'Fee
Waiver: ❑ Yes 5(Xo
Public
In -kind Support., police $� Eire $ Works
Reassigned
Staff $ Other $ Explain
$200 SEP
In -Kind Financial Support Fee Waiver
Total Amount of Request: $ �o {� $ $ -
Provide a detailed description of how the financial support will be used:

Facility Rental Fees to be waived
❑r
Women
❑■
Homeless
❑■
Entire Community
CS/Rental $ }- .

Total Overall c-4
Request, fl 0 n P-> cz"
Oity of v,ir n;nn rnnmmirirtv Arrivity Grams Annlication. Rev. 0312023283 Pane 3

What other in -kind financial contributions has your organization received to fund this event/program (separate from City funding)?
In -Kind
Amount
0 Financial
Support Amount
0 $
$
$
$
Total Funds Received To Date:
--
Total Funds Requested Via Grant Application:
$
$
Remaining nalancc That Will Be Funded
By $
$
Organization:

SECTION 6— Fl. NANCI Al
1'rovidc 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
2022-2023
❑
❑
1-12-23 $ 357.30
❑
❑
❑
$
1, the undersigned, do hereby attest that the above information is true and correct to the best of my knowledge, and understand at the awarded financial grant amount needs to be spent prior to submitting another grant request. anahire Title Date
Date Received: ' ' ~ % '� r Date Reviewed; +' ` �L' _-_� Amount Funded: $ City Council Meeting:

Type of Grant: De I11 Kind ❑ Financial Support ❑ Fee Waivcr Date City Council received follow up report:

City of Ynraina i-:ommunity Activity Grants Application, Rev. 03/2023 284 page 4

4110/23,1:45 PM
PermitContract
Permit
City of Yucaipa Community
Services
34272 Yucaipa Blvd
Yucaipa, CA 92399
PHONE:(909) 790-7460
FAX:(909) 790-2589
EMAIL,[email protected]
Organization Name
Yucaipa Valley Lions Club -131
Customer Type
Nora -Profit (R)
Organization Address
10961 Desert Lawn Dr. #92
Calimesa. CA 92320
Agent Name
Jane Van Norstrand
System User Tish Christian
Pt
COMMUNITY`S
SERVICES "Ll
Betr.

Permit #
R5200
Status
Tentative
Date
Mar 6, 2023 2.38 PM
Expiration Date
Mar 5, 2024
Organization Phone 1 (909) 240.3491
Number
Home Phone Number {909) 240.3491
Cell Phone Number 1909) 240-3491
Email Address [email protected]
A F, Y. � a0',.q b
4,
.� I i �f� fees � ��. i ; C �� �� �rnf•
Fax ��.
[?lrCcz/rf P-0
FcG1 !J Dee, r
Lions Club Monthly Mtg,
Booking Summary
START DATEfrlME END DATE71ME
Jul 17, 2023 5:30 PM Oct 16, 2023 8:30 PM
Occurs on selected dotes: Jul 17 2023, Sep 18, 2023, Oct 16, 2023 Jul 17, 2023 5:30 PM Jul 17, 2023 8:30 PM
Rental - Daily $36.00 / Hour x 3 $108.00
Rental - Weekday Event Assistant (8P-12A) $22.201 Hour x 0.5 $11.10 Sep 18, 2023 5:30 PM Sep 18, 2023 8:30 PM
Rental - Daily $36.00 / Hour x 3 $108.00
Rental - Weekday Event Assistant (813-12A) $22.201 !-lour x 0.5 $11.10 Oct 16, 2023 5:30 PM Oct 16, 2023 8:30 PM
Rental - Daily $36.00 / Hour x 3 $108.00
4 Rental Fee $s9s-so
Discounts $0,00
Subtotal $595.50
Deposits $100.00
Deposit Discounts $D.00
Total Permit Fee $695.50
Total Payment $0.00
Refunds $0.00
Balance $595.50
1 resouece(s) 5 booking(s) Subtotal: $695.50

ATTENDEE I AMT W/O TAX
1 $119.10
15 $119.10
15 $119.10
https:llanprod.:}ctive.comlyucaipalui.do7method-showPermitContr8Ct&perm3M_�C9B0071394E36 V3 4 Rental Fee $s9s-so
Discounts $0,00
Subtotal $595.50
Deposits $100.00
Deposit Discounts $D.00
Total Permit Fee $695.50
Total Payment $0.00
Refunds $0.00
Balance $595.50
1 resouece(s) 5 booking(s) Subtotal: $695.50

ATTENDEE I AMT W/O TAX
1 $119.10
15 $119.10
15 $119.10
https:llanprod.:}ctive.comlyucaipalui.do7method-showPermitContr8Ct&perm3M_�C9B0071394E36 V3 Total Permit Fee $695.50
Total Payment $0.00
Refunds $0.00
Balance $595.50
1 resouece(s) 5 booking(s) Subtotal: $695.50

ATTENDEE I AMT W/O TAX
1 $119.10
15 $119.10
15 $119.10
https:llanprod.:}ctive.comlyucaipalui.do7method-showPermitContr8Ct&perm3M_�C9B0071394E36 V3

4110123;
1;45 PM ParmitContract
Rental - Weekday Event Assistant ($P-12A} $22.20 / Hour x 0.5 $11.10 Aug 21, 2023 5:30 PM Aug 21, 2023 8:30 PM 15 $119.10
Rental - Daily $36.00 / Hour x 3 $108.00
Rental - Weekday Event Assistant (8P-12A) $22.20 / Hour x 0.5 $11.10 Nov 20. 2023 5:30 PM Nov 20, 2023 8:30 PM 1S $119.10
Rental - Daily $36.00 /Flour x 3 $108.00
Rental -Weekday Event Assistant (8P-12A) $22.20 / Hour x 0.5 $11.10 Resource level fees $100.00
Deposit $100,001 Each x 1 $100.00
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 17 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, losses and expenses that may arise during or be caused in anyway by such occupancy or use of facllitles, but the facility user shall not be liable for any claims, damages, losses and expenses caused by the sole negligence or willful misconduct ofthe City of Yucaipa. Permittee shall have received any and all permission or license(s) as may ba 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, andtor damages which may accrue as a result of Permlttee's failure to comply wlth this requirement.

I have read the ruie5 and regulations relating to use of facrlities and accept responsibility for meeting the requirements stated herein.

Signature
Deposit

EVENT RESOURCE I DEPOSIT FEE I CHARGE I TAX I AMOUNT PAID I REFUNDS I BALANCE Lions Club Community Deposit $100.00 $0.00 $0.00 $0.00 $100.00 Monthly Mtg. Meeting
Room
Payment Schedules Original Balance: $695.50 Current Valance: $695.50

DUE DATI I AMOUNT DUE I AMOUNT PAID I WITHDRAWAL ADJUSTMENT I BALANCE _ Jul 3, 2C23 $695.50 $0.00 $0.00 $695.50
https:llanprod. active, comlyucaipalui.do7rnethod=showPermitContractgpemQ W9BD07890E36 2l3

ATTACHMENT 11
287

aw or
Fiscal Year:

Date Application submitted:

Submit to:

City orYucaipa
General SmiGes/City Clerk Department
34272 Yucaipa Blvd.

Yucaipa, CA 92399
Attn: Kimberly Metzler

COMMUNITY ACTIVITY GRANT
FINA NIvIA L / IN -KIND f FEE WAIVER

A PPL ICA TI N
2023- 7024
Received
City Of Yucaipa
APR 2 7 2023
General Services/
City Clerk's Department
All sections of the application roust 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 Mailing Address:

Applicant/Organization Phone Number
Contact (1)
Yucaipa Youth Basketball
PO Box 31 Yucaipa, CA 92399
(909 )9101276
Ryan Kerns
(909 ) 9 I (1-1276
Name Phone Number
yucaipayouthbasketbal I@outlkin k,cwu
E-mail address
Tyler Overstreet
C;nnlact (2) (909 ) 729-5372
Name Phone Number
yucaipayoutlibaskctbxllca(ci�i-!ntai I.cotn
E-mail address
Yes No
Is your organization located in another community? ❑ El Will the programlevent take place in ammher community? © ❑� Are you aware orany other City program providing this advice? ❑ Q Vso, which one:?
"If vuu answered "Yes" to any of the questions listed above, your request is not eligible for the Community Activin, Grartl.

Laity of Yt aip,t Ccnrl+nunity Activiiy Crrtinli Applic,iflc)n, iiCv. 03/2023 288 11ag4 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)?
a
3 3-0862817
If yes, please provide Tax 1DN and attach all supporting documents.

Does this application include silbmittal of documentation verifying 501(c) status'? 1 ❑
yrs
Ilow long has your 501(c) organization been in existence?existence?24 Number of Employees working for organization:
20 Number of Volunteers working for organization:

Is a can ent City Council Member on your board?
©
❑
400
How many Yucaipa residents does your organization currently serve'? Does the organization charge admission, membership fees. dues, etc.? ❑
�
If yes, please describe;
Narnes and Titles ofOfflicers and Board of Directors: (Please attach an organization chart, ifaWiilable) Tyler Overstreet - President
Melissa Case -- Secretary
Ryan Kerns - Treasurer
Bryce Shink - Chief of Officals
Jackie Overstreet - Publicity Chair
Name of the program/event:

Datc(s) ofprogram/event:

Yucaipa Youth Basketball 2023-24 Season
01 /01 /2 024- 04/0 1/2 024
Doscribe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) We are seeking assistance for the following items

1. Providing duality, fun uniforms for our youth.

2. Use of the Yucaipa Community Center.
3, Assistance with the cost of CIF referees.

The usage of'the Yucaipa Cominunity Center would be to create content for our volunteer coaches, referees and players. Our coaching support is 1001�o volunteer and creating inSLruclonal videos will allow Ior increased support and coitfidence in helping our yattth develop and grow. t: itv of Yucaipa Community Aclivify Grants Application, Kev. 03/2023 289 Nigc 2

Describe how the progratrt/event benefits the residents and/or commttatity of Yucaipa:

Our program as a whole provides a safe and fun experience playing, basketball. We strive to teach and nfFiml principles such as teamwork. communication and building character Our our youth. Uniforms have bee,l a cltallonge as they lend to be expensive, players have worn mismakched shorts and socks snaking it difficult to create a uniformed scum. Our unilbrkns help our youth by making lltetn 1'eol itrcluded and part of a team.

Creating content Ibr our referees and coaches is our way to connect all oI us to our mission ofs,viiig our 4ommuniiy.'nc�. use oraic community l:cntcr wiII allow us to tllm shop Ik gructional videos so that they can scree m a hasClille Of pl'OPCI' IslayCknlIiDg I] Rd CORCII etnl114ttV, TI]is 7ViII r4St1Ir;;I a better experience for our children as well as parents who are engaged with their cliOd's team.

A constant challenge in providing the best experience for our children is consistent playcalling, Hiring, CIF tofcrces whereby they can guide the youiiger referees in a game will kriake for a hettcr experience for our players, inexpicrenced rcfcrew that are still learning and parents, Prograrn/Event Primary Target Population (check all that apply):
0 Children or Youth
Scniors
❑
Women
❑
Low Income
❑
Victims
❑
Monle:lohw
©
Persons with Disabilities
❑
'Welfare Recipients
■❑
Entire Community
Number of Residents Projected to Serve: 450
Please identify what your organization is seeking:

Financial Support: ❑ Yes ❑ No $zaaa_
5200 SIE P Fee
Waiver: ❑ Yes ❑Igo
In -kind Support: Police $ Fire $�
Reassigned
Staff $ Other $
Ill -Kind Financial Support
,total Amount of Request: $aasa _ $2000
Public
Works S CSlRcntal Saaha
Explain _
$200 SEP Total Overall
Foe Waiver Request
$� _ $ cnso
Provide a detailed description of how the tnancial stippott will be used:

The Financial support Will be used to purchase duality uniforms that include a jersey and matching shor(s, In addition, financial support will also be used to pay for [CIF referees to llctp educate our younger referces and bring consistency to cacti game.

The in -kind support will be used to create video documentation to better train our referees and provide a reference for coaches to create a better experience for our youth.

City of Yucaipa Community Activity Grants Applicution, Rcv, 03/2023 290 Page 3

What other in-kind/financial contributions has your organization received to fund this event/prograin (separate from City funding)?
Registration Fees
Sponsorships
Total Funds Received To Datc:

Total Funds Requested Via Grant Application: $
Remaining Balance That Will Be Funded By S
Organization:

In -Kind Financial
Amount Support Amount
$ 58,101.28

10.822.82
74,924.10
25,000
$ 49,924.10
Provide City funding; received by organization in the past three years (required):

Program In -Kind Financial $16.25 SEP Date
Support Fcc Waiver Received
El
Total Received
1, the undersigned, do hereby attest that the above information is true: and coiTect to the best of nay knowledge, and understand that the a c i vial grant amount needs to be spent pI'ioi' to NUbmitting another grant request.

UNA�11� 4 - ---- -
5ignature Title Dais

COMPLETEDTO BE BY CITY
Date Received: 4 - 2,7 - Datc Reviewed:

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

City Council Mcctiug:

Financial SuPPnrt
PAD
❑ Fee Waiver
City of Yuculpa Community Ac:livily Grant,; Applic:uitm, Rev. 01/2023 291 Paw 4

Permit
CQMMUN17 Y NI
pIffroe SERVICES � ¢
City of Yucaipa Community
Services
34272 Yucaipa Blvd
Yucnlpa, CA 92399
PF(ONE:(909) 790-7460
FAX:(909) 790.2509
EMAIL:cvllllnurtiity;rr; IV14Gs'rryur.,:�ip4t,grcy
Organization Name
Yucaipa Youth Basketball -17
Customer Type
Non-Profil (R)
Organization Address
PO Box 31
Yucaipa, CA 92399
Agent Nettle
Ryan Kerns
System User Julia sash
Yucaipa `youth Basketball
Rooking Sumnls2ry
Permit # R5291
$totals Tentative
Data Apr 25. 2023 9:21 AM
ExpirationDate, Apr 24. 2024
Organizaton Phone 1 (909) 910-1276
Number
Momc Phonc Number (909)91a 1
EmallAddres5 a ind{. r' q: ld r.'srrl
Rental Fee
$4.080 00
Discounts
$0.00
Subtotal
$4.080.00
Depv6it.
$200.00
Dopoml Discounts
$0100
Total Permit Fee $4,280,00
Total Payment $0.00
Rofunds $0.00
Balance $4.280.00
2 resource(s) 19 boWng(s} Subtotal: $4,280.00

START DATE/TIME

END DATE/TIME
ATTENDEE AMT W/0 TAX
Aug 9, 2023 5:00 PM
Jun 12, 2024 7:00 PM
— $w,00
occurs the sscorrd wednesdey u(
every f Inuntigs) of wive Aug 9.2023 until Jua 12, 2024 from 5:00 PM to 700 PM Aug 9, 2023 500 PM
Auq 9.2023 7.00 PM
1 $80.00
Pr+nl»I - rmlly
,s,0,001 Wrnm c 7,
SFS{} 10
Sep 13, 2023 5:00 PM
Sep 13. 2023 7,00 PM
1 $80.00
Rontnl - r',aily
540 001 ♦•luul x 7
5S4.00
DO 11. 2023 5,00 PM
Oct 11. 2023 7:00 PM
1 $80.00
Rental - Daily
140 CQ 1 Flout r. J
559.44
Nov S, 2023 5 00 PM
Nov 8, 2023 7:00 PM
1 $80.00
kt,ntnl ^ Dnily
'PWU i I l joul 2
yF=c5.Cs15
Dec 13. 202S 5:00 PM
Dec 13, 2023 7:00 PM
1 $80.00
i�¢ nlnl • E ally
$+1.(I.UO i t IUUr x 7
, . 1. JI.

Jan 10, 2024 5:00 PM
Jan 10, 2024 7:00 PM
1 Moo
anlal • f>,'illy
S40.00 r Fluur Y 7
VQ 00
# R5291 Status Tentative Page 1 of 3
292

Fels 14, 2024 5.00 PM
Feb 14, 2024 7:00 PM
1 5$0.00
',C,nml - gaily
$40 U01 How x 2
vUo 00
Mar 13, 2024 5:00 PM
Mar 13, 2024 7:00 PM
1 $80.00
'r?,ilul - {"°,l l:'
,40.00 f !dour x 2
580 00
Apr 10, 2024 5:00 PM
Apr 10, 2024 7:00 PM
1 $80.00
Re-nlal - ally
$40.00 1 HOW K 2
58:2 00
May $, 2024 5:00 PM
May 8, 2024 7-00 PM
1 $80.00
Rental - E3TIly
$40 00
Jun 12, 2024 5:00 PM
Jun 12, 2024 7:00 PI41
1 $80,00
Rental E'Cuhf
'�10 p0; 1 Iqw x 2
5SQ.00
Resource level fees
$100,00
f]gr;r,i of
$100.001 EkIch K 1
$10o ()U
..

START DATE/TIME

ENO OATEJTIME ATTENDEE
AMT W10 TAX
Aug 12, 2023 9:00 AM
Oct 14, 202311:00 AM
—
$9,2flQ,OD
Occurs bri selerted dates: Aug f2, 2023, Aug 19. 2023. Aog 26, 2023, S&p J6, 2023. Sop 23. 2023. Sop 20. 2023. Orr 7, 2023. Ort 14, 2023 Aug 12, 2029 9:00 AM
Aug 12. 202311:00 AM
1 $400.00
F."0111al - I l0urly
tiJS:D,[10 " riour e :'
�',41, ),OM:

Aug 19, 2023 9:00 AM
Aug 19, 202311:00 AM
1 $400.00
R0111c1l - HOLASI
5400.(Y(')
Aug 26, 2023 9:00 AM
Aug 26, 202311:00 AM
1 $400.00
anlal •, Hcjlully
S200.11i,' ' i oiir A .1
Sep 16, 2023 9:00 AM
Sep 16, 202311:00 AM
1 $400.00
'2r:ntvl • I'1plrlly
'$—t 0,U0,' H0Ur)L 2
-Mi7C).0
Sep 23, 2023 9:00 AM
Sep 23, 202311:00 AM
1 $400.00
:ie ntal - I Iriurly
S:r00.00 J Hour r. 2
3400.OU
Sap 30, 2023 9:00 AM
Sep 30, 202311:00 AM
1 $400 00
ov-niol - Ha.irly
S200.00 ' How x :

S4():) oC.;
Oct 7, 2023 9,00 AM
Oct 7, 2023 11,00 AM
1 $400.00
Rt'lli l- Hourly
$200,00 f H:A,ir x 2
W11),00
Oct 14, 2023 9:00 AM
Oct 14, 202311:00 AM
1 $400.00
RL,rlml - K.Jully
$200.00.,Hour x 2
S400.0;)
Resource level tees
$100.00
V00 00 I Ucl1 ;t 1
$100.0u
Waivers wid Information

INFORMATION DESCRIPTION
Alcohol Sales Lic
Proof of Liability Insurance
Security Guard Contract

SIGNING STATUS
Checked
Checked
Checked
I
# R5291 Status Tentative
293

Proof of Non Profit Status Chetked
WAIVER NAME DUE DATE FOR 51GNINC STATUS
Facility Usage Waiver Aug 12, 2023 Waiver Signed
Facility user hereby agrees to Indemnity, defend and hold harmless Oty of Yucaipa, Its ofFlcr:rs, oINCI&Ig, empleyeps and votunlocrs from and agalnsl all claims, damages. losses and expenses that may arise during or 09 caused In anyway by such occupancy Or use of facilities. but the facility user shall not be Ilable for any claims, damages, losses and expenses caused by the sole negilla or willful misconduct of the City Of Yucrrlpr,, Permltteg Shall havg mceived any and all permission or licensg(s) as may bg required to perform or use any protected materialS in itS uSe of floe Premises PCrmitteC agrees to protect and save harmless the City, its elected officials, employees and agents from and against any And all claims, penalties, andlor damages which may accrue as a 1­95ult Of PemtittlaWS failure to tOmply with this requirement. ! I have read the rules and regulations relating to use of facilities and accept responsiWIlty for meeting the requirements stated herein, Slgrtature f'
Nposlt
EVENT

RESOURCE

DEPOSIT FEE

CHARGE TAX

AMOUNT PAID

REFUNDS

BALANCE
Yucaipa
Community
Deposit
$100.00 $0,00
$0.00
$0.00
$100.00
Youth
Meeting
Basketball
Room
Yucaipa
Gymnasium
Deposit
$100.00 $0100
$0.00
$0,00
$100.00
Youth
Basketball
Payment 5chedoles
Original Balance: $4.280.00
Current B4'ilancc: $4.2,90.00

DUE DATE

AMOUNT DUE

AMOUNT PAID

WITHDRAWAL ADJUSTMENT

BALANCE
Apr 25, 2023
S1,290.80
$0,00
$0.00
51,290,B0
Jul 29.2023
$2.989.20
$0.00
$0.0o
$2,980.20
X
Date.

City of Yucaipa Community SeMcas
Mailing Address: 34272 Yucaipa Blvd, Yucaipa, CA
92399
Phone Number: (9091 790-7460
Fax Number: (909) 790-2589
Email Address: cgmmunityservicese-yucaipa.org
X:

Date: * '
Yucaipa Youth Basketball
Customer Type; Nan -Profit (R)
Customer ID; 43436
Mailing Address: PO Box 31, Yucaipa, CA
92399
Oig8nizatlOrl phone 1 Nuw"r: (909) 910-1276
Authorized Agent Name: Ryan Kerns
Home Phone Number: 1909) 910.1276
Email Address: kernsjerftmail.com
# R6291 Status Tentative Page 3 of 3
294

4127123, 9:45 AM Tax Exempt Organization Search Detail's I Internal Revenue Service Yucaipa Youth Basketball
League
EIN: 33-0862817 + Yucaipa, California, United States
Publication 78 Data
organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of the ircontributions.

On Publication 78 Data List: Yes
Deductibility Code: PC
Form 990-N (e-Postcard)
Organizations who have filed a 990-N (e-Postcard) annual electronic notice.

Most small organizations that receive less than $50,000 fall into this category.

Tax Period:
2013(09/01/2013-08/31/2014)
EIN:
33-0862817
Organization Name (Doing Business as):

YUCAIPA YOUTH BASKETBALL LEAGUE
Mailing Address:

PO Box 31
Yucaipa, CA 92399
United States
Principal Officer's Name and Address:

Victor M Garnez
PO Box 31
Yucaipa, CA 92399
United States
Cross receipts not greater than:
$50,000
Organization has terminated-
https:/iepps.irs.gov/appleosfdetailst 295 112

ATTACHMENT 12
296

Fiscal Year:

COMMUNITY A C l IVITY GRANT
FINANCIAL f IN -KIND
/ OFF VIIAlVFR

APPLICATION
202.3-2024
Date Application submitted: 7 April 2023
Submit to:

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

Yucaipa, CA 92399
Attn: Kimberly Metzler
Received
Ivry of Yucaipa
APR 10 2023
City CierWs Department
All sections Of the 11Ppliculion must lic returned completu and all supporting documeutlltion provided prior to City Council review, Incomplete applications receivetl will he returned to the applicant.

Name of Applicant/organization: The Church of Jesus Christ of Latter Day Saints - Bryant Glen Warta Applicant/Organization Mailing Address: 12776 6th St, Yucaipa, CA,, 92399 Applicant/Organization Phone Number: ( I
Contact (l) Jason Tang
801 )376-8496
Name
Phone Number
[email protected]
E-mail address
Contact (2) David Ridge
562 572-1856
Name
Phone Number
[email protected]
E-mail address
Yes
No
Is your organization located in another community?
©
a
Will the program/event take place in another community? j]
1Z
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. 03/2023 297 Pagc 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)? 0 d
57-0234341
If yes, please provide Tax ID4 and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? 0 Q How long has your 501(c) organization been in existence? July 1941 0 Number of Employees working for organization:
100
Number of Volunteers working for organization:

Is a current City Council Member on your board? ❑
Mow many Yucaipa residents does your organization currently serve? Thousands 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) Name of the program/event. Yucaipa Freedom Run - 5k Fun Run and walk Date(s) of program/event: Memorial Day
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) We are creating a 5k fun run fundraiser to benefit the health of the community with 100% of the proceeds going towards the youth ages 12-1 S to pay for their summer camps.

City or Yucaipa Cgrnrnunity Activity Grants Application, Rev. 0312023 pagc 2

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

With the start of this annual event, it will be something that celebrates something that Yucaipa residents value - their health, their neighbors, their freedom, and this country. We will organize this event every year, with the plant to grow it better each time.

Program/Event Primary Target Population (check all that apply):
■❑
Children or Youth
■❑
seniors
t#❑
Women
Low Income
Victims
0 Homeless
Q
Persons with Disabilities
❑■
Welfare Recipients
■❑
Entire Community
Number of Residents Projected to Serve: 200
Please identify what your organization is seeking:

Financial Support: 0 Yes ❑ No $ fin
$200 SEP Fee
Waiver: ❑ Yes 0 No
In -kind Support: Police $ Fire $
Reassigned
Staff $
In -Kind
Toted Amount of Request: $
Other $
Financial Support
$Imp
Public
Works $ CS/Rental $
Explain
$200 SEP Total Overall
Fee Waiver Request
Provide a detailed description of how the financial support will be used:

The financial support will be used to purchase t-shirts and medals for all participants. Cost of the shirts will be close to $2000 itself, so this will help subsidize the cost of it, allowing for more registration funds to be benefit the youth.

City of Yucaipa Community Activity Grants Application, Rev. 03/2023 299 Page 3

What other in-kind/financial contributions has your organization receiver} to fund this event/prograul (separate from City funding)?
Church members volunteering time
Stater Bros gift cards for food
Walgreens for water
Total Funds Received To Date:

Total Funds Requested Via Grant Application:

Remaining Balance That Will Be Funded By
Organization_
In -Kind
Amount
2500
a
$
$
Financial
Support amount
100
Spp
$
$
0 1000
$ 2000
Provide City funding received by organization in the past three years (required):

Program In -Kind
Financial
S16.25 SFP Date
Support
Fee Waiver Deceived
Cl
❑
❑
❑
❑
❑
❑
❑
❑
c
e
Total Received

SECTION
1, the undersigned, do hereby attest that the above information is true and correct to the best ofmy knowledge, and understand that the a vial grant amount needs to be spent prior to submitting another grant request.

Sig tore Title Dat
Date Received: Date Reviewed:

Amount Funded:

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

City Council Meeting:

Financial Support
7—N--'n-'3
Q - -- �-
❑ Fee Waiver
City of Yucaipa Community Activity Grants Application, Rev, 0312023 Pagc 4 300

THE CHURCH OF

JESUS CHRIST

OF LATTER-DAY SAINTS
FINANCE AND RECORDS DEPARTMEN7
TAX Administration
50 E North Temple St. Rm 2225
Salt Lake City, UT 84150-0022
Phone: 1-801-140-30030c0c
October 25, 2021
Ladies & Gentlemen:

The Church of Jesus Christ of Latter-day Saints (the "Church") is a bona fide church as described in Section 508(c) of the Internal Revenue Code (the "IRC"). Since it is not otherwise disqualified as an exempt organization as defined in Section .501(c)(3) of the IRC, its recognition is automatic per Section 508.

In addition, the Internal Revenue Service ("IRS") expressly recognizes the exemption of the Church and its subordinate organizations. The Church's exempt status can be confirmed at any time through the IRS' Tax Exempt Organization Search Tool found on the following IRS website: https://www,irs.gov/charities-non-profits/tax- exempt-organization-search. As stated in IRS Publication 1828 Tax Guide for Churches & Religious Organizations (Rev.8-2015) pp. 2 ( https://wwwJrs,gov/Rub/irs- pdf/p 1828.ndf}, the tax-exempt status of the Church's subordinate organizations is recognized even though the subordinate organizations are not separately listed, If you have any questions regarding this information, please contact me at (801) 240-1203 or via email at jnelsen@,churcholjesuschrist,org, JKN:If
Sincerely,
Jason K. Nelsen, Director
Tarp Administration
301

Internal Revenue Service
P. O. Box 2508
Cincinnati, OH 45201
Date: A U G 18 2020

THE CHURCH OF JESUS CHRIST OF LATTER-DAY
SAINTS
50 E NORTH TEMPLE 22ND FLOOR
SALT LAKE CITY UT 84150
Dear Sir or Madam:

Department of the Treasury
Person to Contact:

Employer Identification Number:
87-0234341
Group Exemption Number:
5376
This is in response to your request dated, May 4, 2020, for information about your tax-exempt status.

Our records indicate we issued a determination letter to you in July 1941, and that you're currently exempt under internal Revenue Code (IRC) Section 501(c)(3).

We also recognized the subordinates on the list you submitted as exempt from federal income tax under IRC Section 501(c)(3).

Because IRC Section 170(c) describes your subordinate organizations, donors can deduct contributions they make to them.

Please refer to www.irs.govtcharities for information about filing requirements. Specifically, IRC Section 60330) provides that, if you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked on the filing due date of the third required return or notice.

In addition, each subordinate organization is subject to automatic revocation if it doesn't file a required return or notice for three consecutive years. Subordinate organizations can file required returns or notices individually or as part of a group return.

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

If you have questions, call 1-877-829-5500 between 8 a.m. and 5 p.m., local time, Monday through Friday (Alaska and Hawaii follow Pacific Time).

Sincerely yours,
a- - Ifta, -
Stephen A. Martin
Director, Exempt Organizations
Rulings and Agreements
302

ATTACHMENT 13
303

Fiscal Year:

COMMUNITY ACTIVITY GRANT

FINANCIAL / IN -KIND / FEE WAIVER

APPLICATION
2023-2024
Date Application submitted: May S, 2023
Submit to:

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

Yucaipa, CA 92399
Attn: Kimberly Metzler
Received
City of YLlcaip
MAY 0 S 2023
General Servic:esl
City Clerk's Department
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 Mailing Address;
Applicant/Organization Phone Number:

Contact (1)
Contact (2)
Family Promise of Yucaipa-Calimesa
P.O. Box 72, Yucaipa, CA 92399
(909 )712-8430
Jacqueline Klof
909 712-8430
Name Phone Number
[email protected]
E-mail address
Chris Hallenbeck
(909 )908-1193
Name Phone Number
[email protected]
E-mail address
SECTION 2 - ELIGIBILITY REQUIREMENTS:

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 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. 03/2023 304 Page i

Your organization must be an established 50I(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)?❑ ❑
82-5498565
If yes, please provide Tax ID# and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? El ❑ How long has your 501(c) organization been in existence? 3yrs lOmos 1 Number of Employees working for organization:
1 Number of Volunteers working for organization:

Is a current City Council Member on your board? ❑ ❑�
0 Tow 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) Please see attached document
Name of the program/event: N/A
Date(s) of program/event: _
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) NIA
City of Yucaipa Community Activity Grants Application, Rev. 0=023 305 Page 2

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

Family Promise of Yucaipa-Calimesa (FPYC) is an independent nonprofit organization, in cooperation with Yucaipa-Calimesa Joint Unified School District to assist students and their families who are currently experiencing homelessness or are at risk of becoming homeless. On average 75% of homeless children that experience homelessness will drop out of school and have a higher incidence of incarceration. These children also may experience family violence, addiction, social isolation, behavior problems and inconsistent education.

Without interventions, it is likely this cycle of poverty and homelessness within YCUSD. FPYC provides service navigation assistance and case management to families in attempt to stabilize households and prevent deepened levels of crisis and trauma.

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

Children or Youth
❑
Seniors
❑■
Women
Q
Low Income
©
Victims
a❑
Homeless
❑
Persons with Disabilities
■❑
Welfare Recipients
0 Entire Community
Number of Residents Projected to Serve:

Please identify what your organization is seeking:

Financial Support. ❑r Yes ❑ No $ a 7,500M
$200 SEP Fee
Waiver: ,@#I'esa<:A
In -kind Support: Police $0.00
Reassigned
Staff $0,00
In -Kind
Total Amount of Request: $0.00
Fire $ 0.00
Other $0.00
Public
Works $0.00 CS/Rental $0.00
Explain
$200 SEP
Financial Support Fee Waiver
$1 r,sna.00 _'$72P"0i-
Provide a detailed description of how the financial support will be used:

Total Overall
Request
17� 5 �c
100% of the Yucaipa Community Activity Grant will be utilized for operational expenses. That will allow Family Promise of Yucaipa-Calimesa to assist at risk and/or homeless families with students that are enrolled in the Yucaipa-Calimesa Unified School District. These families are vetted through the YCUSD and referred to FPYC. The families are in need of immediate assistance with shelter, late rental payments, hotel/motel assistance to prevent any type of eviction. The financial support would also allow for assistance with barriers to family sustainability, such as vehicle registration, minor vehicle repairs, haircuts, laundry, gasoline to attend appointments and meetings. This assistance will support Families in our comimunity to stabilize their living situations and children the opportunity to thrive.

City of Yucaipa Community Activity Grants Application, Rev. 03/2023 306 page 3

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

Total Funds Requested Via Grant Application:

Remaining Balance That Will Be Funded By
Organization:
hi -Kind Financial
Amount Support Amount

0.00 $ 17,500.00
$ $ 0.00
Provide City funding received by organisation in the past three years (required).

Program In -Kind Financial $16.25 SEP
Support Fee Waiver
Family Promise of Yucaipa-Calimcsa
0 �
0 Date
Received
03/28/2022
Total Received
722.00
fi
J.

I, the undersigned, do hereby attest that the above information is true and correct to the best of my knowledge, and understand tbat,thq awarded financial ant amount needs to be spent prior to submitting arther grant request " 'Wmt:�&a� 6ffg-Av'� 76" '? ­", 3
5ie a urc Title Date
Date Received:

Amount Funded:
5" —
Type of Grant: ❑ In -Kind
Date City Council received follow up report;
Date Reviewed:

City Council Meeting:

Financial Support
Q-tea�-P'�
❑ Fee Waiver
City of Yucaipa Community Activity Grants Application, Rev. 03/2023 307 Page 4

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Impact of Homelessness
on Children`
3 times more likely to be
placed in special
education programs
42910
Dropped out of
school at least once
7 times more likely to
attempt suicide
8-9
times more likely
to repeat grades
471suffer from anxiety,
o depression, or
withdrawal

INTERNAL REVENUE SERVICE
P. 0. BOX 2508
CINCINNATI, QH 45201
Oate: JUL 17 2019
FAMILY PROMISE OF YUCAIPA•CALIMESA

CIO CALI BINKS
PO eOX 72
YUCAIPA, CA 92399
Dear Applicant:

DEPARTMENT OF THE TREASURY
Employer Identification Number:
82-5498665
4LN;
W053130306039
Contact Person:

MICHAEL T UPSKAW I04 17310
Contact Telephone Number:
(877) 829-5500
Accounting Period Ending;
December 31
Public Charity Status:
170(b)(1)(A)(vi)
Form 9901990-EZ1990-N Required:

Yes
Effective Date of Exemption:

October 26, 2018
Contribution Deductibility:

Yes
Addendum Applies:

No
we're pleased to tell you we determined you're exempt Dfrom federal
income
tax
under Internal Revenue Code (Inc) section 501(c)(3). ors can uct
contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106, or 2522. This letter could help resolve questions on your exempt status. Please keep it for your records.

Organizations exempt under IRC section 501(c)(3) are further classified as either public charities or private foundations. we determined you're a public charity under the 120 Section listed at the top of this letter, if we indicated at the top of this letter that you're required to file Form 9901990-EZ1990-N, our records show you're required to file an annual information return (Form 990 or form 990-EZ) or electronic notice (Form 990-N, the e-Postcard). if you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked.

If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of tnis letter:

For important information about your responsibilities as a tax-exempt organization, go to www.irs.govlcharitxes . Enter "4221-Pc" in nuthe search bar
to view Publication 4221-PC, compliance Guide for 501(c)( ) whien describes your recordkeeping, reporting, and disclosure requirements.

Letter 947
310

FAMILY PROMISE OF YUCAIPA-CALIMESA
•2-
Sincerely,
.'dAA�qc A"
Director, Exempt Organizations
Rulings and Agreements
Letter 947
311

ATTACHMENT 14
312

Fiscal Year:

Date Application submitted:

Submit to:

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

Yucaipa, CA 92399
Attn: Kimberly Metzler

COMMUNITY ACTIVITY GRANT

FINANCIAL / IN -KIND / FEE WAIVER

APPLICATION
2023-2024
4/12/2023
Deceived
City of Yucaipa
MAY 01 Z023
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. Incomplete applications received will be returned to the applicant.

Name of Applicant/Organization:

Family Service Association of Redlands
Applicant/Organization Mailing Address: 612 Lawton Street Applicant/Organization Phone Number:

Contact (1)
(909 ) 793-2673
Kyra Stewart
Name
(909 ) 793-2673 ext_ 134
Phone Number
kyraredlandsfamilyservice.org
E-mail address
Contact (2) Andrea Laughlin (909 ) 793-2673 ext, l 13
Name Phone Number
[email protected]
E-mail address
SECTION 2 - ELIGIBILITY REQUIREMENTS:

Yes No
Is your organization located in another community? ❑ r❑ Will the programievent take place in another community? Are you aware of any other City program providing this service? If so, which one?
❑ ❑
❑ 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 C'mnts Application, Rev. 03/2023 313 Page l

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)? ❑r ❑
If yes, please provide Tax ID# 95-1655614 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? 125 years Number of Employees working for organization: 17
Number of Volunteers working for organization: 500
Is a current City Council Member on your board? ❑ ❑
How many Yucaipa residents does your organization currently serve? 100 Does the organization charge admission, membership fees, dues, etc.? ❑ 0 If yes, please describe:

Names and Titles of Officers and Hoard of Directors: (Please attach an organization chart, if available) Carol Soodgress - President Marilyn Bean -Board Member
Crary Fagan - Vice President, Personnel Ann Bryan - Board Member Matt .Miller - Vice President, Resource Charlotte Burgess - Board Member Joseph Shaw- Vice President, Horsing Yolanda Contreras - Board Member Diane Remy - Treasurer
Debbie Evans - Secretary
Pang. Allen - Board Member
Narne of the program/event:

Date(s) of program/event:

Deborah Crowley - Board Member
Lori Hatfield -.Board Member
See complete list attached
Housing Assistance Program/Yucaipa Outreach
7/ 1 /2023 to 6/3 0/2024
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) Family Service Association of Redlands requests $5,000 from the City of Yucaipa's Community Activity grant initiative to support our Housing Assistance Program at the Yucaipa Outreach Project located at 11985 Street Suite 4216, Yucaipa, CA 92399. If 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, and homeless families of the City of Yucaipa.

With the handing, we will provide net safety services for the City of Yucaipa residents in a housing crisis. The goal of the project is to prevent and remedy homelessness, (Please see attached for service counts) City of Yucaipa Couununity Activity Grants Application, Rev. 03/2023 314 Page 2

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

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

Strengthening this program creates safety and stabilization for residents facing the imminent dangers of homelessness or who are already homeless. It shall also provide food resources for clients battling food insecurity/hunger.
kxogram/Event Primary Target Population (check all that apply):

Q Children or Youth
❑■ Low Income
❑■ Persons with Disabilities
Number of Residents Projected to Serve: 50
Please identify what your organization is seeking:

Financial Support: F3 Yes ❑ No
$200 SEP Fee
Waiver: ❑ Yes ❑ No
❑■
Seniors
0 Victims
Welfare Recipients
$ s,000
❑■
Women
[]■
Homeless
❑
Entire Community
Public
In -kind Support: police $
Fire $
Works $
CS/Rental $
Reassigned
Staff $
Other $
Explain
$200 SEP
Total Overall
In -Kind
Financial Support
Fee Waiver
Request
Total Amount of Request; $
$ soon
$
_ $ s,000
Provide a detailed description of how the financial support will be used:

If £ttnding is received, the entire amount shall go towards direct client services, which include motel vouchers, emergency rental assistance, move -in deposits, goods, and transportation assistance. We are grateful for your past, present, and, hopefully, future support as we continue to service and deal with growing inflation and housing costs, significantly impacting low-income and low waged workers in our communities
City of Yucaipa Community Activity Grants Application, Rev. 03/2023 315 Page 3

SECTION 6 — FINANCIAL t
What other in-kind/financial contributions has your organization received to fund this event/program (separate from City funding)?
In -Kind
Amount
San Manuel Band of Mission Indians
Emergency Food and Shelter Program
Private Donations
Event Fundraising
Total Funds Received To Date: $
Total Funds Requested Via Grant Application: $
Remaining Balance That Will Be Funded By $ 70,000
Organization:

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

Program In -Kind Financial $16.25 SEP
Support Fee Waiver
Community Activity Grant
CDBG funding
CDBG- Yucaipa Gram and City Funding
the
Date Received:
❑
0 II
❑
❑
❑
❑
Financial
1Supp/�o/�rt Amount
$ $1 5,000
$ $25,000 (all cities)
$25,000
$10,000
$ 5,000
$ 75,000
Date
Received
716/2022
8/01/2021
Total Received
�,snu
w i ua�
7/01/2022 S6,500
7/1/2022
7/112021
1, do hereby attest that the above information is true and correct to the best of my knowledge, and understand financial grant amount needs to be spent prior to submitting another grant request. a..

Executive Director 4/12/2023
Title Date
Amount Funded: $
Type of Grant: ❑ In -Kind
Date City Council received follow up report:

Date Reviewed: -1
r.

City Council Meeting: `
ErFinancial Support ❑ Fee Waiver
City of Yucaipa Community Activity Grants Application, Rev. 03/2023 316 Page 4

r- . jAmny SERVICE Assocuum F REDLANDS
TO ALLEVIATE POVERTY, ENCOURAGE SELF-SUFFICIENCY, AND PROMOTE THE DIGNITY OF ALL. 612 Lawton Street, Redlands, CA 92374
125 Years of Building Strong Families
2023 BOARD OF DIRECTORS
C041 Cif A:;�
President
'Dice President, Personnel
Vice President, Resource
Vice President, Housing
Treasurer
Secretary
Carol Snodgress
Gary Fagan
Matt Miller
Joseph Shaw
Diane Remy
Debbie Evans
BOARD MEMBERS:

Pam Allen
Deborah Crowley
Janine Ledoux
Marilyn Bean
George DeLange
Victor Madero
Ann Bryan
Lori Hatfield
Barbara Rozema.

Charlotte Burgess
Robert Heinze
Lori Shelffo.

Yolanda Contreras
Renee Kern
Shelli Stockton
President
2022 BOARD OF DIRECTORS
OFFICERS:

Lori Hatfield
Vice President, Personnel
Gary Fagan
Vice President, Resource
Matt Miller
Vice President, Housing
Carol Snodgress
Treasurer
Diane Remy
Secretary
Christina Rivera
BOARD MEM13URS:

Pam Allen
Deborah Crowley
Pamela Allen -Coleman George DeLange
Marilyn Bean
Sam Edison
Ann Bryan
Debbie Evans
Charlotte Burgess
Robert Heinze
Yolanda Contreras
Al Hernandez
STAFF
Kyra Stewart Executive Director
Kimberlee Knox Fund Development Manager
Corey Ronto
Program Manager
Samantha Morgan
Office Manager
Donna Olson -.lanes
Office Assistant
Adela Brown
Accounting Clerk
Andrea Laughlin
Grant Writer
Leah Rios
MarketinglVofunleer Coordinator
Aundrea De La Cruz
Donation Center Lead
Terry Vines
Christopher Walker
Tyler Warier
Ellen Weisser
Janine Ledoux
Lori Shelffo
Robin Maupin
Terry Vines
Sue Morasco
Christopher Walker
Barbara Rozema. Tyler Waner
Joseph Shaw
Ellen Weisser
Paula Petty Case Manager
Vanessa Jasso Case Manager
Abi Pate Case Manager
Stephanie Montero Case Manager
Lori Villarreal Program Assistant
Mary -Ellen King Program Assistant
Stephanie Villana Program AssistaW
Jennyfer Melgoza Program Assistant
317

.-(I -
THE
YUCATA OUTREACH A.CH PROJECT

A PROGRAM OF FAMILY SERVICE ASSOCIATION OF REDLANDS
2022 Sexvice Counts
Total Families 189 Total Individuals 375
Food Distribution:

Emergency Food — number of families 42
Emergency Food — bags of food 247
Housing Assistance:

Emergency Dental Assistance — number of families 5
Months of Rent Paid 4
Rapid Re -Housing — homeless families moved into stable housing 6 Motel Vouchers Issued number of nights 56
Clothing Distribution:

Families 66
Support Services:

Transportation — gas vouchers or bus passes 29
Hygiene Fits 70
Scholarship/Employment Asst: 1
Yucaipa Case Studies
Overall Yucaipa Community
In 2022 - 23 households from the City of Yucaipa received either mortgage support, move -in deposits, or rental assistance in our fight against homelessness in the region. We provided motel vouchers for nine families who reported being initially from the City of Yucaipa but, at the point of intake, had no shelter options and were homeless e. Within that number, we paid for 56 voucher nights. Five families who were faced with a housing crisis or were in a homeless situation received emergency move -in deposits. All the families mentioned also received wrap -around support such as clothing, food, and transportation assistance. (edited for content)
318

Internal Revenue Service
P.O. Box 250t1
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 2622 of the Code.

Please refer to our website wvvw.irs.cov/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 annuai 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, _
Tamera Rip erda
Director, Exempt Organisations
319

ATTACHMENT 15
320

CITY or

COMMUNITY ACTIVITY GRANT
Fiscal Year:

Date Application submitted:

Submit to:

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

Yucaipa, CA 92399
Attn: Kimberly Metzler
2023-2024

FINANCIAL / IN -KIND /FEE WAIVER

APPLICATION
Received
City of Yucaipa
APR 0 6 2023
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. Incomplete: applications received will be returned to the applicant.

SECTIONtr
Name of Applicant/Organization:LA V'JO`'iu -
Applicant/Organization Mailing Address: P6, \`1
Applicant/Organization Phone Number: `30 '._ i 0
Contact (1) n nn x Aovyx)n 0� - v
Name Phone Number
E-mail address UU
Contact (2)].1'�, cl�_d
Name Phone Number
lc? l ('0: i1 n el
E-mail addre s
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 service? ❑ 0 If go, 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. 03/2023 `" 1 Page i

SECTION 3 ORGANIZATION INFORMATION/APPLICANT 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.

Is your organization a 501(c)?
If yes, please provide Tax ID# ` f W "'�� 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? Number of Employees working for organization:

Number of Volunteers working for organization:

Is a current City Council Member on your board?
How many Yucaipa residents does your organization currently serve? Does the organization charge admission, membership fees, dues, etc.? If yes, please describe:
902
Yes No
0 ❑
21 ❑
Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) P re -6� _C
Tall %a
d x na+w-
0 Name of the progranVevent: (A ►S (y) PCA VD &)Ije r
Date(s) of program/event: J-"W I, —
Describe the program/event that organization is seeking support for: M a l s l r) vy).01r) e v Co(- f 7�a� 10 Co ve r, (Attach any event/program promotional materials associated with program/event) 1 City of Yucaipa Community Activity Grunts Application, Rev. 0312023 JL,G page 2

Describe how the program/event benefits the residents and/or community of Yucaipa: , edarleecs ctn& C.t,ah>m Ckr18ren IIn
,�� ,
c) lna.r'6 C( ► -' ° ` l c� rr ►a�La LOS
Cole(- ��d �� ��-� v���� OC
i-b e i r nlfe,ds -
Program[Event Primary Target population (check all that apply):

Q Children or Youth
❑ Low Income
0 persons with. Disabilities
❑ Seniors
❑ Victims
❑ Welfare Recipients
Number of Residents Projected to Serve: �'` O / 01c) r `r 1 '_ Please identify what your organization is socking:
(20—
Financial Support: ® Yes ❑ No $�b
$200 SEP Fee
Waiver: Syes ❑ No
In -kind Support: police $ -&
Reassigned
Staff $�
In -Kind
Total Amount of Request: $ -&—
❑ Women
❑ Homeless
X Entire Community
Public
Fire $ -4;;) Works $ - CS/Rental $ •`
64 Other $ Explain -�
$200 SEP Total Overall
Financial Support Fee Waiv r Request
$ $ A S 14 i,7n o
Provide a detailed description of how the financial support will be used:

TNf lemon wlu t be C.Crmbcr e_8 tui Sn �Un8s �rcrn 0LAr- 0� a62-S +0 paf
(� `_
,e he�& fylcy to ) -) So r-\/ WOL
City of Yucaipa Community Activity Grants Application, Rev, 0312023 JL J Page 3

1 What other in-kind/financial contributions has your organization received to fund this eventlprograni (separate from City funding)?
S UUCP
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
$
$
—T'13D
$
$
$
$
$
$
$
$"
$
$
$ 4U
Provide City funding received by organization in the past three years (required):

Program
In -Kind
Financial
$16.25 SEP Date
Support
Fee Waiver Received
❑
El
❑
❑
❑
Total Received
$
Y, the undersigned, do hereby attest that the above information is true and correct to the best of my knowledge, and understated thattheawarded financial grant amount needs to be spent prior to submitting another grant request.

Signature Title Date
Date Received:

Amount Funded: $
Type of Grant:
-- ' r , .3 Date Reviewed:
❑ In -Kind
Date City Council received follow up report:

City Council Meeting:

Fitnancial Support
❑ FCC Waiver
City of "Yucaipa Community Activity Grants Application, Rev. 03/2023 Page 4

i Gmail
donna solomon {[email protected]}
Better autism flier
1 message
Talicis Hinkle
To: d
• Put together a fundraising team with students,
teachers, family, or friends.
• Visit our website at garde nworksforkids.org
to sign up, starting April 1st.
• Download fundraising forms
Have fun & make a difference!
$20 .PER PERSON REGISTRATION FEE
ANO FREE T—SHIRT
GardenWorks for Kids
10966 Bryant St. Yucaipa, CA 92399
Sat, Mar 4, 2025 8I 7A7 PM
Proceeds benefit our special needs learning
and sensory garden & covered patio with ramps
and accessible seating area.
325

I

INTERNAL REVM UE SERVICE
P. O. BOX 2508
CINCINNA.TI, OH 45201
Date:�J
DES X t

GARDENWORKSPORKI DS

C/O DONNA SOLOMON
36159 BLUE HILL DR
BEAii3MONT, CA 92223
Deax Applicant:
bEPAR'YDMNT OF T14E TREASURY
Employer identification Number:
46-2428869
3DLN
17053240328033
Contact Person:

SHERRY 4 WAN xD## 31052
Contact Telephone Number:
(877) 829-5500
Accounting Period Ending:

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

Yes
Effective Date of Exemption:

February 13, 2013
Contribution Deductibility:

Yes
Addendum Applies:

No
We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Cade. Contributions to you are deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records. organizations exempt under section 501(c)(3) of the Code are further classified as either public charities or private foundations. We determined that you are a public charity under the Code section(s) listed in the heading of this letter.

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

Letter 947 (DO/CG)
326

ATTACHMENT 16
327

Fiscal Year:
[:late Application submitted;
Submit to:

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

Yucaipa, CA 92399
Attn: Kimberly Metzler

COMMUNITY ACTIVITY GRANT

FINA NCIA L / IN -KIND / FETE' WAIVER

APPLICATION
2023-2024
Received
City of Yucaipa
MAY 11 2023
General Services/
City Clerk's Department
All sections of the application must be returned complete and all ,supporting ducumenta ion pruvjd(,,d prior to City Council review. Incomplete Applications received will be returned to the appRoint.

Name of Applicant/Organization: Smiles for Seniors Foundation Applicant/Organization Mailing Address:

Applicant/Organization Phone Number:

Contact (1)
Contact (2)
P.O. Box 1113
(909 )790-6671
Catherine Serianni
Name
E-mail address
stlliles4sciiioi's ii,y21hoo.coIll
Name
E-mail address
(909 ) 790-6671
Phone Number
Phone Number
Yes No
Is your organization located in another community? ❑ ✓❑ Will the prograrri/event take place in another community? ❑ ❑� Are you aware of any other City program providing (his service? [] Q 11`so, which one?
None specifically ecifical[ for low income seniors
*If you answered "Yes" to any of the questions listed Above, your request is not eligible for the Community Activity Grant, City of Yacaipa Cuinmunity Activity Grants Application, Rm 03/2023 328 page I

SECTION 3 — ORGANIZATION INFORMATIONIAPPLIC.A.NT 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 ❑
26-0373602
If yes, please provide Tax TO# and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? ❑✓ ❑ 2007
[-low long has your 501(c) organization been in existence? 2 Number of Employees working for organization;
35 Number of Volunteers working for organization:
is a current City Council Member on your board? ❑
100
}-low many Yucaipa residents does your organization currently serve? Does the organization charge admission, membership fees, dues, etc.? [� ❑v If yes, please describe,
Names and Titles of Officers and Board of Directors: (Please attach an organization cliart, if available) -, Enclosed in supporting documents
-SECTION 4 - PROGRAM 1 4ADDITIONAL PAGES IF NECESsARY)
NaIr,e of the program/event: Low Income Seniors Emergency Assistance Date(s) of prograrn/event: 01 /01 /2023 -12/31 /2023
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) Smiles for Seniors Low Income Senior Emergency Assistance Program is to provide low income seniors financial assistance for 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 hundreds of 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.

City of Yucaipa C'oit7invilily Activity Grants Ai3plicatiun. Rev. ON2023 329

Describe how the prograra/event benefits the residents and/or community of Yucaipa; 11 A1.Tli. %ML, pror,4k emcrgrecy railing for Co -pay., nDl eo,cred by Medi•CRI1Medi•Care ur privale inxnraa00.4vr prOynna NIN ehhlhvrd low iucolllese»tarswtth hfesarulg rncdicotunhand medical supplies,('0CIlleor 'Till l:Tits. hevlring aids. glasses and eye 00MN. JOIN rrrlccdures. proxlhdw lim4bs, ea Irhnhi8 c, nnlrilislnul xupplclIT'im , diahcICa.wupplecmnaunnce s, euatrpphes, uxypn and hloud precsure atmnitiname a llr. jVg 11r nre,%.

We arr alien the tosl ream/ for soniora who cnnulR affUrd IO par Ilea co-ppys dr a'hn Ilare IID Illram to gr1Ille Ilfraal'Illp 0114dieatlnu.e nr mehRal agmpnlcnl Ihrtrdoerori IIaye prcmcfllsh.

POOR, we provide }nwcry,lore kill curds that nui senium can use al pet (611 areal, hcgeables :Ind Saul pn>t11ICIr, I hrhe Itrnls me Ile{ ahllally proVlded by e'hurell, Ini4sirlllh (it ro0d pantries. We riko hold filft r,wd drives ,nil dellvar Ibnd and nlruIs to home hound xnuurh Mang wide providing ruluuhlc re?�wreo n, Irsal tnid prnbnuns IMUSINC. Smiley fisrSmlinrs AWIR ,yip, lacntir,g aid procuring afthrdahla sonar houehry, Akpusq ;1"Mnnce mid milal aisim atec almlg with minur hums rcpnirs, We ore proud drlhe I,KI Ihal w0 hove Iletpcd place many IIonicI s ernldra of rD hhLrdaldc huuxing ails] off of-tl I sireela, UTILITY AMNLrhN{:L.!imllNrnncciiorvpinrideicmergencyax5ixumccfurltease,vholrre•havmgdlrliamgonlyingm4iuhlilybdle, wcluwcclnaerdhsinnr,tell* With Many Wit ilycmmpllTIMWInr6iirIII iarlrgcncVand We arc Vrtgn able la #eI (wit wild lale charges marred ur reduced. We I1rc IIIF0 Me Of Ilse 011Iy agenelea pruvidml, Gniplvinl ;,+ kllmw: Tot )rdcr bills in the Iul:rrsd lirnpin:. 140MM Ii 11I'AIRS, Smiles rep Senieri provlks Pna,iOrxl na Wgricc with handicap urce9914i llry pgplpnrrru, ramps. Rmh burs, aprcinky medienl equ ipincnl and minor home repairs thol are needed to eusur,, die iM1rely or OUT uliunll: and utilize measures steal alhav limp ter milnin in (hair own homey ns long m fir—iblc ADVOCACY, Sinh, rn, Sodnrs 4cculr,cs IIw: voice lot those wla eau VIDE ul am nor able to %pink f,r themselves We work elrr cly whir vAiigl, Vmnp: IN the Ireuenneul of our rrliilI lD need. sal wq IMW a vrsl nelwah nr ,Igcrwwi and Ian Frain; lilal the callntn,mte will Ie provide rdercals ftlr uir tcniurh.

E(, (INOMI(: DEVG.1,01"ME:NT, %Vc pnwide Irur vendor elienrx —.v ti vnliDldc prDµnuui dhu nt ter 6mmcrrrl.elhita..Ind glliduner In m,mrulry nagten toll pinvldr iwuesh to %—.1 irrneas Program/Event Primary Target Population (check: all that apply):
❑ Children or Youth
0 Low Income
❑■ Persons with Disabilities
Number of Residents Projected to Serve
0 Seniors 0 Women
❑ victims ❑■ Homeless
❑ Welfare Recipients ❑ Entire Community
_ FS c-,
SECTION 5 — GRANTF UNDING REQUEST
Please identify what your organization is seeking:

Financial Support: E Yes ❑ No $3.000
S200 SEP Fee
Waiver: ❑ Yes ❑ No
Public
In -kind Support: Police $ Fire $�_-- Works $_ CS/Rental $ Reassigned
Staff $
In -Kind
Total Amount of [itchiest: S_
Other S Explain
S200 SEP Total Overall
Financial Support Fec Waiver Request
$ g = $ 3.000
Provide a detailed description of how the financial support will be used:

Emergency assistance for food, housing, utility payments such as water, gas, electricity, minor home and auto repair and help pay for life saving prescriptions and medical equipment .just to name a Few. To be eligible for the program senior clients must be age 65 and be very low income. Please note that most of our clients only receive an average Social Security of 950.00 per month Each year our agency provides emergency assistance and safely 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 lit 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 and provide valuable resources and referrals.

City of Yucaipa Applioation, Rev, 03/2023
330

SECTION 6 — FINANCIAL CAPABILITIES/BUDGET:

What other in-kind/financial contributions has your organization received to fund this event/program (separate from City funding)?
FLNpfNG FROM GRANTS, EVENTS, AND INDIVIDUALS
Total Funds Received To Date:

In -Kind Financial
Amount Support Amount
$ $ 29,460
Total Funds Requested Via Grant Application: $
Remaining Balance That Will Be Funded By $
Organization:

CAPABILITIES/BUDGETSECTION 6 — FINANCIAL (CONTINUED):

Provide City funding received by organization in the past three years (required); Program
Low Income Senior Assistance
T-ow Income Senior Assistance
S
$ 29,460
$ 3,000
$ 117,540
$16.25 SEP Date
Fee Waiver Deceived
❑ June 2020
❑ August 2021
Low Income Senior Assistance ❑ ❑� ❑
SECTION 7 — CERTIFICATION
In -Kind
Financial
Support
❑
0 ❑
0 July 2022
Total Received
$ 5,000
$3,587
2,800
I, the undersigned, do hereby attest that the above information is true and correct to the best of my knowledge, and understand th he awarded fna 1 grant amount needs to be spent prior to submitting another grant request.

Executive Director 05/11/2023
Signttture Title Date

COMPLETEDTO BE BV CITY
Date Received:"`1 _ Date Reviewed:

Amount Funded: $ _ City Council Meeting: tf'r~�
Type of Grant: ❑ In -Kind Et/Financial Support ❑ Fee Waiver Date City Council received follow up report:

City uf' Yucuipa Comrnrmity Activity Grouts Application. Rev. 03/2023 331 Page 4

Smiles for Seniors Foundation Tax ID 26-0373602.

P.O. Box 1113 Yucaipa Ca 92399 Ph-909-790-6671
www.smiles4seniors.org [email protected]
Supporting Documents for Smiles for Seniors Foundation Funding Request Name of Organization Smiles for Seniors Foundation
Federal Tax 1D # 26-0373602
Year Founded 2007
Ruling year 2007
Contact Name Catherine 5erianni, Founder Director
Address: 34910 Ave C Yucaipa Ca 92399
Mailing Address: P.O. Box 1113 Yucaipa Ca. 92399
Program Office Address: 34045 Yucaipa Blvd Ste 104 Yucaipa Ca 92399 Phone Number (909 )790-6671 Fax (909) 790-7112
Website Address: wwwsmiles4seniors,ore
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 financial assistance for 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 hundreds of 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 Low Income Senior EmergencV Assistance Fund Population Helped 10M/, Low income seniors 65 and over
Geographic Areas served All of the Inland Empire San Bernardino and Riverside Counties 332

Smiles for Seniors Foundation Tax ID 26-0373602
P.O. Box 1113 Yucaipa Ca 92399 Ph--909-790-6671
www.smiies4seniors.org smiles4seniors c,yahoo.com
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 food, housing, utility payments such as water; ,gas, electricity, minor home and auto repair and help pay for life saving prescriptions and medical equipment just to name a few, To be eligible for the program senior clients must be age 65 and be very low income. Please note that most of our clients only receive an average Social Security of 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 budges, We also work closely with variousgovernment and iron -government agencies, law enforcement, social workers, senior centers and others in collaboration for the good of our seniors and provide valuable resources and referrals.

Our Programs and Services
HEALTH. We provide emergency funding far Co -pays, not covered by Medi-Cal/Medi•Care or private insurance, Our program has assisted low income seniors with lifesaving medications and medicol supplies, Cochlear implants, hearing aids, glasses and eye exams, dental procedure., prosthetic limbs, cancer treatments, nutritional supplements, diabetes supplies, incontinence supplies, oxygen and blood pressure monitors, just to name a few. We are often the last resortfor seniors who cannot afford to pay their co -pays or who have no means to get the lifesaving medications or medical equipment their doctors have prescribed.

FOOD, We provide grocery store gift cards that our seniors can use to get fresh meat, vegetables and dairy products. These items are not usually provided by church, missions or food 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 far 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 helped place many homeless seniors in to affordable housing and off of the streets.

UTILITY ASSISTANCE, Smiles forseniors provides emergency assistance for those who are having difficulty paying their utility bills, We have close relationships with many utility companies who refer to our agency and we are often able to get fees and late charges waived or reduced. We are also one of the only agencies providing financial assistance for water hills in the Inland Empire.

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

ADVOCACY, Smiles for Seniors becomes the voice for those who can not or are not able to speak for themselves.

We work closely with various groups for the betterment of our seniors in need, and we have a vast network of agencies and non profits that we collaborate with to provide referrals for our seniors.

ECONOMIC DEVELOPMENT, We provide our senior clients access to valuable programs that offer financial stability and guidance in monetary matters and provide access to social services 333

Smiles for Seniors Foundation Tax ID 26-0373602
P.Q. Box 1113 Yucaipa Ca 92399 Ph-909-790-6671
www.smiles4seniors.org smiies4seniorspyahoo.com
Why funding is needed
We are seeki►tgfunding for our Senior AssistanceProgrom which is an ongoing program, From thisprogram we directly assist qualifying low income seniors with safety net services and basic necessities needed to survive. With the economy being what it is, and the rising cost of food, utilities rents and those HIGH GAS BILLS, we have seen the need for our services increase while the funding has decreased. When the economy is bad it is usually the Non profits thatsuffer, as most people are feeling the pinch themselves and are unable to donate. Our low income seniors are really struggling to make ends meet
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 around the Inland Empire
These agencies refer low income seniors to our program because they know that Smiles for Seniors is one of the only agencies that are able to help, We do whatever 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 mast.

There are always seniors in need and not many organizations that are fully capable to do what we do far 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. We want to help 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 dil{gently for,grants and funding from individuals, .small business, foundations and carporote grants along with funding from our three successful fundraising events held each yeor, We feel it is important riot 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.
334

Smiles for Seniors Foundation Tax ID 26-0373602
P.O, Box 1113 Yucaipa Ca 92399 Ph-909-790-6671
www.smiles4seniors.org [email protected]
Organizational structure, board and staff responsibilities including volunteers.

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

Our volunteers are the life blood of our organization. We utilize the senior work force volunteers as well as students who enjoy helping our community. We appreciate their knowledge, insrght and dedication. Our program is much needed in the community and our volunteers ore 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 the goals of the organization. We also have many children/teen representatives that volunteerand 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 company.

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 andshare in our mission along with many Thankyou notes from the seniors who have been through our program, Our greatest 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 our program is changing and saving lives.

How we track and measure impact
We are able to secure important 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 needs can be found. We use the data revealed to ensure our program is utilizing the funding in the most responsible capacity possible.

Belowyou will find a few real life testimonials from our newsletter file (Now your donation dollars are helping the lives of low income seniors)
335

Smiles for Seniors Foundation Tax 1D 26-0373602
P.O. Box 1113 'Yucaipa Ca 92399 Ph-909-790-6671
www.smiles4seniors.org [email protected]
A very sweet lady in her late Sos called our officejust before the New Year. She was beginning to tell me what kind of assistance she needed when she broke down in to tears. She stated that she had never had to ask anyone for help in the post and was feeling ashamed and embarrassed and was very distraught. We comforted herby 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 often being ill and hospitalized forseveral months.

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 he went to a board and care from there he went to a nursing home and from there he entered hospice and sadly he passed away after 8 months of being hospitalized.

She was in dire need of assistance after her late husband's 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. We 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 82year old lady who was in need of a utility payment of $296,oa Her water had been shut off for weeks and her bill had not been paid for close to 6 months. She sorted 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 restroom. She did not drive so she would walk a �6 mile every day to the water machine at the local grocery 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 toilet so that she would be able to Bush. 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 hotline for 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 he couldn't see where he wasgoing. Apparently he had been without electricity for quite a while and one night hegot up to use the rest room in the pitch dark, cracked his head open on a table and laid therefor 2 days before his granddaughter found him, He was rushed to the emergency room where he was treated for his head wound, given I.V. fluids and held overnightfor observation. While in the hospital the social workergave him a list of safety net organizations that can help with his utility payment. Smiles for Seniors was on that list.

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 336

Smiles for Seniors Foundation Tax 1D 26-0373602
P.O. Box 1113 Yucaipa Ca 92399 Ph-909-790-6671
www.smiles4seniors.org [email protected]
yahoo.com
War and he felt that he could get through anything,"so when they shut off his electricity he would use flashlights to see, read books instead of watch T.V. and to keep busy he would play solitaire by candle light ,Because of friends likeyou in the community Smiles for Seniors was able to pay his electric bill get his services back on and also give him and his, granddaughter 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 he 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. We were able to give him a gift card to his local pharmacy so he could get the medical equipment he needed.

Recently we received a call from a gentleman whom well call Sam. He was calling to see if Smiles forSeniors would be able to help him 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 he called, he needed his medication immediateiy or he 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 pay for the hfesavinq medication he could not afford. We were shocked to find out the price of his prescriptions. It was ($3.20)
Three dollars and twenty cents just saved a man's life ... yet three dollars and twenty cents also could have killed him.

What a shame it is that this man almost lost his life over what would amount to pocket change for mostof us.

The pharmacist informed us that per his insurance we were only able to buy him a 3 month supply so we did. We were also able to pay for his eye exam and glasses, and a blood ,glucose monitor. We also gave him a few grocery store gift cards .so that he could get the healthy food that he needs. This is happening allover America. Many seniors are finding it difficult to pay for their medications and often cut their medication in half or skip doses all together. Sam was so verygrateful to Smiles far 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 forhim (of course we will Sam) On behalf of our newfriend Sam; we thankyou foryoursupportand friendship towards our low income seniors.
337

Smiles for Seniors Foundation Tax [D 26-0373602
P.O. Box 1113 Yucaipa Ca 92399 Ph-909-790-6671
www.smiles4seniors.org [email protected]
Mission Statement
Our motto is...
"Helping the lives of seniors through acts of kindness" Our mission Is...
...To alleviate some of the pressure and tear 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 each month, 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 few 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, food, warmth, electricity and lifesaving medicine, This does not have to happen. T17is is where we come in: Smiles for Seniors will put a smile on the faces of those who need it most. Smiles for Seniors has became a beacon of light to the elderly in our community who have nowhere else to turn.
338

Smiles for Seniors Foundation Tax ID 26-0373602
P.O. BOX ] ] 13 Yucaipa Ca 92399 Phw909-790-6671
www.smi1es4sciiiors.org smiles4seniors@yahoo,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 Macias- Treasurer
Legal Secretary
Stephanie Robinson- 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
339

Smiles for Seniors FOLindation Tax 11) 26-0373602
P.O. Box 1113 Yucaipa Ca 92399 Ph-909-790-6671
www.smiles4seniors,org [email protected]
2023
............

SOURCE OF CONTRIBUTED SUPPORT
... ...... ....... . .... --- .... ............ . ......

INDIVIDUAL/SMALL BUSINESS CONTRIBUTIONS
. ....... .... . I.. I .... . .. . .....

CORPORATEGRANTS

FOUNDATION GRANTS

FUNDRAISING EVENTS
TQT'A"L PROJECTED INCOME
Expense

DIRECT ASSISTANCE TO SENIORS

PAYROLL
PAYROLL 40 hrs 14.00 per hr
PAYROLL 40 - hrs.' 14.00per h ' r ...... PAYRCLLTAXES
PAYROLL and TAX SERVICE
END of YEAR TAX SERVICE
LeqBudget0 L/01-/­2023. to 12/3 1/2023

SENIOR ASSISTANCE
............
2 FULL TIME EMPLOYEES

ED WORAVKA

MARY SERIANNI
TAXES

ADP PAYROLLSERVICE

YUCAIPA TAX SERVICE
AUTO
PAYMENT .......... .... . .... . .......

WELLS FARGO AUTO

MAINTENANCE

INSURANCE

PROGRESSIVE INSURANCE

REGISTRATION
— ----------- -
. ....... .

GAS
...... .... ....
'[.,NON PROFIT INSURANCE

NON PROFIT ALLIANCE-AMS

IRFNTS AND UTILITIES

RENT/WATER/TRASH/SEWER
EC PROPI':R f Y'M07GNENT
E.LECTRI.C.ITY-.....

EDISON
TELEPHONE/INTERNIET �FRVICT
........... .... ..... .

FRONTIER COMMUNICATIONS

POST OFFICE BOX RENTAL

I PALM SPRINGS-YUCAIPA POSI OFFICE

POSTAGE/STAMPS
YU .. CA P .. A - PO - ST OF I FICE
OFFICE SUPPLIESMISC.
..... .. . ......... .... . . . ..... .... ... .

WEEISITE HOSTING X2
REGI5TFR.COM
DOMAINE NAMES X2
... . . ......... ....... .

REGISTER.COM

ADVERTISING AND PROMOTION

FUNDRAISING EVENTS

UMBRELLA AWARDS

BOWL-A-THON
STOCKINGS 4 SENIORS HOLIDAY

TO HONOR GOOD SAMARITANS

BOWLING FUNDRAISER
'�Ij7j��b�-j'ENIORS IN NUR51NG HOMES
29,120
..........
840
400
2,049
300
960
..... -------
980 .. .. ......
—['960
�2,4ID9
372
............ .
240
.10
240
155,000 BUDGETTOTAL
2,000
1000
2,000
340

Smiles for Seniors Foundation Tax ID 26-0373602
P.O. Box 1113 Yucaipa Ca 92399 Ph-909-790-6671
www,smiles4seniors.org smiles4seniors [email protected]
?I.-ERNAL REVENUE SEPVIOE

0. Box 2$00
CINCINNATT, OH 4,1201
Date: OCT 2 3 2007

SMILES FOR SUNICRS FOCINAATION
24910 AVC C
YOCAIPA, CA 92399
hs✓
Dear Applicant:

DEPARTMENT DF TH3 l TREASI Ay
E7�ploy#z Identification NnrI1lr�&r:
— 2a-0373603
1;=s:
1"053261361037
Contact Peraon:

DEL TRIMBLE ID0 31?09
ContaC'c Telephone Number:
(8?7) $29-5500
Accounting Period Ending;
December 31
Public Charity statue;
170:(b) (1) CA) (vi)
Form 996 Required:

Yea
--- - El�ecki:ce ]7ata'..ol...Itixe�r_i ari: •• . .� -
June 8, 2001
Contribution Deductibility:

Yes
Advance Ruling Ending Date:

December 31, 201.1
Addendum AppI jttz:

NO
We aze pleased to infOrm ynri tblt upon review of your al7plicatieh for tax exempt statue we have derevinined taut you are pxetapt from redeVzal income tax under' aecti= "I Io)(3) of, the intarnal Rcvenue Coda. Contributiona to you and dPduet.iblc undez section 170 of the Code, you mr4 oleo qualifietd to retcaiven tax ileductiblP hrcluertts, dtvi.sna, trartofers or gifrs t717dCY ljection 2055, 2106 or 2522 of the Code. Btcauao this letter oculd help reaolvo any queati,anS rogardi.ng your exempt status, you should kNop it in your permanent recordn. 4vganiaaticartt3 exempt under :section 501(c•){3) of the Code are further clanniEied in either public charities or Private foundations. During your advas;ce ruling period, you will be treated as at public charity. Your advanco ruling period bcgino with the effective date Of your exemption and ends with advance ruling ending date shown in the heading of the letter.

Shortly befoze the end of your advance ruling period, we... will sertd you Form 8734, Support Schedule for Advance Ruling Period- You will have go days ar,ter the end of your atdvance rulirig Voriod to return the Compla,ted eozm. we. will then notify you, in wrir.ing, about your public Charity atatue.

Pleatac 000 enclosed Publication 4221-PC, Compliance Guide for Sol tc)'13) public Charities, for some, helpful information about your r&*pQnaibilities as an exempt OSY ahitat i4�71.

If you disl:r•ibucr funds to other,- ot:ganizationo, your records. must allow wheLhtr they are exempt under aOCC1On 501[C](31. In cases wheres the recipient Letter 1045 (001CG)
341

Smiles for Seniors Foundation Tax !D 26-0373602
P.O. Box 1 1 13 Yucaipa Ca 92399 PIi-.909-790-6671
www.smiles4seniors.org smiles4sc«iors fryahoo.coni
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 t❑ 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
Respectfully,
at ne Serianni, Founder/Director
Smiles for Seniors Foundation
342

Om No IS4b Ut7a;
0 1 Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) pepnnrncnS 4r the Trea;rfry Do not enter social security numbers on this form as it may be made public.

IntRrnal Rgvanuc Servtcn I Go to www-irs.goviForm990 for instructions and the latest information, A Cn, Ike ']nl) nalo.yrlar vaar nr 4av vamr f-,aninntnn MMA anrlinn 2022
B Check if applicable! C Name of organization SMILES FOR SENIORS FOUNDATION D Empioyer Iderittflcadon number
X❑ Address change Doing business as SMILES 4 SENIOR$
❑ Name
Number and street (or RO, box If mail is not delivered to street sddress) RgOmisurt9 26-D373602
change
34910 AVE C
E Telephone number
❑ Initial return
City or town State ZIP code
YUCAIPA CA 92399
❑ Final raEumACrRlinatktl Foreign country name Foreign provincelstatelcounty Porelgn postal code Amended return
G '4ro5 rM;*M S
104,754
❑ Apptica#ion pending F Name and address of principal officer:

H(a) It th15 a gtola �*iro for 46dinates?
❑ Yrta ❑X No
MARY SERIANNI PO BOX 1113, YUCAIPA CA 92399
H(b)Are
Yoe El No
I Tax-exempt status: X❑ 541(c)(S) ❑ 501(c) f (inaert no.) ❑ eg47(a)(1 j or ❑ 527 ak'�N'o,4anaoh d list. Sae Instructions
J wegsite'
Smilea4Seniors-or
'`M e G u y;taxerci flan number
K Form of organization, El Corporation ❑ Trust ❑ Association ❑ 01hor L Ye2r�¢kf4rmaiioq2007
1 M Slate of legal domicile: CA
5umma
1 Briefly describe the organization's mission or most signifit:ant activities: l-,pVIDING ASSISTANCE TO LOW INCOME SENIO IN TIMES OF FINANCIAL CRISIS WITH ASSISTANCE IN PAYING MEDICA-E, RENT, UTILITIES,_ FOOD_ AND "0

OTHER EXPENSES,
,--,--___ _
>
2 Check this box ❑ If the organization discontinued its operationslor ciispas� c+.of more than 25% of Its net assets,
CD
3 Number of voting members of the governing body (Part VI, line 1 a 1 3 9
°d
4 Number of independent voting members of the governing bo 9 9 9 [Jy'(�'a.rt Ul; dlhe''l b) .
4 0
di
5 Total number of individuals employed in calendar year 2022 (dart V 'lit 2.3) . 5 2
'-
6 Total number of volunteers (estimate if necessary) , ~` - . . . . . . 6
4 7a
Total unrelated business revenue from Part Vlll, column;(G)'Jlpc 12 . ` . . . 7a
0 b
Net unrelated business taxable income from Form 990-T Part 1• line 11 . 7b
Prior Year
Current Year
�
6Contributions
�.,!
and grants (Part VIIl, line 1h) . ,� �
127,011
104,754
0 0
9 Program service revenue (Part VII I, line 2g) • <i:, ;. , , , , , . . 0 0
'
f;
10 Investment income (Part Vlll, column (A), tines 3 a -0a) . . - , . . . . 11 Other revenue (Part Vill, column (A), lines rp, 10c, and 11e) . . . . 01 0
127.011
104,754
12 Total mventte--add lines 8 through 11 must eq I PaA'VlII, column (A), line 12). 13 Grants and similar ameunts paid (Part 15(&glbrr�l,(A), lines 1-3) , . . . . . 0 0
14 Benefits paid to or for members (Part IX; column '{A), line 4) , . . . . . . . 0 0
_
58,525
63,003
15 Salaries, other compensation, employe.,a:b'eqaft-Part IX, column (A), lines 5 10) . 0 16a Professicnal fundraising feescolumn (A), line 11e) . -
0 C
b
Total fundraising expenses (ParfAX,,.c6iulTtn (D), line 25) 0 61,197
53,503
w
17 __ ___
Other expenses (Part IX, ccIU0i((N,,J . es 11a--11 d, 11( 24e) , . . . . . 119,722
116,506
18 Total expenses. Add lints 13�' .17 (must equal Part IX, column (A), line 25) . . , 7,289
-11.752
19 Revenue less ex enses.,'9�]hiea `� m: a 18 from line 12 . 0 3
1 r � '
Beginning of Current Year
end of Year
43,592
32,738
0 -
20 Total assets {Pad, e
2,393
3,285
m
21 Total liabilities `artx, 1s�,26) . . . . . . . . . . . . . . . 41,199
29,447
�LL
22 Net assets Q unt�'�2larlces. Subtract line 21 from line 20 - signaturo"gloc C`
Under penalties of perjury, I declare th8tJ,flave examined this return, Including accompanying schedules and statements, and to the beat of my knowledge and Wier. it is true. 4orract, and camolete. Declaration of preparer (other than officer) is based on all inlormation of which preparer has any knowledge. .Sign
Here
Signature of officer

MARY SERIANNI
Type or print name and title
PrirOype preparer's name
Paid
Preparer
Angela Green
Use Only
F.ine'snamt, Green Accounti
Preparer's aignatu x
kngela Green,
Date
PTIN
Check ❑ If
Firm's address 34161 Yucaipa Blvd Ste D, Yucaipa, CA 92399 1 Phone no. 909-797-5000 May the IRS discuss this return with the preparer shown above? See instructions . . . . . . . ❑ Yes ❑ No For Paperwork Reduction Act Notice, see the separate 'snstructions.343 corm 99U (2022) HTA

ATTACHMENT 17
344

CITY OF
Fiscal Year;

COMMUNITY ACTIVITY GRANT

FINANCIAL / IN -KIND / FFE WAIVER
2023-2024
Date Application submitted: 05/02/2023
Submit to:

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

Yucaipa, CA 92399
Attn: Kimberly Metzler

A PPL I CA TI ON
Received
City of Yucaipa
MAY 0 8 2023
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. Incomplete applications received will be returned to the applicant.

Name of ApplicarttlDrganizatian: Valley Elementary, A Lighthouse Leader in Me School Applicant/Organization Mailing Address; 12333 Eighth Street ^ Applicant/Organization Phone Number:

Contact (1)
(909 )797-1125
Kathlene Miller
(760 )792-2036
Name Phone Number
Principal Kathlene_Miller c@r ycjusd.us
F-mail address
Chris Rekstad
Contact (2)
Name
Chris_ [email protected]
E-mail address
(909 )797-1125
Phone Number
Yes No
Is your organization located in another community? ❑ 0
Will the prograin/event take place in another community? ❑ ❑r✓ 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 Colninmity Activity Grunts Application, Rev, 03/2025 " Fag(, 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, t- J ( Yes No
Is your organization a 501 (c)? t ,. ' 1 t C '] r" � "" . ( S ED ❑ 95-225.41205...--. _r
If yes, please provide Tax I 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? 54 years 70 Number of Employees working for organization:
100
Number of Volunteers working for organization:

Is a current City Council Member on your board? ❑ ❑
515
How many Yucaipa residents does your organization currently serve? Does the organization charge admission, membership fees, dues, etc.? ❑ ❑✓ If yes, please describe,
Naines and Titles of Officers acid Board of Directors: (Please attach mi organization chart, if available) Leader in Me Coordinators - Tamara Schoonover Leader in Me Coordinator - David Domena School Principal T Kathlene Miller
Name of the program/event: Leadership Day & Memorial Day Event Date(s) ofprogram/event: April 26,04 &May 23, 2024
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) We are seeking additioanl support for our annual Leadership Day & Memorial Day events that take place every spring. The purpose of Leadership Day & our Memorial Day event is to showcase the hard work and accomplishments of our students, staff, parents, and the community. This is an excellent event that allows our students to practice and develop their leadership skills. Our Memorial Day event is our annual event that honors Nathan Tyler Davis, a former valley student that was killed during the Afghanistan War. 346 -
City of Yucaipa Comtnunity Activity Grants Application, Rev. 03/2023 Page 2

Describe how the prograiydevent benefits the residents and/or community of Yucaipa:
,See attached documentation
Prograrn/Event Primary Target Population (check all that apply):
❑■ Children or Youth ■❑ Seniors
d Low Income ■❑ Victims
© Persons with Disabilities ■❑ Welfare Recipients
Number of Residents Projected to Serve: 400 Guests
Please identity what your organization is seeking:

Financial Support: R3 Yes [] No $1,500
$200 SEP Fee
Waiver: ❑ Yes ❑ No
R1
Women
❑■
Homeless
Entire Community
Public
In -kind Support; Police $
Fire $
Works $
CS/Rental $
Reassigned
Staff $
Other $
Explain
$200 SEP
Total Overall
In -Kind
Financial Support
Fee Waiver
Request
Total amount of Request: $
$1,500
$
_ $1.500
Provide a detailed description of how the financial support will be used:

Student Lighthouse Leadership shirts, advertising, invites, mail/stamps, hospitality, military flags & American flag
of Yucaipa Comnunity Activity Grants Application, Rev, 03/2023 Page 3

What other In-kind/financial contrihntions has your organization received to fund this event/program (separate from City funding)?
In -)Bind
Amount
$
S
Total Funds Received To Date;
Total Funds Requested Via Grant Application: S
Remaining Balance That Will Be Funded By $
Organization:

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

Program lit -Kind Financial $16.25 STP Date
Support Fee Waiver Received
Leadership Day
Leadership Day
Memorial Day Event
❑
Q
❑
❑
0 �
Financial
Support Amount
Total. Received
2020 $1,000
2021 $1,000
2022 -- 1,000
1, the undersigned, do hereby attest that the above information is true and correct to the best of my knowledge, and understand *t1hia awarded financial grant amount needs to be spent prior to submitting another grant request. l'C Title Pi Data
Date Received:
5 _ ?-� x IL 1
Amount Funded: $
Type of Grant: ❑ In -Kind
Date City Council received follow up report;
Date Reviewed:

City Council Meeting:

ER"IFinancial Support
�] Fee Waiver
_ '2 d A_
City of Yucaipa Community Activity Grants Application, Rev. 03/2021 f Page 4

Inspiring Learners, Empowering Leaders!
Valley Elementary,
A Lighthouse Leader in Me School
Cordially Invites You to
Leadership Day
polo�
Th path to
WOOThe o �oree�
college` Here.
s
1 starts �
r � °
Friday, April 14, 2023
7:00 AM to 10:00 AM
12333 8th Street
Yucaipa, California 92399
Registration and Refreshments from 7:00 AM to 7:30 AM
Leadership Day is a unique opportunity to invite parents, community feaders, business partners, and feflow educators to showcase our understanding of the Leader in -Ve's S Mabits
and our exceptionaf leadership cuhture.
ourgoaf is "Vanity in the Community!"
Aease W5VP by,4prah7, 2023 to Pam Ifeggenderger
at vameCcx_ eaaen6errjer@ycTu„ ,scfu,s or (909 797-1125 We Cook forward'to your visit!
Special Leadership Seminar to follow with Major General Doug Schiess a former Valley Student and Yucaipa High School Graduate, `88. He is currently the Vice Commander, Space Operations Command, U.S. Space Farce. He'll be shaving some leadership wisdom from 12:30 to 1:30 P.M. in our Multi Purpose Room. You won't want to miss it! Le . adermMe

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In Memory of
Nathan Tyler
January 27,1992 - June 9. 20 12
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79"JAY, T% 26, 2022
9:00 am
• P ofa&glat=
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In Memory of
Nathan Tyler Davis
January 27, 1992 - June 9, 20,12 ,;..
350

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351

Farm W-9
(Rev. October 2018)
Department of the Treasury
Intemal Revenue service
D g
C C
IL
U
Q)
a
U)
��
Request for Taxpayer
Identification Number and Certification
0, Go to www.irs.gov/Fom7W9 for instructions and the latest information. (as shown on your Income
Elementary
on this line: do not leave this line blank.
nameldisregaeded entity name, if different from above
Give Form to the
requester. Do not
send to the IRS.
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemption4 (4odes apply only to following seven boxes. certain entities, not individuals; see instructions on page 3):
© Individual/sole proprietor or ❑ C Corporation El Corporation ElPartnership ❑uSVestaia Tr single-member LLC Exempt payee code (if any)
❑ Limited liability company, Enter the tax classificatlon (C--C corporation, S=$ corporation, P�Partnershlp) ■ Note; Check the appropriate box In the line above for the tax classification of the single -member owner. po 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) another LLG that Is not disregarded from the owner for U.S. federal iax purposes. Otherwise. a single-mernber L.LC that Is dlsregarded from the owner should check the appropriate box for the tax classification of its owner. 0 Other(sm Instructions)►
5 Address (number, street, and apt. or
12333 Eiali Street
6 City, state, and ZIP code
Yucaipa, California 92399
7 List account numbar(s) here (optional)
for Identification Number i
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part 1, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later.

Note, If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter.

Certification
rMpi.. roar wn m mmd OUPWa,M U.S.I
name and address IOptbr i)
-Ell -1
or
Employer identification number
0©®©©©00©El
Under penalties of perjury. I certify that:
1, The Humber shown on this form is my Correct taxpayer identification number (or I am waiting for a number to be issued to me), and

2. I 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 I 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
11 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 abandon msnt 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 corracl TIN. See the Instructions for Part II, later.

Her Signature of ' V �L! rI LL� fir J - 3 ".0 3
Here U.S. person ► �,�0 V d1 Gate ■
General Instructions
• Form 1 099DIV (dividends, including those from stocks or mutual funds)
Section references are to the Internal Revenue Code unless otherwise . Form 1099-MISC (various types of Income, prizes, awards, or grPSS noted.
proceeds)
Future developments. For the latest information about developments • Form 1099-13 (stock or mutual fund sales and certain other related to Form W-9 and its instructions, such as legislation enacted transactions by brokers)
after they were published, go to wwwdrs.govlFortt'rWB,
a Form 1099-5 (proceeds from real estate transactions)
Purpose of Form
+ Form 1099-K (merchant card and third party network transactions) An Individual or entity (Form W-9 requester) who is required to file an • Form 1098 (home mortgage interest), 1098-E (student loan interest), information return with the IRS must obtain your correct taxpayer 1098-T (tuition)
Identification number (TIN) which may be your social security number • Form 1099-C (canceled debt)
(SSN), Individual taxpayer identification number (ITIN), adoption taxpayer Identification number (ATIN), or employer Identification number a Form 1099-A (acquisition or abandonment of secured property) (EIN), to report on an information return the amount paid to you, or other Use Form W-9 only if you are a U.S. person (including a resident amount reportable on an information return, Examples of information alien), to provide your correct TIN,
returns include, but are not limited to, the following, If you do not return Form tN 9 to the requester with a TIN, you might • Farm 1099-INT (Interest earned or paid)
be subject to backup withholding. See What is backup withholding, later.

Cat. No. 10231 X Form W-g (Rev. 10-2010)
352

ATTACHMENT 18
353

Fiscal Year:

Date Application submitted:

Submit to:

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

Yucaipa, CA 92399
Attn: Kimberly Metzler

COMMUNITY ACTIVITY GRANT

FINANCIAL / IN -KIND / FEE WAIVER

APPLICATION
2023-2024
Received
City Of Yucaipa
APR 2 5 2023
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. Incomplete applications received will he returned to the applicant.

Name of Applicant/Organization;
Applicant/Organization Mailing Address:

Applicant/Organization PlioneNumber:

Contact (1)
Contact (2)
The Well Outreach Center
12717 14th Street Yucaipa, CA 92399
(909 ) 795-0614
Vicki Wood
Name
[email protected]
E-mail address
Ken Jones
909 213-6708
Phone Number
(95 i ) 2l 3-1927
Name Phone Number
[email protected]
Email address
Yes No
Is your organization located in another community? ❑ ❑
Will the program/event take place in another community? ❑ 0 Are you aware of any other City program providing this service? ❑ s❑ 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 Gtants Application, Rev. 03/2023 Page I

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

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

Yes No
Is your organization a 501(c)? ✓❑ ❑
If yes, please provide Tax ID# 83 1042899 and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? 2 ❑ 2019
How long has your 501(c) organization been in existence? Number of Employees working for organization: 3
14 Number of Volunteers working for organization:

Is a current City Council Member on your board? ❑ Q
322
How many Yucaipa residents does your organization currently serve? Does the organization charge admission, membership fees, dues, eta.? R1 ❑ If yes, please describe: Our professional counselors charge for services Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Ken Jones
Board President and Board Member
'Ferry Knight
Board Secretary and Board Member
Jose Banda
Board Member
Natalie Brasher
Board Member
Coleen Hinkle
Board Member
Sue Moreland
Board Member
Melissa Williamson
Board Member
SECTION 4 - PROGRAM DESCRIPTION/SCOPE:
(PLEASE USE ADDI"HONAL PAGES IF NECESSARY)
Name of the program/event:

Our Neighbors Clothing Closet
Date(s) of program/event:

On -going
Describe the program/event that organization is seeking support for; (Attach any event/program promotional materials associated with program/event) The goal of Our Neighbors Clothing Closet (ONCC) is to provide for the basic clothing needs of at -risk students living within the Yucaipa-Calimesa community. We target middle and high school students in need of clothing to support them through their learning journey. ONCC also provides vocational training opportunities to special education high school students who are enrolled in the YHS's Transition Program.

City of Yucaipa Community Activity Grants Application, Rev. 0312023 Page 2

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

ONCC volunteer director coordinates the day-to-day activities of the clothing closet. Teachers, counselors, administrators, and youth pastors in our community refer secondary (grades 6th - I2th) students to ONCC. Once the a referral is received, the director contacts the student's parent, guardain, or teacher and an appointment is made for the student to visit the closet. When a student visits the closet they pick out several outfits and hygiene items free of charge and are encouraged to return to ONCC as needed to meet the demands of changing seasons and their growth needs. Students who are enrolled in the YHS's Transition Program support the clothing closet by washing the donated clothing, steam washed clothing, and display the clothing on display racks.

Program/Invent Primary Target Population (check all that apply):
■❑
Children or Youth
❑
Seniors
❑
Women
0 Low Income
❑■
Victims
❑■
Homeless
■❑
Persons with Disabilities
Welfare Recipients
❑
Entire Community
Number of Residents Projected to Serve. 350
Please identify what your organization is seeking:

Financial Support: E] Yes 0 No $ s.M
$200 SEP Fee
Waiver: ❑ Yes ❑ No
Public
In -kind Support: Police $ Fire $ Works $ CS/Rental $,� Reassigned
Staff $ Other $ Explain
$200 SEP Total Overall
In -Kind Financial Support Fee Waiver Request
Total Amount of Request: $ $3.000 $ _ $.LOQQ
Provide a detailed description of how the financial support will be used:

Funding for this project is essential and will be used to provide at -risk secondary students in our community with new undergarments, shoes, belts, and any additional special clothing needs they may have. Other types of slightly worn clothing items can be donated, cleaned, ironed, and displayed, but we believe that the items listed in this paragraph need to be purchased new. In order to provide these, we are seeking $3000.000 in funding, In addition, this financial support will allow us to provide our students with hope, encouragement, and confidence simply by wearing clothing they are proud of when they go to school.

City of Yucaipa Community Activity Grants Application, Rev. 03/2023 Page 3

What other in-kind/financial contributions has your organization received to fund this event/program (separate from. City funding)?
Donated Clothing
YCJUSD Classroom
Private Donations
Morongo Band of Mission Indians
Total Funds Received To Date:

Total Funds Requested Via Grant Application:

Remaining Balance That Will Be Funded By
Organization:

In -Kind
Financial
Amount
Support Aniount
7,123
$
$
---
6,000
$
$
1,445 ,05
$
$
1,000
$
$
13,123
2445.05
$
$
3000.00
$
$
$
$
-554.95
Provide City funding received by organization in the past three years (required):

Program In -Kind Financial $16.25 SEP
Support Fee Waiver
❑
a
❑
Date
Received
2022
Total Received
$ 1,000
I, the undersigned, do hereby attest that the above information is true and correct to the best of my knowledge, and understand that the a arded financial grant amount needs to be spent prior to submitting another grant request.

A i�X D4 April 14, 2023
Signature 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 ❑ Fee Waiver
City of Yucaipa Community Activity Grants Application, Rev. 0312023 Page 4

TESTIMONY FROM RAFAFL OCAMPO

OAK VIEW HIGH SCHOOL

COUNSELOR
"HAVING OUR NEIGHBORS CLOTHING CLOSET, RIGHT NEXT

TO OUR CAMPUS, HAS BEEN 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!"
358

{maker .!s�
Narrative Focused
Trauma Care Groups
Prodding a safe place for healing through
writing & sharing our stories from
brokenness to masterpiece, leading to
freedom in relationships with
God, self, and others,

SUPPORT OFFERED BY TRAINED

FACILITATORS WHO HAVE
SIMILAR EXPERIENCES.

We also Offer Low Cost
Truama Informed Conferences
For we are Gorf's masterpiece. He has created us
anew In ChristJesus so we can do the goad things He
planned far us long ago. EPH. 2: TO
909-274-91 17
[email protected]
www.mosaictwoc.com
The Well Counseling Center
Supporting our community and surrounding
areas by providing hope during trying times.
e offer professional therapy for children,
teens, single adults, couples, and families.

Individual and Group
Sessions are Available
tdr have to fight
o:lattles alone.

IN —
Call or em&il
(909) 353-3920
[email protected]
www.counselingtwcc.com
r i.11 r
j OUR
;i
, k .1 1 k

NEIGHBORS
Providing for the basic needs of at -risk
students living within the Yucaipa-Caiimesa
community. we target middle school and
high school students in need of clothing in
order to support them through a successful
learning journey.

Our clothing outreach also provides
vocational training opportunities to special
education high school students who are
enrolled in the Yucaipa High School
Transition Program,
909-353-3254
INFO NEIGFIBORSCC.COM
Suppose you see a brother or
sister who has no food or clothing,
today! and you say, "Good-bye and have
a good dory; stay warm and ea£
well,"but then you don't give that
person any food or clothing. What
good does that do?
JAMFS 215-16 (&L
A691di Visit our website:
www.neighborscc.com

INTERNAL REVENUE SERVICE
P. o. Box 250a
CINCINNATI, OH 45201
Date: .BAN 21 2020

THE WELL OUTREACH CENTER INC
12717 14TH ST
YUCAIPA, CA 92399
Dear Applicant:

DEPARTMENT OF THE TREASURY
Employer Identification Number:
83-1042899
DLN:
29053262315009
Contact Person!
ERIC KAYE 1D# 31612
Contact 'Telephone Number:
(877) 829-5500
Accounting Period Ending:

December 31
Public Charity Status:
509 (a) (2)
Form 990/990 EZ/990-V Required:

Yes
Effective Date of Exemption:

December 3, 2018
Contribution Deductibility:

Yes
Addendum Applies:

No
We're pleased to tell you we determined you're exempt from federal income tax under .Internal Revenue Code (IRC) Section 501(c)(3). Donors can deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106, or 2522. This letter could help resolve questions or your exempt status. Please keep it for your records.

Organizations exempt under TRC Section 501(c)(2) are further classified as either public charities or private foundations. We determined you're a public charity under the IRC Section listed at the top of this letter. 1f we indicated at the top of this letter that you're required to file Form 990/990-EZ/990-N, our records show you're required to file an annual information return (Form 990 or Form 990-EZ) or electronic notice (Form 990-N, the e-Postcard). If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked.

If we indicated at the top of this letter that an, addendum applies, the enclosed addendum is an integral part of this letter.

For important information about your responsibilities as a tax-exempt organization., go to www.irs.gov/charities . Enter 114221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements.

Letter 947
360

THE: W.E:4L OU'T'RE,ACI{ CP.NTER INC
Sincerely,
0%90YC a. AVAfTw
Exzeetor, Exempt Organizations
Rulings and Agreements
Letter 947

H
R
File File Stmement f1��u�*5t
Aniendme-nt of Mformation 'Ccrtlficat€
Initial Filing Date 12 03/2018
Staters Active
,r
5tundi" - SOS Gilod
Standing - FT8 Good
.Standing - Agent Good
Standing - VCFCF Good
Formed In CALIFORNIA
Entity Type Nonprofit Corporation- CA
Public Benefit
Pr0cipaf Address, 12717 14TH STREET
YUCAIPA, CA 92399
Mailing Address 12717 14TH ST
YUCAIPA,CA92393
.Statement Of 0716 12131/2024.

Due Date
Agent Individual

RON WOOD
12717 14TH ST
YUCAIPA, CA 92399
362

ATTACHMENT 19
363

Fiscal Year:

COMMUNITY ACTIVITY GRANT
FINANCIAL I IN -KIND r FEE WAIVER
2023-2024
Date Application, submitted: May 3, 2023
Submit to:

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

Yucaipa, CA 92399
Attn: Kimberly Metzler

APPLICATION
Received
City Of YLIcaipa
MAY 0 3 Z023
General Service:_,�l
City Clerk's Department
All sections of the nppHcEn0cn must be returned coptjph,,tc: 4 riid 09 supporting documentotiont pmvQdud pi-iu - to City conned revnevv. I¢neompnlete ,%PP15e nllW2s reeci vc�7 will be rerawned to the applica ,1C.

Name of Applicant/Organization:

Applicant/Organization Mailing Address:

Applicant/Organization Phone Number:

Contact (1)
Yucaipa 1 Calimesa Family Assistance, Inc.

P.O. Box 130 Yucaipa CA 92399
(909 _ ) 856-0954
Name Phone Number
[email protected]
909 797-0244
Paul Kielhold
E-mail address
Contact (2)
Melissa Brunken
Name
yvwfa000@la,twe.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?
(909 )797-0244
Phone NuInber
Yes
No
❑
0 *If you answered "Yes" to any of the questions fisted above, your request is not eligible for the Community Activity Grant.

City of Yucaipa Community Activity Grants Application, Rev. 03/2023 364 Page 1

SECTION 3 — ORGANIZATION INFORMATION/APPLICANT 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)?
❑
95-6102982
If yes, ,please provide Tax ID# _ _ and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? a
❑
Bow long has your 501(c) organization been in existence? 74 years
1 (half-time)
Number of Employees working for organization:

Number of Volunteers working for organization:
18 Is a current City Council Member on your board?
❑
Haw many Yucaipa residents does your organization currently serve? Ira cp,
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) Debbie Wilson, Secretary
Margaxet Vanckeleer, Treasurer
Jackie Klof, Director
Paul Kielhold, Director T
Richard Rios, president
Name of the program/event:

Date(s) ofprograrra/event:

Security Cameras
As soon as funded
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) Installation of security cameras, see attached proposal frorm TBM Fire and Security.

City of Yucaipa Community Activity Grants Application, Rev. 03/2023 365 Page 2

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

YCFA provides food and clothing to those in need. We operate on monetary donations, as well as donations of food, household goods and clothing. Household goods and clothing are sold from a small thrift store on -site. In addition to our registered clients we are able to supply more limited service to those who are homeless.The operation relies upon contributions which come from individuals and organizations throughout the community.

Program/Event Primary Target Population (check all that apply):
❑ Children or Youth
Q Low Income
❑ Persons with Disabilities
Number of Residents Projected to Serve:

Please identify what your organization is seeking:

Financial Support: 0 Yes 0 No
$200 SEP Fee
Waiver. ❑ Yes No
❑
Seniors
❑
Women
❑
Victims
0 Homeless
[01
Welfare Recipients
❑
Entire Community
$ 4,557
Public
In -kind Support: Police $� Fire $� Works $ CS/Rental $ Reassigned
Staff $
In -Kind
Total Amount of Request: $
Other $ Explain
$200 SEP Total Overall
Financial Support Fee Waiver Request
$4,557 $ = $4,557
Provide a detailed description of how the financial support will be used:

Financial support would be used to puchase and install security cameras for monitoring the premises.

We have been subject to a greater frequency of vandalism and shop lifting than in the past. Cameras are intended to be mounted inside the building as well as on the exterior and will be able to be monitored on - and off -site.

City of Yucaipa Community Activity Grants ,Application, Rev. 03/2023 366 Page 3

SECTION 6 — FINANCIAL t l
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
Total Funds Received To Date: $
Total Funds Requested Via Grant Application: $
Remaining Balance That Will Be Funded By $
Organization:

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

Program In -Kind Financial $16.25 SFP
Support Fee Waiver
Purchase refridgerator and repair roof.

Add fencing and repair existing.

Replace countertop and add gate.
❑
0 ❑
❑
❑✓
❑
$ 4,557
$ Any remaing balance not
granted by the City,
Date
Received
2020
Total Received
1h2,350
2021 $1,875
2022
I, the undersigned, do hereby attest that the above information is true and correct to the best of my knowledge, and understand that t awarded f"inanci 1 grant mount needs to he spent prior to submitting another grant request.

Director May 3, 2023
agna ure Title Date
Date Received:
}J,
Date Reviewed:

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

City Council Meeting:

EZ"Financial Support
❑ Fee Waiver
City of Yucaipa Community Activity Grants Application, Rev. 03/2023 3 6'/ Page 4

Internal Revenue Service
District Director
DaLe; W,AY n 6 in
"' 37//
-� /1 3
a Yucaipa Valley Welfare, Inc,
35075 Avenue B
Yucaipa, CA 92399
Dear Applicant:
.. ,ter •: .�'3. 'r�{prp�x .
_ �fvJr •.'
Dep,irtment ' of` the Treasul
{
Employer Identificatlon Number.

Accou<<ting Peried Ending:

Dt rtirnl,er 31
Form 99D RQquired: E3 Yes 0 N
Demon to Contact:

I. Hill
Contact 7a1ephone Number.
(213) 668-4889
Based on information supplied, and assuming your operations will be as state in your application for recognition of exemption, we have determined you are exem From Federal income tax under section 501(c)(3) of the Internal Revenue Code.

We have further determined that you are not a private foundation within the meaning of section 509(a) of the Code, because you are an organization described in section 170(b)(1)(A)(vi) and 509(a)(i).

If your sources of support, or your purposes, character, or method of operat change, please let us know so we can consider the effect of the change on your e;tempt status and foundation status. Also, you should inform us of all changes Ir your name or address.

Generally, you are not liable for social security (FICA) taxes unless you fi a waiver of exemption certificate as provided in the Federal insurance Contributi Act. If you have paid FICA taxes without filing the waiver, you should contact u:� You are not liable for the tax imposed under the Federal Unemployment Tax Act (M], Since you are not a private foundation, you are not subject to the excise t under napter 42 of the Code. However, you are not. automatically exemp, from o,io Federal excise taxes. If you have any questions about excise, ezployment, or etlo Federal taxes, please let us know.

Donors may deduct contributions to you as provided in sectiu:% 170 of the Coy ,,.Bequest:;, 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, 2106r and 2522 of the Code.

The box chocked.. n the heading of this letter shows whether you must fide Form 990, Return of Organization Exempt from Income tax. If Yes is check--a;-you are required to file Form 990 only if your gross receipts each year are normally more than $10,000;`If a return is required, it must be filed by the 15th day or of the fifth month after the end of your annual accounting period. The lave impos a penalty of 810 a day, up to a maximum of $5,000, when a return is filed late, unless there is reasonable cause for the delay.

P.D. Box 2350, Los Angeles, Calif. 90053 '°•t'' Lett er947(DO) 368

TOM
S
OW Co.—
9,09.793.2194
March 8, 2023
Yucaipa Calimesa
Family Assistance, Inc
Richard
35075 Avenue 8
PO Box 130
Yucaipa, California 92399
Hi Richard
Reprised;
Email: yvwfaOOD[7a ia.twcbc.cam
Phone:

Cell: 951-505-9350
Pursuant to our conversation this proposal is to install cameras at locations discussed during our walkthrough and can be adjusted at the time of installation. This proposal includes connection to your Frontier equipment for access to the internet.

These cameras are 8-Megapixal 4K cameras and will see extremely well during the daytime as well as nighttime with some minimal lighting. The day of the install you would need to be on premise to confirm the wiring path and locations.

Estimate of work to be Performed

1. New IP PoE Camera System
a) Install and program (1) B-channel NVR
• 2-TB storage
• 8-Magapixel 1080p Recording
• 30-month factory warranty on NVR
• Add 273.00 to install UPS battery backup at NVR, this allows the camera system to record when the power is turned off by intruders or others.
• Add 456.00 to upgrade to 16-Channel NVR with 4-Terrabite storage to accommodate additional cameras. b) Install (5) 8MP-Megapixel, 2.8MM, IP ball dome cameras at each point of entry Install (3) Interior cameras with Infra -Red vision as directed at time of installation Install (2) Exterior cameras with Infra -Red vision as directed at time of installation Install (2) Camera Short arm brackets and weatherproof mounting boxes Install (5) new Gat-5 wire runs from cameras to new NVR unit c) Install (1) Internet connection to customer's router and program new IP address as needed d) Add 154.00 to install Network hub to isolate cameras from current router, if desired e) All wiring, fittings, system equipment and mounting included for new and relocated cameras. f) Set up (1) iPhone/braid telephones for viewing and instruct customer on operation, phones must be an site during installation to allow service technician to verify the app and instruct you on how to use the system.

Additional, training is available at 110.00 per hour after the installation has been completed. g) Cameras will be viewable from homeloffice computers or anywhere there is internet access.

2. Monitor at Register Area
a) Install (1) HDMI cable from NUR location inside office area to sales register area b) Provide (1) 22" Flat panel monitor and set on desktoplcountertop.

Total Materials & Labor $ 4.,957.00
Non -Profit Discount - 400.00
Net Cost $ 4,557.00
369

Installation Notes:

1. This proposal includes all materials and labor as needed to provide complete and operable system,

2. All work is to be performed in timely and workmanship like manor.

3. Cameras to be mounted in accessible customer specified locations with cabling installed through open building -ceiling space.

4. Cornmercial Properties Only:

TBM can provide our optional 24-7 Live Camera Monitoring, during specified times, afterhours, including weekends and holidays with optional "speaker -voice" command to speak directly to people on your property. Contact us for details.

5. Due to the complexities of work -office -home -cellular protocols, computer and cellular set up we have included 1 hour of set up. If additional time is required to work with your internet or IT provider, it will be performed on time and material basis at 129.00 per hoar as directed by owner.

6. Cameras need to be cleaned to keep clarity and viewing ability.

7. NVR to be set up and connected to customer provided computer network inside specified office area as directed by owner. (if included)
S. Manufactures Warranty is 30-month on cameras and 36-months on NVR, excluding labor.

9. This system is viewable from anywhere Internet connections is available.

10. Owner understands that Internet connection is needed for external monitoring or viewing and responsible to maintain that protocol and connection.
11, Owner is responsible to learn how to use the system and operations, TBM will provide telephone tutorial as needed.
12, TBM can program your camera system for non -operating hours notification and monitor your system at our 24-Hour Central Monitoring Station if desired. Additional monthly monitoring rates apply.

Any alteration or deviation from the above specifications involving extra costs will be performed only upon your request and subsequence approval. Any and all additional work is to be performed on Time and Material basis and billed at rate of 129.00 per hour plus materials, unless otherwise agreed/quoted. By signing below, you agree to the above proposal, specifications, conditions and authorize TBM Fire & Security to proceed as per this proposal. payment for services is due upon completion of work, Monitoring contract payments are separate and not part of this proposal, Submitted By: Accepted By:
1`8M Fire & Security Owner
Tim Murone
Date
370

371

Fiscal Ycar:

COMMUNITY ACTIVITY GRANT

FINANCIAL / IN -KIND / FEE WAIVER
2 2% 3 -L«24
Date Application submitted: May 11, 2023
Submit to:

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

Yucaipa, CA 92399
Attn: Kimberly Metzler

APPLICATION
Received
City of Yucaipa
MAY 112023
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. Incomplete applications received will he returned to the applicant.

Name of'Applicant/Organization:

Applicant/Organization Mailing Address:

Applicant/Organi'radmi Phone Number:

Con iaci (I )
Contact (2)
Yucaipa Elks #2389
12165 2nd St., Yucaipa CA 92399
( 90; ) 797 5268
Andrea Jorgcnson
Namc
(909 ) 503 5093
Phone Nutnhc:r
jorgetisoti.atidrea(c)icloud,com
E-mail address
`Jilgiriia Cosby
Nil L11G
earth I935 cc,gmail.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'?
(909 ) 795 2549
Photie Nuinber
Yes No
a
❑
❑
u
`iiYOU iilis"'eIT'•d "Yes" to Al iy of use ques6ofis 1*isied above, youk' tequea[ is Ylll 4119iWe Ally the Comiliunity AtiMiy G('iial.

City of Yucuipa Community Activity Orants Application. Itcv. 03/2023 372 Page 1

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

Please submit doCilYiYt rication verrifyhig 01-ganiz€itiori 50i(c) status along With thi3'Upplication. ;'ea
,
l5 your Organization a 501 (c)?
u
❑
95-2777976
if yes, -lease provide Tax !D# and attach all supporting documents.

Dons this appUrati,on ineludc submittal ofdocumcniation verifying 501(c) status? I,I
1 55 years
How long has your 501(c) organization been in existence? 3 Number of Employees working for organization:

Number of Volunteers working for organization;
varies
Is a current City Council Member on your board?
400 plus
How many Yucaipa residents does your organization currently serve? Does the organization charge admission, membership fees, dues, etc.? ❑�
❑
Dotes $145 per year
If yes, please describe:

Names and Titles of Officer-, and Board of Directors: (Please attach an organization chart, if available) Andrea Jorgenson Exalted Ruler
Other new officers will be give as soon as possible
1611
1♦ M k. ■ Mel 1614 w a
Hoop and Soccer Shoots
i'�la���r of the prUgrart;/ewertt: - r-
op
Date(s) of program/event:

December 2023
Describe the program/event that organization is seeking support ior:
kAttach any event/program promotional a-L ateriais associated with program/evert) A If school -age are invited 1'0 participate itt these national programs, ,sponsored by Grand Lodge of the BPOE City of Yucuiiht Community Activity Gnints Application, Rev, 0312023 373 Page 2

Describe how the program/event benefits the residents and/or community of Yucaipa:
11 Zr1.rrlc� crl2�YL Stl;'�lp'..!r are yli�-it11a to aCtci 2t�. It provides an .rain and �k:: ttE.le :'±I:V Yl:3lc�Cea 8E.G1 C �r-le �. l r p L'
the parents and adults volunteers. v
Prograir/Event Primary 1 argeL Population (check aii that appiy):
0 Children or Youth
❑ Low Income
❑ Persons with Disabilities
Number of Residents Projected to Serve:
❑
Seniors
�]
Victims
❑
weltare Recipients
REQUEST —SECTION 5 — GRANT FUNDING
Please identify what your organization is scaking:

Financial Support: ❑r Yes ❑ No $i000
$200 S EP Fee
Waiver. u Yes C ter,
hi -Mud Support: Police $ Fire $
Reassigned
Staff $ Other S
❑
Women
❑
Homeless
❑
Entire Community
Public
Works $ C$1l?crtul $Wx?vc:

Explain
S200 SEP
In -Kind Financial Support Fee Waiver
Total Amount of Request: $ 't „ , $ ]rtacr S
Total Overall
Request
= $ s10on
Providc a detailcd dCoGription of .rw the f;rancial suppw, will be used:

The Ells will u-,-- the grant to purchase bask-. balls, soccer balls, trophies, t-Shirts,--d-ml-nistrat:V:-naterials.

City ofYucaipit Community Activity Gnint% App) ication, Rev. M2023 374 Page 3

What other in-kind/financial contributions has your organization received to fund this event/programs (separate from City funding"?
In -Kind Financial
Amount Support Amount
Two years, during the covid shut down the Elks were $
awarded a grant bUt reiL3i-IICA it �ara,ica t1i- mxi,,n •++.YY..N wuv aY
could not be schedaticd.

Total Funds Received To Date: �
Total Funds Requested Via Grant Application: S
Remaining Balance That Will Be Funded By as necossaly
Organization:

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

Program In -Kind
Financial
$16.25 SEP Date Total Received
SUN)Ovt
Fee Waiver Received
El
S
❑
❑ S
1, the undersigned, do hereby attest that the above information is true aItd Correct to the best of my knowledge:, and understand that tho a rded financial grant arnount needs to be spent prior to submitting another grant request.

Member #2265 5/ 11 /2023
Signature Title Datc

TO BE COMPLETED BY CITY
Datc Received: `J ` i _ Cate Revicwcd: � � It —:2�
Amount Funded; $ City Council Meeting: A I
Type of Grant: ❑ In -Kind T Financial Support U l"Ce Waiver -- Date City Council received ioiiow up report:

City of Yucaipa Community Activity Grants Application, Rev. 0312023 3,/5 Page 4

ATTACHMENT 21
376

Carr
Fiscal Year:

Year:

Date Application submitted:

Submit to:

City of Yucaipa
General Services/City Clerk Department
34?72 Yucaipa Blvd.

Yucaipa, CA 92399
Attn: Kimberly Metzler

COMMUNITY ACTIVITY GRANT
2023-2024

FINANCIAL / IN -KIND / FEE WAIVER

APPLICATION
Received
City of Yucaipa
MAY 0 4 2023
General Services/
City Clerk', Department
All sections of the application must be retarded complete and all supporting; documentation provi0d prior to City Council review. Incomplete applications received will lie returned to the applicant.

Name of Applicant/Organization: YUCAIPA PiCKLEBALL, INC.

Applicant/Organization Mailing Address: 9346 YUCAIPA RII)GE ROAD YUCAIPA CA 92399 Applicant/Organization Phone Number: _(909 )709-1770
PATRICIA IN63RAM
Contact (I } 909 j 7t}9-1770 _--- ,
Name Phone Number
YucaipaPickleball@a gmail.corn
E-mail address
Contact (2) _
Name Phone Number
E-mail address
Yes No
Is your organization located in another community? E] 0 Will the program/event take place in another community? ❑ f Are you aware of any other City program providing this service? lfo, which one?
"if you answered i°Yes" to any of the queFtio n,s lis.ed sibove, your request Is not eligible for the Community Activity Grant. ity O'Ymnipa Community Activity Grunts Application, Rev. 03/2023 377

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�
!❑
❑
87-1919472
Ifyes, please provide Tax ID# and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? ❑
❑
2 years
How long has your 501(c) organization been in existence? 0 Number of Employees working for organization:

Number of Volunteers working for organization: varies
Is a current City Council Member on your board?
❑
❑✓
400+
How many Yucaipa residents does your organization currently serve? Does the organization charge admission, membership fees, dues, etc.? ❑J
❑
$2Nyear for members or $ I drop in fee non-members for Open If yes, please describe: Play
Names and Titles of Officers and Board of Directors: (Please attach an organization chant, if available) Patricia Ingram, President &. 'Youth Coordinator -
Char Broersma, Treasurer &. Web Master
John Manly, Facility Maintenance. & Coordinator
David Hughes, Director
Richard Rios, V. Pres
Debra Hitter, Secretary
Dennis Banaag, ,Adult Coordinator
SECTION 4 - PROGRAM DESCIZIPTION/SCOPE: (PLEASE USE ADD1110NAL PACES IF NECESSARY) Name of the program/event: Youth and Adult Instruction and General Play/Tournaments - Community Pickleball Day Date(s) of program/event: year round clinics and play - Community Pickleball date TBD Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) We run low cost clinics for adults and youth throughout the year. These include monthly clinics for adults and youth at Ave 1 park, summer clinics at the Yucaipa Community Center, Instructional clinics at 7th Street. We currently offer free instruction two days a week at the Community Center. We run special tournaments for youth and adults as well as have daily Open Play at 7th Street and the Community Center.

Hosting a community pickleball day can encourage people to get out and be physically active, which can have nuincrous health benefits. It allows the City to showcase the programs it supports and the proposed facility.

City of Yucaipa Community Activity Grants Application, Rev. 03/2023 Page 2 378

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

1. 1nclusivity: Pickleball is a sport that can be played by pcople of otl ages and skill levels_ It is a great way to bring together people of different generations and abilities, which can promote social inclusion and help to break down barrios between groups,

2. Health benefits: Pickleball is a low-impecl sport that can provide a range of health benefits for both youth and seniors. it can improve cardiovascular hcalth, enhance mobility and coordination, and reduce the risk of chronic condition, %ri(;h as diabetes, heart disease, and obesity.

3. Community engagement: Picklebalt is a popular sport that can attract a wide range of participants and spectators. By providing opportunities for youth and seniors 10 engage in pickleball oetiviti", a community grant can help to foster a sense pfcommunity and create opportunities for social interaction and engagement.

4. Access io facilities: Pickleball requires access to proper facilities and equipment, whidr can be a bonier for many youth and seniors. A Community grant Can help to fund the construction or renovation of Pickleball courts, purchase of equipment, and provide training for coaches and volunteers.

5. A community pickleball day can bring together people from till walks of life and create a sense of community. it can help to build social connections and promote a sense of belonging among residents. it can create opportunities for partnerships between the city and local businesses.

G. Hosting a community pickleball day can help to improve the city's public relarions by demonstrating that the city cares about the health and wellbeing of its residents.

7.: Hosting a community pickleball day can attract visitors from outside the oily, which can bring in revenue for local businesses.

Program/Event Primary Target Population (check a]I that apply):
❑■ Children or Youth
❑ Low Income
© Persons with Disabilities
Number of Residents Projected to Serve: 1000
Please identify what your organization is seeking:

Financial Support: 0 Yes ❑ No
S200 SEP Fee
Waiver: 17 Yes ❑ No
In -kind Support- 'Police $
Reassigned
Staff $
E Seniors
❑ Victims
❑ Welfare Recipients
`S M LA b
Public
fire $ Works $
Other $ Explain
$200 SEP
In -Kind Financial Support Fee Waiver
Total Arnount of Request: $ $14,450.01D $
Provide a detailed description of how the financial support will be used. 0 Women
❑ Homeless
Q Entire Community
CS/Rental $
Total Overall
Request
o S 14,450.00
These are items we can use and would prioritize the purchases subsidized with other donations for both benefit of the instructional programs as well, as general play for the community & Community Pickleball Day.

Portable nets : 5 a@ $500 each (rolling)
Ball drilling machine : 1 a@ $1,600 - for clinics
Replacement balls: 500 @ $200/100 ( we use about 500/year) Youth Paddles : S @ $25 each ( we have donated adult paddles) Picnic table with shade : 4 each @ $2,000 each ( for seating and comfort while watching play) Visibilty screening @ 7th Street; $150 for netting along the north side of temporary courts.

Food/ give aways/ advertising: $1000 for Community Pickleball Day city of Yucaipa Community Activity Grants Application, Rev. 0312023 Page 3 379

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
Membership Dues $ $ 5,000.00
Tournament Income $ $ 5,000.00
Clinic Income $ 1,000.00
Donations $ $ 1,000.00
$ $
Total Funds Received To Date: $ $ 12,000.00
Total Funds Requested Via Grant Application: $ $ 14,450.00 Remaining Balance That Will Be Funded By $ $ 2,450.00
Organization:

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

Program In -Kind Financial M6.25 SEP
Support Fee Waiver
Facility Use
0 ❑
❑
❑
❑
❑
❑
❑
❑
Date
Received
2021-23
Total Received
,,unknown
$
1, the undersigned, do hereby attest that the above information is true and correct to the best of my knowledge, and understand ihat tl a awarded financial grant amount needs to be spent prior to submitting another grant request.

President 4/30/23
Signature Title Date
Date Received: --4 '�15 Date Reviewed: - 1f
Amount Funded: $ City Council Meeting:
'type of Grant: ❑ In -Kind Financial Support ❑ Fee Waiver Date City Council received follow up report:

City of'Yuenipa Community Activity Grants Application, Rev. 03/2423 Page 4 11 380

May 4, 2023
City of Yucaipa
General Services/City Clerk Department
34272 Yucaipa Blvd.

Yucaipa, CA 92399
Attn: Kimberly Metzler
Re.: Community Activity Grant Application
Dear Ms. Metzler:

Attached you will find our application for funding through the Community Activity Grant Program. I have also included our approval letters from the Internal Revenue Service and the State Franchise Tax Board as to our tax-exempt status. Some flyers from previous events are also provided to show the types of services we offer to the community.

We appreciate the opportunity to be considered for this grant as we believe our program serves a large population of the city that is currently underserved. Pickleball is for all ages, but we have seen that the senior population truly benefits from this activity for continued healthy living.

We are the only program in the area that is also targeting the youth. We have been asked by the High School Tennis Coach to assist him in a pickleball program that hopefully will develop into a Citrus Belt League sport. Yucaipa High School currently has one student who is a Pro Player and represents the city well.

Thank you again for this opportunity. We welcome any questions about our program or application.

Sincerely,
A&V�4"W-r-i
Patricia Ingram, President
Yucaipa Pickleball Inc.

For more information:
www.yucair)apickleball.com
y4paipapickleball(aDgmail.com
Facebook —Yucaipa Pickleball
909-709-1770
381

YOUTH YOUTH

YUCAIPA
CLINIC ? = TOURNAMENT
Learn how to play the
game or improve your
skills. Students will
be in leveled groups.

WHEN: Saturdays
Feb. 251" &
March 4, 2023
5:30am -- 1 1:00am
WHERE: 1 Street Park
Yucaipa, CA
Corner of Ave. i and 5th place
COST: $5
for both days
Format: Rotating Partners
Round Robin
You DO NOT need a partner.

Guarantee of 4 games.

Single Elimination Playoff if needed.

WHEN: Saturday
March II, 2023
9:00am - 1 r1:30am
WHERE: 7th Street
Parr Yucaipa, CA
Corner of Ave. E and 71h St.

Under the large roof
COST: $15
All levels & ages 10-17 welcome
Register a@ YucaipaPickleball.colm
For more info contact Patty Ingram at
[email protected] or text 909-709-1770
382

WHEN:

Wednesday
March 15, 2023
1-3pm
WHERE: Crafton Hills Fire Station
32664 Yucaipa Blvd, Yucaipa, CA 92399
Learn CPR and use of
an AEC), Automated
External bef i bri l lator
No certification card will be issued,
Space is limited.

Register on our website at
h!tp,-;.//yucaipapickleball.com/misc/
(under MISC)
Thanks to the Yucaipa Crafton
Station and Cal Fire for• putting on
this FREE special class just for
our Picklebail Players!!
For more info contact Patty Ingram
at yucaiipapicklebail6d ggmail.com or
text 909-709-1770

YUCAIPA PICKLEBALL CLINIC
Tips for leveling up your game
Geared towards the Intermediate Player (3.0)
Things to be covered... Court Positioning, 3' shot drops, 3' shot drives, lobs and more!

WH EM SATU RDAY
Check in at 8:30am
February 26 , 2022
Clinic 9:00 am- IIam
Open practice for registrants 11 am-12pm
WHERE: 7T11 STREET PARK SHADE STRUCTURE
12385 7th St, Yucaipa, CA
COST:

YUCAIP-A
_6
Sponsored by:
t7
ziCARL3L7x '
P 1 Q K L F Y A L L
FREE FOR YUCAIPA PICKLEBALL, INC. CLUB MEMBERS
$10 FOR NON - MEMBERS
Registration open until full
Receipt of registration/entry fee holds slot
No refunds after Feb. 19, 2022
This is a covered facility so we should be a go rain or shine! Register on yucaipapickleball.com
Non-members can pay via VENIVIO a@yucaipa-pickleball-1
Or ZELLE- [email protected]
Or Pay on the registration website with credit card ($1 fee applies) Text Patty Ingram at 909-709-1770 for additional info.

Hosted by Yucaipa Pickleball, Inc.

YUCAIPA PICKLEBALL INVITES KIDS TO

OUR FREE YOUTH CLINIC
All levels & ages 10-17 welcome
WHEN: The first 3 Saturdays in April
April 2, 9 and 1611 , 2022
Starts at 8:30 am
Ends at 10:30 am
WHERE: Ave 1 Park
34014 Avenue I, Yucaipa
Near the corner of 51" Place and Avenue H
COST: FREE FOR all YOUTH

YUCAIPA'

PICKLEBALL
Register on www.YucaipaPickleball.com - Space is limited.

Loaner paddles available on first Saturday only, after that students must bring paddle.

YOUTH 1 JUNIOR TOURNAMENT ON SATURDAY APRIL 23, 2022
AT 7Tw STREET PAIN[ TO TEST YOUR SKILLS!
Tournament has separate registration an
www.YucaipaPickleball.com
Email Yucai aPickie balls imail.com for more information.

YUCAIPA HALLOWEEN
f'IGKLEB�o RouMp K-0 EWA

REGISTRATION
Early Registration DiSCOUNT!
On or before July 15, 2022
$25 Registration, $10 Each Event
After July 15, 2022
35 Registration, $10 Each Event
Registration Closes. Oct. 20, 2022
EVENTS
Ellen's Doubles
Women's Doubles
Mixed Doubles
Skill Levels - 3.0, 3.5, 4.0
Age Divisions - 12+1 50+, 60+

START TIMES
Womem's Doubles - 8:00 a.m.

Wod Doubles-10.00 a.m. & 12.O0 P.M.

Mama° Doubles - 2:00 p.m.
aways and Opportunity Basket drawings with
ear and other fun things.

No refunds for bad weather. No refunds after October 14, 2022. Each event will be limited to 36 teams total with 7 teams per division. Waitlist will be available. The Tournament Director reserves the right to adjust divisions and times.

r
Department cf the Treasury
Internal Revenue Service
�I Tax Exempt and Government Entities
t P.O. Box 2508
Cincinnati, OH 45201
YUCAIPA PIC.ICLEBALL INC
CIO DIANE SMITI1
12841 MEDLAR STREET
YUCAIPA, CA 92399-4955
Dear Applicant:
uata;
11101/2021
Employor ID number:
87-1919072
Person to coMset:

Name: Customer Service
it) number: 31954
Telephone: (877) 829 5500
AGcpunting porivd ending:

June 30
Public charity status;
509(a)(2)
Form 999 r 990•EZ1 990-N required;
Yes
Effecliyp data of exemption:

July 17. 2021
Corkwoution deduttibliity; _.

Yes
Addendum applies:

No
DLM:
26053630002901
We're pleased to tell you we determined you're exempt from tedeml income tax tuider Internal Revenue Code (IRC) Section 501(c)(3). Donors can deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfors or gifts under Section 2055, 2106, or 2522. This letter could help resolve questions on your exempt status. Please keep it for your records.

Organi2ations exempt under IRC Section 501(c)(3) are furthor classified as either public charities or private foundations. We detenmined you're a public charity under the IRC Section listed at the top of this letter.

If we indicated at the top ofihis letter that you're required to file Form 990/490-EZ/990-N, our records show you're required to file an annual information return (Form 990 or Form 990-FZ) or electronic notice (Form 990-N, the e-Postcard). If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked.

If we indicated at the tap of this letter that an Addendum applies, the enclosed addendum is fill integral part of this letter.

For important information about your responsibilities as a tttx-exempt organization, go to www.its,gov/chtlrities .

Enter "4221-PC" in the search Isar to view Publication 4221-PC, Compliallec Guide for SOI (o)(3) Public Charities, which describes your recordkee.ping, reporting, and disclosure mquirements, Sincerely,
Stephen A. Martin
Director, Exempt Organizations
Rulings and A gT4l.InCntS
C❑laf" Number 35152P
a y
r✓�:51i

"� STATE OF CALIFORNIA

FRANCHISE TAX BOARD
IT :��. PO Box 1286
Rancho Cordova CA 95741-1286

YUCAIPA PICKLEBALL INC
12841 MEDLAR STREET
YUCAIPA CA 92399
Regarding:

Organization's Name:

CM
Purpose:

R&TC Section:

Form of Organization:

Accounting Period Ending:

Tax-ExernPt Status Effective:

Tax -Exempt Status

YUCAIPA PICKLEBALL INC
4766963
Charitable
23701d
Incorporated
06/ 30
07/17/2021
Exernpt Acknowledgement Letter
Date: 03.21.2022
Case: 3611-0790683147290
Case Unit: 36110790683147293
in reply refer to: 760:JNM:F120
'Vie have received ,your federal determination letter and Form 3500A, Submission of Exemption Request, and have approved your request for California Tax-exempt status.

Under California law, Revenue and Taxation Code (R&TC) Section 23701 provides that an organization is exempt from tares imposed under Fart 11 upon submission of the federal determination letter approving the organization's tax-exempt status.

Generally, the effective date of an organizations California tax-exempt status is the same date as the federal tax-exempt status.

To retain tax-exempt status, the organization roust be organized and operating for nonprofit Purposes within the provisions of the above R&TC section. An inactive organization is not entitled to tax-exempt status.

In order for us to determine any effect on the tax-exempt status, the organization must immediately report to us any change in:
• Operation
• Character
• Purpose
• Name
Address
Frg 9944 PASS (REV 08-2014) Emnipt Appiic3tionNCorresponcience \LTR 001 • E4L
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